MATERIA MEDICA AND THERAPEUTICS. POTTER. From The Southern Clinic. “We know of no series of books issued by any house that so fully meets our approval as these ? Quiz-Compends ?. They are well arranged, full, and con- cise, and are really the best line of text-books that could be found for either student or practitioner.’’ > » . BLAKISTON’S ?QUIZ-COMPENDS? The Best Series of Manuals for the Use of Students Price of each, Cloth, $1.00. Interleaved, for taking Notes, $1.25. -KS'These Compends are based on the most popular text-books and the lectures of prominent professors, and are kept constantly revised, so that they may thoroughly repre- sent the present state of the subjects upon which they treat. flSf The authors have had large experience as Quiz-Masters and attaches of colleges, and are well acquainted with the wants of students. 4®~They are arranged in the most approved form, thorough and concise, containing over 600 fine illustrations, inserted wherever they could be used to advantage. 4®“Can be used by students of any college. 4Pg" They contain information nowhere else collected in such a condensed, practical shape. Illustrated Circular Free. No. i. HUMAN ANATOMY. Fifth Revised and Enlarged Edition. Including Visceral Anatomy. Can be used with either Morris' or Gray’s Anatomy. 117 Illus- trations and 16 Lithographic Plates of Nerves and Arteries, with Explanatory Tables, etc. By Samuel O. L. Potter, m. d., Professor of the Practice of Medicine, Cooper Medical College, San Francisco ; late A. A. Surgeon, U. S. Army. No. 2. PRACTICE OF MEDICINE. Part I. Fifth Edition, Revised, Enlarged, and Improved. By Dan’l E. Hughes, m.d., Physician-in-Chief, Philadelphia Hospital, late Demonstrator of Clinical Medicine, Jefferson Medical College, Philadelphia. No. 3. PRACTICE OF MEDICINE. Part II. Fifth Edition, Revised, En- larged, and Improved. Same author as No. 2. No. 4. PHYSIOLOGY. Seventh Edition, with new Illustrations and a table of Physi- ological Constants. Enlarged and Revised. By A. P. Brubaker, m. d., Professor of Physiology and General Pathology in the Pennsylvania College of Dental Surgery; Demonstrator of Physiology, Jefferson Medical College, Philadelphia. No. 5. OBSTETRICS. Fifth Edition. By Henry G. Landis, m. d. Revised and Edited by Wm. H. Wells, m. d., Ass’t Demonstrator of Obstetrics, Jefferson Medical College, Philadelphia. Enlarged. 47 Illustrations. No. 6. MATERIA MEDICA, THERAPEUTICS, AND PRESCRIPTION WRITING. Sixth Revised Edition. By Samuel O. L. Potter, m.d , Professor of Practice, Cooper Medical College, San Francisco ; late A. A. Surgeon, U. S. Army. No. 7. GYNAECOLOGY. A New Book. By Wm. H. Wells, m. d., Ass’t Demonstrator of Obstetrics, Jefferson College, Philadelphia. Illustrated. No. 8. DISEASES OF THE EYE AND REFRACTION. Second Edition. Including Treatment and Surgery. By L. Webster Fox, m. d., and George M. Gould, m. d. With 39 Formulae and 71 Illustrations. No. 9. SURGERY, Minor Surgery, and Bandaging. Fifth Edition, Enlarged and Improved. By Orville Horwitz, b. s., m.d., Clinical Professor of Genito-urinary Surgery and Venereal Diseases in Jefferson Medical College; Surgeon to Philadelphia Hospital, etc. With 98 Formulae and 167 Illustrations. No. to. CHEMISTRY. Inorganic and Organic. Fourth Edition. Including Urin- alysis, Animal Chemistry, Chemistry of Milk, Blood, Tissues, the Secretions, etc. By Henry Lepfmann, m.d., Professor of Chemistry in Pennsylvania College of Dental Surgery and in the Woman’s Medical College, Philadelphia. No. 11. PHARMACY. Fourth Edition. Based upon Prof. Remington’s Text-Book of Pharmacy. By F. E. Stewart, m.d., ph.g., late Quiz-Master in Pharmacy and Chem- istry, Philadelphia College of Pharmacy; Lecturer at Jefferson Medical College. Carefully revised in accordance with the new U. S. P. No. 12. VETERINARY ANATOMY AND PHYSIOLOGY. Illustrated. By Wm. R. Ballou, m.d., Professor of Equine Anatomy at New York College of Veterinary Surgeons; Physician to Bellevue Dispensary, etc. With 29 graphic Illustrations. No. 13. DENTAL PATHOLOGY AND DENTAL MEDICINE. Second Edition, Illustrated. Containing all the most noteworthy points of interest to the Dental Student and a Section on Emergencies. By Geo. W. Warren, d.d.s., Chief of Clinical Staff. Pennsylvania College of Dental Surgery, Philadelphia. No. 14. DISEASES OF CHILDREN. Colored Plate. By Marcus P. Hatfield, Professor of Diseases of Children, Chicago Medical College. No. 15. GENERAL PATHOLOGY AND MORBID ANATOMY. 91 Illustra- tions. By H. Newberry Hall, ph.g., m.d., Professor of Pathology and Medical Chemistry, Chicago Post Graduate Medical School. Price, each, $1.00. Interleaved, for taking Notes, $1.25. P. BLAKISTON, SON & CO., PUBLISHERS, 1012 Walnut Street, Philadelphia. ? QUIZ-COMPENDS ?. No. 6. A COMPEND OF MATERIA MEDICA THERAPEUTICS AND PRESCRIPTION WRITING WITH ESPECIAL REFERENCE TO THE PHYSIOLOGICAL ACTIONS OF DRUGS. BASED ON THE SEVENTH REVISION OF Zbe HI. S. ipbarmacopceia, 1890, INCLUDING ALSO MANY UNOFFICIAL REMEDIES. BY SAM’L O.L. POTTER, M.D.,M.R.C.P.L., \X \ LATE PROFESSOR OF THE PRACTICE OF MEDICINE IN COOPER MEDICAL COLLEGE, SAN FRANCISCO ; AUTHOR OF “A HANDBOOK OF MATERIA MEDICA, PHARMACY, AND THERAPEUTICS," “AN INDEX OF COMPARATIVE THERAPEUTICS," “A COMPEND OF HUMAN ANATOMY," “SPEECH AND ITS* DEFECTS; " FORMERLY A. A. SURGEON, U. S. ARMY. SIXTH EDITION, REWRITTEN AND ENLARGED. PHILADELPHIA: P. BLAKISTON, SON & CO., IOI2 WALNUT STREET. 1894. Copyright 1894 By P. BLAKISTON SON & CO. WM. F. FELL & CO., ELECTROTYPERS AND PRINTER8, 1220-1224 SANSOM STREET, PHILADELPHIA. PREFACE TO THE FIRST EDITION. This Compendis based on the last revision of the U. S. Pharmacopoeia, on the regular text books of Materia Medica and Therapeutics, particularly those by Bartholow, Wood, Ringer, Stille, Phillips, Piffard, Biddle,'Trousseau, and Waring; and on the author’s own notes of two courses of didactic and clinical lectures by Professors Bartholow and Da Costa. Intended as a book for medical students, brevity of statement is one of its principal features. At the same time, the essentials of the subject have been kept in view ; from a desire to make the book not only the best of its kind, but a compact compendium of the established maxims of therapeutical science, and the most advanced views concerning the physiological actions of drugs. The preparations noted under each title are those in most general use; to have described all would have been to unnecessarily burden the student’s memory. Tort Douglas, Utah, February, 1883. PREFACE TO THE SIXTH EDITION. In the last edition of this book the former text was almost enti-rely re- written and greatly expanded. The opening sections on Preparations and Classification of Medicines were enlarged from nine to twenty-five pages, in the effort to do greater justice to those important branches of the subject. V VI PREFACE. Nearly every drug section received more or less elaboration, and new matter was inserted upon 75 additional articles of the Materia Medica, of which 42 were described in new sections, and 33 in brief notices. For this edition the text has again received a thorough revision, bringing it into conformity with the seventh revision of the U. S. Pharmacopoeia (1890). Articles have been inserted on Chloralamid, Hypnal, Hydrogen Dioxide, Phenacetin, Phenocoll, Piperazin, Somnal, Sulphonal, Trional, etc., and the section on Prescription Writing has been elaborated in greater detail. The author embraces this opportunity of again thanking his brethren, the teachers and students of medicine, for the favor which they continue to extend to his Compends. The rapid exhaustion of each edition of these books is the best evidence that his efforts for the systematizing and facilitating of their work are appreciated. The only return he can make is one which he has constantly aimed at, namely—that each edition should prove a better book than the pre- ceding one. Sam’l O. L. Potter. San Francisco, October, 1894. TABLE OF CONTENTS. PAGE INTRODUCTION, 9 Pharmacology 9 Pharmacy 9 Materia Medica, 9 Pharmacodynamics, 9 Toxicology, 10 Therapeutics, 10 Pharmacopoeias and Dispensatories 11 Official Preparations 12 Unofficial Preparations, 18 Administration of Medicines, 21 Classification of Medicines, 24 Stimulants and Sedatives 24 Agents acting on the Nervous System, 24 Agents acting on the Organs of Special Sense, 27 Agents acting on Respiration, 29 Agents acting on the Circulation, 3° Agents acting on the Digestive System 31 Agents affecting Metabolism, 37 Agents acting on Excretion 39 Agents acting on the Generative Apparatus 41 Agents acting on the Skin 43 Agents acting on Microbes, Parasites, etc., 44 Agents acting upon Each Other, 46 RESTORATIVE AGENTS, 47 Digestion-Ferments, 47 Lactic Acid 49 I Mineral Acids, 5° 1 Oils and Fats 5* Phosphorus, 53 Phosphates and Phosphites 54 /iron 54 Manganese, 56 V Bismuth, 57 Arsenic 5§? /Bitters, Simple and Aromatic 60 Eucalyptus, 62 ' Hydrastis, 63 63^ AGENTS PROMOTING WASTE 66 Potassium, • 66, Sodium 68 Lithium 69 Calcium 69 Ammonium ■ 7° Antimony, 7V /'Vegetable Acids 72 Sulphites, Sulphides 73 VII VIII TABLE OF CONTENTS. PACE ALTERATIVES, 74 Iodine, Iodides, 74, -'/"Mercury, 78 CGold 80 Colchicum, 81 Guaiacum, 82 Stillingia 83 83^, Xanthoxylum, . 84 7Mezereum, 85 Berberis, . . i 85 Fucus Vesiculosus 86 Sarsaparilla, 86 ASTRINGENTS, 87 Tannic and Gallic Acids 87 Silver, 91 Copper 93 " Lead, 94 Zinc, 95 Cadmium, 96 v Cerium, 97 Alum, 97 MOTOR EXCITANTS, 98 —Nux Vomica 98 flgnatia, 100 Ficrotoxin 101 .Ergot 102 (Digitalis, 104 Strophanthus, 107 /OCimicifuga 109 Convallaria 110 Scoparius (Sparteine) in Scilla, -. 112 —Belladonna, 113“ // Hyoscyamus 116 / Stramonium 117 Duboisia, 1:8 CEREBRAL EXCITANTS 119 Camohor. 1 it Asafoetida, 12CN ' ,. Ammoniac, '. 121 > Valerian, 122 Serpentaria 123 . Cannabis Indica, 124 i2u^ Calfeine, Theine, etc., 128 Stimulant Beverages, 129 .CEREBRAL DEPRESSANTS 132 . J Alcohol and Aldehydes, 132 , Ether, 137 Chloroform 139 Carbon Disulphide 141 Chloral and other Hypnotics, 142^ Opium, 147'' ' / Hops, 151 . Lettuce, 152 .7 Bromine, Bromides, 152 MOTOR DEPRESSANTS J56 Conium, 156 Gelsemium, *57 Curare, 15S, TABLE OF CONTENTS. IX PAGE Pilocarpus,’ , Physostigma, *52 Aconite *• ’3 Pulsatilla *55 Veratrum „—Arnica and Trimethylamine, *°9 Tobacco 7 Lobelia, 7 Nitrites, :'3 ——Hydrocyanic Acid ;'5 * , Grindelia *7° 2 / Quebracho, 77 Phytolacca, : 7 — ANTIZYMOTICS, ANTIPYRETICS, ANTIPERIODICS, i79~ * -7 Cinchona Alkaloids, J£9 i / r Antipyrin, Chinolin, Kairin, etc., • • I8° Phenacetin, Phenocoll, . ... . . . y?. *53 . .4yf# 185 i 3 Carbolic Acid, Creosote/ResoratKetc. . . V.j . *8Z_ * Salicin and Salicylic Acia V - &*•***&<*.: *9^ /Thymol, Menthol, and the Mints (/. *93 ■ ' Antiseptic Oils, . Benzoin and Benzoic Acid, J Chlorine and Chlorides *9°^ EVACUANTS, 2°* / . Emetics 2 * Ipecacuanha 203 Cathartics 2°4 Laxatives, 2°3 Simple Purgatives, 2 5 Saline Purgatives 2~; 2"/ Drastic Purgatives, 2°Z * < Cholagogue Purgatives 208 Bryonia, 209 Baptisia, 210 Anthelmintics, 2*L- , . Diuretics, . . . .. 212 Refrigerant Diuretics Hydragogue Diuretics, 212 ' Stimulant Diuretics 213 Turpentine, Pitch, Tar, etc., 218 Emmenagogues TOPICAL AGENTS, 221 Rubefacients and Epispastics, 221 Counter-Irritation 223 Emollients and Demulcents, 224 MEMORANDA ON NEW REMEDIES, 225 PRESCRIPTION-WRITING 229 Incompatibility, . 233 Table of Precipitant Solutions, 237 Latinizing a Prescription, Table of Genitive Case-Endings, Abbreviations 24* EXPLANATION. Preparations marked thus * are not official in the U. S. Pharmacopoeia of 1890. The Doses given are for adults ; for children the following rule (Young’s) will be found the most convenient. Add 12 to the age, and divide by the age, to get the denominator of the fraction, the numerator of which is 1. Thus, for a child two years old, 2 ~^1- = 7 and the dose is one-seventh of that for an adult. Of powerful narcotics scarcely more than one-half of this proportion should be used. Of mild cathartics, two or even three times the proportion given may be employed. For Hypodermic Injection, the dose should be three-fourths of that used by the mouth; by rectum five-fourths of the same. Pronunciation.—Attention is particularly directed to the accentuation of words commonly mispronounced; as for example, ac6tas, atropa, chimapliila (kima), chloridum, codeia, conium, enema, iddidum, radicis, ricinus, sinapis, syrupus, eczema, umbilicus, abdomen, bromidum, paresis. The Sign (?) after a preparation signifies that it is of doubtful utility; after a statement of physiological action, that the question is disputed and as yet unsettled. WEIGHTS AND MEASURES apothecaries’ or troy weight. Pound. Ounces. Drachms. Scruples. Grains. lb. 3. 3. 9. gr. I =12 = 96 = 288 = 5760 1 = 8 = 24 = 480 1 = 3 = 60 1 = 20 metric weights. I Milligramme, 0.001—gr. 1 Centigramme, 0.01 — gr. £ 1 Decigramme, o. I = gr. 1^ 1 Gramme, I. = gr. 15.432 I Kilogramme, 1000. —lbs. 2.7 APOTHECARIES’ or wine measure. Gallon. Pints. Fl’ounces. Fl’dr’ms. Minims. c. O. f%. f£. rr^. x=8 = 128 = 1024 = 61440 1 = 16= 128 = 7680 1 = 8 = 480 1 = 60 APPROXIMATE EQUIVALENTS. I IT\, or I grain, == .06 gramme. I f or I 3, =4. grammes. 1 f.i = 3°- “ 1 % =3I- “ 1 fz Glycerin, = 37. “ I f 5 Syrups, = 40. ‘ ‘ X ACOMPEND OF Materia Medica AND THERAPEUTICS. INTRODUCTION. Pharmacology, or the Doctrine of Drugs (dp/ianov, a drug, 16yog, a discourse), is the science which treats of the drugs employed in medicine. It embraces, therefore, in its scope, all of Materia Medica and Therapeutics relating to drugs. By a few writers this term is employed in a more restricted sense, so as to include only the physiological action of drugs,—a subdivision of the Materia Medica, and a subject which is more correctly designated by the term Pharmacodynamics, (see below). Pharmacy is the name of the art which supplements the science of Pharma- cology, viz:—the art of preparing drugs according to the requirements of the pharmacologist, and of dispensing them on the prescription of the therapeutist. It includes a Thorough knowledge of the Materia Medica, an acquaintance with the theories and manipulations of chemistry, and an intimate practical experience in many special operations peculiar to itself. MATERIA MEDICA AND THERAPEUTICS Materia Medica is that branch of Pharmacology which treats of the sub- stances used as medicines, and describes their origin, composition, physical characteristics, chemical properties, modes of preparation and administration, and their physiological and toxicological actions. Its divisions are— Pharmacodynamics ((pappaKov, a drug, dvvaptq, power), signifying the discussion of the physiological action of drugs,—that is, the modifying 10 INTRODUCTION. power of drugs upon the normal physiological activity of the human organism. Toxicology, a poison, hoyog, a discourse), teaches of the effects of drugs when administered in poisonous doses; also, of their drug-antagonists and chemical antidotes. Therapeutics, (OepanEveiv, to attend upon), relates to the treatment of dis- ease, and includes the discussion of all matters relating to the science and art of healing. Not only does it consider the application of medicines to the alleviation or cure of disease, but it embraces the employment of all other agents which are capable of contributing to the accomplishment of that result. The operations of Nature herself, the actions of the various substances des- cribed in the Materia Medica, also those of food, clothing, climate, heat, cold, electricity, and of all other remedial agents, forces, and measures,—are all in- cluded in the term Therapeutics, which may be divided into two grand divisions, viz.— Natural Therapeutics, including the operations of the Vis Medicatrix Naturae,—the modes and processes of healing which occur independently of Art, for the spontaneous decline and cure of disease. There is no fact in science more fully established than that the living organism is in itself adequate to the cure of all its curable disorders. Applied Therapeutics comprises the application by Art, of agents foreign to the living organism, for the purpose of aiding Nature to restore the body to a comparatively healthy condition. When used in connection with Materia Medica, the term Therapeutics is restricted to the remedial uses of those substances only which are generally considered medicinal. When systematically discussed under the various titles of these substances, or under the names of the diseases treated therewith, the matter is termed the Special Therapeutics of a certain article or of a particular disease. When arranged so as to present certain great principles, which may be deduced from the mass of isolated therapeutical observations, it is termed General Therapeutics. Thus we say “ the special therapeutics of Arsenic,’ ’ —“ the special therapeutics of Rheumatism,”—“ the general therapeutics of digestion.” Other divisions of the subject, constantly referred to in profes- sional conversation and literature, are those designated by the terms Empirical Therapeutics and Rational Therapeutics. By Empirical Therapeutics we mean the employment of a drug, or other remedial agent or measure, in a certain case of disease, for the sole reason that some person had previously used it successfully in a case which was apparently identical with the one under treatment. Necessarily the original method in Therapeutics, its reign has continued to the present time, and it is by many authorities lauded as the Therapeu- PHARMACOPOEIAS AND DISPENSATORIES. 11 tics of Experience, founded on observation and experiment. At best, however, it is utterly unscientific ; and would be destructive to all exactness in therapeutical pro- gress, if permitted to rule unchallenged. It is a mere elaboration of Mrs. A’s advice to her daughter, Mrs. B, to give her baby hot saffron tea for the measles, because Mrs. C’s great grandmother had brought a family of ten safely through the disease with no other medicinal aid. Rational Therapeutics is the very antithesis of Empiricism, as it consists in the employment of remedies with a definite object, and for reasons based on known laws of the remedies and of the diseases. When working by this method we administer a certain drug in a certain disease, with a more or less clearly defined idea of the morbid conditions present, and of the modifying action of the drug upon those conditions. Based, as it is, upon pathology and pharmacodynamics, these upon physiology, and it upon chemistry and biology, its progress must be slow, being dependent upon the advances made in all these fundamental branches of knowledge. PHARMACOPOEIAS AND DISPENSATORIES. Drugs, (Drugan, to dry), are material agents of every kind employed in the treatment of disease. The term was formerly applied to vegetable medica- ments in their original form, and is still, by many persons, used in a similar sense. A Pharmacopoeia is the official list of drugs and their preparations recog- nized by the medical profession in a certain country ;—as The Pharmacopoeia of the United States of America, (U. S. P.),—The British Pharmaco- poeia, (B. P.), etc. In other countries this list has the force of law, being issued under governmental auspices ; but in the United States it has only the prestige of a professional publication, being revised every ten years by a con- vention of delegates representing the medical and pharmaceutical professions. The seventh decennial revision of the U. S. Pharmacopoeia was made in 1890, published in 1893, and is official from January 1st, 1894. A Dispensatory is a Commentary upon one or more of the national phar- macopoeias, and treats of the medicinal substances official therein and their preparations, as also of such unofficial ones as are of especial interest. It is a private publication, having only such authority as is conceded to the reputa- tion of its author. The two great dispensatories are American publications, and are veritable drug-encyclopaedias, so elaborately do they deal with the subjects treated of by them. They are— The Dispensatory of the United States of America, by Dr. Geo. B. Wood and Dr. Franklin Bache, 17th edition, revised and largely rewritten, by Wood, Remington and Sadtler. Philadelphia, 1894. The National Dispensatory, 5th edition, revised by Professors Stills, Maisch and Caspari. Philadelphia, 1894. 12 INTRODUCTION. OFFICIAL PREPARATIONS. The Preparations Official in the U. S. Pharmacopoeia number thirty- three, and are grouped as follows,—viz. Aqueous,—Waters, Solutions, Infusions, Decoctions, Syrups, Honeys, Mu- cilages, Emulsions, Mixtures; the last five containing sweet or viscid substances. Liquid Preparations, (20). Alcoholic,—Fluid Extracts, Tinctures, Wines, Spirits, Elixirs. Ethereal,—Oleoresins, Collodions. Oleaginous,—Liniments, Oleates. Acetous,—Vinegars. Glycerines,—Glycerites. Solid Preparations, (13). Extracts. Resins. Masses. Pills. Troches. Confections. Powders. Triturations. Ointments. Cerates. Plasters. Suppositories. Papers. Besides the above-mentioned there are the Natural Preparations, namely the Alkaloids, Glucosides, and other Neutral Principles, also the Acids, Alka- lies, etc. The two latter groups are described under Agents acting on the Digestive System. Aceta, Vinegars,—are solutions of the active principles of certain drugs in dilute acetic acid. They number only 2, are made by percolation, and each contains the soluble principles from io per cent, of drug. Alkaloids,—are active, nitrogenous principles existing in plants, from which they are extracted by chemical art. They are organic bases, forming salts with acids, and regarded as compound ammonias, products of albumin- ous decomposition in the plant-cells during the process of growth. Like am- monia, they all contain N, with C and II; most of them also containing O, though a few are devoid of the latter element, occurring as oily liquids,—e. g., Nicotine, Coniine, Sparteine, Piperidine, Lupuline, Lobeline, Muscarine, and Pilocarpine. Alkaloids are alkaline in reaction, sparingly soluble or insoluble in water, but readily soluble in alcohol ; while their salts are more soluble in water than in any other liquid. Their solutions are intensely bitter. They are easily decomposed by alkalies or alkaline carbonates; and are precipitated from their solutions by a solution of Iodine in Iodide of Potassium, by Potas- sio mercuric Iodide, and by Picric, Phosplio-molybdic and Phosphotungstic OFFICIAL PREPARATIONS. 13 Acids. They generally have a powerful physiological action, and their offi- cial names always end in —in a, (—me). Allied to the alkaloids are the organic products— Leucomaines and Ptomaines,—the former being alkaloids produced by decomposition of albuminous matter in the living animal tissues during the normal processes of waste ;—and the latter being alkaloids produced by putre- faction. Many of the ptomaines are identical with vegetable alkaloids. There are 16 alkaloids official, either under their own names or under those of one or more of their salts, as follows, viz.— Apomorphina. Atropina. Caffeina. Cinchonidina. Cinchonina. Cocaina. Codeina. Hyoscina. Hyoscyamina. Morphina. Physostigmina. Pilocarpina. Quinidina. Quinina. Strychnina. Veratrina. V Veratrina is not an alkaloid, but a mixture of alkaloids. Unofficial but important Alkaloids are the following, viz.— Aconitina. Berberina. Brucina. Colchicina. Conii'na. Curarina. Duboisina. Emetina. Gelsemina. Homatropina. Muscarina. Pelletierina. Aquae, Waters,—are aqueous solutions of volatile substances, which may be either solids, liquids or gases. They are dissolved either by solution in cold or hot water, by filtration through an absorbent powder, by percolation through cotton saturated with the substance, or by distillation. They number 15 in all, including two forms of Aqua itself, viz—Water and Distilled Water. Cerata, Cerates,—are unctuous preparations, similar to ointments, but of a much firmer consistence, as they all contain wax (cera), and do not melt below 104° F. There are 6 official cerates, including Ceratum itself, which is made by fusing together 30 parts of White Wax and 70 of Lard. Chartae, Papers,—are strips of paper medicated by impregnation with medicinal substances, or by coating therewith. The official papers number 2, one being intended for smoking, (Charta Potassii Nitratis), the other for application as a vesicant or counterirritant. Collodia, Collodions,—are liquid preparations, having for their base a solu- tion of gun-cotton in a mixture of Ether and Alcohol. They number 4, and are intended for external use. Confectiones, Confections,—are medicinal substances formed into a mass 14 with sugar, honey, water, etc., with the object of rendering them palatable and preserving them from change. They number only 2, that of Rose and that of Senna. INTRODUCTION. Decocta, Decoctions,—are aqueous preparations of vegetable drugs, made by boiling them in water for 15 to 30 minutes, and adding enough water to make the finished product of 5 per cent, strength, unless otherwise directed. Only 2 Decoctions are now official, out of 12 in the Phar. of 1870. They are not desirable preparations, as heating is injurious to the active principles of most plants.- Elixiria, Elixirs,—are aromatic, sweetened preparations, containing active medicinal agents in small quantity, and made with a menstruum of Alcohol and Water. There are 2 official Elixirs, one (Elixir Aromaticum) being practically an alcoholized syrup, flavored with Orange, and intended as an ex- cipient for use with extracts, salts and tinctures in prescriptions. Emplastra, Plasters,—are solid compounds, of tenacious but pliable con- sistence, and intended for external application. They are prepared by incor- porating the medicinal substances with certain bases, to make a mass, which is then spread evenly on chamois-skin, muslin or kid-skin. The official Plasters number 13. Emulsa, Emulsions,—are aqueous, liquid preparations containing an in- soluble medicinal substance (as an oil or a resin) in a state of minute subdi- vision, and suspended therein by the aid of some viscid excipient, as gum. The official Emulsions number 4, and were all classed as Mixtures in the Pharmacopoeia of 1880. The Emulsions are further considered under Un- official Preparations. Extracta, Extracts,—are solid or semi-solid preparations, obtained by evaporating solutions of vegetable principles. The drug is first powdered, and then percolated with an aqueous or alcoholic menstruum to exhaustion, when it is evaporated at a temperature not to exceed 1220 F., to a pilular consist- ence, and in some cases has a small quantity of glycerin added to keep the mass from becoming hard. There are 32 official Extracts, of which one is an inspissated juice, (Extr. Taraxaci), and one is made by evaporating a Fluid Extract, (Extr. Ergotse). Extracta Fluida, Fluid Extracts,—are alcoholic solutions, or concentrated tinctures, of vegetable drugs, prepared by percolation and partial evaporation, with menstrua of Alcohol, diluted Alcohol, or Alcohol and Water in various proportions. They are of uniformly definite strength if the crude drugs are so, a cubic centimeter, or fluid gramme, representing in each case the medicinal OFFICIAL PREPARATIONS. 15 powers of one gramme of the drug ; or, approximately, one minim of the fin- ished preparation representing the active constituents of one grain of the drug. There are 88 official Fluid Extracts, and several hundred unofficial ones, one manufacturing firm alone carrying over 400 on their trade-list. A class of superior fluid extracts, named Normal Liquids, has been introduced by Parke, Davis & Co., embracing all the official vegetable drugs in common use. It is claimed for these preparations that they are adjusted, by assays for alkaloids, at every stage of their manipulation, and that the preparation is finally adjusted to a standard alkaloidal strength, irrespective of the grade of the particular sample of the crude drug employed. Glucosides,—are organic compounds, belonging to the group of Neutral Principles which exist in plants; and which are resolved into glucose and some other principles by the action of reagents or natural ferments. Few, if any, of these compounds, contain any N,—-but among them are some very active agents. The official glucosides number six, and like other neutral principles, are designated by titles which end, in Latin in—inum, (English, in), viz.— Chrysarobinum, (Chrysarobin). Elaterinum, (Elaterin). Glycyrrhizinum, (Glycyrrhizin). Picrotoxinum, (Picrotoxin). Salicinum, (Salicin). Santoninum, (Santonin). Besides these, there are several other substances recognized by pharma- copoeia! names which terminate in—inum,—in, but which have no relation- ship to the group of Glucosides. They are the following, viz.— Aloinum, Aloin,—A neutral principle from Aloes. Benzinum, Benzin,—A purified distillate from Petroleum. Benzoinum, Benzoin,—A balsamic resin, from Styrax Benzoin. Chinoidinum, Chinoidin,—A mixture of Cinchona alkaloids, unofficial. Glycerinum, Glycerin,—A liquid obtained from fats or fixed oils. Lupulinum, Lupulin,—A glandular powder from the hop plant. Naphtalinum, Naphtalin,—A hydrocarbon from coal-tar. Pancreatinum, Pancreatin,—A mixture of enzymes from the pancreas of the hog. Pepsinum, Pepsin,—A ferment from the stomach of the hog. Piperinum, Piperin,—A neutral principle from pepper. Pyroxylinum, Pyroxylin,—Soluble gun-cotton. Pesorcinum, Resorcin,—A diatomic phenol. Glycerita, Glycerites,—are mixtures of medicinal substances with glycerin, of which 6 are now official. Infusa, Infusions,—are aqueous preparations of vegetable drugs, using hot or cold water, but without boiling, and in the proportion of 5 per cent., unless 16 INTRODUCTION. otherwise directed. The official Infusions are 4 in number, varying from lj!4 to 4 and 6 per cent, of drug to menstruum. Linimenta, Liniments,—are thin, oleaginous preparations, for external use with friction, and are made by dissolving various drugs in oily liquids, or in alcoholic liquids containing fatty oils. There are 9 official Liniments, 2 of which have Cotton-seed oil as their bases, 3 have Alcohol and Water, 1 Lin- seed Oil, 1 Oil of Turpentine, and I Alcohol. Liquores, Solutions,—include all aqueous solutions of non-volatile sub- stances, except the syrups, infusions and decoctions, which naturally form distinctive classes. There are 24 official Solutions; of which 7 are simple aqueous solutions, the rest being chemical aqueous solutions, in which the dissolved substances are altered by chemical action and new ones formed. Massae, Masses, Pill-masses,—are prepared as described under Pilulae below, those which are official numbering 3, viz.—Massa Copaibae, Massa Ferri Carbonatis, and Massa Hydrargyri. Mellita, Honeys,—differ from Syrups merely in their having honey as their base. The Oxymel and Oxymel Scillce of the B. P. are similar preparations, with the addition of Acetic Acid. There are 3 official Honeys, including the two forms of Honey itself, viz.—Mel, Mel Despumatum, and Mel Rosse. Misturae, Mixtures,—are aqueous preparations of insoluble substances, held in suspension by a suitable vehicle. In extemporaneous pharmacy, however, the term Alixttire is applied to every fluid compound intended for internal use, except a few which have distinctive titles, as Emulsions, Draughts, Enemas, Elixirs, and Drinks. There are 4 official Mixtures,—Mistura Cretoe, Mistura Ferri Composita, Mistura Glycyrrhizae Composita, and Mistura Rhei et Sodae. Mucilagines, Mucilages,—are thick, viscid liquids, prepared by dissolving gum in water, or by extracting with water the mucilaginous principles of cer- tain plants. They are easily spoiled, and hence should be kept only in small quantities. There are 4 official Mucilages. [Neutral Principles of plants include the Carbo-hydrates, (starch, sugars, gum, etc.),—Albuminous Bodies, which may act as ferments,—Bitter Prin- ciples,—and Glucosides. ] Oleata, Oleates,—are liquid solutions of metallic salts and alkaloids in Oleic Acid, intended for external use. They are not definite chemical com- pounds, though the term Oleates is also employed in the drug trade to distin- guish certain solid preparations which are claimed to be chemical compounds of the same acid with various bases. There are only 3 official Oleates,—the OFFICIAL PREPARATIONS. 17 Oleate of Mercury (20 per cent.), the Oleate of Veratrine (2 per cent.), and the Oleate of Zinc (5 per cent.). Oleoresinse, Oleoresins,—are liquid preparations, consisting principally of natural oils and resins extracted from vegetable drugs by percolation with stronger Ether. They are the most concentrateddiquid preparations of drugs which can be produced, and there are 6 official members of the class. Pilulae, Pills,—are spherical masses composed of medicinal agents, and intended to be swallowed whole. The “pill-mass" or “mass" consists of the active ingredients and the excipient, the latter being the substance which gives to the mass its adhesive and plastic qualities. Besides the 3 official Masses enumerated above under Hassle, there are 15 official Pills, in the composition of which some 9 different excipients are specified. One pill-mass has no excipient, (Massa Copaibae), one of its ingredients having sufficient moisture in itself to give it the necessary viscidity. Pulveres, Powders,—consist of dry substances in a state of minute sub- division, obtained by pulverization ; the ingredients being rubbed together in a mortar until reduced to a fine powder and thoroughly mixed. There are 9 official Pulveres, one of which is really a Trituration, viz.—the Pulvis Ipecacuanhae et Opii. Resinae, Resins,—are solid preparations obtained by precipitating the resinous principles of plants from their alcoholic solutions by the agency of water. There are 4 official Resins, namely Resina Copaibae, Jalapae, Podo- phylli, and Scammonii. Spiritus, Spirits,—are alcoholic solutions of volatile substances, which may be solids, liquids or gases. The official Spirits number 25, and are prepared either by simple solution, by solution with maceration, by gaseous solution, by chemical reaction, or by distillation. Suppositoria, Suppositories,—are solid bodies containing medicinal sub- stances, and intended for introduction into the rectum, vagina or urethra. There is but one official Suppository, that of Glycerin, in which Stearic Acid is employed to give the requisite consistence. The Pharmacopoeia prescribes a general formula for these preparations, and directs that the medicinal con- stituent be incorporated with Cacao-butter (Oleum Theobromse). Syrupi, Syrups,—are concentrated solutions of Sugar in water or in aque- ous liquids, sometimes containing Acetic Acid, and occasionally Alcohol. They are termed simple, medicated, or flavored, according as they are simple solutions of sugar in water alone, or contain soluble medicinal substances, or flavoring ingredients. The official syrups number 32. 18 INTRODUCTION. Tincturae, Tinctures,—are alcoholic solutions of medicinal substances, all, except one, (Tincture of Iodine), being from non-volatile bodies. They are prepared by percolation, maceration, solution or dilution; the menstrua em- ployed being chiefly Alcohol and diluted Alcohol of various strengths, though in a few cases the Aromatic Spirit of Ammonia is used. There are 71 official Tinctures, varying in strength from 0.4 per cent. (Tinct. Opii Camph.) to 50 per cent. (Tinct. Lactucarii). Tincturae Herbarum Recentium, Tinctures of Fresh Herbs,—is the title of a general formula for the preparation of the so-called “ Green Tinctures,” according to which, unless otherwise directed, 50 grammes of the fresh herb, bruised or crushed, are to be macerated in 100 Cc. of Alcohol for 14 days, then expressed and filtered. Triturationes, Triturations,—are finely comminuted powders, each con- sisting of a suitable medicinal substance and Sugar of Milk as a diluent, in the proportion of 10 per cent. There is but one official Trituration, (Trituratio Elaterini), though the Pul vis Ipecac et Opii practically belongs to this class, except in respect of the proportions prescribed. Trochisci, Troches,—also called Pastilles, Tablets, or Lozenges,—are small flattened cakes consisting of medicinal substances incorporated with Sugar, Mucilage of Tragacantli, etc. There are 15 official Troches. Unguenta, Ointments,—are soft, fatty mixtures of medicinal agents with a basis of lard, petrolatum, or fixed oils ; intended for application to the skin by inunction. There are 23 official Ointments, including Unguentum itself, which is a mixture of Lard 80 and Yellow Wax 20 parts. Vina, Wines,—when medicated are practically Tinctures ; White Wine, of a definite alcoholic strength, being the menstruum used. There are io official Wines, of which number 2 are unmedicated, namely—Vinum Album and Vinum Rubrum. UNOFFICIAL PREPARATIONS. Balnea, Baths,—are often medicated, and then become medicinal prepara- tions. In prescribing for them, the ingredients only are enumerated, with directions that they shall be added to the necessary quantity of water,—usually about 20 gallons. Bolus, Bolus,—is a solid preparation, larger than a pill, but intended to be swallowed whole. Bougia, Bougies, or Pencils,-—are urethral and uterine suppositories, made long and slim for adaptation to those canals. They consist of various solid UNOFFICIAL PREPARATIONS. 19 medicaments, astringents usually,—which are incorporated with a basis of Gelatin 3 and Glycerin 1, melted together. The compound is finally run into well-oiled tubes, in which it cools to the proper shape, and is then cut into the proper lengths. Cachets, Wafers,—are thin disks made of flour and water, forming a very convenient vehicle for the administration of many powdered drugs, such as Quinine Sulphate, Rhubarb, etc. The wafer is first moistened with a very small quantity of water,—next the powdered drug is dropped upon it,—the edge of the wafer is bent inwards so as to completely cover up the powder, and the whole then forms a bolus, which can be swallowed easily. Capsulae, Capsules,—are short tubes made of gelatin, and of such sizes that one slips over the other, so as to form a cover for it. They are a very convenient means of administering oils or other nauseous drugs, as when filled they are swallowed as easily as large-sized pills, and quickly dissolve in the gastric fluids, setting their contents free in the stomach. Another form is the Soluble Elastic Capsule, each one containing a dose of such medicines as Castor Oil, Cod-liver Oil, etc., enclosed in a yielding wall of gelatin, which bears any ordinary pressure, and accommodates itself readily to the shape of the oesophagus. Cataplasmata, Poultices,—are well-known devices for applying heat and moisture to an external part, and are sometimes medicated with anodyne, counter-irritant, or disinfectant agents. They are always prepared at the resi- dence of the patient, the prescription calling for the ingredients only. The British Pharmacopoeia recognizes six of these preparations, but they are not official in the U. S. Pharmacopoeia. Collunarium,—is a nasal douche or wash, consisting of a mixture of various substances with water, to which a little glycerin is often added. Collyrium,—is a similar preparation for use on the eye,—an eye-wash ;— and generally contains a soluble, astringent salt, dissolved in rose-water or filtered (not distilled) water, in the proportion of gr.j-v to the g. Discus, A Disk,—is a thin scale of Gelatin, medicated as required, for local application to the eye. The various mydriatics, also several mild astringents and anodynes, are put up in this form for use by ophthalmologists. Dragee,—is the French name for a sugar-coated pill;—e. g. “ Dragees Ferrugineuses.” Electuaria, Electuaries,—are preparations of a similar character to Confec- tions, consisting of medicinal powders, etc., beaten up with sugar, honey or 20 INTRODUCTION. molasses, to the consistence of a thick paste, and administered with a spoon, like preserves. The term is now practically obsolete. Emulsa, Emulsions,—are mixtures which contain an oil or a resin min- utely subdivided and in a state of “ suspension ” in the mixture ; the suspen- sion being accomplished by the aid of some viscid excipient, as gum, soap, alkali, or yolk-of-egg. Natural Emulsions are such as exist ready formed in nature, as milk, the yolk-of-egg, etc.; and also the emulsions formed by rub- bing up gum-resins with water,—the members of that class of substances, (Ammoniacum, Asafetida, Myrrh, etc.) each containing, along with its resin, a sufficient amount of gum to make a perfect emulsion when triturated with water. There are four official Emulsions (see ante), but these preparations are usually extemporaneously prescribed by the physician. Excipients used for emulsification are Acacia, Tragacanth, (either these gums in powder or their Mucilages), Yolk-of-Egg, Liquor Potassse, Tincture of Senega, Tincture of Quillaja, Milk, Syrups, Soap, etc. To give good results, the following proportions in parts by weight are recommended, viz.— Gum Acacia. Water. i part of Fixed Oils or Copaiba requires .... y2 and i “ “ Balsam of Peru “ .... 2 “ 1% 1 “ “ Oil of Turpentine “ .... 1 “ 1 Enemata, Enemas, Clysters,—are liquid preparations for injection into the rectum, and may be laxative, demulcent, nutritive, stimulant or vermifuge in character. Their diluent is always water, which should be warm or tepid, and with which are incorporated such medicaments as may be desired. They may consist of water alone, as a wash for the purpose of cleansing the lower bowel. Fotus, A Fomentation,—is a Lotion used hot,—and may consist of water alone, or medicated with a soluble salt, or perhaps alcohol, turpentine, etc. Gargarysma, A Gargle,—is a mixture or solution for application to the pharyngeal mucous membrane, and usually contains some astringent or disin- fecting salt, with a vegetable astringent perhaps, and frequently honey,—all in aqueous solution or mixture. Glycecol,—is a jelly troche, the base of which is a mixture of gelatin or isinglass with glycerin, called Glycecolloid. Granulum, A Granule,—is a very small pill, also called Parvule, and usually composed of alkaloidal or other powerful drugs. Haustus, A Draught,—is a mixture consisting of a single dose, and usually about one or two fluid-ounces in volume. The old-time Black Draught is, perhaps, the best known preparation of this class,—but having been promoted from the ranks, it is now commissioned in official pharmacy under the title Infusion Sennce Composition,—the Compound Infusion of Senna. ADMINISTRATION OF MEDICINES. 21 Inhalationes, Inhalations,—also called Vapores, Vapors,—are medicines in the form of a vapor, a gas, or an atomized spray, intended for inhalation for their local action on the respiratory mucous membrane. The best apparatus for the production of these preparations is the steam-atomizer;—but many substances may be inhaled from the surface of hot water,—from a sponge in a wide-mouthed bottle surrounded by a hot cloth,—or from a heated slab of stone or iron. Injectiones, Injections,—are aqueous preparations, intended for introduc- tion into the cavities of the body by means of a syringe; and are termed vaginal, urethral, vesical, nasal, aural, hypodermic, etc., according to the local- ity wherein employed. A special form of syringe is employed in each case. Lotio, A Lotion or Wash,—is an aqueous solution or mixture of medicinal agents, intended for external use, and usually consisting of some soluble, astringent salt, dissolved in water, together with, perhaps, some glycerin or alcohol. The best known Lotion is “ Leadwater and Laudanum,” of daily use as an anodyne, refrigerant and astringent application. Pessaria, Pessaries,—are suppositories of large size for use in the vagina. The term is also applied to certain mechanical contrivances used by gynecolo- gists to support the uterus in position, and hence its medicinal application is all but obsolete. Pigmenta, Paints,—are fluid or semi-fluid preparations for external use, to be applied with a brush over inflamed joints, in skin-diseases, or to the pha- ryngeal mucous membrane. The familiar application of Tincture of Iodine, painted over the skin as a counter-irritant and sorbefacient, is the best-known example of this class. Potus, A Drink,—is a mixture or solution, intended to be used ad libitum,—■ and usually consists of a Potassium salt, or a mineral acid, in dilute solution, sweetened and flavored to the patient’s taste. ADMINISTRATION OF MEDICINES. Medicines may be introduced into the circulation by various routes, as the gastro-intestinal tract, the rectum, the respiratory tract, the veins and arteries, the subcutaneous cellular tissue, and the integument itself. The Gastro-intestinal Route is the one most frequently employed, being the most convenient. The remedies, after being swallowed, find their way INTRODUCTION. 22 into the current of the circulation, through the walls of the gastro-intestinal bloodvessels and the lacteals. When the stomach is empty and its mucous membrane healthy, crystalloidal substances in solution pass through the walls of its vessels with great rapidity. Colloidal substances (fats, albumen, gum, gelatin, etc.) require to be digested and emulsified before they can be absorbed. The Rectum will absorb many substances applied in the forms of Enemata or Suppositories. Those most suited to this route are the salts of the alkaloids in solution, especially those of Morphine, Atropine, and Strychnine, the latter being absorbed more rapidly per rectum than by the stomach. Acid solutions, if not too frequently repeated, are also well administered by this channel. The Respiratory Tract admits of the rapid absorption of medicinal substances through its extensive blood-supply. The inhalation of vapors or atomized fluids, the insufflation of powders into the nares, fauces, larynx, etc., and the use of a medicinal nasal douche, are methods whereby this channel may be utilized. The Veins are only used as a route of medication in emergencies, when the other channels are not available, and where immediate action is necessary to the preservation of life, the operation being a highly dangerous one. The injection intravenously of Saline Solutions in the collapse of cholera, diabetic coma, etc.,—Blood or Milk as a last resort in excessive hemorrhage, epilepsy, uraemia, the collapse of cholera, etc.,—and a solution of Ammonia for the bites of venomous reptiles, Hydrocyanic-acid poisoning, Opium narcosis, Chlo- roform asphyxia, etc., are the instances admitted in practice. Arterial Transfusion has also been performed successfully in a number of cases, and is considered safer than venous transfusion when a large quantity of fluid has to be introduced into the circulation. A special apparatus is employed for these purposes, known as Aveling’s Transfusion Syringe, but the ordinary Dieulafoy’s aspirator slightly modified, may be used with safety and convenience. The danger of the operation lies in the liability of the introduction of air into the circulation, an occur- rence which may cause instant death in the human subject. The Hypodermic Method is the introduction of medicines into the organ- ism by injecting them into the subcutaneous areolar tissue, from which they are quickly absorbed by the lymphatic and capillary vessels. The medicines must be in solution, of neutral reaction and freshly prepared, the usual menstruum being distilled water; though spring water filtered will answer just as well, and much better than distilled water which has been standing several days, and exposed from time to time to the air. The solution is to be injected beneath the skin, by a hypodermic syringe, care being taken to avoid puncturing a vein. The most suitable localities for the injection are the external aspect of the arms and thighs, the abdomen, the back, and the calves of the legs. On the external aspect of the ADMINISTRATION OF MEDICINES. 23 thigh, just in front of the great trochanter, there is an area of some two inches square, over which the insertion of a fine hypodermic needle is not felt, so barren is the skin in that region of sensitive nerve filaments. After nearly filling the syringe with the solution to be used, the needle should be screwed on tightly; and with the instrument held in a vertical position, point upper- most, the excess of solution over the amount required should be ejected, thus expel- ling air-bubbles and filling the needle itself. The needle should then be quickly inserted until its point has passed beneath the skin, when the piston may be pressed down slowly, delivering the solution gradually so as to avoid rupturing the tissue. If the solutions are freshly prepared with clean water, the needles kept clean and sharp, and the injection be made beneath the skin not into it, there will be no risk of pro- ducing abscesses with the agents ordinarily employed. Parenchymatous Injection is the delivery of a medicine deeply into the tissues, either to affect a muscle itself or to locally influence some important nerve-trunk. The principal agents used in this manner are Strychnine for palsied muscles, Chloroform for sciatic and other neuralgias, Salts of Cocaine for local anaesthesia, and Carbolic Acid for deep-seated inflammations. The Skin is an active absorbent of crystalloidal substances when its epi- dermis or cuticle is removed. By this route there are four methods of intro- ducing medicaments into the circulation, viz.—the Enepidermic, Epidermic and Endermic Methods, and Inoculation. The Enepidermic Method consists in placing the medicine in simple contact with the epidermis, no friction being used to hasten its penetration. Solutions of the alkaloids in Chloroform and Oleic Acid pass by osmosis in this manner with comparative ease, but aqueous solutions act very slowly, and alcoholic ones with great difficulty if at all. The Epidermic Method consists in the use of friction to promote the pas- sage of the medicament between the cells of the epidermis. Mercurial Oint- ment, Cod-liver Oil, and other fats, Oleates, etc., are used in this way for their local and systemic effects. The Endermic Method obviates the difficulty of absorption through the cuticle by removing the latter through the agency of a blister, and then pow- dering the medicament over the surface of the denuded derma. An ordinary cantharides-plaster, followed by a poultice to raise the blister, may be employed; but a quicker method is to place upon the skin a piece of lint soaked in Stronger Water of Ammonia, covering it with a watch-glass or a piece of oiled silk to prevent evaporation. The blister raises rapidly and should then be removed with scissors. Morphine, Atropine, Quinine and Strychnine, are the agents generally used in this manner, but the method is painful and unpopular. Inoculation is the introduction of medicinal agents through the scraped or punctured skin by an operation similar to that employed for vaccination. 24 INTRODUCTION. CLASSIFICATION OF MEDICINES. Every medicine should be first studied as an individual, both with respect to its physiological actions and its therapeutical applications. When the stu- dent has thus familiarized himself with the characteristic features of each article of the Materia Medica, he may commence to seek out their more delicate lights and shades, by comparing them, one with another, according to their general scope of action and application. In order to do this intelligently, some method of classification becomes necessary, to guide and direct the mind, and to assist the memory, in grasping the subject with a firm grip. Stimulant, (Stimulus, a goad),—is a term which is used in various senses when applied to medicinal agents. It is properly employed when used to designate the action of any agent which increases the organic activity of any part of the organism. Alcoholic preparations are commonly termed “ stimu- lants,’ ’ though their action is that of a true narcotic. Diffusible Stimulants are those which have a prompt but transient effect, as Alcohol, Ammonia, Camphor, Ether, etc. Spinal Stimulants exalt the functions of the spinal cord, as Strychnine. Cerebral Stimulants those of the brain, as Opium. We also have Cardiac, Vaso-motor, Renal, Stomachic, Hepatic, Intestinal, and Cutaneous Stimulants, and many others, according to the special seat of the action in each case. Stimulants and Sedatives. Sedatives, (Sedo, I allay),—are agents which lessen the functional activity of organs, lower motility and diminish pain, and so exert a soothing influence on the system. So we have General Sedatives, which include the narcotics and anaesthetics,—the Local Sedatives, which affect a part only,— also Pulmonary, Spinal, Nervous, Vascular, Cardiac Sedatives, etc., all of which will be indicated under their appropriate titles. All the groups which follow are merely local applications of the two fore- going grand divisions. Agents Acting on the Nervous System. Motor-Excitants,—are agents which increase the functional activity of the spinal cord and the motor apparatus, producing heightened reflex excitability, disturbances of motility, and tetanic convulsions when given in large doses,— their ultimate result being motor paralysis from over-stimulation. Such are Nux Vomica and Ignatia, with their alkaloids, Strychnine and Brucine,— also Thebaine, the tetanizing alkaloid of Opium, and Ergot, Picrotoxin, Digitalis, Pilocarpine, etc. CLASSIFICATION OF MEDICINES. 25 Motor-Depressants,—lower the functional activity of the spinal cord and motor apparatus, and in large doses paralyze them directly. The principal members of this class are Alcohol, Ether, Chloroform, Opium, Aconite, Conium, Chloral, Tobacco, Lobelia, Belladonna, Gelsemium, and Methyl- Strychnine. Cerebral Excitants,—increase the functional activity of the cerebrum, without causing any subsequent depression or any suspension of brain-func- tion. The chief members of this group are Camphor, Cannabis, Valerian, Caf- feine, Theine, Cocaine, Tobacco, Strychnine, and Alcohol (in small-doses). Deliriants,—excite the functional activity of the higher brain to such a degree as to disorder the mental faculties, and produce intellectual confusion, loss of will-power, delirium and even convulsions. They are all narcotics, though all narcotics are not deliriants. Among these agents are Belladonna, Stramonium, Hyoscyamus, Cannabis Indica, Chloral, Lupulus (at first), Opium (at first), and Alcohol (in full doses). Cerebral Depressants,—lower or suspend the functions of the higher brain after a preliminary stage of excitement. Under this head may be in- cluded the Narcotics, the General Anaesthetics, the Hypnotics, and many of the Antispasmodics,—all of which act upon the cells of the convolutions, and at first stimulating the cerebral functions, they produce after a time stupor, coma, and insensibility. The principal agents of this class are Alcohol (in large doses), Opium, Chloroform, Bromides, Chloral. Narcotics, (vdpKij, stupor),—are drugs which lessen the relationship of the individual to the external world (Brunton). At first excitant to the higher brain, they soon cause profound sleep, characterized by increasing stupor,— and if the dose be sufficient, coma, insensibility, and finally death by paralysis of the centres in the medulla which govern respiration and the other functions of organic life. Narcotics are closely related to stimulants,—Alcohol and Opium being good illustrations, in the different stages of their actions, of stimulant followed by narcotic effects. Such agents give us the means of lowering hyper-acute perception, of inducing sleep, and of soothing the vital functions by rest,—all of which are means of great therapeutical value. The principal narcotics are Opium, Cannabis Indica, Alcohol, Belladonna, Humu- lus, Chloral, Chloroform, Ether, etc. Hypnotics, (virvog, sleep),—are agents which, in proper doses, induce sleep, without causing deliriant or narcotic effects. Many of the most effi- cient hypnotics are narcotic in full dosage, the principal agents of the class being Sulphonal, Trional, the Bromides, Chloral, Paraldehyde, Cannabin Tannate, and Methylal, described under Chloral in the following pages. 26 INTRODUCTION. Analgesics or Anodynes, (av, without, a/yog, oSvvtj, pain),—are agents which relieve pain, either by impairing the conductivity of the sensory nerve fibres, or by depressing the cerebral centres of perception and sensation. Opium does both, and hence it is the most efficient of all the analgesics. The General Anodynes act when taken internally, and affect the whole organism,—the Local Anodynes affect the part to which they are applied, some by direct depression of the terminal nerve-organs in the skin, others by reducing the local circulation. The principal agents of this class are as follows:— General Anodynes. Local Anodynes. Opium, Morphine. Opium. Belladonna, Atropine. Belladonna. Hyoscyamus, Hyoscine. Carbolic Acid. Aconite. Cocaine. Antipyrin. Veratrine. Acetanilid. Aconite. Chloral. Chloroform, etc. Anaesthetics, (av, without, iuofli/aig, perception),—are agents which tem- porarily destroy sensation. The General Ancesthetics are volatile substances, which, when inhaled, produce more or less complete unconsciousness and loss of sensation, (anaesthesia), also lessened motor power. The Local Ancesthetics act similarly to the local anodynes, (see above), except that, while the latter diminish the sensibility of the part, the former destroy it entirely, for a time. The principal agents belonging to this group are the following-named :— General Ancesthetics. Local Ancesthetics. Ether, (Ethyl Oxide). Extreme Cold. Ice. Ether Methylic Ether. Spray or Methyl Chloride. Chloroform. Carbolic Acid. Creosote. Methylene Bichloride. Cocaine and its salts. Ethylene Bichloride. Oil of Turpentine. Ethylidene Chloride. Hydrocyanic Acid. Nitrous Oxide. Veratrine. Antispasmodics, (avrl, against, OKaofidg, a spasm),—are agents which prevent or allay spasm of voluntary or involuntary muscles in any portion of the organism. In this group is included a long list of drugs, some of which act (i) by tonic stimulation of the nerve-centres, and thereby of the coordina- ting power and the circulation, others (2) by direct depression of the motor centres, and others (3) by paralyzing the end-organs of the vaso-motor nerves. A few (4) depress all the vital functions, and a large number (5) stimulate the muscular fibres of the intestines to expel gaseous accumulations. The following list includes the principal antispasmodics, the numbers referring to the special action of each, as stated above, viz. :— CLASSIFICATION OF MEDICINES. Alcohol, I. Ether, I. Camphor, I. Musk, 1, 5. Valerian, I, 5- Aconite, 4. Tobacco, 4. Lobelia, 4. Hellebore, 4. Hydrocy. Acid, 4. Bromides, 2. Amyl Nitrite, 2. Asafetida, 5. Cajuput, 5. Aromatic Oils, 5- Coordination of Movement, or the Maintenance of the Equilibrium, is the function apparently governed by the cerebellum, and is markedly dis- turbed by the few drugs which specifically affect that organ, chief among them being Alcohol. In considerable doses this drug causes a staggering gait, and a tendency to fall; and different preparations thereof seem to affect different portions of the cerebellum. Intoxication by wine or beer is said to be accom- panied by a tendency to fall sideways,—that by whiskey, especially Irish whiskey, an inclination to fall on the face,—and that by cider, a backward ten- dency ; and these disturbances correspond exactly with those caused by injury to different lobes of the cerebellum (Brunton). Apomorphine in large doses seems to act upon the cerebellum or corpora quadrigemina, as the animal poisoned by it does not vomit, but moves round and round in a circle. Agents Affecting the Organs of Special Sense. Mydriatics,—are agents which cause dilatation x»f the pupil of the eye (mydriasis). Some act only when applied locally, others only when taken internally,—but the principal ones, Atropine and its congeners, act both locally and internally, and at the same time, produce temporary loss of accommoda- tion, the eye remaining focussed for distant objects, and the intra-ocular ten- sion being increased. The loss of accommodation is due to the drug’s causing paralysis of the ciliary muscle,—and the dilatation of the pupil to its producing stimulation of the end-organs of the sympathetic nerve, and paralysis of the end-organs of the 3d cranial (motor oculi) nerve ; the former increasing the power of the radiating muscular fibres of the iris, and the latter lessening the power of its circular fibres. The smallest quantity of Atropine which will affect the pupil is stated by Donders as the y^ttoooth of a grain. Cocaine acts by stimulation of the ends of the sympathetic alone, and does not paralyze the 3d nerve. As a mydriatic it has peculiar qualities, which should make it 28 INTRODUCTION. preferred by eye-surgeons. These are referred to in detail in the body of the book under the title Coca. The chief mydriatics are:— Atropine. Hyoscyamine. Daturine. Cocaine. Duboisine. Homatropine. Anaesthetics, (at last). Gelsemine, (locally only). Belladonnine, (internally only). Myotics, (/wu, to close),—are agents which produce contraction of the pupil (myosis). The principal local myotic, and the only one used in oph- thalmic practice is Physostigmine, (Eserine), which acts by stimulating the cir- cular muscular fibres of the iris,—at the same time contracting the ciliary muscle so that the eye is accommodated for near objects only, and diminishing intra-ocular tension,—in all of which respects it exactly antagonizes the action of Atropine, (see above). The other myotics areas follows, viz.:— Pilocarpine. Muscarine. Morphine. Ergot. Gelsemine (internally). Lobeline (internally). Nicotine (locally). Anaesthetics (at first myotics, but mydriatics at last). Ocular Sensibility is increased by Strychnine, the vision being thereby rendered more acute, and the field of vision being enlarged. This drug also increases the field of vision for blue colors, while Eserine diminishes it for red and green, and Santonin causes objects to appear of a violet color at first, and of a greenish-yellow color afterwards. Amblyopia, or impairment of vision due to nerve changes, is often produced temporarily by Quinine, and may be permanently induced by Alcohol and Tobacco, also by Lead and Urea poisoning. Visions are caused by several drugs, the action of which is probably ex- erted on the sight-centres in the cerebrum (angular gyrus and occipital lobes), —rather than on the eye itself. The delirium and hallucinations produced by Alcohol are familiar examples,—the objects raised thereby being usually animals, as snakes, toads, dogs, etc. Cannabis Indica often causes pleasant visions, while Sodium Salicylate, in some persons, produces very disagreeable ones. The Bromides, if taken in continued large doses, may, in the typhoid condition which follows, cause visions of such intense character that they are often impressed permanently on a brain which, at the time, was utterly uncon- scious of all its real surroundings. Digitalis may produce subjective sensa- tions of the continued presence of light,—and Cannabis Indica, among the many curious effects produced by its ingestion in large doses, frequently gives origin to similar disturbances of the visual function, of indefinite and varied character. CLASSIFICATION OF MEDICINES. 29 The Ear is affected by several drugs. Strychnitie and Morphine increase the excitability of either the auditory nerve, or the auditory centre in the supe- rior temporo-sphenoidal convolution,—making that faculty much more acute than normal. Quinine, Antipyrin, and Salicin produce hypersemia of the auditory apparatus, and cause subjective noises, such as humming, buzzing or ringing, which are very unpleasant to their subject. The Smell is rendered more acute by Strychnine, and is depressed by all the cerebral depressants, and by such agents as cause changes in the nasal mucous membrane, as Potassium Iodide. The Taste is not heightened or lowered as a faculty by any drugs that we know of. Each substance makes its own peculiar impression on the nerve- organs of taste, and that of one agent may be so potent as to overcome the impression left by another agent. The so-called * ‘ after-taste ’ ’ of drugs is often entirely different to their original taste, and substances which are excreted by the salivary glands, (the Iodides, etc.) leave a very persistent after-taste be- hind them. Respiratory Stimulants,—exalt the function of the respiratory centre in the medulla, quickening and deepening the breathing. The most important of these agents are—Strychnine, Atropine, Thebaine, Digitalis, Ammonia, Heat, Electricity, Tobacco (briefly), Alcohol (briefly), Ether (briefly), and Opium (in small doses). Agents Acting on Respiration. Respiratory Depressants,—lower the action of the respiratory centre, rendering the respirations slow and shallow. The chief members of this group are—Opium (in full doses), Gelsemium, Aconite, Veratrine, Conium,Chloral, Alcohol, Ether, Chloroform, Caffeine, Cold, etc. Many of these at first excite the centre, but soon depress it. Pulmonary Sedatives,—relieve cough and dyspnoea, by lessening the irritability either of the respiratory centre or of the nerves of respiration. Some act by direct depression of the respiratory centre, (as the Depressants above enumerated);—others by lessening local congestion, as the Expectorants, (see below);—and others by lowering the excitability of the vagus end-organs in the lungs and other afferent filaments throughout the respiratory tract. The most powerful of these directly sedative agents is Opium, and next are Hydro- cyanic Acid and Potassium Cyanide. Others are—Bellado7ina and its con- geners, which stimulate the centre but depress the vagus end-organs, and arrest secretion in the bronchi;—Cannabis Indica, Quebracho, Codeine, Amyl Nitrite, Turpentine, Iodide of Ethyl, Conium, Tobacco, etc. 30 INTRODUCTION. Expectorants, (ex, out of, pectus, the breast),—are agents which modify the broncho-pulmonary mucous secretion, and promote its expulsion. They, consequently, act as pulmonary sedatives, indirectly; and are subdivided into— Nauseating Expectorants, in small doses increase osmosis from the inflamed mucous membrane, in large doses cause vomiting and the mechanical expulsion of the mucus. They also increase secretion generally, and lower the blood- pressure. Such are Antimonial salts, (Tartar Emetic, etc.), Ipecacuanha, Lobelia, Jaborandi, Apomorpliine, Alkalies, etc. Stimulant Expectorants,—are eliminated from the system largely by the bronchial mucous membrane, which they at the same time stimulate, thus altering its secretion, and facilitating expectoration. They diminish secretion generally, and increase the blood-pressure, and include the Ammonium salts, Balsams of Peru and Tolu, Benzoin, Ammoniac, Squill, Senega, Nux Vomica, Terebinthinates, Sulphur, Saccharine substances and Acids. Ciliary Excitants,—promote the expulsion of bronchial mucus by their reflex excitation of the tracheal and bronchial cilia when dissolved in the mouth. This group includes such agents as the Chlorides of Ammonium and Sodium, Potassium Chlorate, and Gum Acacia. Errhines and Sternutatories,—are agents, which, when locally applied to the nasal mucous membrane, produce sneezing and increase of the nasal secretion. The first term, (ev, in, piv, the nose), is usually applied to sub- stances which simply increase the mucous discharge,—the second, (sternuto, I sneeze), to those which invariably produce the violent expiratory effort called sneezing. Both should be in powder-form for application. Another result of their use is the stimulation of the vaso-motor centre at the same time that they excite the respiratory centre,—thus producing a contraction of the smaller vessels throughout the body, and consequently a general rise in the blood- pressure. This class includes—Ammonia-vapor (dilute), Cubeb-smoke, etc., which are simple errhines,—and the vapor of Ammonia-water, also Tobacco, Ipecacuanha, Sanguinaria, Ginger, Veratrum Album, etc., in powder,as snuff. Agents Acting on the Circulation. Cardiac Stimulants,—are such agents as rapidly increase the force and frequency of the pulse, in depressed conditions of the cardiac apparatus. The most rapid, energetic and available agents of this class are Ether, Alcohol, Heat and Ammonia, the last-named also stimulating the vaso-motor centre. The list also includes—Sparteine, Atropine, Cocaine, Morphine (in small doses), Camphor, Chloroform, Turpentine, the Aromatic Oils, Counter-irrita- tion, the continuous Galvanic Current, Nitro-glycerin, etc. CLASSIFICATION OF MEDICINES. 31 Cardiac Tonics,—in moderate doses stimulate the cardiac muscle, slowing and lengthening its contractions;—but in large doses they produce irregular action of the heart, and some of them may cause sudden death by syncope if pushed to any great extent. The typical agent of this class is Digitalis, which also contracts the arterioles and greatly increases the blood-pressure. Others, less powerful and correspondingly safer, are—Convallaria, Strophanthus, Squill, Cimicifuga and Erythrophloeum. The list also includes Caffeine, Strychnine, Helleboreln and Adonidin (from Adonis vernalis). Cardiac Sedatives,—lessen the force and frequency of the heart’s action. They are used to control palpitation and overaction of that organ, also to slow the pulse in febrile conditions in sthenic subjects, especially when local inflam- mation is the exciting cause thereof. Most of them are direct cardiac poisons, depressing both the heart-muscle and the motor ganglia. The list includes— Aconite and Veratrum Viride, also Muscarine, Pilocarpine, Saponin, Hydro- cyanic Acid, Antimony, Potassium salts and Digitalis,—the last-named acting as a sedative by stimulation of the vagus centre and the cardiac muscle, slow- ing the rate and giving regular rhythm to the action of the heart. Vascular Stimulants,—dilate the peripheral vessels, and increase the peripheral circulation ; thus equalizing blood-pressure and preventing internal congestions. The most useful are Alcohol and Ether, as they stimulate the action of the heart simultaneously with the vascular relaxation. The other chief members of the group are—Nitrites, Nitro-glycerin, Nitrous Ether, Liquor Ammonii Acetatis, Opium with Ipecac, (as in Dover’s powder), and Heat, applied locally by poultices, etc. Vascular Tonics and Sedatives,—are a group of agents which increase the contractile power of the arterioles, thereby lessening the capillary circula- tion, and raising the blood-pressure. They do this by a stimulating action upon either the vaso-motor centre or its mechanism in the walls of the vessels. Their most important uses are the checking of hemorrhages, and the cutting short of local inflammations. This group is well represented by Ergot and Digitalis, and besides these it includes—Squill, Opium in small doses, Strych- nine, Salts of Iron, Lead and Silver, Hamamelis, and Cold, applied locally, as by the Ether spray, or by evaporating lotions containing Alcohol, Vinegar, Ammonium Chloride, etc. Dentifrices, {dens, a tooth, frico, I rub),—are medicated pastes or pow- ders employed with a stiff brush to cleanse the teeth and gums. Their base is usually Chalk, for its mechanical action and its alkaline quality; besides Agents Acting on the Digestive System. 32 INTRODUCTION. which, there should be some antiseptic, as Quinine, Borax, etc., and an aromatic stimulant, like Myrrh. The Teeth are injuriously affected by several drugs, especially the Mineral Acids, and the Persalts of Iron. These should always be administered through a glass tube, and the mouth should be rinsed out afterwards with a weak alkaline solution. Dental Anodynes,—employed locally in toothache due to caries exposing a nerve filament, are Aconite, Opium and Cocaine salts,—also Carbolic Acid, Creosote, Chloral, and Potassium Chlorate. A solution, containing the three first named, applied on a pledget of cotton, will promptly relieve whenever the nerve is accessible. Chloral should never be employed for this purpose, as in solution sufficiently strong to be of any service it is very apt to cause slough- ing of the gum, especially if injected thereinto by a hypodermic syringe, as is frequently done by ignorant dentists, who advertise the “ extraction of teeth without pain.” Sialogogues, (aialov, saliva, ayu, I carry off),—are drugs which promote the secretion and flow of saliva and buccal mucus. They may be subdivided into two groups, viz. :— Topical Sialogogues,—which act by reflex stimulation,—including the Acids and Alkalies, Ether, Chloroform, Mustard, Ginger, Pyrethrum, Mezereon, Tobacco, Cubeb, Capsicum, Rhubarb, etc. General Sialogogues,—which influence the glands or their secretory nerves, viz.—Pilocarpus (Jaborandi), Muscarine, Physostigma, Ipecac, Iodides, Mer- curials and Antimonials, etc. Antisialics,—are agents which diminish the secretions of the salivary and buccal glands. The typical member of this group is Atropine, which acts by paralyzing the terminal filaments of the secretory nerve. Physostigmine antagonizes this paralysis, but in large doses acts also as an antisialic, by lessening the blood-supply to the glands. Opium diminishes this secretion among many others, and also lessens the excitability of the reflex centre, by which the secretion is largely stimulated. Others acting locally are—Lime, Soda, Lithia, Magnesia, Borax, Potassium Chlorate, and insipid or nauseous articles of food or medicine. Refrigerants,—are remedies which impart a sensation of coldness, (re- frigero, I cool), and thereby allay thirst and restlessness. Among them are the Vegetable and Mineral Acids, (greatly diluted, especially the latter), Ice, Cold Water, Effervescing drinks, Fruit juices, and many diaphoretics. Gastric Tonics or Stomachics,—increase the appetite and promote gastric CLASSIFICATION OF MEDICINES. 33 digestion. Some act by stimulating the production of the gastric juice, among which are Alkalies before meals;—others by stimulating the local circulation, as the Aromatic Oils, Aromatic Bitters, Alcohol, Ether, etc. ;—and several by exciting the activity of the nervo-muscular apparatus of the stomach, as Nux Vomica, Arsenic, Hydrastis, dilute Acids, etc. The various Digestive- Ferments, such as Pepsin, Ingluvin, and dilute HC1 Acid, are adjuvants to digestion, and are used to supplement the gastric juice when deficient in quantity or quality. Acids,—considered physiologically and therapeutically, are medicines which in concentrated form act usually as caustics, to destroy the tissues ; but when administered internally in medicinal doses they check the production of glands having acid secretions if coming in contact with the mouths of their ducts,— and increase the production of those having alkaline secretions. Thus, a dilute acid given before meals will check the production of the acid gastric juice, but will stimulate that of the alkaline pancreatic juice. They should always be largely diluted for internal administration. The principal Acids are Acetic, Citric and Benzoic, from the vegetable kingdom, and Nitric, Phosphoric, Sulphuric and Hydrochloric from the mineral kingdom. Alkalies, or Ant-acids,—from the same stand-point, are agents which neutralize acids, also act as escharotics on the tissues, and check alkaline and stimulate acid secretions, when in contact with the mouths of the ducts of the glands producing them. Thus, a dilute alkali given before meals will stimu- late the production of the acid gastric juice, and if applied to the mouth of the pancreatic duct will check the secretion of the alkaline pancreatic juice. Al- kalies may be subdivided into two groups, named, from their physiological actions,—Direct Antacids, those which lessen the acidity in the stomach, and Indirect or Remote Antacids, which have no power over the acidity in the stomach, but are oxidized in the blood, and excreted as Carbonates in the urine, and lessen its acidity. The following List of Alkalies comprises the chief members of both groups, and also some which have the actions of both. They should all be largely diluted before administration. Direct Antacids. Remote Antacids. (Lessen Acidity in the Stomach.) (Lessen Acidity of the Urine.) Liquor Potassae. Liquor Sodae. Liquor Potassae. Liquor Sodae. Carbonates and Bicarbonates of Carbonates and Bicarbonates of K, Na, Li, Mg, and NH4. K, Na, Li, Mg, and NH<. Lime-water. Chalk. Potassium Acetate, Citrate, Calcined Magnesia. Tartrate and Bitartrate. Ammonium Carbonate. Sodium Acetate and Citrate. Aromatic Spirit of Ammonia. Lithium Citrate. 34 INTRODUCTION. Emetics, (e/iiu, I vomit),—are agents which cause vomiting. They are subdivided into two groups, viz.:— Local Emetics,—act by irritating the end-organs of the gastric, oesophageal or pharyngeal nerves, and by reflex irritation of the vomiting centre. They include—Alum, Mustard, Salt, the Sulphates of Zinc, Copper and Mercury, Tepid Water in quantity, etc. Systemic, or General Emetics,—act by direct irritation of the vomiting centre in the medulla, through the medium of the circulation. Among them are— Ipecac (Emetine), Apomorphine, Tartar Emetic, Veratrine, Senega, Squill, etc., also Opium and its alkaloids Morphine and Codeine, which cause vomiting as one of their after-effects, though ordinarily classed among the anti-emetics. Vomiting is an evacuant act which consists in compression of the stomach by the simultaneous spasmodic contraction of the diaphragm and abdominal muscles; and relaxation of its cardiac orifice by contraction of the radiating muscular fibres in the gastric wall. If both acts occur at the same time, the contents of the stomach are expelled and vomiting occurs ; if, however, the two acts do not take place simultaneously, the contents of the stomach are retained, and the abortive efforts are called retching. These acts are con- trolled and regulated by a nerve-centre in the medulla oblongata, which is closely connected with the respiratory centre, the muscular movements of vomiting being merely modified respiratory movements. This vomiting cen- tre is ordinarily excited in two ways,—(1) by the peripheral stimulation of afferent nerves going to it from other parts of the body,—(2) by impulses sent down to it from the brain. (Brunton.) Anti-emetics,—are agents which lessen nausea and vomiting, some by a local sedative action upon the end-organs of the gastric nerves, the Local Gastric Sedatives;—others by reducing the irritability of the vomiting centre in the medulla, the General Sedatives. The principal Anti-emetics are the following named substances, viz. :— Local Gastric Sedatives. General Sedatives. Arsenic. Bismuth. Ice. Alcohol. Amyl Nitrite. Alcohol. Belladonna. Opium. Nitroglycerin. Chloral. Alum. Creosote. Ipecac. Opium. Morphine. Calomel. Cerium Oxalate. Cocaine. Hydrocyanic Acid. Bromides. Of these the most generally efficient is Cocaine, in 6-minim doses of a 4 per cent, solution every hour by mouth, for two or three doses. Carminatives, {camlino, I soothe),—aid in the expulsion of gas from the stomach and intestines, by increasing peristalsis, stimulating the circulation, CLASSIFICATION OF MEDICINES. etc. They are also diffusible stimulants. The most important members of this class are as follows, viz.:— 35 Asafetida. Capsicum. Cardamom. Fennel. Camphor. Ginger. Mustard. Pepper. Oil of Anise. Oil of Cinnamon. Oil of Peppermint. Oil of Pimento. Cathartics, or Purgatives, (nadalpu, purgo, I cleanse),—are agents which increase or hasten the intestinal evacuations. According to their various degrees and modes of action, they are subdivided into several groups, as follows :— Laxatives, or Aperients,—include those which have the most moderate action, of which Sulphur is the type, the group including also Magnesia, Figs, Prunes, Tamarinds, etc. Simple Purgatives,—cause active peristalsis, and some irritation and grip- ing. Senna is the type of this group, its list also including Rhubarb, Calo- mel, Castor oil, Aloes, etc. Drastic Purgatives,—act still more intensely, causing large watery stools, with much griping pain, tenesmus and borborygmi. Jalap is a representative drastic, and the other chief agents of the group are Colocynth, Elaterium, Scammony, Gamboge and Croton oil; all of which in large doses act as irri- tant poisons. Saline Purgatives,—increase peristalsis, promote osmosis, stimulate the in- testinal glands, and thus produce free, watery evacuations. The most com- monly used Saline is Magnesium Sulphate, the well-known “Epsom salt,” but the list is a long one, including all neutral salts of metals of the alkalies or alkaline earths, such as the Potassium and Sodium Sulphates, Sodium Phosphate, Potassium Tartrate and Bitartrate, Sodium and Potassium Tar- trates, etc. Hydragogue Purgatives, (yrfup, water),—include the most active of the drastics and the salines, those which remove a large quantity of water from the vessels. Elaterium, Gamboge, Potassium Bitartrate, and Croton oil, are the chief Hydragogues. Cholagogue Purgatives, (yo/y, bile),—stimulate the flow of bile, causing green-colored or ‘'bilious ” stools. Podophyllin is the typical cholagogue,— the others being Aloes, Rhubarb, Euonymin, Iridin, and the Mercurials. Intestinal Astringents,—contract the intestinal vessels, diminishing the exudation therefrom and lessening the fluidity of the fecal discharges. The chief members of this class are the diluted Mineral Acids, and Acetic Acid, Lead Acetate, Silver Nitrate, Alum, Tannic and Gallic Acids, Zinc Oxide, 36 Copper Sulphate, and the Persalts of Iron. Of these, the six last-named are the most powerful, and have a strong constringing action upon the intestinal mucous membrane, as well as their ordinary astringent action upon its vessels. INTRODUCTION. Cholagogues, and Hepatic Stimulants,—are two groups of agents which have a marked selective action upon the biliary secretion, hence the term Cholagogue, from (bile), and ayu, (I bring away). The Hepatic Stimulants increase the functional activity of the liver-cells, and the amount of bile secreted; while the Cholagogues remove the bile from the duodenum, interfering temporarily with the entero-hepatic circulation, and preventing the reabsorption of bile by the portal vessels. Some Hepatic Stimulants are also cholagogues, others are not;—while the Cholagogues proper act indirectly as Hepatic stimulants, by carrying off the bile and thereby urging the liver to secrete more. The following List includes the principal drugs in both groups. Cholagogues and Hepatic Stimulants,—Aloes, Podophyllin, Iridin, Baptisin, Jalapin, Euonymin, Arsenic, Rhubarb, Colchicin, Colocynthin, Sodium Phos- phate, Potassium Sulphate, Sodium Sulphate, etc. Cholagogues,—Mercurous Chloride, (Calomel), Pil. Hydrargyri, Mercury with Chalk, and many other mercurials. Hepatic Stimulants,—Mercuric Chloride, (Corrosive Sublimate), Nitro- hydrochloric Acid, Nitric Acid, Benzoic Acid, Sodium Benzoate, Ammonium Chloride, Sodium Bicarbonate, Ipecac, Antimony, Guaiac, etc. Hepatic Functions, other than the biliary, are stimulated by the following- named drugs, viz.:— The Glycogenic Function is stimulated, and the production of Glycogen increased,—by Sodium Bicarbonate, Amyl Nitrite and Nitro-hydrochloric Acid. Urea is Increased—by Arsenic, Antimony, Ammonium Chloride, Iron and Phosphorus. Hepatic Depressants—lower the functional activity of the liver, certain drugs acting upon certain of its functions, as follows, viz. :— Bile-production Lessened—by Opium and Morphine, Quinine, Alcohol, Acetate of Lead, and many purgatives. Glycogen Diminished—by Opium, Morphine, Codeine, Phosphorus, Arsenic and Antimony. UrealLessened—by Opium, Morphine, Colchicum, Alcohol and Quinine. The Pancreas is stimulated to increased secretion by Ether given internally, also by galvanism of the gland itself. It is depressed by Atropine, or by any agent which induces nausea and vomiting. CLASSIFICATION OF MEDICINES. 37 Anthelmintics, (avn, against, eTi/uvg, a worm),—are drugs which destroy (vermicides), or expel (vermifuges) worms inhabiting the intestinal canal. The principal vermifuges are the purgatives Castor Oil, Jalap and Scammony,—and the vermicides are classed according to the worm they are each most efficient against, thus,— Thread-worm, (Oxyuris Vermicularis),—Alum, Ferrous Sulphate, Lime- water, Quassia, Sodium Chloride, Tannin,—all by enema. Round-worm, [A scar is Lumbricoides),—Santonin, Spigelia, Chenopodium, Azedarach, internally,—with Senna or Calomel. Tape-worms, (Tcenice, etc.),—Filix mas, Kamala, Cusso, Granatum, (Pelle- tierine), Pepo, Turpentine, Chloroform. Agents Affecting Metabolism. Restoratives,—promote the constructive metamorphosis, and include the Foods, Haematics, Tonics, and many stimulants. Foods,—supply material to renew some structure of the body, or to maintain some vital process ; and are derived from the three natural kingdoms,—the vegetable, animal, andmineral,—as Oils and Fats, Sugar, Starch, Gum, Water, Alcohol, Calcium Phosphate, Sodium Chloride, etc. . Hematics, (aifia, the blood),—augment the quantity of hsematin in the blood, enriching its red corpuscles, and thus restoring the quality of that tissue. They include principally Iron and Manganese, and their compounds. Tonics, {rovoq, tension),—improve the tone of the tissues on which they have specific action, increasing the vigor of the entire system. Those which act most generally are Strychnine, Quinine, Iron, and the Vegetable Bitters;— those acting more on particular organs will be found enumerated under the titles of the organs or tissues which they affect specifically,—as Cardiac Tonics, Respiratory Stimulants, etc. Alteratives,—are agents which alter the course of morbid conditions, modi- fying the nutritive processes while promoting waste, and thus indirectly curing many chronic diseases. Mercury, Iodine and Arsenic are the typical altera- tives, the first breaking up new deposits, the second stimulating the absorbent circulation, and the last acting like the first on pulmonary deposits, and being almost specific to the chronic diseases of the skin. Those who denounce the term Alterative as “ a cloak for ignorance,” have never been able to replace it by any more definite designation for a group of agents whose effects upon disease are facts of clinical medicine. The principal Alteratives are the three above-named, also Antimony, Aurum, Colchicum, Guaiacum, Sulphur, Stil- 38 INTRODUCTION. lingia, Xanthoxylum, Calcium Chloride, Phosphorus, Cod-liver Oil, etc. A subdivision may be formed of the— Resolvents or Discutients, (resolvo, I unbind, discutio, I dissipate),—agents which promote the absorption of morbid products, probably by stimulating the lymphatic system. This group includes Iodine, Mercury, Arsenic, and Cad- mium, also such local measures as Poulticing and Counter-irritation. Destructive Metamorphosis of the tissues is promoted by a large number of agents, most of which are classed as Alteratives or as Astringents,— the principal ones being the following, viz., the Alkalies, Vegetable Acids, Metals and their salts, Colchicum, Sulphides, Iodides, Stillingia, Xanthoxylum, Tannic and Gallic Acids, and the Vegetable Astringents. Metabolism may be diminished by—Alcohol, Glycerin, Oils and Fats, Salicin, Quinine, Resorcin, Chinolin, etc. Antipyretics, (avrt, against, ‘Kvperbq, fever),—are agents which reduce high body-temperature. This may be done by 5 different actions working upon 2 principal lines, viz.—By— . . r . Tr , , f (1). Diminishing tissue-change. (a) Lessening Heat-production, by , 7 . v ' * l (2). Reducing the circulation. (3) Dilating cutaneous vessels, thus increas- ing heat-radiation. (4) Promoting perspiration—its evaporation lowering the temperature. (5) Abstracting heat from the body. (£) Promoting Heat-loss, by The following list of Antipyretics includes a few for each of the above- named actions, to which the numbers refer in each case, viz.:— Quinine, I. Berberine, I. Carbolic Acid, 1. Salicin, 1. Digitalis, 2. Aconite, 2. Alcohol, 1, 3. Nitrous Ether, 3, 4. Kairin, I, 4. Antipyrin, I, 4. Thallin, 1, 4. Antimony, 2, 4. Cold Bath, 5. Cold Drinks, 5. Ice to body, 5. Wet Pack, 5. Antiphlogistics, (avri, against, I burn),—include all measures and medicines which reduce inflammation, the principal among them being : — Mercury and Opium for inflammations of serous membranes, Aconite and Antimony for those of the respiratory apparatus, and Veratrum Viride in puerperal metritis. Others are—Digitalis, Ergot, Ipecac, Venesection, Local Depletion, Purgation, Counter-irritation, Cold, and Rest in the recumbent position. CLASSIFICATION OF MEDICINES. 39 Antiperiodics,—are agents which check the progress of certain periodically- recurring diseases, lessening the severity of their paroxysms and preventing their return, probably by a toxic action upon the microbes, whose development in the blood by successive crops is supposed to cause the disease. The great antiperiodic is Quinine, next in efficiency is Arsenic, and others of less im- portance are Salicin and its derivatives, the other alkaloids of Cinchona, Bebeeru Bark and its alkaloid, Iodine and Eucalyptol. Diuretics, (diovpqcng, urination),—are remedies which increase the renal secretion, either by raising the general or local blood-pressure, by stimulating the secreting cells or nerves of the kidneys, or by flushing those organs, and washing them out. They are usually divided into Refrigerant, Hydragogue, and Stimulant Diuretics, according to their physiological action ;—or they may be classified according to the different purposes for which they are employed. Both these classifications are fully described under the title Diuretics, at the end of the book. Agents Acting on Excretion. Renal Depressants,—are agents which lower the activity of the renal cells, thereby lessening or suspending the urinary secretion. The drugs which act thus are Morphine, Quinine and Ergot. Instead of acting as a diuretic Digitalis may stop the secretion of urine, by so stimulating the vaso-motor centre as to greatly contract the renal vessels, and arrest the renal circulation (Brunton). This it might do if a preparation were used which was deficient in Digitoxin or Digitaleln, the dilators of the renal arteries: (see under Digitalis. ) The same is true of Caffeine and Strychnine, both diuretics,— hence it is well to combine these with other diuretics which dilate the renal vessels, as the Nitrites, (Nitrous Ether, etc.), and Alcohol. Digitalis con- tains in itself the power of doing both these actions, and hence it is the ideal diuretic. Urinary Alkalinizers,—when taken internally cause the urine to have an alkaline reaction. They include the Alkalies, especially salts of Potassium and Lithium, but excepting Ammonia, which is broken up in the organism, and Sodium salts, which are not so efficient as other agents, being partly ex- creted by the bile and the bronchial mucus, and partly locked up in the system as the neutral chloride, while the urate of sodium is insoluble. Urinary Acidifiers,—are very few, comprising only Benzoic Acid, Salicylic Acid, and Vegetable Acids in excess;—also excess of proteids, sugar and starch, in the food, and certain wines and spirits. The Mineral Acids, being 40 INTRODUCTION. excreted as neutral sulphates, chlorides, phosphates, etc., have little or no influence on the acidity of the urine. Vesical Tonics,—increase the tone of the muscular fibres in the wall of the bladder, and consequently the contractile power of that organ. The chief members of this class are Strychnine, Cantharis, Belladonna, and the Bromides; all of which, carried to excess, will paralyze these same fibres by over-stimulation. This is particularly true of the Bromides. Vesical Sedatives,—lessen irritability of the bladder, decreasing the desire to micturate, and relieving vesical pain. The most important are—Opium, Belladonna, Hyoscyamus, Cannabis, Stigmata Maidis, Calcium Carbonate, Buchu, Uva Ursi, Pareira, Copaiba, and Cubeb; also Barley-water, Linseed tea, and other mucilaginous drinks. Urinary Sedatives,—act in a sedative manner upon the whole extent of the urinary tract, through the medium of the urine, which, being charged with them, brings them into contact with the genito-urinary mucous membrane. Some of them may be applied locally as far as the urethral and vesical mucous surfaces, the portion above being inaccessible to direct local medication. Such are Potassium and Lithium Salts to lessen the acidity of the urine ;—Copaiba, Cubeb and Oleum Santali as antiseptics and astringents, in cystitis and ure- thritis ; also Eucalyptus and Corn Silk for the same purpose ;—and urethral and vesical injections of solutions containing Boracic Acid, Alum, Lead and Zinc Acetates, Silver Nitrate, etc., agents which may also be applied to the urethra through the medium of gelatin pencils (Bougia) medicated with them. Antilithics, and Lithontriptics, (dm, against, MOog, a stone, Tpi/3u, I wear down),—are agents which are supposed to prevent the formation of con- cretions in the ducts, (antilithics), or to dissolve said concretions when formed, (lithontriptics). The efficiency of any agents, for the purposes named, is more than doubtful. Those recommended for the various concretions are as follows, viz.— For Uric Acid Calculi,—Distilled Water, Potash or Litliia, and salts of these metals, Magnesium Citroborate, Potassium Tartraborate, Piperazin. For Phosphatic Calculi,—Benzoic Acid and the Benzoates, especially Ammo- nium Benzoate, Dilute Nitric Acid. For Calcium Oxalate Calculi,—Dilute Nitro-hydrochloric Acid, Carbonic Acid Waters, Lactic Acid, for the digestive disturbance. For Biliary Calculi,—Ether and Turpentine, (Durande’s Solvent), Sodium Salts, Castile Soap, Alkaline Waters, especially Vichy. Diluents,—are indifferent substances which, being absorbed, pass readily through the body, diluting its fluids and excretions. Water is the only true CLASSIFICATION OF MEDICINES. 41 diluent, whatever form it may be disguised in, as teas, weak fluid foods, acidu- lated drinks, etc. Diaphoretics and Sudorifics, (dcacpopew, I carry through; sudor, sweat, facio, I make),—increase the action of the skin, and promote the secretion of sweat, those which act most energetically being designated by the latter title. Simple Diaphoretics,—are those which enter the circulation and stimulate the sudoriferous glands during their elimination,—as Jaborandi, Spirit of Min- dererus (Liq. Ammonii Acetatis), Sweet Spirit of Nitre (Spiritus Etheris Nitrosi), Alcohol, Salicylates, Camphor, Sulphur, etc. Nauseating Diaphoretics,—are those which act by producing relaxation and dilatation of the capillaries,—as Tartar Emetic, Ipecacuanha, Dover’s Powder, Lobelia, Tobacco, Baths, Heat, etc. Refrigerant Diaphoretics,—are such as act by reducing the force of the circulation, and perhaps also by a specific action on the sweat-centre in the medulla,—as the Potassium and Ammonium salts, Aconite, Veratrum, Cocaine, Tobacco, Jaborandi, Ether, Nitrites, etc. Anhidrotics, (av, without, I6puq, sweat),—are agents which check per- spiration, acting in either of three ways, the reverse of those for the diaph- oretics. The most energetic member of this class is Atropine, and others are Muscarine, Ergot, Zinc Salts, Acids locally, Cold locally, Opium, etc. The latter in small doses checks perspiration, but in large doses promotes it. Aphrodisiacs, (AtypodiTij, Venus),—are agents which stimulate the sexual appetite and function, by direct or reflex action on the genital centres in the brain and spinal cord. Such are Nux Vomica, Cannabis, Cantharis, Phos- phorus, Aurum, Alcohol, Opium (at first), Camphor (at first), Ergot, Iron, Bitter Tonics, and Meat Diet,—the last three being indirectly aphrodisiac, as are all measures which promote the general nutrition of the body. Agents Acting on the Generative Apparatus. Anaphrodisiacs,—diminish the sexual appetite and lower its functional power, either by depressing the special nervous apparatus or by decreasing the local circulation. The chief anaphrodisiacs are—Tobacco, Cocaine, Bella- donna, Gelsemium, Lupulin, Camphor (at last), Opium (at last), Bromides, Iodides, all Nauseants, Purgation, Cold locally, Vegetable Diet. A drop of a 4 per cent, solution of Cocaine upon the glans penis will destroy all erection- power for a quarter to half an hour. Emmenagogues, (epiuyvta, the menses, ayo, I move),—are measures and remedies which restore the menstrual function. They may be divided into— Direct Emmenagogues,—which stimulate the uterine muscular fibre, and are 42 INTRODUCTION. Ecbolic in large doses; as Ergot, Rue, Savine, Apiol, Borax, Petroselinum, Quinine, Pulsatilla, Myrrh, Cantharis, Potassium Permanganate, Oxalic Acid, Indigo, etc. Indirect Emmenagogues,—which act by improving the blood and toning up the nervous system ; among which are Iron, Manganese, Mercuric Iodide, Strychnine, Cinnamon, Aloetic purgatives, Cod-liver Oil, Hot Hip-baths, Leeching the genitals, Rubefacients to the thighs, Tonic remedies, etc. Oxytocicsor Ecbolics, quick, voting, childbirth; in/Soli/, abortion),— are agents which produce abortion, by stimulating the gravid uterus to contract upon its contents, perhaps by direct irritation of the uterine centre in the cord. The chief oxytocics are Ergot, Ustilago, Savine, Quinine, Borax, Cotton root Bark, Oil of Rue, Pilocarpine, Viscum jlavescens, etc.,—but any violent purgative, or gastro-intestinal irritant, may produce abortion by reflex action. It is in this way that all the Volatile Oils act as abortifacients, also Tansy. Colocynth, Pennyroyal, and many other drugs used by women for that purpose; all of which are dangerous to the woman’s life, in doses large enough to excite uterine action. As for the physician who should prescribe such agents for the purpose indicated, he would stand on a par with a drunken husband who kicks his pregnant wife in the abdomen. Both operators initiate uterine contractions in the same manner, namely—by reflex action from a powerful impression upon the woman’s system, made in the one case, by an irritant boot with a brute behind it,—in the other case by an irritant drug with either a scoundrel or a fool behind it. Uterine Depressants,—lower the activity of the nervo-muscular apparatus controlling uterine contraction. The chief members of this group are : Opium, Cannabis, Bromides, Chloral, Chloroform, Tartar Emetic, Tobacco, Copper Sulphate, and all Emetics,—also Viburnum prunifolium, Piscidia erytlirina, etc. Uterine Tonics and Alteratives,—are remedies which are considered to have these actions upon the nutrition and functions of the uterus ; concerning which there is much variance of opinion among authorities. The following list, however, contains those which are generally acknowledged to have con- siderable value in uterine therapeutics, viz.:— Uterine Tonics. Uterine Alteratives. Potassium Bromide. Pulsatilla. Iodine. Iodoform. Potassium Chlorate. Cimicifuga. Iodized Phenol, Helonias dioica. Savine. (Carbolated Iodine). Iodine, and Astringents, (locally). Glycerin. Hydrastis. Viburnum Opulus, and V. Prunifolium. Silver Nitrate. Galvanism. CLASSIFICATION OF MEDICINES. 43 Galactagogues, (ya'Xa, milk, ayu, I bring away),—are medicines which are supposed to increase the lacteal secretion. The value of many of these is very doubtful, probably the most efficient being Pilocarpus (Jaborandi). Others are, the leaves of the Castor-oil plant, (Ricinus communis) locally, Black Tea, Anise, Fennel, and Potassium Chlorate. Milk, Beer or Porter, as beverages, are thought to help the secretion. Anaemia must be corrected, sore nipples attended to, good food supplied, and tonics if needed. Galactophyga, (tyevyu, I shun),—are remedies which arrest the secretion of milk. The most efficient is Belladonna or its alkaloid Atropine, locally and internally. Others are Potassium Iodide, Colcliicum with Magnesium Sulphate, Camphor, Tobacco, Sage, Quinine, Tannin, etc. Agents Acting on the Skin. Irritants,—are substances, which, when applied to the skin, produce more or less of vascular excitement. When employed to excite a reflex influence on a part remote from their site, they are called Counter-irritants, and may be subdivided into the following groups, viz. :— Rubefacients, (ruber, red, facio, I make),—those which cause redness (congestion) of the skin, as Mustard, Camphor, Iodine, Capsicum, Turpen- tine, Ammonia, Pitch, etc. The stronger agents of this subdivision are capa- ble of destroying the tissue if left in contact with it for too long a time. Epispastics, Vesicants, or Blisters, produce decided inflammation of the skin, and the outpouring of serum between the epidermis and the derma. Cantharides is the agent most used for this purpose, but Mezereon, Euphor- bium, etc., are equally efficient. Pustulants,—affect isolated parts of the skin, as the orifices of the glands, etc., giving rise to pustules. Such are Croton Oil, Tartar Emetic, Ipecacuanha and Silver Nitrate. Escharotics or Caustics, (kogapa, a slough, /c«tw, I burn),—are sub- stances which destroy the life of the tissue to which they are applied, either by abstracting its water, as Sulphuric Acid,—or by corrosive oxidation, as Bromine. The chief caustics are Potassa, Lime, Arsenous Acid, Zinc Chlo- ride, Silver Nitrate, Corrosive Sublimate, Mercuric Nitrate, Mineral Acids, Bromine, Zinc and Copper Sulphates. Chromic Acid is one of the most effi- cient, but must be carefully used, it being a violent poison. Astringents, (ad, to, stringo, I bind),—produce contraction of muscular fibre, and condensation of other tissues, also lessen secretion from mucous membranes. Remote Astringents, act on internal organs through the circula- tion, as Gallic Acid, Sulphuric Acid and Lead Acetate. Local Astringents 44 affect the part to which they are applied, as Tannic Acid, Alum, salts of Bis- muth, Lead, Copper, Zinc, and Cadmium, the per-salts of Iron, the Mineral Acids; Galls, Kino, Catechu, and other plants containing Tannic Acid. INTRODUCTION. Styptics and Hemostatics, (o, I contract;—ai/m, blood, cramg, a standing),—are agents which arrest bleeding; Styptics being applied locally, and Hemostatics administered internally, for the same purpose. Some act mechanically, by promoting clot-formation in the mouths of the bleeding vessels, others by causing the vessels themselves to contract, and thereby check the flow of blood. The principal members of this class are the follow- ing named, to wit,— Styptics,—Acids, Alum, Ferric Chloride, Ferrous Sulphate, Zinc Sulphate, Lead Acetate, Silver Nitrate, Matico, Cold, Spider’s Web, Tannic Acid and all the Vegetable Astringents. Hemostatics,—the dilute Mineral Acids, especially Sulphuric, Gallic Acid, Ergot, Digitalis, Hamamelis, Ipecacuanha, Lead Acetate, and Oil of Tur- pentine. Emollients and Demulcents, (emollio, I soften, demulceo, I soothe),— are substances which soothe and protect tissues to which they are applied. Emollients act as external demulcents, being used upon the cutaneous surface, to soften and relax the part, dilate the vessels, diminish tension, and protect from the air or from friction. Demulcents are generally of oleaginous or mucilaginous character, employed on the mucous membranes for similar pur- poses. The chief agents comprised in these two groups are as follows,— Emollients. Demulcents. Petrolatum, (Vaselin). Isinglass. Bland Oils. Soap Liniment. Starch. Marsh-mallow. Honey. Adeps, (Lard). Glycerin. Tragacanth. Almond Oil. Cacao-butter, (01. TheobromEe). Acacia. Cetraria. Starch. Flaxseed Poultices. Olive Oil. Liquorice. Glycerin. Olive Oil. Protectives,—are articles employed to cover an inflamed or injured part, and to protect it from the air, water, friction, etc. Collodion and Gutta percha are those in general use, but Cotton Wool, and certain plasters, the Adhesive, Lead or the Soap Plaster, may also be employed. Agents Acting on Microbes, Parasites, etc. Antizymotics, (am, against, (v/ioci-c, fermentation),—are agents which arrest all fermentative processes, not only those due to the action of Organic Ferments, (diastase, pepsin, ptyalin, etc.), but also those depending on Organ- CLASSIFICATION OF MEDICINES. 45 ized Ferments, (the yeast-plant, bacteria, cocci, etc.). They maybe divided into two groups, viz.:— Antiseptics, (avri, against, oynTCKog, putrefaction),—are those which retard or prevent septic decomposition, by destroying the bacilli which produce it,or by arresting their development. The principal Antiseptics are—Potassio- Mercuric Iodide, Mercuric Chloride, Iodide and Oxide, Mercurous Chloride, Hydrogen Dioxide, Potassium Permanganate, Hydronaphtol, Sulphurous Acid, Sulphites and Hyposulphites, Salicin, Quinine, Thymol, Carbolic Acid, Creosote, Alcohol, Eucalyptol, Borax, Chlorine, Chlorides and Chlorates. Disinfectants,—are those which destroy the germs of infectious diseases. They act in several different modes;—some are Oxidizants, as Lime, Chlorine, Iodine, Bromine, Heat 230°-250° F., etc. ; others are Desulphurants, as Ferrous Sulphate, Lime, etc.; and others are Absorbents, as Charcoal, Dry Earth, etc. Many members of this group have the additional property of destroying foul smells, and are called Deodorants, such being Ozone, Earth, Lime, Charcoal, Ferrous Sulphate, Chlorine and Sulphurous Acid Gases, etc. Fermentation is a general name for certain processes of decomposition, during which certain carbon compounds called Ferments act upon other carbon compounds, as on their food,—splitting these latter up, setting free their elementary constituents, and thereby leading to the formation of still other carbon compounds, by the re- arrangement of the freed molecules. These processes are of two kinds, viz.:— (1) —Those in which water is taken up, (hydration),—chiefly carried on by enzymes. (2) —Those in which O is transferred from the H to the C association, as in lactic and alcoholic fermentation, and the putrefactive processes,—and are chiefly car- ried on by the agency of organized ferments. The Ferments producing these fermentative changes are also carbon compounds, and are divisible into two groups, viz.:— Enzymes, or Organic Ferments,—have no definite structures, and are unorganized, i. e., not living,—as Diastase, Ptyalin, Pepsin, etc. Organized Ferments,—are minute, living organisms, as the moulds, yeast-plant, bacteria, and other members of the Protophytes, the lowermost class of plants, which, in the course of their life history, split up the carbon compounds in which they live, appropriating some part of their elements. Antizymotic Drugs are drugs which arrest or inhibit these fermentative processes, either by destroying or by rendering inactive the causative ferments. Parasiticides, (napaaiToq, a parasite, ccedo, I kill),—destroy the various animal and vegetable organisms which live upon the human body. They are generally employed in the form of lotions, ointments or oleates, and include the following articles, viz.—Sulphur, Sulphites, Sulphurous Acid, Iodine, Sulphur Iodide, Mercury and its Chlorides, Nitrate, Oxide, and Ammoniated Mercury, Carbolic Acid, Storax, Petroleum, Staphisagria, Balsam of Peru, etc. 46 INTRODUCTION. Antidotes, (avrl, against, difiu/u, I give),—are agents which act upon poisons in such a manner as to alter their composition, rendering them more or less innocuous, and so preventing their toxic action being exerted upon the organism. Antidotal action takes place in the alimentary canal, upon such portion of the poison as is unabsorbed, and is applicable to vegetable as well as to mineral poisons. Antidotal Measures are such medicinal or mechanical processes as tend to remove a poison from the body, either before or after the use of an antidote ; and include Emesis, the use of the Stomach-pump, Purga- tion, etc. The term Antidotal Treatment covers the employment of both antidotes and antidotal measures, and is often used in a still wider sense, namely, to mean all the treatment of a case of poisoning, including the use of Antagon- ists as well as that of Antidotes. Agents Acting upon each other. Antagonists,—are agents which directly oppose each other, in some or all of their physiological actions, and therefore may be used, one against the other, in a case of poisoning by either, to counteract its effect upon the organism, after it has been absorbed, and when, therefore, the time for an antidote has passed. Antagonistic action takes place in the blood and tissues, and is appli- cable almost entirely to vegetable poisons. Antagonistic Measures are such mechanical procedures as tend to the same end, the antagonism of the effects of poisons, and include Artificial Respiration, Faradism of certain muscles, Douching, Motion, Rest, etc. For example, in a case of poisoning by Digitalis, the antidote would be Tamiic Acid, because it forms with the active principle of Digitalis a com- pound, (Tannate of Digitalin), which is not readily soluble, and is therefore comparatively innocuous. But as this new compound is not wholly inert, it must be removed from the body ; an antidotal measure is, therefore, employed, viz. Evacuation of the Stomach,—which maybe accomplished by the adminis- tration of Zinc Sulphate or any other emetic, or by the use of a stomach- pump. t But, supposing that sufficient time had elapsed, between the ingestion of the poison and the administration of the antidote, for some degree of absorption to have occurred, and that we observe evidences of the presence of the poison in the blood, we must resort then to an antagonist. Now, Aconite and Morphine antagonize the cardiac action of Digitalis, but Saponin and Senegin are its most complete antagonists, their counteraction extending throughout the whole range of its physiological effects. Having made our selection, we would use one of these agents cautiously, being careful not to substitute its toxic action for that of the original poison; and we would aid its influence by enjoining DIGESTION-FERMENTS. 47 absolute Rest in the recumbent posture, which is an antagonistic measure of great importance against the effects of Digitalis upon the heart. In most cases of poisoning by powerful vegetable drugs assistance is not obtained until absorption has proceeded so far that antidotes are of little value, and the chief reliance must be placed upon the appropriate physiological antag- onist, and such supporting measures as will sustain the action of any vital function which shows signs of failing. In this way we endeavor to maintain life until the excretory functions of the organism have had time to eliminate the poison by way of the natural channels. Under each title in the following pages its appropriate Antidotes and Antag- onists are given, for every substance which is liable to be used as a poison. RESTORATIVE AGENTS. This division of the Materia Medica includes all agents which in any way promote the constructive metamorphosis of tissue,—such as the Digestion- ferments, which aid digestion; the Foods, Tonics, Haematics or blood-restorers, and many substances generally known as Stimulants. The Digestion-Ferments include the three animal products named Pep- sin, Pancreatin and Ingluvin, also Papain, from the vegetable kingdom. DIGESTION-FERMENTS. Pepsin,—is an organic ferment which constitutes the digestive principle of the gastric juice of animals, and is usually obtained from the mucous membrane of the pig’s stomach. Pancreatin,—is a mixture of the enzymes naturally existing in the pancreas of warm-blooded animals, obtained from the fresh pancreas of the hog. It contains four ferments, viz.—'Trypsin, Pancreatic Diastase, an Emulsifying and a Milk-curdling ferment. * Ingluvin is obtained from the gizzard of the domestic fowl, and owes its digestive activity to a peculiar bitter principle. * Papain, Papaw, or Papayotin, is a ferment obtained from the milky juice of Carica Papaya, a South American fruit-tree. It is too powerful a digestor to be used internally undiluted, as it might digest the gastric mucous membrane itself. Preparations. Only two are official,— Pepsinum Saccharatum, Saccharated Pepsin,—is Pepsin from the stomach of the hog, triturated with 9 of Sugar of Milk. Dose, gr. v-xxx, after meals. 48 RESTORATIVE AGENTS. * Liquor Pepsini, Solution of Pepsin, Liquid Pepsin,—has of the preceding 40 parts, with HCI12, Glycerin 400, in Water to 1000. Dose, Pancreatinum, Pancreatin,—is a grayish-yellow, amorphous powder, of faint odor and meat-like taste. Dose, gr. ij-v. It is marketed in various forms, Pancreatic Emulsion, Liquor Pancreaticus, etc., and is also put up with three times its weight of Sodium Bicarbonate, as “ Peptonic Milk Powder” or “ Peptonizing Tubes,”—for the preparation of Peptonized Milk. *Ingluvin,—from the gizzard of the fowl. Dose, gr. x-xxx. Every manufacturer of digestion-ferments has his own preparation of Pepsin and Pancreatin, and his peculiar name therefor. These various products vary considerably in their properties. A few of the most prominent are— *Lactopeptine,—a powder, said to contain Pepsin, Diastase, Pancreatin, Lactic and Hydrochloric Acids. Dose, gr. v-xv. *Jensen's Crystal Pepsin, in yellowish, translucent scales, soluble in water, and claimed to be pure pepsin without admixture. Dose, gr. j-iij. * Pepsine in Scales (Fairchild), is a similar preparation, gr. j of which is claimed to digest 1000 grains of albumen in 4 hours. Dose, gr. j-iij. * Essence of Pepsine,—a solution similar to the Official Liquor. Dose, 3 j. * Liquid Pancreopepsine,—is said to contain Pepsin, Pancreatin, Lactic, Hydrochloric and Phosphoric Acids. Dose, ss-j, after meals. * Diastasic Essence of Pancreas,—for starchy foods. Dose, £j-ij. * Trypsin, the fibrin-digesting ferment of the pancreatic juice. Is used in aqueous solution, 3 ss to the §, with gr. x of Sodium Bicarb., locally. Scheffer’s Process is the standard process for the preparation of Pepsin. The mucous membrane of a pig’s stomach is scraped off and digested in a solution of HC1, and the Pepsin is then precipitated by adding a solution of NaCl. Ten grains of Scheffer’s Saccharated Pepsin, with gtt. x of dilute HC1, and £ j of water, will dissolve 200 grains of albumen in from five to six hours, at loo° Fahr. Incompatibles. Alkalies and many mineral salts precipitate pepsin. Alcohol destroys its activity. Alkalies promote the action of pancreatin. Physiological Action. Pepsin and Ingluvin digest the nitrogenous principles of the food (albumen, casein, fibrin, etc.) converting them into peptones for assimilation ; in which they are materially aided by Lactic and HC1 Acids. Official Pepsin should be capable of digesting not less than 3000 times its own weight of freshly coagulated and disintegrated egg albu- men. Pancreatin digests the same principles, and in addition, with the aid of an alkali, it emulsifies fats and oils. Pepsin is an essential element of the gastric juice, and will digest pancreatin, which probably therefore never passes LACTIC ACID. 49 into the duodenum in its own character. Trypsin, unlike Pepsin, will dissolve mucin, and like Pepsin it is inert toward nuclein, horn and amyloid matter. Therapeutics. Pepsin is indicated in atonic dyspepsia, the apepsia of infants, gastralgia, anaemia, chlorosis, gastric ulcer and cancer, diarrhoea of infants, and the vomiting of pregnancy. It is added to nutritive enemata, the rectum not being a digestive organ; and is injected into the substance of morbid growths which are homologous to the tissues, for their destruction, especially fatty tumors. Ingluvin is particularly useful against vomiting, and has been found very efficient in the vomiting of pregnancy. Pancreatin is used to assist the digestion of oils and fats, and should be administered 2 or 3 hours after meals; whilst Pepsin is best given near meal time. The various Pancreatic preparations are used to partially digest (peptonize) milk, gruel, soups and other foods, before administration, in cases where there is great digestive debility. These peptonized foods may be administered by rectal injection (enemata), as well as by the mouth, and are invaluable in wasting diseases, in intestinal dyspepsia, and in convalescence from acute affections. A teaspoonful of Liquor Pancreaticus, taken directly after a dose of Cod-liver Oil, will prevent the disagreeable eructations which so frequently follow, and will assist in the digestion of the oil. Trypsin is used with real benefit as a solvent of the diphtheritic membrane, but requires to be thoroughly and fre- quently applied. Papain is a powerful digestor of fibrin, acting in solutions of any reaction, and at higher temperatures than Pepsin will. It is a rapid solvent of false membranes and of intestinal worms. It has been injected into tumors for their destruction, and successfully, but with much pain and considerable febrile reaction. It is used internally under the name Papoid, in doses of gr. j-iij. ACIDUM LACTICUM,—Lactic Acid. Properties of Lactic Acid. It is a syrupy, oily liquid, of specific gravity 1.213, and difficult to obtain pure. It should be given in quantity sufficient to render water distinctly sour, and always well diluted. It is found in the stomach, being a product of the food, and combines with bases in the blood, forming lactates, which being oxidized are converted into carbonates. Dose, 3 ss- ss, well diluted. Physiological Action. It aids digestion, and promotes the appetite ; in large doses causing flatulence and much epigastric pain. Injected into the peritoneal cavity of animals, it excites endocarditis, and given in diabetes it has caused acute rheumatism and rheumatic endocarditis. Hence its supposed causation of acute rheumatism, when in excess and free in the blood. 4 50 RESTORATIVE AGENTS. Therapeutics. It is used in diabetes, atonic dyspepsia, oxaluria, and in the lithic and phosphatic diatheses when due to imperfect digestion and assimi- lation. As a solvent of false membrane in croup and diphtheria, it is unques- tionably of great service, but is difficult of application, as in a solution of sufficient strength to act upon the membrane it causes considerable smarting pain. In chronic cystitis it arrests the ammoniacal decomposition of the urine. Preparations and Doses. Acidum Sulphuricum Dilutum, strength -fa. Dose, lt\v-xv, well diluted. Acidum Sulphuricum Aromaticum, Elixir of Vitriol, strength Dose, rrpv- xx, well diluted. Contains sulphuric acid, alcohol, ginger, and cinnamon. Is not an acid, but an ether, formed by the reaction of the acid on the alcohol. Acidum Hydrochloricum Dilutum, Dose Vtpiij-x, well diluted. Acidum Nitricutn Dilutum, (jq). Dose, trpiij-x, well diluted. Acidum Nitro-hydrochloricum Dilutum, Nit. Ac. 4, HC1 18, Aq. 78. Dose, trpiij-xv, well diluted. Acidum Phosphoricum Dilutum, strength Dose, Ttpiij-x, well diluted. An average dose of all the dilute mineral acids is tl\nj-x. MINERAL ACIDS. Physiological Action. The strong acids are escharotics, abstracting the water from the tissues, combining with the bases, destroying the protoplasm, and are very diffusible. Sulphuric carbonizes (black); Nitric tans (yellow). The dilute acids act in the stomach chemically. Secretion is promoted by Nitric, lessened by Sulphuric, Hydrochloric acid acting thereon between the other two. To mouths of ducts having an acid secretion, they check the flow ; to those of alkaline secretion they promote it (e. g., bile, pancreatic juice, etc.). Fermentation is checked by the mineral acids. Bowels are constipated by Sulphuric, relaxed by Nitric acid. As these agents are synergistic to pepsin, they at first aid digestion; but if continued they lessen the production of gastric juice, and so impair digestion. Given before meals in small doses they will relieve excessive acidity of the stomach, by checking the production of the acid gastric juice. Poisoning by Mineral Acids is treated by Alkalies, as washing soda, soap-suds, etc., to neutralize the acid; cautiously empty the stomach; give oil, albumen, or milk, to protect the mucous membrane. Stimulants, Opium, Ammonia intravenously, to combat the resulting depressed condition of the vital powers. OILS AND FATS. 51 , Therapeutics. The Mineral Acids are used in— Atonic Dyspepsia,—small doses of Hydrochloric Acid with Pepsin, given after meals, except where there is acidity of the stomach. Acidity,—Hydrochloric or Phosphoric Acids in small doses before meals. Oxaluria,—Nitric or Nitro-hydrochloric. Lithamia, Nitric Acid. Diarrhoea,—when profuse secretions, Sulphuric Acid with Opium. Choleraic Diarrhoea and Dysentery,—Sulphuric Acid with Opium, or with Magnesium Sulphate, is found very serviceable. Fevers,—especially typhoid,—Hydrochloric Acid is preferred. Lead Poisoning,—Sulphuric Acid, to form the insoluble sulphate of lead. Hemorrhoids,—Sulphuric Acid; also for hemorrhage from lower bowel. ILemorrhages,—Sulphuric Acid is undoubtedly effective in uterine hemorrhage from fibroids, and in other hemorrhages at points distant from the stomach ; also sometimes in purpura hemorrhagica. Chronic Hepatic Disorders,—Nitro-hydrochloric Acid in all forms of liver affec- tions due to malaria, internally, and locally as a bath. Intermittent and Rernittent Fevers,—Nitric Acid in full doses, is beneficial. Aphonia of Singers,—Dilute Nitric Acid in io-drop doses, has proved efficient. Phthisis,—Aromatic Sulphuric Acid for the sweats. Local Uses. They are employed against— Ulcers,—Fuming Nitric Acid as an escharotic, also in Gangrene. Hemorrhoids, of the bleeding, strawberry-pile kind,—Fuming Nitric Acid. Diseased Joints,—Counter-irritation by Brodie’s liniment, composed of Sul- phuric Acid one-fourth, Olive Oil, three-fourths. Uterine Diseases are often treated with fuming Nitric Acid, locally applied. OILS AND FATS. Fixed Oils and Fats used in Medicine are as follows:— Adeps, Lard. Adeps Lana Hydrosus, Hydrous Wool-fat, “ Lanolin.” Sevu?n, Mutton Suet. Cetaceum, Spermaceti. Oleum Adipis, Lard Oil. Ol.Amygdalce Expressum, Almond Oil. 01. Gossypii Seminis, Cotton-seed Oil. Oleum Lini, Linseed (Flax-seed) Oil. Oleum Morrhua, Cod-liver Oil. Oleum Oliva, Olive Oil. Oleum Sesami, Benn£ Oil. Oleum Theobromatis, Butter of Cacao. The two other official fixed oils, Oleum Ricini and Oleum Tiglii, are used for their cathartic qualities, and are therefore classed with the Evacuants, in another place. 52 Composition. All the oils (except Cod-liver Oil) contain olein, stearin, and margarin, in varying proportions, the olein giving fluidity, the stearin solidity. Olein, Stearin, and Margarin are respectively oleate, stearate, and margarate of glycerin. Cod-liver Oil consists chiefly of olein and margarin, with a peculiar principle,—Gaduin,—also propy'lamin, bile constituents, and traces of sulphuric and phosphoric acids, bromine, iodine, phosphorus, iron, lime and magnesia. Three kinds are sold,—the pale, the light-brown, and the dark. The pale oil is considered to be the purest. Linseed Oil contains much vegetable albumen, which coagulates on exposure to the air, making it a drying oil. Its olein furnishes linoleic acid, instead of oleic, when saponified. Lanolin is a cholesterin fat obtained from the washing of sheep’s wool. It contains 25 to 30 per cent, of water, and unites readily with 110 per cent, of its own weight of water. It differs from all other fats, in resisting saponifica- tion, the action of water, and the tendency to rancidity. It is perfectly neutral as a base, and readily penetrates the integument, carrying with it any medica- ment it is charged with. Cottonseed Oil is used largely in place of Olive Oil, and is sold as Olive Oil in the shops. Hence it was made official, and its use directed for certain pharmacopoeial preparations. RESTORATIVE AGENTS. Physiological Action. Fats in small quantity are necessary to the diges- tion of nitrogenous food (Lehmann), and form the molecular basis of the chyle. They are prepared for absorption by the pancreatic juice and the bile, especially by the latter. Fat is an essential constituent of the products of tissue formation, whether physiological or pathological, and is the chief material concerned in the formation of force. After oxidation it is excreted as car- bonic acid and water. Locally applied fat reduces the body temperature. Therapeutics. Locally, by inunction, oils and fats may be used in the scaly diseases of the skin, and in chronic wasting diseases; also in rickety and scrofulous children, and in febrile disorders, particularly the desquamative stage of scarlatina. Cod-liver Oil may also be used by inunction, in the fore- going disorders, but it is best administered internally, and in the following diseases, viz. :— Chronic Forms of Phthisis. Chronic Bronchitis and Emphysema. Chronic Rheumatic Disorders. Atheroma of the Arteries. Strumous Skin diseases. Syphilo-dermata. Neuralgia, Chorea, Epilepsy. Diarrhoeas of strumous subjects. Cod-liver Oil is best administered in small doses, a teaspoonful tlirice a day for an adult, in black coffee, beer or lemon-juice. One drop of the Essen- tial Oil of Eucalyptus will extinguish the odor and taste of ioo drops. PHOSPHORUS. 53 PHOSPHORUS. Preparations. Oleum Phosphoratum, Phosphorated Oil,—strength Dose, trpj-v. Pilulce Phosphori, Pills of Phosphorus,—each contains gr. of Phos. Elixir Phosphori, Elixir of Phosphorus,—each 3 has gr. of Phos. Zinci Phosphidum, Zinc Phosphide, Zn3P2. Dose, gr. 3-5-3V Is irritant. Physiological Action. Phosphorus in small closes is a stimulant to the growth of the bones, to the genital function, and to the brain, circulation and stomach. It aids digestion by irritating the end organs of the stomach nerves, and causes eructations of hydrogen phosphide. Its fumes cause necrosis of the upper or lower jaw bones, especially in those whose teeth are decayed ; but this may be prevented by the inhalation of the fumes of old acid turpen- tine. In poisonous doses it is a powerful gastro-intestinal irritant, causing vomiting and purging, with great depression ; reaching the blood as phosphorus it destroys the red corpuscles, causing acute hemorrhages from fatty degenera- tion of the arterial walls, rapid steatosis of the stomach, liver and heart, with deep jaundice; then delirium, convulsions, coma and death, generally from gradual failure of both respiration and circulation. Antidotes. Copper Sulphate is the best emetic (forming a nearly insoluble phosphide of copper), 3-grain doses in dilute solution every five minutes until emesis. Hydrated Magnesia as a quickly acting purgative. Lime-water or Charcoal to prevent its action on the tissues. The antidote is the common Commercial Oil of Turpentine (Bartholow), crude French Acid Turpentine (Wood), which has been exposed to the air for some time. Transfusion has been efficacious in repairing the blood. No oils or fats, as they dissolve phosphorus and promote its absorption. Acute Phosphorus Poisoning most reseqjbles Acute Yellow Atrophy of the Liver; so much so that it is generally impossible to distinguish between them. Chronic Nervous Exhaustion, when the nerve centres are implicated. Neuralgia requires large doses, gr. T’j, or 3 v of the Elixir. Ancemia, pernicious anaemia, and their results ;—small doses. Wakefulness of the aged, and that from cerebral anaemia;—small doses. Impotence, of functional character;—no remedy more efficient. Progressive Locomotor Ataxia is decidedly ameliorated by Phosphorus. Skin Diseases; as a substitute for Arsenic in acne, psoriasis and lupus. Paraplegia, of myelitic origin, from excessive venery. Therapeutics. Phosphorus is used in— 54 RESTORATIVE AGENTS. Osteomalacia and Rachitis are much benefited by Phosphorus. Threatened Cerebral Softening, in which no other drug seems to affect the nerve centres as beneficially as Phosphorus does. PHOSPHATES AND PHOSPHITES. Preparations. Calcii Phosphas Prcecipitatus, Precipitated Calcium Phosphate. Dose, gr. j-x. Syrupus Calcii Lactophosphatis, Syrup of C. Lactophosphate. Dose, z j. Sodii Phosphas, Sodii Pyrophosphas, g ss-5j ss. Syrupus Hypophosphitum cum Ferro, Syrup of H. with Iron, 5J j- !| ss. * Syrupus Phosphatum Compositus, Compound Syrup of Phosphates, Parrish’s Chemical Food,—each drachm contains gr. 2of Ferric Phosphate, and gr. I of Calcium Phosphate. Dose, gj-ijss. Physiological Action. Calcium Phosphate is an essential ingredient of all the tissues, forming more than 50 per cent, of the bones. Lactic and HC1 Acids dissolve it in small quantities. It increases the alkalinity of the blood and its power to hold carbonic acid, and diminishes the excretion of urea. Sodium Phosphate acts similarly on the blood and urea, and increases secre- tion, especially that of the bile, being an excellent cholagogue, and thereby aiding the digestion of fats. In ounce doses it is laxative. Therapeutics. Calcium Phosphate and the Hypophosphites are used with advantage in all diseases of mal-nutrition, and where repair or development of the bones is required. They are particularly useful in— Osteo-malacia. Protracted Suppuration. Rachitis. Scrofulosis. Caries. Phthisis. Amemia and Bone Soften- ing of Lactation. Sodium Phosphate, in % doses ter die for adults, gr. x-xx for children, is extremely useful in conditions depending on catarrh of the bile ducts and duodenum, as headache, chalky stools, etc. Gall-stones may be prevented from forming by scruple or drachm doses of this salt before meals, for months. It is also a good remedy for the following conditions,— Obesity. Diabetes. Incipient Hepatic Sclerosis. Chronic Infantile Diarrhoea. Cerebral Debility. Bilious Sick-headache. Pasty white stools of ill-conditioned children. FERRUM,—Iron. Chief Preparations. Tinctura Ferri Chloridi, Tincture of Ferric Chloride,—contains about 13 per cent, of the anhydrous salt, with some free HC1. Dose, tqy-xxx, well diluted. Is one of the best preparations of iron. IRON. 55 Liquor Ferri et Ammonii Acetatis, Solution of Iron and Ammonium Acetate, Basham’s Mixture,—Dose ss well diluted. Massa Ferri Carbonatis, Mass of Ferrous Carbonate, Vallet’s Mass,—one of the most efficient preparations. Dose, gr. j-v, in pill, after food. Ferri Sulphas Exsiccatus, Dried Ferrous Sulphate,—gr. ss-ij, in pill. Liquor Ferri Subsulphatis, Solution of Ferric Subsulphate, Monsel’s Solution. Used as a styptic. Dose, Pb iij—x, well diluted. Syrupus Ferri Iodidi, Syrup of Ferrous Iodide,—Dose, well diluted and taken through a quill or a glass tube. Ferrum Reductum, Reduced Iron,—Dose, gr. ss-ij or v, after meals. Ferri Oxiduvi Hydratum, Hydrated Oxide of Iron, Ferric Hydrate,—a soft magma, only used as an antidote to Arsenic. Prepared by adding 100 parts of the Solution of Ferric Sulphate to no parts of Aqua Ammonfe, and Water to 250. Dose, gj in water, frequently repeated. * Ferrum Dialysatum, Dialysed Iron. Is highly praised by many physicians, and unqualifiedly condemned by many others. Dose, Pbx- 3 ss. * Ferri Albuminas, Albuminate of Iron,—a cinnamon-brown powder, soluble in water slightly acidulated with IICl. Dose, gr. x-xl, in simple aqueous solution, or in pill. Incompatibles, are Acids, Acidulous salts, Alkalies and their Carbonates, Tannic and Gallic Acids and all Vegetable Astringents, hence the Bitters, except Calumba, Quassia, Chiretta, and Gentian, which contain no tannin. The Tincture of the Chloride is decomposed by the Alkalies, Alkaline earths and their Carbonates, Astringent Vegetable infusions, and Mucilage of Acacia. Physiological Action. Iron is present in the blood (i part to 230 of red corpuscles), also in the bile, lymph, gastric juice, etc. Given medicinally, in small doses, it improves the blood, increasing the number of the red corpuscles, and promoting the appetite and digestion. In large doses, nausea and vomit- ing are produced by the soluble preparation^; the Iodide, Chloride, Nitrate and Sulphate being active irritant poisons. Nearly all the preparations are more or less astringent, and act injuriously on the teeth. Only a small portion is absorbed, the rest being eliminated by the intestinal canal, blackening the feces by conversion into tannates and sulphides. The Tincture of the Chloride is diuretic. Therapeutics. The chief indication for Iron is anaemia; when plethora exists it is contra-indicated. It should be given after meals, and occasionally suspended for a time, to avoid deranging the digestion. Pseudo-Leucocythcemia is much benefited by chalybeates. Syphilitic Cachexia is greatly influenced by the Iodide of Iron. 56 RESTORATIVE AGENTS. Acute Rheumatism, in anaemic subjects only ; in them highly useful. Chorea, of anaemic girls, about the age of puberty,—with purgatives. Neuralgia, of the anaemic,—large doses of the Tincture of the Chloride. Cardiac Disorders, fatty heart, weak heart, dilatation, mitral disease. Nocturnal Incontinence of Urine in delicate children,—the Syrup of the Iodide, n\xv-xx ter die, has given excellent results. Menstrual Disorders, due to anaemia, especially amenorrhoea. Hemorrhages, of every form,—Monsel’s Solution, locally. Chronic Bright's Disease, the Tinct. Ferri Chlor. as a chalybeate diuretic. Erysipelas, half-drachm doses of the Tinct. Ferri Chlor. every four hours in very many cases controls the disease; how is not known. To protnote Appetite and Digestion,—the Sulphate in pill, or the official Pil. Aloes et Ferri, will generally give satisfaction. Diphtheria,—the Tincture of the Chloride in full doses, has a well-established reputation in this disease. MAN GANUM,—Manganese. Preparations. Mangani Dioxidum, Manganese Dioxide,—Dose, gr. ij-x. Mangani Sulphas, is freely soluble in water, and of bad taste. Dose, gr. ij-v. Potassii Permanganas, Potassium Permanganate,—should not be triturated nor combined in solution with organic or readily oxidizable substances. Dose, gr. ss-ij, in pill or distilled water. *Syntpus Ferri et Mangani Iodidi,—Dose, trpx-xxx. See U. S. Disp., P- I527- * Ferri et Mangani Carbonas Saccharatus,—Dose, gr. v-xx. It is a tasteless, reddish-brown powder. For its formula see the U. S. Disp., page 1683. Physiological Action. The salts of Manganese in small doses improve the appetite and digestion, increase arterial tension, and stimulate the action of the heart. In larger doses they lower the heart’s action, paralyze the mus- cular system, especially the muscular coat of the arteries, causing progressive wasting, paraplegia, and acute fatty degeneration of the liver. They are gastro-intestinal irritants, have specific excitant action on the uterus, and the sulphate is a decided cholagogue. Manganese is closely associated with Iron in the blood, bile, etc., in the proportion of about I to 20. Therapeutics. Manganese is prescribed in— Anosmia and Chlorosis,—in combination with Ferric preparations. Cachexia: of various kinds,—the Syrup of Iron and Mang. Iodide. Hepatic Disorders, and catarrh of the bile ducts,—the Sulphate. BISMUTH. 57 Chronic Skin Diseases,—the Dioxide as an ointment. Gastrodynia and Pyrosis,—the Dioxide in doses of gr. x-xv. Amenorrhcea, and other menstrual derangements,—the Dioxide, in freshly- made pills of 2 grains each, of which 1-5 pills may be taken thrice daily. Uses of Potassium Permanganate. As an antiseptic and oxidizing agent it is used in diphtheria, scarlatina, septicaemia, etc., and is given with benefit in dyspepsia, lithaemia and obesity. Locally it is employed as a deodorizer in cancer, ozaena, otorrhoea, foul breath, and fetid perspiration of the feet, in solution of g j to the pint. It is considered a very efficient emmen- agogue by many authorities, and is employed in amenorrhcea, and other derangements of the menstrual function. When used internally it must be instantly decomposed in the stomach, and cannot be absorbed in its own form. It has recently come into prominence as an antidote to Morphine and Strych- nine in the stomach. Preparations. Bismulhi Subcarbonas, Bismuth Subcarbonate,—Dose, gr. x-xxx. Bismulhi Subnitras, Bismuth Subnitrate,—Dose, gr. x-xxx. Both these salts are heavy, white powders, insoluble in water or alcohol, and so nearly insoluble in the gastric juice, that larger doses may be safely given if uncon- taminated with Arsenic. They are administered in powder, emulsion, troche, or simply stirred up in milk. Bismuthi et Avimonii Citrus, Bismuth and Ammonium Citrate,—small, shining scales, very soluble in water. Dose, gr. j-v. *Bismuthi Subiodidum, Bismuth Subiodide,—a heavy, dark-red, impalpable powder, insoluble, stains fabrics deeply. Not used internally, BISMUTHUM,—Bismuth. Physiological Action of the insoluble salts of Bismuth is chiefly that of a local sedative and astringent,—though a minute quantity passes into the blood, where it acts as a tonic, promoting the constructive metamorphosis by stimulating the appetite and digestion. After a time these salts produce con- stipation, and always give to the stool and tongue a dark clay color, by reason of their conversion in part to a sulphide in the gastro-intestinal canal. Toxic effects, when occurring, are generally due to the presence of Arsenic, with which most of the commercial preparations are contaminated. Poisonous effects have, however, been observed from their absorption when freely used upon a large wound. The soluble salts, (Acetate, Citrate, etc.), when given in large doses,have an action like that of Mercury, Antimony or Arsenic;—producing severe gastro-enteritis, fatty degeneration of the liver, etc. The Subiodide has an 58 RESTORATIVE AGENTS. energetic antiseptic and stimulant action upon wounds, ulcers, etc., promoting the growth of granulation tissue, and preventing the formation of pus. Therapeutics. The Subcarbonate and Subnitrate are given internally in most forms of disordered digestion, vomiting, and diarrhoea, but large doses are necessary. The best vehicle for them is milk. They are well used in— Acute Gastritis. Gastralgia, Gastric Ulcer. Acute Indigestion. Aphthae, and Stomatitis. Vomiting of Children. Vomiting of Pregnancy. Gastro-intestinal Disorders of Children. Diarrhoea of ty- phoid fever and phthisis. Chronic Diarrhoea. The Citrate, being soluble, is used in solutions with Pepsin, Strychnine, etc., for various affections of the digestive apparatus, as dyspepsia, gastralgia, feeble digestion, etc. Locally, these salts may be applied with advantage in cases of— Stomatitis. Nursing Sore Mouth. Acne Rosacea. Eczema. Intertrigo. Conjunctivitis. Gonorrhoea. Gleet. Leucorrhoea. As a dressing for wounds, ulcers, etc., where an antiseptic and stimulating action is desired, there is no application equal to the Subiodide, freely dusted on to the surface after it has been washed and dried. ARSENUM,—Arsenic. Preparations. Acidum Arsenosum, Arsenous Acid, White Arsenic, As2Oa,—soluble in water, i in 33 to 80, according to its physical condition. Dose, gr. -jg—xV> a^ter meals. Liquor Acidi Arsenosi, Solution of Arsenous Acid, Solution of Chloride of Arsenic,—strength Dose, Ttyj-x, after meals. Liquor Potassii Arsenitis, Solution of Potassium Arsenite, Fowler’s Solution, —strength Dose, rtyj-x, after meals. Liquor Sodii Arsenatis, Solution of Sodium Arsenate, Pearson’s Solution,— strength . Dose, fiyj-x, after meals. Arseni Lodidum, Arsenic Iodide,—soluble in water. Dose, gr. gg-xV- Liquor Arseni et Hydrargyri Lodidi, Solution of Arsenic and Mercuric Iodide, Donovan’s Solution,—strength T-Jg. Dose, rtyj-x, after meals. * Liquor Bromi Arsenitis, Solution of Bromine Arsenite (or Arsenic Bromide), Clemen’s Solution,—'Dose, rtpij-vj, once or twice daily. * Cupri Arsenis, Cupric Arsenite, contained in Paris Green. Is often em- ployed as a poison. Dose, gr. daily, in divided doses. ARSENIC. 59 Toxicology. Arsenical poisoning is treated as follows :—First, the prompt evacuation of the stomach. Then, administration of the official antidote, which is the Hydrated Ferric Oxide (Ferric Hydrate) with Magnesia. This should be freshly prepared, and given in doses of 5; j, frequently repeated. Then oil, milk, or mucilaginous drinks, to protect the mucous membrane ; and diluents, alkaline mineral waters, Potassium Iodide, etc., to promote elimination. Arsenic Antidote (U. S. P.), Ferric Hydrate with Magnesia. The two fol- lowing solutions should be kept ready: (i) Solution of Ferric Sulphate 50 Cc. in water 100 Cc. (2) Magnesia, 10 grammes rubbed up with water 750 Cc. in a bottle of 1000 Cc. capacity. When wanted, shake the latter to a homo- geneous magma, add it gradually to the former, and shake them together to a uniform, smooth mixture. Dose, frequently repeated. Chronic Arsenical Poisoning may be avoided by commencing with full doses of Fowler’s solution), then reducing the dose regularly. Unless very small doses are used, Arsenic should always be given just after meals, so as to avoid its irritant action on the gastric mucous membrane. Physiological Action.—Arsenic is a very painful escharotic, exciting violent inflammation. Taken internally it is a powerful irritant to the gastro- intestinal and bronchial mucous membrane. In Small Doses, Arsenic is a stomachic tonic, promoting the appetite and digestion ; increases cardiac action, respiratory power, and the secretions of the intestinal tube; stimulates the mind, the sexual appetite, and intestinal peristalsis; causes rotundity of form and a fair skin. When tolerance is estab- lished, large doses are taken with impunity, as by the arsenic-eaters of Styria. In Full Medicinal Doses continued, it produces oedema and itching of the eyelids, increased saliva, nausea, vomiting of mucus, diarrhoea or dysentery, epigastric pain and soreness, irritable and feeble heart, dyspnoea, disordered sensibility, herpes zoster, urticaria, eczema and other skin eruptions, jaundice and albuminuria. In Toxic Doses, the phenomena may be either gastro-intestinal or profoundly cerebral in character. In the first and most usual form, there is burning pain at the stomach, extending over the abdomen, vomiting, thirst, bloody stools, strangury, suppressed or bloody urine, a rapid and feeble heart, great anxiety, cold breath, albuminuria, collapse. In the nervous form, profound coma, like that of opium narcosis, comes on suddenly, and without any gastro-intestinal symptoms. Post-mortem shows erosions, ecchymoses, and softening of the gastrointesti- nal mucous membrane, congestion of the lungs and the bronchial mucous mem- brane, fatty degeneration of the internal organs, especially the liver and kidneys. 60 RESTORATIVE AGENTS. Stomach Disorders, as chronic gastric catarrh, irritative dyspepsia, chronic gastric ulcer, cancer of the stomach, gastralgia, and vomiting due to these affections. Very small doses here, gtt. j of Fowler’s solution. Bronchial and Pulmonary Affections, as chronic catarrhs, chronic phthisis, spasmodic asthma, acute coryza, hay fever, etc., are much benefited by smoking arsenical cigarettes. Diabetes Mellitus,—The Bromide has recently done good service; also Lithi- ated Arsenical Water as a beverage, made by mixing Lithium Carbonate and Sodium Arsenate in the ordinary carbonated water. Diarrhoeas and Dysentery, chronic and choleraic. Liver Disorders, of malarial origin, and catarrhal jaundice. Anamia and Chlorosis, to promote constructive metamorphosis. Vomiting of Pregnancy, gtt.j of Fowler’s solution before each meal. Weak Heart, with dyspnoea and oedema of the feet and ankles resulting there- from,—Arsenic with Iron and Strychnine. Chorea, large doses, P\v thrice daily, are very useful. Malaria is well treated by Arsenic as an adjunct to Quinine. Typhoid Fever,—Cupric Arsenite is highly recommended. Epithelioma, and many other forms of cancer, are retarded by it. Chronic Skin Diseases, particularly psoriasis, and eczema squamosum, and those affecting the superficial strata of the integument. Rheumatoid Arthritis has been well treated with Arsenic. Locally, Arsenical paste is used as an escharotic in cancer, but is excessively painful. It is a good depilatory. Therapeutics. Arsenic is very useful in— BITTERS. Bitters are divided into the Simple Bitters and the Aromatic Bitters. The latter contain Gallic and Tannic acids, besides aromatic constituents, and are, therefore, more or less astringent. There are also certain special bitters, Eucalyptus, Hydrastis, Cinchona, etc., which will be treated of separately. Quassia,—The wood of Picrana excelsa. Principle, Quassin. Extractum Quassia, gr. j-iij. Tinctura Quassia, Tt\v-3j. Extractum Quassia Fluidum, Gentiana, Gentian,—The root of Gentiana lutea. Composition, Gentianin, Gentesic Acid. SIMPLE BITTERS, their Principles, Preparations and Doses. BITTER TONICS. 61 Extractum Gentiance, gr. j-v. Extr. Gentiance Fluidum, 3 ss-j. Tinctura Gentiance Composita, 3 ss-ij. Contains Cardamom 1, Bitter Orange Peel 4, Gentian 10, Dilute Alcohol to 100. * Mistier a Gentiance Alkalina, 3 j. Contains Sodium Bicarb., gr. xv, Dil. Hydrocyanic Acid, tt\hj, Infusum Gentianse Co. to !|j. *Mistura Gentiance et Senna, has of Infusum Sennse 3 iij, Tinct. Carda- momi Co. 3j, Infusum Gentianse Co. 3yj. One dose. Calumba, Columbo,—The root of Jateorrhiza palmata. Composition, Ber- berine, Colombin, Columbic Acid and Starch, but no Tannin. Extractum Calumbce Fluidum, hlv -xxx. Tin dura Calumbce, 3 ss—ij. *Cornus, Dog-wood,—The bark of the root of Cornus Jlorida. Composition, Cornin, also a resin, and Tannic Acid. * Extractum Cornus Fluidum, "lA-3 j- AROMATIC BITTERS, their Principles and Preparations. Serpentaria, Virginia Snake-root,—Described under Cardiac Stimulants. Prunus Virginiana, Wild Cherry, —The bark of Prunus serotina. Com- position, Amygdalin and Emulsin (which by their mutual reaction with water produce Hydrocyanic Acid), Tannic and Gallic Acids, etc. Extractum Pruni Virginiana Fluidum, 3ss-j. Infusum Pruni Virg., ss—ij. Syrupus Pruni Virg., 3j-iv. Cascarilla,—The bark of Croton Eluteria. Composition, Cascarillin, Tannic Acid, etc. * Infusum Cascarilla, ss-j. Physiological Action. The Simple Bitters increase appetite and aid digestion, thus promoting the constructive metamorphosis. They increase the mucous secretion, the flow of saliva and of gastric juice. As they also increase the gastric mucus, their continued use will set up gastric catarrh, and interfere with digestion. The Aromatic Bitters have similar properties ; and in addition, a local stimulant action upon the alimentary canal, due to the presence of a volatile oil, as well as decided astringent qualities from their Tannic and Gallic Acids. Cornus is a good antiperiodic. Therapeutics. They are used as tonics chiefly in— Atonic Dyspepsia, with pain after eating,—Quassia or Calumba. Convalescence,—to promote the appetite and to aid digestion. Diarrhoea, depending on indigestion, or an irritable intestinal mucous mem- brane,—Gentian or Calumba. Flatulence,—an infusion of Calumba, Ginger, aa 3 ss, and Senna gj. Malaria,—Cornus, as a tonic and antiperiodic, has considerable repute. 62 RESTORATIVE AGENTS. Bronchial Catarrh,—Prunus Virginiana has a domestic reputation. Hectic Fever, from any source,—Prunus Virginiana is an efficient tonic. Ascarides Vermiculares,—Quassia internally, and as an enema. Cough of Phthisis,—Prunus Virginiana in cold infusion. As Vehicles, the various bitter infusions are much used. The Syrup of Wild Cherry is an ingredient of almost every cough mixture. Quassia, Gentian and Calumba may be prescribed with Iron, as they contain no Tannin. Composition. The leaves of Eucalyptus globulus, or Blue Gum-tree, (nat. ord. Myrtacese),a native of Australia, now grown in California, Italy, etc. It contains Tannic Acid, a Volatile Oil, a fatty acid, and a resin which is resolv- able into Turpene, Cymol, etc. The oil consists of three oils, which distil over at different temperatures, the first product being called Eucalyptol. EUCALYPTUS,—Blue Gum-tree. Preparations. Extractum Eucalypti Fluidum,—has three-fourths alcohol. Dose, 3 j. Oleum Eucalypti,—Dose, TT\v-xx, in emulsion or capsules. Physiological Action. It promotes appetite and digestion, stimulates the flow of saliva, gastric juice, and the intestinal secretions; increases the heart’s action, and lowers the arterial tension. In large doses it causes great muscular weakness, lowered temperature, nausea and vomiting, indigestion, diarrhoea, and if continued will irritate and congest the kidneys. It reduces the size of an enlarged spleen, and has anti-malarial properties, absorbing noxious germs, as well as enormous quantities of water from the soil, and by its emanations purifying the atmosphere in its vicinity. It is largely cultivated in malarial districts for these properties, and has rendered habitable a portion of the deadly Roman Campagna. It is destructive to low forms of life. Eucalyptus is diaphoretic, and a stimulating expectorant. It is eliminated by the skin, bronchial mucous membrane and kidneys, imparting its odor to the breath and urine, being more or less irritant at the points of elimination. The Oil and its derivatives are described under Antiseptic Oils. Therapeutics. Eucalyptus is well administered in— Chronic Catarrhal Affections—of the genito-urinary organs, the broncho-pul- monary mucous membrane, and the bladder, especially the latter. Bronchitis, acute and chronic,—in the former after the most acute stage. Asthma,—the leaves smoked in combination with Stramonium, Belladonna. Chronic Gastric Catarrh,—and other conditions of the intestinal canal which favor the development of parasites. HYDRASTIS—CINCHONA. 63 Cachexia, and Convalescence,—as a tonic and stimulant. Stomatitis and Tonsillitis,—a decoction of the leaves, locally. Ulcers,—as a disinfectant, it destroying low forms of life. Hysteria, Chorea, etc.,—in debilitated persons. Malaria,—as a reconstructant, Eucalyptus is better than Quinine. Intermittent Fever,—in which Eucalyptus has some utility, especially in ob- stinate cases, where it is desirable to stop the use of Quinine. HYDRASTIS,—Golden Seal. Hydrastis is the root of Hydrastis Canadensis, (nat. ord. Ranunculacese), and contains three alkaloids,—Hydrastine, Berberine and Xanthopuccine, with Tannic and Gallic Acids, etc. Preparations. Extractum Hydrastis FI aid uni, Tinctura Hydrastis, g ss-ij. Physiological Action.—Hydrastis is an astringent bitter, promotes appe- tite and digestion, increases the secretions of the gastro-intestinal tract, and the flow of bile. Long used, it deranges digestion and causes constipation. It is an antiperiodic, and a protoplasmic poison, arresting the movements of the white blood corpuscles. Therapeutics. Hydrastis is chiefly used as a stomachic tonic, an anti- periodic, a mild astringent, and an antiseptic. In— Catarrh,—of the stomach, duodenum, gall ducts, intestine, bladder, uterus, vagina; in gonorrhoea, gleet and chronic nasal catarrh, it is an excellent remedy, both locally and internally. Syphilitic Affections, of the mouth, throat and nares,—the fluid extr. locally. Ulcers and Sores, of unhealthy character,—locally applied. Stomatitis, both mercurial and aphthous,—the fluid extract locally. Constipation,—when due to deficient intestinal secretion. Rectal Fissure and Hemorrhage,—the fluid extract locally. Intermittents,—here Hydrastine stands next after Quinine. Malarial Foisoning,—the fluid extract with Iron preparations. Official Species of Cinchona are two, viz. :— (i). Cinchona,—the bark of Cinchona Calisaya, C. officinalis, and of hybrids of these and other species of Cinchona, (nat. ord. Rubiacese), yielding not less than 5 p. c. of total alkaloids, and at least p. c. of Quinine. CINCHONA,—Peruvian Bark. 64 RESTORATIVE AGENTS. (2). Cinchona Rubra, Red Cinchona,—the bark of Cinchona Succirubra, containing not less than 5 per cent, of its peculiar alkaloids. Cinchona Flava, Yellow Cinchona,—is the bark of C. Calisaya. Cinchona Pallida, Pale Cinchona,—is no longer official. Peculiarities possessed by each variety. They should contain not less than 5 p. c. of the alkaloids and at least i]/2 p. c. of Quinine. Yellow Bark contains most Quinine, Pale Bark most Cinchonine, while the Red Bark has these alkaloids in about equal proportions. The tree is a native of the western mountains of S. America, and has been planted largely in India, Ceylon and Burmah. The Bark from Colombia affords no alkaloids except Quinine. Composition of Cinchona. It contains 4 chief alkaloids and 17 others, also 2 simple acids, 2 tannic acids, a resinoid, and coloring matter, as follows:— Alkaloids, 4,— f Quinina, Quinine,—the most valuable. J Quinidina, Quinidine,—the strongest antiperi- odic, but it exists in very small quantity. Cinchonina, Cinchonine,—the least valuable. Cinchonidina, Cinchonidine,—]/2 the strength of Quinine^ Acids, 4,— Kinic. Kino-tannicx Kinovic. Kin ovo-ia n n 2V v Other Constituents— Kinovin, a resinoid. Cinchona Red Chinoidin, Quinetum, and Quinquinina. Chinoidin is the black, bitter residue left after the crystallizable alkaloids have been removed from the mother-liquor, and it evaporated. It contains the four alkaloids in amorphous condition, and has about one-fourth the strength of Quinine. Quinetum (also called Quinquinina) is an impure preparation, much used in India. It con- tains all the alkaloids, the woody fibre being removed, and is about half as strong as Quinine. Preparations. Infusum Cinchona^—Dose, Cinchona 6, Aromatic Sulphuric Acid 1, Water to ioo. Is the only official infusion containing Sulphuric Acid. Tinctura Cinchona,—strength 20 per cent. Dose, sjss-ij. Tinctura Cinchona Composite,—a substitute for Huxham’s Tincture of Bark, strength io percent., £)-% ss. Contains Cinchona Rubra io, Serpentaria 2, Orange Peel 8, Glycerin Alcohol, Water, aa q. s. ad. 100. Quinines Sulphas,—Quinine Sulphate. Dose, gr. j-xx, even xl. Soluble in 740 parts of cold water, and in smaller proportions of acidulated water. CinchonidincB Cinchonidine Sulphate.—Dose, gr. ij-xxx. It is being much used, especially in hospitals and dispensary work. CINCHONA. 65 Incompatibles. Free Tannic Acid is incompatible with the infusion. Iodine, Alkalies, Alkaline Carbonates and earths are incompatible with the alkaloids, the first named forming insoluble compounds therewith, and the latter precipitating them from solution. In *<.'*■*' Antagonists. As to its cerebral action Morphine is antagonistic ; Bella- donna or Atropine to its nervous, cardiac, and antipyretic powers. Physiological Action. Cinchona is an astringent bitter tonicj an septic, antiperiodic, antiphlogistic, antipyretic and antimiasmatic, a diminishes of reflex: action, a protoplasmic poison, and a direct emmenagogue and an oxytocic. Its alkaloids are rapidly diffused and slowly excreted, being found in the urine in of an hour after administration, and for three days after- wards, At first it promotes appetite, digestion, the flow of saliva and of gastric juice ; but long continued it sets up a gastric catarrh, impedes digestion and causes constipation. It arrests the movements of the white blood though increasing their number ; and prevents acetification and decay of the blood. The Heart and arterial tension are somewhat stimulated by small doses, but depressed by large ones (gr. xl-lxx), which slow and enfeeble the pulse, the drug acting directly on the cardiac ganglia*. The Brain is exhilar- ated by small doses, large ones causing ansemia, pallor, a sense of fullness andi constriction in the head, singing in the ears, vertigo, a staggering gait, amau- rosis and deafness (though the eyes and ears are rarely ever injured seriously), great headache, coma, dilated pupils, delirium, and in animals convulsions. These symptoms collectively are termed “ Cinchonism. ” The Reflex Func- tion of the cord is lowered very markedly by large doses* The Spleen is reduced in size, and the temperature of pyrexia lowered, though it does not depress the body temperature in health. In some subjects it causes sexual excitement, in others cutaneous eruptions followed by desquamation j it lessens the excretion of uric acid, but not that of urea; and is a uterine stimulant in labor. Its power to initiate uterine contractions is still a much debated question, Therapeutics. The principal use of Cinchona is in the malarial diseases, over which its influence is that of a specific. In— Intermittents,—gr. x of Quinine Sulphate in the sweating stage and again five hours before the expected time of the next paroxysm. Arsenic in the intervals, in lieu of Quinine, which may cause a daily exacerbation of tem- perature if long continued. Remittent Fever•—gr. xx-xxx of Quinine Sulphate once or twice a day, until the temperature is reduced to the normal point. Pernicious Fevers,—large doses of Quinine gr. xxx-lx, are necessary to safety. AGENTS PROMOTING WASTE. Chronic Malarial Poisoning,—Chinoidin is more effective than Quinine. Prophylactic, against malaria,—Quinine, gr. ij-iij per diem, is effective. Inflammations,—at their inception, may be aborted by Quinine, gr. xv-xx, combined with Morphine, which here is synergistic to it. Acute Tonsillitis,—may sometimes be aborted by Quinine in full dose. Acute Catarrh,—may often be aborted by Quinine, gr. x, Morphine, gr. y. Surgical Fever,—and before surgical operations, Quinine is much used. Septiccemic Fevers, and Hectic, are well treated with Quinine and Alcohol. Neuralgias,—of the ophthalmic div. of the 5th, and when due to malaria. Skin Diseases,—especially erythema nodosum, and erysipelas. Eruptive Fevers,—especially scarlet and measles, throughout course. Hay-asthma,—a solution of the neutral chloride, gr. vj ad pj locally. As a Tonic,—the Infusion or Compound Tincture is best with a mineral acid; has many applications, as in atonic dyspepsia, gastric catarrh of drunkards, adynamic states, convalescence, asthma, chronic bronchitis, insanity, and generally in weak subjects of flabby flesh and perspiring skin. AGENTS PROMOTING WASTE. Preparations. Potassa, Potassium Hydrate, (Caustic Potash),—soluble in y2 of water and in 2 of alcohol; a painful and deeply-acting escharotic. Liquor Potasses, Solution of Potassa,—Dose, ttpv-xxx, well diluted. Potassii Acetas, Potassium Acetate,—very soluble in wrater and in alcohol. Dose, gr. v- 3 j. Diuretic and diaphoretic. Potassii Citras, Potassium Citrate,—very soluble in water. Dose, gr. v-xxx, as diaphoretic and diuretic. Potasii Bitartras, Potassium Bitartrate, (Cream of Tartar),—sol. in 201 of water. Dose, gr. xx-3_j,as diuretic and refrigerant; 3 j—(5j, as purgative. Potassii et Sodii Tartras, Rochelle Salt,—sol. in 1 y2 of water. Dose, (5 ss-j. Is a constituent of Pulvis Effervescens Compositus. Potassii Bicarbonas,—sol. in 3)4 of water. Dose, gr. v-xxx. Potassii Nitras, Potassium Nitrate, (Nitre),—sol. in 4 of water, insol. in alcohol. Dose, gr. ij-xx, well diluted, as diuretic and diaphoretic. Potassii Chloras, Potassium Chlorate,—sol. in 17 of water. Dose, gr. v-xx. Explosive when mixed with organic matters (cork, sugar, tannic acid, etc.) or with oxidizable substances (sulphur, phosphorus, etc.) or when heated, POTASSIUM. POTASSIUM. 67 triturated or concussed. It should never be mixed with glycerin in the presence of a free acid. Potassii Bichromas, Potassium Bichromate,—Dose, gr. T(y-j. The Bromide is treated of under Bromides ; the Permanganate under Manganese, page 57. Physiological Action. Caustic Potash, like the other caustic alkalies, destroys the tissues by combining with their water, dissolving the albumen and saponifying the fats. The Potassium Salts increase the saliva, promote oxida- tion and the retrograde metamorphosis. In small doses on an empty stomach they promote the formation of acid gastric juice, by favoring the outward osmo- sis of its constituents from the blood ; in large doses they act chemically in the stomach, neutralizing its free acids, and disordering digestion. The Bicarbon- ate, given on an empty stomach, enters the blood unchanged, meets the neutral phosphate of sodium, forming the acid phosphate, and making the urine more acid. On a full stomach it is decomposed before entering the blood, and makes the urine less acid. The Vegetable Acid Salts (Acetate, Citrate, etc.) enter the blood in their own form, are there decomposed, forming C02 and alkaline carbonates, in which form they are excreted, alkalinizing the blood and urine. They are also diuretics, increasing both the water and the solids of the urine, but decreasing the uric acid by increasing oxidation. The Mineral Salts (Nitrate, Chlorate, etc.) are not decomposed in the blood, but are elim- inated in their own form; the Nitrate being a most active diuretic, the Chlorate irritating the kidneys, and causing albuminuria. In large doses these salts decompose the red corpuscles of the blood, and paralyze the motor ganglia of the heart. All Potassium Salts, in large doses, are cardiac poisons, muscular paralyzers, poisonous to protoplasm, especially to nerve tissues, and destructive to the ozonizing function of the blood. This is especially true of the Bromide. Poisoning by Caustic Alkalies is treated by the Vegetable Acids, as vinegar, lemon-juice ; then Demulcents and Oils to protect the mucous mem- brane, and sustaining measures to support the vital powers. Therapeutics. As Alkalies the Potassium salts are used in— Acute Rheumatism,—the Bicarbonate and Nitrate, to saturate the blood, and make the urine alkaline; is effective treatment for sthenic patients. Lithcemia,—the Acetate or Citrate, to promote oxidation. If the Bicarbonate is given, it should be during digestion, to render the urine less acid. Acidity and Atonic Dyspepsia,—the Bicarbonate, or Liquor Potassse with a bitter, in small doses before meals. If given after meals larger doses are required for temporary alleviation by neutralizing the food acids. Mouth Affections, as ulcerative stomatitis, aphthae, nursing sore mouth, follicu- 68 AGENTS PROMOTING WASTE. lar pharyngitis,—the Chlorate locally, as detergent wash. This salt must be cautiously used internally, as it is a dangerous irritant to the kidneys. Inflammations,—the Acetate, to promote the excretion of resulting products. Cardiac Dropsy, if general,—the Bitartrate in infusion of Juniper. Acute Desquamative Nephritis,—the Bitartrate, but not in Juniper infusion. Diphtheria,—the Chlorate both locally and internally, with the Tincture of the Chloride of Iron, has a high reputation. It should never be prescribed in a mixture with glycerin, lest an explosion result. Skin Affections, as acne, eczema, prurigo, etc.,—alkaline solutions, locally. Catarrhs, nasal, buccal, or vaginal,—the Bichromate (gr. j-x ad 3 iv aquae), locally;—or the Chlorate as a detergent wash. SODIUM. Preparations. Soda, Sodium Hydrate, (Caustic Soda),—sol. in 1.7 of water. Liquor Soda;, Solution of Soda,—Dose, Tt\Jj-x> well diluted with water. Sodii Bicarbonas,—sol. in II x/2 of water. Dose, gr. v- 3 j, well diluted. Sodii Boras, Sodium Borate, (Borax),—Dose, gr. ij—xx, well diluted. Pulvis Effervescens Compositus, Seidlitz Powder,—has of the Bicarbonate gr. xl, Rochelle Salt, gr. cxx, Tartaric Acid, gr. xxv, for one dose. The Phosphate is noted under Phosphates,—the Bromide under Bromum,—the Arsenate under Arsenum,—the Chloride under Chlorum,—the Sulpho-carbolate under Carbolic Acid. Physiological Action is similar to that of Potassium, except that the Sodium salts are feebler alkalies, are not so depressant, and are not such powerful cardiac and nerve poisons. The Chloride exists normally in the blood, where it keeps the fibrin and albumen in solution ; and in inflamma- tion, being greatly needed therefor, it accumulates at the seat of the morbid action, disappearing for the time from the urine. Its reappearance therein is a sign of improvement. Therapeutics. Internally the Sodium salts are not much used, the Potas- sium and Lithium salts being preferred. Locally in— Burns, a saturated solution of the Bicarbonate is an agreeable application. Skin Diseases, as eczema, acne, prurigo, pityriasis, fetid sweats. Freckles may be removed by using a saturated solution of Borax in rose-water, as a face-wash night and morning. Intussusception may be treated by effervescing powders, the soda being first injected, then the acid. Danger, rupture of the bowel. Narcotic Poisoning,—the same method, as an emetic, per orem. CALCIUM. 69 Seidlitz Powders are used as refrigerants and gentle laxatives. In Lithcemia, Acid Urine, and Acidity of the Stomach, the Sodium salts should not be used,—Potassium or Lithium salts being far superior. In Epilepsy and Paralysis Agitans,—Borax is employed with great benefit in many cases. LITHIUM. Preparations. Lithii Citras, Lithium Citrate,—Dose, gr. v-xxx. Extemporaneously prepared by adding Citric Acid to a solution of the Carbonate in water. Lithii Carbonas,—Dose, gr. ij-xv. Lithii Bromidum,—Dose, gr. v-xx. Physiological Action. It acts purely as an alkali, being the most decided alkali of the group. Therapeutics are but few. In the— Indigestion and Rheumatism of the obese,—the Lithium salts are useful. Lithcemia,—is best treated by the Citrate or Bromide, in full doses. Chronic Rheumatic Arthritis,—the Bromide, both internally and locally. Myalgia,—the Bromide is very useful, in 5-grain doses. Diabetes Mellitus,—Lithiated Arsenical Water, as a beverage; see Arsenum. CALCIUM. Preparations. Liyuor Calcis, Solution of Lime, (Lime-water),—Dose, Jss-ij. Syrupus Calcis, Syrup of Lime,—strength 6p. c. Dose, g ss-ij. Linimentum Calcis, Lime Liniment (Carron Oil),—has equal volumes of Lime-water and Linseed Oil, shaken together. For local use. Calcii Carbonas Prcecipitatus, Precipitated Calcium Carbonate,—insoluble in water or alcohol. Dose, gr. v-xx. * Testa Prceparata, Prepared Oyster- shell,—contains Calcium Carbonate and organic matter. Dose, gr. v-xx. Creta Prceparata, Prepared Chalk,—is native Calcium Carbonate, freed from its impurities by elutriation. Dose, gr. v-xx. Alistura Cretce, Chalk Mixture,—20 per cent. Dose, g ij-iv. The Phosphate is treated of under the title Phosphates, Calx Sulphurata• under Sulphur, and Calx Chlorata under Chlorum. Physiological Action. Feebly alkaline, the preparations of Calcium are mere astringent antacids. The actions of the phosphate have already been described. Syrupus Calcis is an antidote to Carbolic Acid, or Oxalic Acid poisoning. Therapeutics. Lime-water is used in the summer vomiting of children, 70 AGENTS PROMOTING WASTE. and is added to their milk when the latter is not well retained. Chalk mix- ture is prescribed in the diarrhoea of children, with sour-smelling watery stools. In Diphtheria and Croup, the vapors of slaking lime, or lime-water spray, are often very serviceable. Lime Liniment is a good application for burns. AMMONIUM. Aqua Ammonia:, Water of Ammonia,—an aqueous solution of the gas NH3, of jJj strength by weight. Dose, tt\v-xxx, well diluted. Ammonii Carbonas, Ammonium Carbonate,—Dose, gr. ij-x. Ammonii Chloridwn, Ammonium Chloride, (Sal-Ammoniac), NH4C1,—solu- ble in 3 of water. Dose, gr. j-xx. Spiritus Ammonia Aromaticus,—contains the Carbonate and Water of Ammo- nia, with aromatic oils. Dose, gss-ij. Liquor Ammonii Acetatis, Spirit of Minderems,—contains about 7 p. c. of the Acetate. Dose, freshly made. * Raspail's Eau Sedative,—Aq. Ammonia; J ij, Sodii Chloridum 3 ij, Spt. Vini Camphorat. Sjiij, Aqua 3 xxxij. For local use. The Bromide is treated of under Bromum, the Iodide under Iodum, the Benzoate under Benzoin, and the Phosphate under Phosphates. Physiological Action. The Gas Ammonia is intensely alkaline, and irritant to mucous membranes ; inhaled, it causes spasmodic cough and a sense of suffocation, prolonged inhalation inducing violent inflammation and oedema of the glottis. It exists normally in the blood, to maintain its fluidity by help- ing to keep its fibrin in solution. The Aqua, swallowed, sets up violent inflammation of the passages and the stomach, and may cause stenosis of the pylorus or oesophagus. Ammonium Salts, in medicinal doses, act as stimulant expectorants, diffuse rapidly, and stimulate the heart’s action; continued, they produce rapid emaciation, from the impaired digestion and increased tissue- waste set up. In large quantity, they injure the structure of the red blood- corpuscles. The Chloride has decided cholagogue powers, promotes the excre- tion of urea, and is purgative in 30-grain doses. The Phosphate and Benzoate are diuretic, and the latter acidifies a phosphatic urine. Antidotes. For Ammonia inhaled, give HC1 vapors, by inhalation, to form the Chloride ; if in solution, give Vegetable Acids, and demulcents to protect the mucous surfaces. Therapeutically, its antagonists are the cardiac sedatives, Aconite, Digitalis, Veratrum, etc. Therapeutics. As a stimulant expectorant in— Chronic Bronchitis, and Bronckorrhcea,—the Chloride is of great service. ANTIMONY. 71 Pneumonia, at the crisis,—the Carbonate, in infusion of Senega, liquefies the products of inflammation, and counteracts the adynamia. Neuralgias, as ovarian and migraine, also in nervous headache,—the Chloride, in 30-grain dose, with gtt. ij-v Tinct. Aconiti, to relieve pain ; or Raspail’s Eau Sedative applied locally. Exanthemata, especially variola, scarlatina and erysipelas, when feeble circu- lation, cyanosis and delirium,—the Carbonate in a solution of the Acetate or the Liquor Ammonii Acetatis. Catarrhs, gastric, duodenal and intestinal,—the Chloride has a high reputation, also in bronchial catarrh, when secretion is scanty and tough, and in chronic bronchitis, as a stimulant expectorant. Hepatic Disorders, as incipient cirrhosis, chronic torpor, catarrh of the bile ducts and its jaundice, bilious conditions, etc.,—the Chloride with fluid extract of Taraxacum, gives great relief in many cases. Acidity and Vomiting,—the Carbonate in a solution of the Acetate. Hysteria,—the Valerianate and the Aromatic Spirit are much employed. Fevers,—the Carbonate is used as a stimulant, and the Acetate as a febrifuge. Poisoned Bites and Stings,—are treated locally with Aqua Ammonise. Inflammations,—the Chloride in Alcohol and Water, as a lotion. As a Cardiac Stimulant in syncope, thrombosis, hemorrhage, chloroform nar- cosis, snake-bites and hydrocyanic acid poisoning,—the Spirit inhaled or the diluted Aqua intravenously; acts by relaxing the cardiac inhibition. Cystitis, with alkaline urine and phosphatic deposits,—the Benzoate acidifies the urine, stimulates and disinfects the vesical mucous membrane. ANTIMONIUM,—Antimony. Preparations. Antimonii et Potassii Tartras, Antimonium and Potassium Tartrate, (Tartar Emetic),—Dose, gr.T\-J ; after tolerance as high as gr. ij may be given. Vinum Antimonii,—has 2 grains of Tartar Emetic to the If. Dose, n\v-xx. Syrupus Scillce Compositus, Compound Syrup of Squill, (Cox’s Hive Mixture), —Dose, ttpv-^j;—contains about grain of Tartar Emetic to the if . Pulvis Antimonialis, Antimonial Powder, (James’ Powder),—Dose,gr. iij-viij. Is one-third Oxide of Antimony, with two-thirds Calcium Phosphate. Treatment of Poisoning by Tartar Emetic. Administer Tannic Acid, in some form, as an antidote ; then Opium or Alcohol as an antagonist, and demulcent drinks freely to protect the mucous membrane. Physiological Action of Tartar Emetic. It is a systemic and local emetic, a diaphoretic, an arterial sedative, and a gastro-intestinal irritant; has AGENTS PROMOTING WASTE. a styptic taste, and causes constriction of the fauces. It promotes body waste and the rapid excretion of waste products. In small doses, it stimulates the secretions of the stomach and intestinal canal, the salivary glands, liver and pancreas. In larger doses, it produces vomiting and purging, with evacua- tions much like the “ rice-water discharges ’ ’ of cholera, and great prostra- tion of the vital powers. Toxic Doses produce similar symptoms, with epigas- tric pain, cyanosis, delirium, motor and sensory paralysis, suppression of urine, collapse,—much the phenomena of Asiatic Cholera. It is paralyzant to the heart-muscle, combines with the red blood-corpuscles, depressing their oxid- izing power, lowering the blood pressure, and reducing the temperature. Being eliminated by all the excretory organs, including the skin, it excites fol- licular inflammation therein, resulting in a papular eruption on the integument, which becomes vesicular and pustular, the pustules being umbilicated, like those of variola. This may be produced by rubbing it into the skin. Therapeutics. The use of Tartar Emetic as an antiphlogistic was for- merly very much abused, and has now practically become obsolete. Its emetic action, though certain, is too slow to be of service in poisoning cases, and too depressant for children. In small doses, however, it is very efficient in acute inflammations of the respiratory tract, especially— Pneumonia and Bronchopnewnonia,—gr. fa for adults, for children, re- peated every 2 hours until diaphoresis and lowered pulse. Acute Cold and Bronchitis,—gr. tV with gr. fa of Morphine, is excellent. Asthma and Emphysema, with lack of secretion,—are much relieved by gr. fa, to relax spasm and promote secretion. Wheezing of young children, with dyspnoea and cough, simulating asthma, may be stopped by gr. j in 0)4 Water, of which teaspoonful doses hourly. VEGETABLE ACIDS. Vegetable Acids used in Medicine. Acidum Aceticum Dilutum, Diluted Acetic Acid,—Dose, 3 j-ij. * Acetum, Vinegar,—an impure dilute acetic acid, formerly official. Acidum Citricum, used as Succus Limonis, I.emon-juice,—Dose, Jss-ij. Acidum Tartaricum,—Dose, gr. x-xxx. 20 grains neutralize 27 grs. of Potassium Bicarbonate. Pulvis Effervescens Comp., see under Sodium. Physiological Action. In concentrated form they have escharotic powers, and produce gastro-enteritis if swallowed. In dilute form they diminish thirst and allay restlessness. They form salts in the stomach, thus enter the blood, and are there oxidized, producing carbonic acid, which increases the acidity of the urine. They promote secretion, and increase the SULPHUR, SULPHITES, SULPHIDES. 73 water of the urine. Long continued they cause emaciation and poverty of the blood, in fact a general scorbutic condition. Tartaric Acid has been fatal in a dose of j|j. Acetic has caused death once. Citric seems to be non-toxic in man. Therapeutics. Tartaric Acid is rarely used except in the effervescing powders, Citric being preferred. The latter is used in— Scurvy, as a prophylactic and a curative agent, in form of Lemon-juice. Acute Rheumatism,—Lemon-juice freely, j-ij used 4 or 5 times a day. Fevers,—Lemonade to be used freely, as a refreshing and refrigerant drink. Inflammations,—Dilute Acetic in superficial inflammations of the skin. Skin Affections, as warts, pityriasis, etc.,—Glacial Acetic as a caustic. Obesity,—Lemon-juice to correct fatness, acts by impairing digestion. Atheromatous Degeneration may be retarded by the daily use of Lemon juice, which dissolves the excess of inorganic matter, permitting its elimination. Preparations. Sulphur Lotum, Washed Sulphur. Dose, gr. in syrup, as a laxative. Acidum Sulphurosum, Sulphurous Acid,—contains 6.4 per cent, of Sulphurous Acid Gas. Dose, largely diluted with water. Acidum Sulphuricum,—Described under Mineral Acids, ante, p. 50. Sodii Sulphis, Sodium Sulphite,—Dose, gr. j-iij, in water. Sodii Hyposulphis, Sodium Hyposulphite,—Dose, gr. v-xx. Calx Sulphurata, Sulphurated Lime, commonly misnamed Sulphide of Cal- cium,—a grayish-white powder, of foul odor and very insoluble ; is a mix- ture of CaS, CaS04 and C. Best given in trituration with sugar of milk, and in dose of gr. y^-j. Pulvis Glycyrrhizce Compositus,—contains 8 per cent, of Sulphur Lotum. See under Purgatives. Dose, 2jj, as a laxative. *Ichthyol, Ammonium Sulpho-ichthyolate,—is obtained by the distillation of bituminous rocks from the Tyrol, and regarded as the residue of extinct fishes. It contains Sulphur in the proportion of about 10 per cent., is soluble in a mixture of Ether and Alcohol, mixes with vaseline, oils and lard, and is non- irritant to the skin. For local use, in a 10 to 20 per cent, ointment. Dose, internally, gr. v-xxx. SULPHUR, SULPHITES, SULPHIDES. Physiological Action. Stilplmr is a very mild laxative. It is dissolved by alkaline solutions and oils, hence is absorbed from the small intestine, entering the blood, and discoloring silver coins carried by those using it, by forming a sulphide of silver. Sulphurous Acid has great affinity for oxygen, 74 ALTERATIVES. and is a powerful disinfectant and deodorizer, and destructive to all low life. Its gas inhaled is irritant to the glottis, causing inflammation of the passages. The Sulphites and Hyposulphites are partly decomposed by the acid of the stomach, sulphurous acid being given off, and the balance converted into sul- phates and absorbed, undergoing elimination as sulphates by the kidneys. The Sulphides also are partly converted into sulphates. They are irritant to the stomach, etc., extremely nauseous in taste and smell, increase the secretion of the intestinal glands, and are laxative. If administered for some time they impair the blood, and cause emaciation, an2emia, trembling and great debility. Ichthyol, in one case, where a 20 per cent, ointment was applied to an eczema infantile, produced a stupor which continued 12 hours, but from which the child made a complete recovery. Therapeutics. Sulphur is used as a laxative when the stools need soften- ing on account of hemorrhoids and fissure, etc. In— Chronic Rheumatism and Sciatica,—Sulphur has some repute. Scabies,—Sulphur locally as a parasiticide ; or a solution of Sodium Sulphite in water, 3 ss ad 3 j, as a bath or wash. Chronic Bronchitis, with bronchorrhoea,—Sulphurous Acid as spray. Acidity, Pyrosis, and Acid Indigestion,—Sulphurous Acid, diluted. Chilblains,—Sulphurous Acid with Glycerin, is a good application. Gangrenous Wounds,—Sulphurous Acid the best antiseptic application. Constipation,—the Blue Lick Water, Oj before breakfast; or the Sulphides. Lead Poisoning,—Sulphur baths to favor the elimination of the metal. Suppuration,—may be prevented or at least limited, by Calx Sulphurata in- ternally, in small doses, gr. \ hourly. For crops of boils, scrofulous sores, glandular enlargements, acne, and suppuration, this remedy proves efficient. Skin Diseases,—Sulphur baths are very useful, especially in pityriasis, prurigo, chronic psoriasis and eczema. In the two last-named diseases Unna em- ploys Ichthyol in ointment with excellent results. ALTERATIVES. IODINE, IODIDES. Iodum, Iodine,—is a non-metallic element, existing in sea-water and sea- plants chiefly, and occurs in bluish-black plates, of rhombic shape, metallic lustre, peculiar odor, acrid taste and neutral reaction. It is sparingly soluble in water (i in 5000), readily so in ether and in alcohol (1 in 10), also in a solution of potassium iodide or sodium chloride. Dose, gr. ss-j, but it is never administered in crude form. IODINE, IODIDES. 75 Preparations. Tinctura lodi,—Tincture of Iodine,—7 per cent. Dose, Tt\j-v, diluted. Liquor Iodi-Compositus, Compound Solution of Iodine, Lugol’s Solution,— has Iodine 5, Potassium Iodide 10, Water 85. Dose, tqj-x, diluted. Unguentum lodi, Iodine Ointment,—I 4, Pot. Iod. I, Aq. 2, Adeps, 93. Ammonii Iodidum, Ammonium Iodide,—Dose, gr. v-xx. Potassii Iodidum,—Dose, gr. v- 3 j. Unguentum Potassii Iodidi, 12 percent. Syrupus Acidi Hydriodici, Syrup of Hydriodic Acid,—I per cent., 3 j-3 iv. Iodoformum,—Iodoform, Formyl Iodide,—lemon-yellow crystals, of vile and persistent odor. Dose, gr. j-v. To remove the odor, mix it with Thymol, gtt. ij ad g, or Balsam Peru, or Oil of Mirbane (Nitro-Benzol), gtt. xx ad , or Oil of Bitter Almonds, or Oil (Attar) of Rose. Unguentum Iodoformi, Iodoform Ointment,—strength 10 p. c. * Suppositoria Iodoformi (B. P.),—each suppository contains 3 grains. *lodol,—a grayish-yellow powder, insoluble in water, tasteless and odorless, and contains 85 to 90 per cent, of Iodine in combination with Pyrol, a constituent of mineral oil. Dose, gr. ss—v, in tablet. *Iodo-tannin,—is Tannic Acid in Tincture of Iodine. For local use. * Iodized Phenol, Carbolated Iodine,—a mixture of Iodine and Carbolic Acid in various proportions, for local use in gynecology. *£ismuthi Subiodidum, Bismuth Subiodide,—a heavy, dark-red, impalpable powder, only used locally, as a dressing for wounds, sores, etc., and a substitute for Iodoform. [See ante, under Bismuth. ] *Aristol, Dithymol Iodide,—a combination of Iodine and Thymol, contain- ing about 46 p. c. of the former; an amorphous, unstable, non-toxic pow- der, used locally as a substitute for Iodoform. *Europhen, Isobutyl-orthocresol Iodide,—contains about 27 p. c. of Iodine, which it gives up in the presence of water ; an amorphous, yellow powder, perhaps the best of the substitutes for Iodoform. Iodides of Arsenic, Silver, Mercury, Iron, Lead, Sulphur and Zinc, are classed with their other bases, being allied more closely with them, in their actions and uses, than with Iodine. Physiological Action. Iodine is irritant, also vesicant if used in quantity, staining the skin yellow. Combining with the hydrogen of phosphuretted and sulphuretted gases it is a disinfectant and deodorant. The Iodides are very diffusible and rapidly excreted ; setting free ozone and iodine at the points of elimination, they are irritant, inducing violent coryza, with soreness of the throat and eyes, headache and profuse mucous discharge, with irritation of the kidneys. They induce great waste and rapid elimination of waste pro- ducts, causing anaemia, emaciation, and depression, if used for any length of 76 ALTERATIVES. time. They combine with foreign substances in the system and remove them. lodism comprises the foregoing symptoms, together with frontal headache, a saline taste in the mouth, dysphagia, an acne-form eruption on the face and limbs, and temporary impotence. Sometimes the eruption is furuncular, or even purpuric. Copious dilution of these salts with water promotes their excretion, and to a great extent prevents these results from following upon their continued administration, as is sometimes necessary in the treatment of disease. Iodoform contains from 94 to 97 p. c. of Iodine. It is a local anaesthetic, and (clinically) an efficient antiseptic, inhibiting, if not destroying, the mi- crobes of putrefaction and pus formation. If applied too freely to an exten- sive raw surface it may be absorbed in dangerous quantity, and produce symp- toms of narcotic poisoning, with increased temperature, quick and feeble pulse, collapse and death. In small doses internally it is considered tonic and alterative, and to possess sufficient power against certain pathogenetic microbes to cause their disappearance from the morbid products accompanying the disease. lodol has the same action as Iodoform, but is odorless and is said to be devoid of toxic power. Though insoluble in water it dissolves readily in the gastric juices, and is rapidly absorbed and diffused through the system. Toxicology. The antidote to free Iodine in Starch, with the object of forming an Iodized Starch, which should then be evacuated from the stomach. In chronic poisoning by the Iodides, a free salivary flow, excited by chewing Pyrethrum-root, will hasten the elimination of the drug. Therapeutics of Iodine. The Tincture is much used locally as a counter- irritant, and an alterative application. Iodo-tannin is chiefly employed as an antiseptic and alterative application in local diseases. The preparations of Iodine are used with benefit in— Catarrh and Hay Fever,—inhalations of Iodine or the Carbolate. Inflammations,—Tincture of Iodine locally, to promote absorption. Skin Diseases,—the Glycerite or Tincture, in chloasma, lentigo, lupus. Chronic Diseases of the Spleen and Liver,—the Tincture or Ointment may be used locally for counter-irritation. Glandular Tumors, hypertrophied tonsils, cervical cysts, etc.,—the Tincture or Compound Solution parenchymatously injected, is an efficient resolvent. Empyema, Hydrocele, Ovarian Cysts, etc.,—the Tincture injected undiluted, is one of the best applications, to prevent return of the effusion. Sores, Ulcers, Fissures, etc.,—Iodoform, Iodo-tannin, or Iodized Starch, are highly recommended, as local antiseptics and alteratives. IODINE, IODIDES. 77 Vomiting of Pregnancy,—drop-doses of the tincture every hour, have often succeeded in very obstinate cases. Therapeutics of the Iodides. They are especially used in— Acute Catarrh and Hay Fever,—Potassium Iodide with Arsenic internally ; also Iodine and Carbolic Acid in weak solution locally. Chronic and Capillary Bronchitis,—the Ammonium Iodide, in small doses, rapidly administered, is remarkably efficacious. Catarrhal Pneumonia,—the Ammonium Iodide, to prevent caseation of the products. Arsenic may well be combined with it. Spasmodic Asthma,—Potassium Iodide, in 15 to 30-gr. doses, is often very efficient, especially when the asthma is due to bronchial catarrh. Hepatic Cirrhosis, in the first stage,—Ammonium Iodide with Arsenic. Duodenal Catarrh, and jaundice therefrom,—Ammonium Iodide. Aneurisms,—Potassium Iodide, in large doses (gr. xv-xxx) is often curative of internal aneurisms, when conjoined with absolute rest. Tertiary Syphilis, and many of its results, as neuralgise, paralysis from gum- mata, syphilitic ulcerations, syphiloma of the internaj viscera, chronic rheu- matism and sciatica of syphilitic origin, lupus of syphilitic or scrofulous origin,—are all best treated by Potassium Iodide. Mercurial Poisoning, and other chronic metallic toxsemise,—Potassium Iodide, to promote elimination of the poison. Malaria,—the Ammonium Iodide with Arsenic, in chronic malaria. Tonsillitis, and simple sore throat,—a weak solution of Potassium Iodide. Chronic Bright's Disease,—the prolonged use of Potassium Iodide has seemed to retard the progress of the parenchymatous changes. Therapeutics of Iodoform. As a local application this agent and its substitutes have been extensively used in the treatment of epithelioma, chancre and chancroid, wounds, ulcers, sores, etc., and but for its offensive odor and the danger of its toxic action Iodoform would have been in unrestricted em- ployment for all such conditions. Aristol and Europhen, if equally efficient, as is claimed, will doubtless replace it largely as a topical agent. Iodoform and Iodol are highly esteemed as internal remedies in— Cfironic Gastric* Catarrh, and intestinal catarrh, ulceration of the gastro- intestinal mucous membrane, etc.,—Iodol given midway between meals. Bronchitis, Bronchial Catarrh, and various respiratory neuroses,—Iodol has ' been found highly useful in many instances. Tuberculosis,—has been successfully treated by Iodoform, which certainly does check the activity of the bacillus of that disease. Diabetes,—has been apparently cured by Iodoform given internally. 78 ALTERATIVES. Syphilis,—may be combated successfully by Iodoform or Iodol, in lieu of Potassium Iodide, in cases where the latter is indicated. Hydriodic Acid is used as a substitute for Iodine and the Iodides, being less offensive to the taste and stomach. It is official only as the Syrup, the Acid itself not being a stable preparation. Preparations. Hydrargyrum cum Creta, Mercury with Chalk, Gray Powder,—Dose, gr. ss-x. Massa Hydrargyri, Blue Mass, Blue Pill,—Dose, gr. ss-xv. Each grain contains gr. of Mercury, with Liquorice, Althaea, Glycerin, and Honey of Rose. Unguentum Hydrargyri, Blue Ointment,—Mercury, Lard, Suet. Hydrargyri Chloridum Corrosivum, Bichloride, Corrosive Mercuric Chloride, (Corrosive Sublimate),—Dose, gr. gV~xV Soluble in 16 of water. Hydrargyri Chloridum*Mite, Mild Mercurous Chloride, Sub-chloride, (Calo- mel),—Dose, gr. x. Insoluble in water or alcohol. Hydrargyri Subsulphas Flavus, Yellow Mercuric Subsulphate, (Turpeth Min- eral),—Dose, gr. ij-vj, as an emetic. Insoluble in water or alcohol. Hydrargyri Oxidum Flavian, Yellow Mercuric Oxide,—Dose, gr. Unguentum Hydrargyri Oxidi Fiavi,—strength y Oleatum Hydrargyri, Oleate of Mercury,—Yellow Oxide of Mercury 2, in Oleic Acid 8. Hydrargyri Iodidum Viride, Green Iodide, Protiodide. Dose, gr. Hydrargyri Iodidum Rub rum, Red Iodide, Biniodide. Dose, gr. Hydrargyri Cyanidum, Mercuric Cyanide,—Dose, gr.y^-yV Unguentum Hydrargyri Nitratis, Citrine Ointment. Mercury 7, Nitric Acid 17/4, Lard Oil 76. * Unguentum Hydrargyri Nitratis Rubrum, Brown Citrine Ointment. Made with Ol. Morrhuse, instead of Lard Oil. Pilulcz Antimonii Compositce, Plummer’s pills. Each pill contains Sulphurated Antimony, Calomel, aa gr. *4, with Guaiac and Castor Oil. * Black Wash, Calomel, gj, Lime-water Oj, producing the Black Oxide. * Yellow Wash, Corr. Sublimate 3 ss, Lime-water Oj, producing the Yellow Oxide. Triturations of the metal itself, its chlorides or oxides, may be prepared ac- cording to the general pharmacopceial formula,—and will be found exceed- ingly efficient preparations. HYDRARGYRUM,—Mercury. Incompatibility of the Chlorides of Mercury. They are incompatible with almost everything. Corrosive Sublimate is easily decomposed, and the MERCURY. 79 combination of Calomel with Hydrochloric Acid or Chlorides is apt to produce Corrosive Sublimate. Antidote to the Mercurial Salts. Albumen,—the white of one egg to 4 grains of Corrosive Sublimate, an excess redissolving it. Prompt emesis is also necessary, or the stomach-pump, after giving the antidote. Physiological Action. Mercury is easily absorbed in any form; is ex- creted by the liver (in which it tends to accumulate while stimulating its cells), also by the intestinal and salivary glands, the kidneys, and partly by the skin. It has a selective action on the glands, especially the salivary and the pancreas, which it stimulates to the production of pathological secretions. In small doses, Mercurial salts are blood tonics, increasing the number of the red corpuscles. They promote waste by stimulating the lymphatic system, and in very small doses are sedative to the mucous membranes. In medium doses, they have a selective cathartic action, and increase the flow of bile by reflex action on the bile ducts, as do resinous purgatives. In Full Doses, continued, they over-stimulate the glands, especially the pancreas, producing pathological secretions, impair the ozonizing function of the blood, diminishing the red corpuscles, and produce a low inflammation in the nervous tissue, result- ing in loss of coordination power. Corrosive Sublimate, in small doses, prevents hyperplasia of the connective tissue, and causes, in large doses, inflammation and ulceration of the lower bowel. It is a powerful gastro-intestinal irritant, and poisonous also to the cardiac muscle. It is an effective parasiticide, and one of the most efficient of all the antiseptics. Calomel is very insoluble, and unirritating. It is tasteless, laxative in grain doses, an efficient diuretic, and acts on the excrementitious intestinal glands. The Red Iodide and the Cyanide are irritant poisons. The Acid Nitrate is a good escharotic, its pain being transient though severe. Salivation (ptyalism) is produced most readily by Blue Mass, next by Calo- mel, and least so by Mercury with Chalk. Its first symptoms are sore teeth, spongy gums, profuse saliva, fetid breath, bluish line along margins of the teeth; then swelling of the glands, aching jaws and muscles, and fever, result- ing in emaciation, marked anaemia, falling of the hair, ulcerated skin, fetid diarrhoea, trembling, obscure, nervous phenomena, albuminuria, and in women abortion, through impoverished blood. Therapeutics.—Mercury is undoubtedly a specific in— Syphilis, in which it is best given in small doses to just short of ptyalism, then stopped, but renewed, and so continued for some time. The Green Iodide in small doses, (gr. yV-! ter die) with Opium, is the best preparation for 80 ALTERATIVES. internal administration. Mercury is not applicable to tertiary syphilis; therein Potassium Iodide is the remedy. Tonsillitis, Parotitis, and other acute glandular inflammations may often be cured rapidly by Calomel, gr. , or Gray Powder, gr. every two hours. Irritable Stomach, vomiting, etc., Calomel in small doses, gr. Gastric Ulcer,—Corrosive Sublimate, gr. -fa-fa, ter die, is an effective remedy. Ileo-colitis of Infants,—gr. £ of Gray Powder, or Calomel, gr. Dysentery of Adults, stools slimy and bloody,—Corrosive Sublimate, gr. T^) gr- 7ooW (Donders). The Brain is congested by Belladonna, a busy delirium being produced, BELLADONNA. and hallucinations with mental disorder, due to a selective action on the cells of the gray matter. The Spinal Cord is stimulated from the 2d cervical vertebra to the 10th dorsal, resulting in paralysis of the motor nerves, central and peripheral; power being lost in the lower extremities first. Sensation is slightly impaired, but the muscular irritability is not. Respiration is increased, and the temper- ature raised. By the increased circulation metamorphosis is greatly promoted. A Diffused Eruption of a scarlet color, greatly resembling that of scarlet fever, is often produced by Belladonna on the skin and fauces, with dysphagia and sore throat, and is sometimes followed by desquamation. It is due to capillary congestion caused by the greatly increased circulation. Diffused rapidly, Belladonna is also quickly eliminated, particularly by the kidneys. The urine of an animal under the action of Atropine will dilate the pupil of another animal. Herbivorous animals and birds are scarcely suscep- tible to the action of Belladonna, and pigeons are not affected by it at all. 115 Antidotes and Antagonists. In poisoning Tannic Acid and emetics should be used. Opium is the physiological antagonist for its effects on the cerebrum, pupil, heart, respiration, arterial tension, and kidneys. Physostig- mine, Aconite, Pilocarpine and Quinine are each antagonistic to some of its effects ; Muscarine to most of them. Therapeutics. Belladonna is especially useful in— Pam of inflammation,—particularly that of gout, rheumatism, neuralgia due to peripheral disturbance, sciatica, cancer, and pelvic affections. Cerebral and Spinal Hypercemia, congestive headaches, encephalitis, menin- gitis and myelitis,—it proves one of the very best remedies. Erysipelas of superficial and non-vesicular character, and when cerebral,— Belladonna is curative in 5 doses hourly, also the extract locally. Inflammation of the lungs, iris, bladder, kidneys and breasts,—are all amen- able to Belladonna applied locally, or Atropine used hypodermically. Constipation due to atony of the bowels,—it is remarkably efficient; the Tinc- ture combined with Nux Vomica and Physostigma Tinctures, equal parts of each, of which combination give 15-drop doses at night. Enuresis of children,—large doses (gtt. x-xx of Tincture) thrice daily. Cystitis, recent, from chill,—the. Tincture internally, and the Extract applied to the perineum, are very efficient treatment. Spasm of the urethra, bladder, anal sphincter, etc.,—is overcome by it. Ulcers of the rectum, anal fissures, etc.,—are soothed and healed by the use of the Extract locally, or the ointment. Ptyalism from Mercury, pregnancy, etc.,—is arrested by Atropine. 116 MOTOR EXCITANTS. Abscesses, boils, carbuncles, and other superficial inflammations,—are remark- ably benefited by Belladonna with Morphine, used locally. Typhus and Typhoid in their early stages,—Belladonna is very useful. Acute Nasal Catarrh, with profuse watery discharge,—it is very efficient. Sore Throat, with fever, inflammation, redness, and swollen tonsils. Scarlet Fever,—Belladonna is said to be prophylactic (?). It relieves many of the symptoms of this disease, and is well used when the rash is imperfect, the pulse feeble, and the condition adynamic. Skin Diseases,—notably erythema, eczema, herpes zoster and prurigo. Sweats of Phthisis,—gr. of Atropine is generally effective. Asthma and Pertussis,—are. well treated by Belladonna in full doses. Cardiac Failure when sudden,—Atropine as a cardiac stimulant. Convulsions, epileptic and puerperal,—are often relieved by Belladonna. Spermatorrhoea and seminal losses,—are best treated by this remedy. Poisoning by Opium, Physostigma and Prussic Acid. In Opium poisoning the unsuccessful cases treated by Atropine are due to overdosing therewith (?). It should be given in very small doses, and for effect. Ophthalmologists use Atropine to paralyze accommodation, dilate the pupil, contract the vessels, lessen pain, and diminish intra-ocular tension. HYOSCYAMUS,—Henbane. Source and Composition. The leaves and tops of Hyoscyamus niger, a biennial plant, also of the order Solanacese. Its alkaloid, Hyoscyamine, is probably identical with Atropine, Daturine and Duboisine ; from it is derived Hyoscine, a semi-liquid alkaloid yielding Tropic Acid and Pseudotropine. Preparations. Extractum Hyoscyami,—Dose, gr. ss-j, if active. Extractum Hyoscyami Fluidum,—Dose, trpv-xx. Tinctura Hyoscyami,—15 percent. Dose, the latter as hypnotic. Hyoscyamince Sulphas, Hyoscyamine Sulphate,—Dose, gr. xV~2(j' by mouth ; hypodermically should not exceed gr. -fa. In very urgent cases, gr. may be given by the mouth. Hyoscince Hydrobromas, Hyoscine Hydrobromate,—Dose, gr. by mouth or hypodermically. Incompatible, most frequently prescribed with Hyoscyamus is Liquor Potassse. All the fixed caustic alkalies destroy its alkaloids, as well as those of the allied plants. STRAMONIUM. 117 Physiological Action. The action of Hyoscyamine is similar to that of Atropine, Duboisine and Daturine, except that it is the least powerful and least irritant of the group, and the most calmative and hypnotic. It is more stimulant to the vaso-motor system and the cardiac accelerator apparatus than is Daturine, but is less active upon the pneumogastric. Its delirium is never furious and is without hypersemia, but is accompanied by insomnia. Hyoscine is still less active and less irritant, is decidedly anodyne and hypnotic, and very depressant to the respiration. Therapeutics. Hyoscyamus is principally used as a hypnotic and ano- dyne when Opium is contraindicated. In— Acute Mania with high motor excitement, obstinate insomnia and varied hallu- cinations,—it is by far the best agent to use. Chronic Mania,—has been benefited by it more than by any other drug. Insanity marked by frequent delusions,—it is very efficient. Delirium Tremens, and the delirium of fevers,—it is an excellent hypnotic, but needs to be used in larger doses than are generally employed. Monomania of hypochondriacs,—is alleviated and often cured by it. Neuralgias,—have been much benefited by Hyoscine hypodermically. Nervous Coughs, Whooping Cough, especially a dry, tickling night cough,—■ are greatly alleviated by Hyoscyamus. Locomotor Ataxia,—Hyoscyamine for the pains and incoordination. Paralysis Agitans, mercurial tremor, etc.,—Hyoscine palliates the trembling. Colic of various forms,—Hyoscyamus has long been used. Constipation,—Purgatives are rendered more efficient and less drastic by com- bination with the Extract of Hyoscyamus. STRAMONIUM,—Thorn Apple. Source and Composition. The leaves and seeds of Datura Stramonium, a bushy, indigenous herb, also of the order Solanacese. It contains an alka- loid, Daturine, probably identical with Atropine, also Malic Acid, etc. Preparations. Extractum Stramonii Seminis,—Dose, gr. ]/(,-%■ Extraction Stramonii Seminis Fluidum,—Dose, try—v. Tinctura Stramonii Seminis,—15 percent. Dose, Tt\v-xxx. Unguentum Stramonii,—has of the extract 10 per cent. Physiological Action is similar to that of Belladonna in almost every particular; but Stramonium is more powerful, and acts chiefly on the sympa- 118 MOTOR EXCITANTS. thetic system, not affecting the motor or sensory nerves. It excites a greater degree of cardiac irregularity, and a more furious delirium ; and seems to have a special affinity for the generative apparatus. Therapeutics. Stramonium is chiefly used to relieve pain. In— Dysmenorrhcea and Neuralgia,—combined with Opium and Hyoscyamus. Spasmodic Affections, as asthma, laryngeal cough, hepatic colic, etc. Asthma,—the leaves are smoked to advantage at the commencement of a paroxysm, the smoke being drawn into the lungs. Mania of furious character, especially the puerperal form, with suicidal ten- dency,—Stramonium is highly serviceable, in 10-20 doses of the tincture every three or four hours, until relief is obtained. Nymphomania, with great mental depression,—it is very useful. Chorea and Stammering,—Stramonium is a good remedy. Ulcers of irritable character,—the Ointment is much used as an anodyne. Tic Douloureux and Sciatica,—it is often efficient. *DUBOISIA. Source and Composition. The leaves of Duboisia myoporoides, an Australian tree of the order Solanacese. It contains an alkaloid, Duboisine, which is apparently identical with Hyoscyamine. Preparations. * Extraction Duboisia.—Dose, gr. )/(,-% • * Tinctura Duboisia, gtt. v-xx. * Duboisina Sulphas, Duboisine Sulphate (Langenberg’s), gr. xocfso- Physiological Action is in every respect similar to that of its congener, Belladonna, except that the alkaloid Duboisine is more soluble in water than Atropine, is less irritating to mucous membranes, and more prompt in mydriatic action, but its effects are of shorter duration. It is also less of a cerebral excitant, and more of a calmative and hypnotic. Ringer says that on man its action is more powerful than that of Atropine, but less powerful on frogs. Therapeutics. Duboisine has hitherto been used only by ophthalmologists as a mild substitute for Atropine, though it may be used instead of the latter in many conditions, especially the night-sweats of phthisis, respiratory neu- roses, and cardiac failure. In— Mania, puerperal and other forms,—Duboisia is of remarkable value, though at first it rather increases the maniacal excitement. CAMPHOR. 119 CEREBRAL EXCITANTS. CAMPHORA,—Camphor. Camphor is a stearopten (solid volatile oil), obtained from Cinnamomum Camphora (nat. ord. Laurinese), a tree indigenous in China, Japan, Borneo, Formosa, etc. It is slightly soluble in water (1 to 1300), but freely so in Alcohol, Ether, Chloroform, Carbon Disulphide, Oils and Milk. Derivatives. Camphor-cymol is obtained by its distillation with Zinc Chloride;—Camphoric and Camphretic Acids result respectively from its lesser or greater oxidation. Preparations. Aqua Camphora, Camphor Water,—strength, 8 in iooo, with 5 of alcohol to aid in the suspension of the Camphor. Dose, Spiritus Camphora;,—10 per cent, in alcohol. Dose, npv-xx. Linitnentum Camphora,—has 2 of Camphor to 8 of Cotton-seed Oil. Camphora Monobromata, Monobromated Camphor. Dose, gr. j-x, in emul- sion. * Rubini’s Tincture is a saturated solution in Alcohol;—Dose, gtt. iv—xx. * Rasp ail’s uEau Sedative” is used externally. [See page 70.] Camphor is an ingredient of Linimentum Saponis, Linimentum Sinapis Compositum, and Tinctura Opii Camphorata. Physiological Action. Camphor is antispasmodic, anodyne, antiseptic, diaphoretic, a stimulant expectorant, a cerebral excitant, a gastro-intestinal irritant, and a counter-irritant. It has an acrid, hot taste ; irritates the skin and mucous membranes, in quantity exciting severe gastric inflammation, with all the effects of an irritant poison. In medicinal doses it stimulates the vaso-motor system and the cardiac motor ganglia, and lessens the influence of the pneumogastric; thus increasing the circulation and raising the arterial tension. It also stimulates respiration and mental activity, even producing intoxication ; promotes perspiration, allays pain, and increases the menstrual flow and the sexual appetite ; but its continued use depresses the generative function. “ Camphora per nares castrat odore mares.” Large Doses depress the heart and lower arterial tension and diminish the reflex functions of the cord, producing coldness of the surface, insensibility, coma, convulsions and perhaps death. Elimination takes place by the bron- chial mucous membrane, skin and kidneys. Camphor has often caused dysuria. Therapeutics. Camphor was much used by the older physicians, and is 120 CEREBRAL EXCITANTS. yet greatly valued in China and Japan. It has a reputation for very uncertain action. It is, however, much employed in— Cholera and choleraic diarrhoea ;—allaying intestinal pain and cramp, check- ing intestinal secretion, and restoring warmth to the extremities. Summer Diarrhoea, from nervous exhaustion and irritability,—a few doses of the Spirit will often check this complaint promptly. Infantile Diarrhoea,—the Spirit, in milk, is an effective remedy, especially when the flux is induced by nervous irritation. Vomiting and Gastralgia,—Camphor has long been effectively employed. Cardiac Depression,—it acts promptly as a cardiac stimulant. Nervousness, nervous headache, restlessness, delirium tremens, hypochon- driasis, hysterical convulsions, etc.,—as a sedative and antispasmodic. Nympho7nania, Erotomania, etc.,—it is an excellent palliative. Whooping-cough, cough from habit, and the sympathetic cough of mothers,— the Monobromated Camphor in 5-grain doses. Capillary Bronchitis with depression,—as a stimulant and expectorant. Fevers,—small doses in milk frequently used are of great value to promote sleep, quiet the reflexes, and antagonize the cardiac depression. Dysmenorrhcea and After-pains,—are much relieved by 10-grain doses. Chordee and Strangury,—are relieved by drachm doses of the Spirit. Toothache,—Camphor and Morphine in a flaxseed poultice, to the cheek. Gangrene,—the Spirit internally and the powder locally to the surface. Myalgia, Lumbago, etc.,—the Liniment is effectively palliative. Catarrhal Colds are readily broken up by Camphor if used in the incipiency internally and by olfaction. Beard’s Cold Powder is made by dissolving 5 parts in Ether to a thick consistence, then adding Ammonium Carbonate 4 parts, and Opium I part. Dose, gr. iij-x. Source and Composition. A fetid gum-resin obtained by incision from the living root of Ferula fcetida, an Afghan plant of the nat. ord. Umbelliferae. Its principal constituent is a Sulphuretted Volatile Oil, which chiefly consists of Allyl Sulphide. It also contains a Gum and a Resin, with Feruliac, Malic, Acetic, Formic and Valerianic Acids. ASAFCETIDA,—Asafetida. Preparations. Tinctura Asafastidce,—strength 20 per cent.,—Dose 3 ss-ij. Emulsum Asafetida, Emulsion of Asafetida, Milk of Asafetida,—strength 4 per cent, in water. Dose, 5ss-ij. Pilulce Asafcetida,—Dose, j-iv. Pilulce Aloes et Asafcetidce,—j-iv. AMMONIAC. 121 Physiological Action. Asafetida is a powerful anti-spasmodic, a nerve and cerebral stimulant, a stimulating expectorant; as well as tonic, laxative, diuretic, diaphoretic, emmenagogue, aphrodisiac and anthelmintic. Its taste and odor are very nauseous and persistent. In small doses continued it is said to cause impaired digestion, alliaceous eructations, acridity in the fauces, gastralgia, flatulent distention, fetid flatus, burning urination, diarrhoea and tenesmus. Full doses produce various phenomena of nervous or hysterical type. It stimulates the circulation by raising the arterial tension, increasing the power of the cardiac motor ganglia, and relaxing the inhibition. It also stimulates the brain, even to a very pleasant intoxication, and produces a subjective sensation of warmth without any rise of the body temperature. It stimulates the secretions and excretions, the general nervous system, the men- strual flow and the sexual appetite. In Asia it is used as a condiment with food, and though extremely nauseous at first to most people, a taste for it may be readily acquired. Therapeutics. The disgust which most every one feels for this agent makes its use very restricted. It is a valuable remedy in— Flatulent Colic of infants,—the Emulsion in teaspoonful doses. Infantile Convulsions,—the Emulsion as an enema is extremely useful. Hysteria and Hypochondriasis, with indigestion and flatulence,—there is no better remedy to fulfill all the indications present. Constipation, and amenorrhoea, in anaemic subjects, with ovarian and intestinal torpor,—the Pill of Aloes and Asafetida. Bronchial Affections, cough of habit, etc.,—there is no better remedy. Chronic Catarrhs, with cough and dyspnoea,—combined with the Chloride of Ammonium it makes a very useful remedy. Source and Composition. Ammoniac is a gum-resinous exudation from Dorema Ammoniacum, a Persian plant of the nat. ord. Umbelliferae. It con- tains a Volatile Oil (not sulphuretted), a Gum and a Resin. Dose, gr. x-xxx. AMMONIACUM,—Ammoniac. Preparations. Emulsum Amtnoniaci,—4 per cent. Dose, 3 ss-j. Emplastrum Ammoniaci cum Hydrargyro, Ammoniac Plaster with Mercury,— has of Ammoniac 72, Mercury 18 per cent. Action and Uses, are similar to those of Asafetida, but it is much less powerful. It is not much used. In— Chronic Bronchial Affections, especially of the aged,—the Emulsion with 122 CEREBRAL EXCITANTS. Ammonium Chloride or Carbonate, is extremely useful, facilitating expec- toration and lessening wheezing. Asthma, spasmodic and hysterical,—it is highly useful, if combined with a little Hyoscyamus or Conium. Glandular Enlargements, and indolent inflammatory swellings,—the plaster as a stimulating alterative and resolvent. VALERIANA,—Valerian. Source and Composition. The root of Valeriana officinalis, a British plant of the nat. ord. Valerianese. It contains a Volatile Oil, from which are developed by oxidation Valerianic Acid, Valerene and Valerol. The Valerianic Acid of Pharmacy is a product of the oxidation of Amylic Alcohol (fusel oil);—it is not identical with the acid derived from the plant, though from it are prepared the Valerianates. (See below.) Preparations. The Oil is by far the best. Extractum Valeriana Eluidum,—Dose, TT^x-^j. Tinctura Valeriana,—strength 20 per cent. Dose, g ss-ij. Tinctura Valeriana Ammoniata,—20 per cent. Dose, g ss-ij. * Oleum Valeriana, Oil of Valerian,—Dose, trQj-v. The Ammoniated Tincture and Fluid Extract are extremely nauseous, and the latter is too bulky to be used. The taste is best covered by combination with Cinnamon. The various Valerianates (of Zinc, Ammonia, Iron, and Quinine) are made with the acid produced from Amylic Alcohol, and do not represent the action of the plant, but rather that of the bases from which they are respectively prepared. Physiological Action. Valerian is generally classed as an antispasmodic, or a nerve tonic. It is powerfully sedative to reflex excitability, and diapho- retic, laxative and anthelmintic. Its taste and odor are horrible, except to cats, they being extravagantly fond of it. It greatly excites the sexual appe- tite in these animals, probably from the resemblance of its odor to their own when under venereal excitement. After a time it produces in them violent spasms and convulsions. In full doses it increases the action of the heart and raises the temperature, in most persons producing exhilaration, and in some slight mental disturb- ance, with formication of the hands and feet. It reduces motility and sensi- bility, and decreases reflex excitability, being antagonistic to the actions of Strychnine, Brucine, Thebaine, etc. Long used, it induces a condition of low melancholy and hysterical depression. Large doses cause hiccough, SERPENTARIA. 123 nausea, vomiting and diarrhoea, with tenesmus of the bladder, frequent mic- turition, and lithates in the urine. The mental disturbance may proceed even to delirium, while hallucinations and excitement are usually produced, together with great restlessness and spasmodic movements of the limbs. Therapeutics. Valerian was formerly much used in Epilepsy, but it was probably only useful in the hysterical form (Hystero-epilepsy). It is a valua- ble remedy in— Hysterical Disorders of all kinds,—wherein it is often very beneficial. Flatulence of the hysterical and in infants,—is quickly relieved by it. Nervous Headache,—is often well treated by the Valerianate of Ammonium in 10-grain doses, administered in the form of an elixir. Hypochondriasis,—especially at the climacteric period, with flatulence. Coughs of nervous type, and Whooping-cough,—it is often efficient. Diabetes Itisipidus,—Valerian is more than palliative; in large and increasing doses it is reported as having frequently proved curative. Convulsions due to worms,—Valerian is doubly indicated. Delirium, with depression of the vital energies,—it is very beneficial. Coma of Typhus,—the Oil was remarkably successful in 135 cases out of a series of 172 treated by it. SERPENTARIA,—Virginia Snake-root. Source and Composition. The root of Aristolockia Serpentaria, and Aristolochia reticulata, plants of the nat. ord. Aristolochiacese, indigenous to the United States. It contains a Volatile Oil, a Camphor-resin, and Aristolo- chine, a bitter principle, soluble in both alcohol and water. Preparations. They should be of the fresh root. Extr. Serpentaria Fluid., rrbx-xxx. Tinctura Serpentaria, % ss- 3 ij. Tinctura Cinchona Composita, 5 j- g ij;—has 2 parts of Serpent, in 100. Physiological Action. Serpentaria is a stimulant tonic and expectorant, also a cardiac stimulant, as well as diaphoretic, diuretic, emmenagogue, aphro- disiac, and somewhat antiperiodic. Its taste is warm and pungent, its odor characteristic. Small doses promote appetite and digestion, increase the bronchial and intestinal secretions, the action of the heart, the cutaneous cir- culation, and the surface temperature; and produce considerable mental ex- hilaration. Large Doses are irritant, causing nausea and vomiting, vertigo and headache, with colic, borborygmi, rectal tenesmus, flatulent distention, and frequent but not watery stools. The irritant action seems to produce gas rather than fluid. Itching of the anus and hemorrhoids are occasionally caused by its use. 124 CEREBRAL EXCITANTS. Therapeutics. Serpentaria is chiefly used as a vehicle for other stimulant drugs, but has many uses of its own. In— Bronchial Affections, it is exceedingly valuable as a stimulant expectorant, and may be combined with other expectorants. Pneumonia of typhoid form,—it is a good vehicle for Ammonii Carbonas. Exanthemata, when depression exists,—it is a good stimulant. Typhoid Conditions generally,—Serpentaria is well indicated. Amenorrhasa of anaemia and chlorosis,—it is a useful emmenagogue. Functional Impotence,—it will often restore the waning sexual power. Remittent Fever,—as a vehicle for Cinchona it acts well. Bilious Vomiting,—it checks the nausea and settles the stomach. Diphtheria, Scarlatina, etc.,—An Infusion is excellent as a gargle. Source and Composition. The flowering tops of the female plant of Cannabis Sativa (nat. ord. Urticacese), grown in the East Indies. It contains a resin named Cannabin, and a volatile oil, from the latter of which are ob- tained Cannabene, a light hydrocarbon, and Cannabene Hydride, a crystalline body. CANNABIS INDICA,—Indian Hemp. Cannabis Americana, which was official iij the U. S. P. 1880, is the same plant, grown in the Southern States, and is specifically identical with the Indian plant, but of much less powerful action. Cannabis should not be confounded with the so-called “ Indian or Canadian Hemp,” which is Apocynum Cannabinum, an entirely different plant, having diuretic properties, but no others of marked character. Preparations. Extractum Cannabis Indicce,—Dose, gr. i—j, if active. Extractum Cannabis Induce Eluidum,—alcoholic, and only miscible with aqueous fluids in form of emulsion, otherwise the active resin will separate and float to the top. Dose, n\j-x, but much more may be given without untoward results. Tinctura Cannabis Indicce,—15 per cent. Dose, TT^x-gj. *Cannabini Tannas, Cannabin Tannate,—Dose, gr. ij-x, in pill. Preparations of Hemp commonly used in the East are— Churrus,—an impure resin, obtained by rubbing the leaves together. Gunjah,—the dried lea£ as sold in the bazaars for smoking purposes. Siddhi, Hashish or Bhd/ftg,—an Arabian confection, containing the leaves mixed with aromatics and various fruits. Physiological Action. Cannabis is antispasmodic, analgesic, anaesthetic and narcotic, a cerebro-spinal stimulant, and a powerful aphrodisiac. It in- CANNABIS INDICA. 125 creases intellectual and motor activity, stimulates the vaso-motor nerves, raising the arterial tension, and depresses sensation. Large Doses cause a pleasurable intoxication, during which the traits pecu- liar to the individual are exalted; the ideas follow each other so rapidly as to produce a sense of great prolongation of time, minutes seeming as if hours 01- even days. With this occurs increased sexual desire, great muscular activity, and sensations of double consciousness and enormous dimensions; the sight and hearing are exalted, the pupils dilated, anaesthesia sets in, the reflexes are lowered by stimulation of inhibition (Setschenow’s centre ?) ; and if the dose be a heavy one a cataleptic state is induced. Sleep or coma follows, according to the size of the dose, but death has never been caused by this drug. After-effects are dullness, heaviness, vertigo, headache, and confused thought; but no nausea, no vital depression, or constipation. Repeated use of the drug produces mental weakness and impotence, the result of over-stimulation. It causes a ravenous appetite, and increases the energy of the uterine muscular fibre, but has no power to initiate uterine contractions. Therapeutics. Cannabis was formerly much used as an anodyne and hypnotic, and as an antesthetic during surgical operations. It is out of fashion now, but very useful in— Migraine, or sick-headache,—in which it often prevents the recurrence of the attacks, seeming to act specifically on Ringer’s migraine centre. Neuralgia,—full doses during the attack, smaller doses in the intervals. Uterine Affections, as chronic metritis, subinvolution, menorrhagia, dysmenor- rhoea, etc.,—its powers as an anodyne and stimulant of the uterine muscular fibre render it a very efficient agent. Traumatic Tetanus, Paralysis Agitans,etc.,—large doses are required in order to lower reflex activity. Delirium Tremens,—if any hypnotic be used, Cannabis is one of the best. Dysuria and retention of the urine,—are often relieved by it. In spasm of the bladder and other painful affections of that organ it will be found a most efficient remedy, if administered in full doses. Impotence of functional character,—Cannabis is a very useful remedy and may be well combined with Ergot and Nux Vomica. Gonorrhoea,—it lessens the discharge, inflammation, burning pain and rest- lessness, and allays chordee. The tincture of the American plant is very useful here, being fully as efficient as Copaiba or Sandal, and much more agreeable. It should be prepared from the fresh plant, and given in 3-5 drop doses 3 or 4 times a day, after the subsidence of the acute symptoms. Insomnia, especially that of acute mania,—the Tannate of Cannabin is rec- ommended as a powerful hypnotic, but not a dangerous one, neither de- 126 turbing the secretions nor leaving unpleasant after-effects, if used in proper dosage, viz.,—gr. ij-x, the average being gr. v. CEREBRAL EXCITANTS. COCA,—Coca, Cuca. Source and Composition. The leaves of Erythroxylon Coca, a small Peruvian shrub of the nat. ord. Linese, also called Cue a. It contains an active, crystalline alkaloid, named Cocaine, which by heat and HC1 Acid is resolved into Benzoic Acid and another alkaloid, Ecgonine;—also a volatile, liquid alkaloid Hygrine, an aromatic oil and Coca-tannic Acid. Dose of the leaves, 3 ss-ij. Coca should not be confounded with Cocoa, a beverage prepared from the seeds of Theobroma Cacao, the Chocolate-tree, for which see page 131. Preparations. Extractum Coca Fluidum, Fluid Extract of Coca,—Dose, % ss—ij. Cocaina Hydrochloras, Cocaine Hydro chlorate,—soluble in of water and in 3/4 °f alcohol. Dose, internally, gr. by hypodermic injection, gr- * Cocaina Oleas, Oleate of Cocaine,—a 10 per cent, solution of the alkaloid in Oleic Acid, for external use. * l-Vines, Glyceroles, Pastes, Lozenges, etc., of Coca,—are sold in great variety. Physiological Action. In small doses Cocaine is a cerebral, cardiac, respiratory and nervous stimulant, and a diuretic. It improves digestion, stimulates respiration, increases the heart’s action, raises the arterial tension, and exalts the irritability of the sensory nerves. It stimulates the brain by increasing its blood-supply, producing wakefulness and marked diminution of the senses of fatigue and hunger. Though decidedly diuretic, it lessens the quantity of urea by checking the processes of waste, thus acting as an indirect nutrient, and enabling the body to maintain its energy on a lessened supply of food. It increases the cutaneous circulation, flushing the surface, exciting perspiration and a sense of heat, and does actually raise the body-temperature. It dilates the pupil, both when locally applied and when taken systemically,— and stimulates intestinal peristalsis as well as the evacuation of the bladder in a few minutes after its ingestion. An overdose produces symptoms of cardiac and respiratory embarrassment in a very short time. The pulse, at first quick and forcible, becomes small, rapid and intermitting;—the heart apparently standing still in systole once in every io or 12 beats. Respiration is slow and shallow, and a sense of “tight- ness ’ ’ about the chest is very marked;—the skin grows cold and clammy, and the subject is seized with a sense of impending dissolution. Death COCA. 127 occurs in animals by paralysis of respiration,—but in man there seems to be a tetanoid spasm of the cardiac muscle, which is equally dangerous to life. Other symptoms are impairment of coordination, hallucinations and delirium. Lethal Doses paralyze the intra-cardiac motor ganglia, the posterior columns of the cord and the sensory nerves, and the respiratory centre. As a Local Anaesthetic the power of Cocaine is very great over a limited area. Applied to such structures as the Schneiderian membrane, mucous covering of the glans penis; or injected hypodermically in other locations, it blanches the structures and causes a profound but temporary anaesthesia throughout a small space. Applied to the tongue it temporarily destroys both taste and tactile sensibility;—to the ocular conjunctiva, it produces profound anaesthesia of that membrane, together with dilatation of the pupil, partial paralysis of accommodation, enlargement of the palpebral fissure, slight lachrymation, and sometimes temporary ptosis. This profound degree of anaesthesia is thought by some to be caused by its paralyzing the terminal twigs of the sensory nerves,—by others to be due to vaso-motor action rendering the nerves bloodless and therefore unable to transmit sensory impressions. It produces mydriasis by stimulation of the ends of the sympathetic in the iris, and does not affect the third nerve or the sympathetic centre. In general action, Cocaine resembles Atropine very closely, especially in its influence upon the pulse and blood-pressure, the respiration, pupils, salivary- and sweat-glands and intestinal peristalsis. In its symptoms, both from large and small doses, it exactly parallels Sparteine, another cardio-inhibitory depressant. Antagonists. Amyl Nitrite combats the earliest symptoms of cardiac depression,—then Alcohol and Opium as stimulants to the heart, also Artificial Respiration. The most direct antagonist is Chloral, so also are Chloroform and Ether. Morphine is also directly antagonistic at almost all points. Therapeutics. Coca-leaves are habitually chewed by the Peruvian Indians, to sustain them during arduous labor. Their example was imitated by Weston, the pedestrian, during his protracted walks. In South America, it is used by 8 millions of people, much as we use tea and coffee. It is useful in— Wasting Diseases, as a stimulant to digestion, and to retard waste. Convalescence from fevers and other acute maladies,—a Wine of Coca. Migraine and Neuralgia, with depression,—it is of real utility. Vomiting of Pregnancy, and vomiting from any cause, it is efficient, even in the vomiting of Yellow Fever ; 6-io-minim doses of a 4 per cent, solution every hour by the mouth. Stomatitis, Gastralgia,—for its benumbing effect on the mucous membrane. 128 CEREBRAL EXCITANTS. As a Local Ancesthetic,—Cocaine has numerous applications, which are being extended more widely every day. It is already a necessity to the ophthal- mologist and the laryngologist, while for minor operations in general sur- gery and to relieve superficial pain, its use is becoming almost universal. In congestions of mucous surfaces it is being freely employed, also as a soothing and antiphlogistic application in skin diseases, to the uterus in labor, hypo- dermically for superficial neuralgise, and locally for itching from any cause. Rhus Poisoning by either the oak or ivy,—is promptly controlled by the appli- cation of a 5 per cent, solution or oleate, freely over the affected surface. It gives instant relief from the burning and itching, and speedily reduces the dermatitis. (Observation by author.) As a Mydriatic for ophthalmological use,—Cocaine has peculiar qualities which make it the most serviceable of the class. The dilatation produced by it is great, is quickly attained, lasts only 12 to 20 hours, is promptly overcome by the application of Eserine, and is not accompanied by much photophobia. The latter is due to the fact that the cocainized pupil is not rigidly dilated, (as with Atropine), but reacts to light. The accommoda- tion, moreover, is greatly reduced, but not entirely paralyzed, and is quickly regained. CAFFEINA,—Caffeine. Caffeine (Theine),—is officially described as a feebly basic, proximate principle, obtained from the dry leaves of Thea Sinensis (the tea-plant), or from the dry seeds of Coffea Arabica (the coffee tree), and also found in other plants. The principles Caffeine and Theine are therefore officially declared to be identical, but their identity with Guaranine is left unsettled. The Caf- feine of commerce is usually obtained from old tea-leaves. It contains more nitrogen than almost any other proximate vegetable principle, and occurs in colorless, flexible crystals, which are soluble in 80 of water and in 33 of alcohol. Dose, gr. j-v. The Coffee-Plant, Coffea Arabica, is a small tree of the nat. ord. Rubi- acere, 15 to 30 feet high, native of South Arabia and Abyssinia, but cultivated in various parts of the world. Its seeds contain Caffeine 0.2 to 0.8per cent, (partly free, partly as a tannate), tannic and caffeic acids, sugar, legumin, etc. By roasting them, part of the caffeic acid is converted into methylamin, the sugar is changed into caramel, and several volatile substances are formed, which give to coffee its peculiar aroma and some of its stimulant qualities, and are collectively known as Caffeone, one of them being called Caffeol. The Tea-Plant, Thea Sinensis, is a native of China and Japan, and a member of the nat. ord. Ternstromiacese. Besides Theine (Caffeine), it also CAFFEINE. 129 contains Tannic Acid and a volatile oil, the latter of which is most abundant in green teas. Preparations. Caffeina Citrata, Citrated Caffeine,—is a very uncertain. mixture, and is not looked upon as a definite compound. Dose, gr. ij-x. Caffeina Citrata Effervescens,—Dose, £j-ij, in a glassful of water. * Extraction Caffece Viridis Fluidum, Fluid Extract of Green Coffee (Squibb), —intended as a substitute for the fluid extract of Guarana. Dose, 3 ss-ij. Physiological Action. Caffeine is at first a stimulant, and subsequently a paralyzant, to the nerve-centres in the cerebrum, medulla and cord. In small doses it quickens the action of the heart and raises arterial tension ; stimulates the cerebral functions, by increasing the supply of blood to the brain; increases the respiration rate and the secretion of urine. Larger doses (gr. v—viij), often over-stimulate the cerebral circulation, causing thereby great heaviness of the head, flashes of light before the eyes, tinnitus aurium, insomnia, restlessness, and even delirium,—the pulse becoming rapid, feeble, irregular and intermittent, and the general body-temperature elevated, though that of the periphery may be lowered. Large doses depress the heart and respiration, and lower the blood-pressure;—in the smaller animals exalting the reflex excitability of the cord and producing tetanic convulsions, and in lethal doses paralyzing the cardiac muscle as well as its motor ganglia, but causing death by paralysis of respiration. It powerfully affects muscular fibre, both voluntary and involuntary kinds, throwing it into a state of tetanic contraction resembling rigor mortis. If administered in sufficient quantity it would doubtless prove fatal to man,—but its lethal dose for him would be very large. Caffeine is excreted unchanged in the bile and urine, and is a reliable hydragogue diuretic ; acting by stimulation of the secreting apparatus in the kidney, as well as by generally raising the arterial tension. (Brunton.) The Qualities possessed in common by these substances, and for which they are so universally esteemed by mankind, are three-fold. They all (i) retard the retrograde metamorphosis of the body-tissues, (tissue-waste);— thereby enabling the work of the individual to be done upon a smaller supply of reparative material, (food), and with less fatigue. Furthermore, when used in moderation, they are all (2) more or less stimulating to the mental processes, and (3) sedative to the nervous system. The Common Stimulant Beverages Compared. This similarity of action they owe to the possession of principles, which, if not iden- tical, are so closely related to each other that until very recently they have been so 130 CEREBRAL EXCITANTS. considered both by chemists and pharmacologists. Their divergence from each other, in the finer shades of their action, depends most probably on the existence in each of differing aromatic and volatile principles, which modify the action of the alkaloid in some degree. Similar principles are developed in them by the various processes of preparation, (as roasting, drying, etc.), all of which have some part in determining the general action of the beverage containing them. Coffee, if used with moderation, assists digestion, promotes intestinal per- istalsis, allays the senses of fatigue and hunger, lessens tissue-waste and con- sequently decreases the formation and excretion of urea (?). Used to excess it disorders digestion, and causes functional disturbances of the nervous sys- tem, shown by headache, vertigo, mental confusion, and palpitation of the heart. It increases secretion, blunts sensation, exalts reflex excitability, in- creases mental activity, and may produce insomnia and great nervous restless- ness. It first briefly stimulates the heart and raises arterial tension, but soon depresses both. The wakefulness is usually preceded by a brief period of drowsiness. The brief stimulation of the intellect, consequent on drinking a cup of good coffee, cannot be obtained from an infusion of raw coffee, and is probably due to the volatile constituents developed in roasting. Caffeone opposes Caffeine in its action on the circulation, as it quickens the pulse and lowers arterial tension. Its action, however, is of brief duration, and soon gives way to the influence of the principal constituent. The Tannin is the ingredient which enables it to produce dyspepsia, and is most abundant in those infusions which are kept a long time on the stove before being served. The green bean produces very different effects from those of the roasted one, exhibiting the action of Caffeine alone, unmodified by that of the empy- reumatic products. A tincture of green coffee, besides being an efficient diuretic, has marked anti-lithic powers, and promotes the elimination of the poison of gout from the system. Tea is the most refreshing and stimulating member of the group. Used to excess, it powerfully affects the stability of the motor and the vaso-motor nerves, the action of the heart, and the digestive function,—producing flatu- lent dyspepsia, tremulousness of the limbs, pallor of the surface, irregular cardiac action, and feeble impulse, hallucinations, nightmare, anorexia, head- ache, nausea and vomiting, obstinate neuralgisc—especially of the supra- orbital and occipital nerves ; also constipation, and a pain in the left side are not infrequent. The condition of chronic tea-poisoning is termed “ Theism,” —and is very often seen among women of the lower class in cities, who do not indulge in alcoholic beverages, but freely accept the dominion of the “ cup that cheers ” and worse than inebriates. CAFFEINE. 131 Mate [Ilex Paraguayensis, Paraguay tea), is supposed to be intermediate in its effects between tea and coffee. It also contains Caffeine, in the propor- tion of 1.2 per cent. Guarana (Paullinia Cttpana of Brazil), contains an alkaloid—Guaranine, in the proportion of 5 per cent., which is probably identical with Caffeine, though some think it more analogous to Theine. It is especially noted for relieving a nervous headache, for which purpose the official fluid extract may be used in doses of three or four times daily, when the basis of that preparation happens to be of good quality. Coca, or Cuca, (Erythroxylon Coca, see page 126), is more sustaining and less of a direct stimulant, than either tea or coffee. The proportion of Cocaine in the leaves varies greatly in different samples, as they occur in commerce. Cocoa (Theobroma Cacao, the Chocolate-tree), is more directly nutritious than any of the group, containing a large quantity of fat, Oleum Theobroma (cacao-butter), which makes it difficult of digestion to many persons. Its alkaloid, Theobromine, is closely allied to Caffeine, the latter being considered a Methyl-theobromine. The various preparations of this agent are made from the seeds, after the oil has been expressed from them. They are ground in a mill, mixed with rice, barley, sugar, flour, etc., and put up in powdered form, called Cocoa,—but if flavored with vanilla and pressed into a cake, the product is Chocolate. The thin husks which envelope the seeds are known as “Shells,” and are used to make a beverage similar to but milder than cocoa or chocolate. Therapeutics. Although without a very extensive range of usefulness, Caffeine is a valuable stimulant in many forms of nervous and cardiac depres- sion, and has proved especially efficacious in— Headaches of neuralgic or nervous type, the pain being general over the head,— gr. j of Caffeine every half hour, or the fluid extract of Guarana, in 20-minim doses every 2 or 3 hours. Choleraic Diarrhoea, and that of phthisis,—it checks outward osmosis by stimulating the depressed nervous apparatus. Dropsy, cardiac and renal,—Caffeine as a diuretic and cardiac stimulant. Cervico-brachial Neuralgia,—Caffeine hypoder., gr. j, increased to gr. v. Lithcemia and Gout,—a tincture of the green bean has marked diuretic and antispasmodic powers, and is very useful in these conditions. Insomnia of chronic alcoholism,—gr. ]/2 of Caffeine hypodermically. Adynamic Fevers,—it may well be used in place of alcoholic stimulants. 132 CEREBRAL DEPRESSANTS. Intermittents,—Coffee has a curative reputation among the inhabitants of the Philippines, which is corroborated by the Dutch physicians. Asthma,—if not used habitually, Coffee is valuable in the paroxysm. Opium Narcosis,—Caffeine hypodermically, or better still, strong black coffee, to antagonize the increasing torpor of the nervous centres. Neuralgia of any kind, cervico-brachial, sciatic, etc.,—Theine, in doses of gr. to gr. y2 hypodermically, is efficient, and may be kept up as long as required. To make a cure, however, the nutrition of the nerves must be attended to. Loco7notor Ataxia, Lumbago, etc.,—Theine has been used with prompt benefit, in the same manner, promptly relieving pain, without producing any nar- cotic effect. (Mays.) CEREBRAL DEPRESSANTS. An Alcohol is a volatile organic compound of an organic radical and Hydroxyl (HO), contains no N, has a great affinity for water, and reacts with acids to form H20 and Ethers. Alcohols are therefore analogous to the metallic hydrates, and Ethers to metallic oxides or salts. ALCOHOLS and ALDEHYDES. An Alcohol is obtained by distillation from the fermented product of grape-sugar, or some substance (as starch) easily converted into grape-sugar, which in the presence and by the growth of certain low vegetable organisms (the yeast plant, etc.) splits up into Alcohol and C02. It may also be made synthetically by shaking Olefiant Gas (C2H4) with strong Sulphuric Acid, then diluting and distilling. C2H4 -)- H20 = C2H60, Ethylic Alcohol. Three most important Alcohols are the following-named, viz.:— Methyl Alcohol, CH3 + HO = CH40, Methyl Hydrate, Wood Spirit,—One of the products of its oxidation is Methylal, (see under Chloral). Ethyl Alcohol, C2H5 -|- HO = C2HeO, Ethyl Hydrate, Grain Spirit, the substance commonly styled “Alcohol. ” Its oxidation products depend upon the rate of its oxidation. If very slowly it forms Aldehyde, C2H40,—if more quickly Acetic Acid, C2II402,—if very quickly, as in burning, C02 and H20, which are, in all cases, the ultimate products of its continued oxidation. Amyl Alcohol, C5H14 -)- HO =C5H120, Amyl Hydrate, Fusel Oil, Potato- spirit,—also occurs in the excessive distillation of fermented grain, along with the Ethylic Alcohol. Its oxidation produces ValerianicAcid, CsHj 0O2. ALCOHOL. 133 An Aldehyde is obtained from an alcohol by removing therefrom two atoms of hydrogen, hence its name—Al(coho\)dehyd(rogen&t\im'). Aldehydes lie in chemical constitution between the alcohols and the acids, and have the power of reducing silver salts in darkness, which is shared also by living protoplasm. The principal aldehydes are— Acetic Aldehyde, C2H40, Aldehyde, Ethyl Aldehyde, Ethylidene Oxide,— a colorless, mobile liquid, antiseptic, locally irritant, anaesthetic when in- haled, and a powerful depressant of the respiration, too dangerous for use. Paraldehyde, C6H1203,—a polymeric form of Aldehyde, and a valuable hypnotic,—(See under Chloral). A Ketone bears the same relation to an Aldehyde that an Ether does to an Alcohol,—being an aldehyde in which the hydrogen has been replaced by a radical. The most important Ketone is— Hypnone, C6H5(CO)(CH3), Phenyl-methyl-acetone. A powerful hypnotic, (described under Chloral). Official Preparations of Alcohol. The official alcohol is Ethyl Alcohol, which is represented in the pharmacopoeia by the several preparations known as Brandy, Whiskey, and Wine, as also under the following four forms, viz.:— Alcohol Absolutum, Absolute Alcohol,—is Ethyl Alcohol, containing not more than I p. c. by weight of water, and having a sp. gr. not higher than 0.797 at 59° F. Used in the manufacture of Chlorofonn. Alcohol,—has about 91 p. c. by weight, or 94 p. c. by vol. of Ethyl Alcohol, and about 9 p. c. of water: sp. gr. 0.820 at 590 F. Alcohol Deodoratum, Deodorized Alcohol,—has about p. c.' by weight of Ethyl Alcohol: sp. gr. about 0.816at 590 F. Alcohol Dilutum, Diluted Alcohol,—has about 41 p. c. by weight, or 48.6 by vol. of absolute Ethyl Alcohol, and about 59 p. c. of water: sp. gr. about 0.936 at 590 F. Prepared by mixing together equal volumes of Alcohol and Distilled Water. Spiritus Frunienti, Whiskey,—obtained from the distillation of the mash of fermented grain ; rye, wheat or corn (U. S.), barley (Scotch), and at least 2 years old. Alcohol strength 44 to 50 p. c. by weight; also has Ethers developed by the action of acetic and butyric acids on the alcohol, and traces of fusel oil even in the best. Dose, 3 j— ij. Spiritus Vini Gallici, Brandy,—obtained by the distillation of the fermented juice of grapes, and at least 4 years old. Alcoholic strength 39 to 47 p. c. by weight; also contains (Enanthic and other Ethers developed by age. Pale Brandy is colored by the cask alone ; dark has caramel added. Brandy is often prepared artificially by adding to high wine (Alcohol) Acetic or 134 CEREBRAL DEPRESSANTS. Nitric Ether, Caramel, and Logwood or Catechu for astringency. Dose, Vinum Album, White Wine,—should contain 10 to 14 p. c. by weight of absolute alcohol, and is made by fermenting the unmodified juice of the grape, freed from seeds, stems and skins. California Riesling, Ohio Ca- tawba, etc. Dose, Vinum Rubrum, Red Wine,—is made by fermenting the juice of colored grapes with their skins. It should contain 10 to 14 p. c. by weight of absolute alcohol. Native Claret, Burgundy, etc. Dose, ss-iv. Unofficial Alcoholic Preparations. * Proof Spirit,—contains 49 p. c. by weight of absolute alcohol, with a pecu- liar oil and other foreign matters : sp. gr. 0.920. * Rectified Spirit,—has 85 p. c. by weight of absolute alcohol, and no fusel oil: sp. gr. 0.835. Is often spoken of as “ 56 over proof,’ ’ meaning that to reduce 100 volumes of it to the strength of proof spirit requires 56 volumes of water. *Rum,—is obtained from the distillation of fermented molasses. *Gin,—is distilled from rye or barley, and flavored in Holland with Juniper berries and Hops; in England often with Oil of Turpentine, various cheap Aromatics, Lead Acetate, Zinc Sulphate, Cayenne Pepper, etc. Pure Gin is an efficient diuretic, from the Oil of Juniper contained in it, but it is so rarely obtained pure that other diuretics are better employed. * Vinum Portense, Port Wine,—has 30 to 40 p. c. of alcohol. Is almost im- possible to be obtained pure, being usually made artificially and heavily fortified with Alcohol. * Vinum Xericum, Sherry,—a dry spirituous wine, also generally made to order by the so-called rectifiers; the process being one of slow heating. Has of absolute alcohol from 20 to 35 p. c. * Sparkling Wines, Champagne, etc.,—are sweet, being bottled before fermen- tation has ceased; have 8 to 12 p. c. Alcohol and considerable C02. * Sweet Wines, Burgundy, Tokay, Muscatel, Malaga, Angelica, Madeira, etc., are of low Alcoholic strength, 6 to 7 p. c., unless fortified. *Light Red Wines, Claret, Red Rhine, Concord Port,—have 5 to 6 p. c. Alcohol, Tannic Acid, grape coloring matter, etc. *Dry Acid Wines, Rhine, Moselle, Ohio, Catawba, etc.,—in which fermenta- tion is completed. Alcohol strength 5 to 7 p. c. * Beer, by slow fermentation, yeast falling,—Alcohol 2 to 3p. c. * Ale, by rapid fermentation, yeast floating,—Alcohol 2 to 6 p. c. * Porter, Stout, have much coloring matter,—Alcohol 4 to 6 p. c.. Also— contain extract of malt, C02, lactic acid, salts of potassium and sodium, aromatics, etc. ALCOHOL. *JCumyss,—is obtained by the fermentation of Milk, that of the mare being used in Tartary. It contains from I to 3 p. c. of alcohol, besides sugar, lactic acid, casein, fat, salts, carbonic acid and ethers. Physiological Action.—Alcohol is a cerebral excitant and depressant, and a narcotic poison. It is anaesthetic, antiseptic, and anti-parasitic, a mild counter-irritant, and coagulates albumen by abstracting its water. It is very diffusible, partly oxidized by the organism, partly excreted. In small doses it relaxes the vessels, stimulates the gastric glands, promotes appetite and digestion, lessens the elimination of waste products, (urea and C02), causes a subjective sensation of heat, and slightly raises the body temperature. It briefly stimulates the heart, prolonging its systole and reducing the length of the diastole, and increases the functional activity of all the organs. A portion is oxidized by the organism in 24 hours?), yielding force, which is utilized as nervous, muscular and grandular power. The long-continued use of moderate doses congests the stomach and liver, over-stimulates the gastric glands and the hepatic cells to the production of pathological secretions, causes gastric catarrh and morning vomiting, and impairs digestion. By irritation it sets up hyperplasia of the submucous con- nective tissue (sclerosis), especially in the stomach, brain, kidneys and liver (cirrhosis); produces fatty degeneration (steatosis) of the blood, the arterial walls, and the various organs; and depresses the heart and the arterial tension. Epilepsy, paraplegia, amaurosis and insanity may result from the long-con- tinued use of spirits, Alcohol having an especial affinity for the nervous system. The malt liquors (beer, ale, etc.,) are less prone than the spirituous to affect the brain, but are apt to set up fatty degeneration of the liver and heart. In large doses Alcohol precipitates pepsin and destroys its activity as a ferment, arrests digestion, produces exhilaration, intoxication, hallucinations, delirium, muscular incoordination, depression of the heart, lowered arterial tension and body temperature, abolished reflexes and coma. A Toxic Dose, after a very brief period of excitement, produces insensibility, stertorous breathing, dilated or contracted pupils, complete muscular resolution, and death by paralysis of the heart and respiration. Alcohol is a food within narrow limits ; g iss per diem (?) is the quantity which the adult organism can oxidize ; more than this is a poison, setting up structural changes in the organs, and lowering the resistance power of the body to morbific influences. It has frequently caused an intractable form of phthisis. The very young and the very old bear more Alcohol relatively than the adult. Alcohol has been proven to exist normally in the human organism. 136 CEREBRAL DEPRESSANTS. Morbid Conditions with which Acute Alcoholism may be Con- founded. Apoplexy, opium narcosis, concussion of the brain, and even acute pneumonia. The differential diagnosis is impossible to make in the state of deep coma. The pupils are not a trustworthy indication, as in alcoholism they may be either dilated or contracted. Treatment of Acute Alcoholism. Evacuate the stomach, Ammonia inhalation cautiously, warmth to the extremities, cold affusion to the head, faradism of the muscles of respiration. Milk, black coffee, mucilaginous drinks afterwards. Nutritious, digestible diet in liquid form, and small quantities frequently repeated. Ammonium Chloride, 3 ss in Oj4 of water at one draught, is said to restore the faculties and antagonize stupor. Chloral Hydrate, gr. xxx, well diluted, and repeated at intervals of 2 or 3 hours to pro- cure sleep. Therapeutics. Though decidedly injurious in health, in disease Alcohol is a most valuable remedy in appropriate cases. In— Vomiting of yellow fever, sea-sickness, etc.,—Iced Champagne is useful. Atonic Indigestion of nervous and depressed subjects,—cautiously! Phthisis,—it does good if it promotes digestion and assimilation; otherwise it is very injurious. Cholera Infantum, Diarrhoea, etc.,—Cognac Brandy in full doses. Cardiac Failure,—Brandy in small doses repeated as fast as oxidized. Chloroform Anaesthesia,—g j-ij of Whiskey beforehand, to sustain the heart, and prolong the chloroform narcosis. Poisoning by cardiac depressants and snake-venom,—Alcohol freely, to sustain the heart. In snake poisoning it is given ad libitum. Diphtheria,—Whiskey or Brandy in small doses frequently from the com- mencement, and dilute Alcohol sprayed into the throat, is very efficient treatment. Adynamic Fevers,—Small doses frequently are often of great value. Gonorrhoea,—Niemeyer is said to have done a lucrative business by treating this affection with injections of Tannic Acid in Port Wine. Insomnia from cerebral anaemia,—may be prevented by small doses of some alcoholic stimulant at bed-time. Wounds,—no better dressing than strong Alcohol, to prevent putrefaction and protect the surface by coating it with a coagulum of its own albumen. Bed Sores if threatening,—Alcohol locally, to harden the tissue. Cold from exposure,—may be prevented by a moderate dose of Alcohol, to restore the balance of the circulation and prevent internal congestions, by relaxing the vessels of the periphery. ETHER. 137 EITHER,—Ether. The substance improperly called “ Sulphuric Ether ” or “ Ether” is Elhylic Ether, or Ethyl Oxide, C4H10O, and is a derivative of Ethyl Alcohol, pre- pared by its distillation with Sulphuric Acid, the latter body dehydrating the Alcohol and remaining in the retort. (C2H60)2 — HaO = C4H10O. Properties. Ether is a volatile, colorless, inflammable liquid, composed of about 96 p. c. of absolute Ethyl Oxide and about 4 p. c. of Alcohol contain- ing a little water. Its sp. gr. is 0.725 to 0.728 at 590 F., therefore it is lighter than water, but its vapor is heavier than air, with which it forms a highly explosive mixture. It evaporates speedily in the open air, with the production of cold. When good, it evaporates from the hand, without leaving behind a disagreeable odor. Its odor is strong and characteristic, its taste hot and pungent. It dissolves oils, fats, resins, caoutchouc, most of the organic alka- loids, and many other substances. Dose, internally, gj, in syrup; hypo- dermically, for heart-failure, It is best prescribed as the Spirit of Ether, which mixes readily with water. Other Ethers used in Medicine are— ALther Aceticus, Acetic Ether, Ethyl Acetate,—an inflammable liquid, of ethereal and acetous odor; used in Cologne-water, and Tinct. Ferri Ace* tatis. Dose, ttpx-3 j. *Hydrobromic Ether, Ethyl Bromide,—is not inflammable. Dose, internally and hypodermically, Ttix-gj. *Hydriodic Ether, Ethyl Iodide,—non-inflammable and insoluble in water. Dose, by inhalation, n\,xv. * Nitrous Ether, Ethyl Nitrite, C2H5NOr A solution of this in Alcohol is the well-known diuretic and diaphoretic—Spiritus Adtheris Nitrosi, Spirit of Nitrous Ether, Sweet Spirit of Nitre,—Dose, Tfly-gij. * Sulphuric Ether, (properly so called),—is Ethyl Sulphate, C4H10SO4. Preparations. Oleum ALthereum, Ethereal Oil,—consists of equal vols. of heavy oil of wine and ether. As it occurs in commerce it is usually worthless. Spiritus ALtheris, Spirit of Ether,—Dose, Ether 32y2, Alcohol 67^. Spiritus Adtheris Compositus, Compound Spirit of Ether, Hoffman’s Anodyne, —contains Alcohol 65, Ether Ethereal Oil 2x/2. Dose, rrpv-gj. *Ancesthetic Mixtures,—have Ether 3 parts, Chloroform 2 or I, Alcohol I. Physiological Action. Ether is anodyne, antispasmodic, diaphoretic, and anthelmintic, a cardiac and cerebral stimulant, an anaesthetic, and a nar- 138 CEREBRAL DEPRESSANTS. cotic poison. Administered internally it is one of the most powerful secretion- stimulants known, acting especially on the secretions of the stomach, salivary glands, and pancreas. On the cerebrum and the motor and sensory nerves, its action is similar to that of alcohol, but more prompt and less protracted. It is eliminated quickly, chiefly by the lungs. Inhaled, it produces at first faucial irritation, a sense of strangulation, and cough, then a stage of excitement (cerebral intoxication), in which the face is flushed and the respiration and pulse are quickened. A tetanic convulsive stage generally follows, the face being cyanosed, the muscles rigid, the respi- ration stertorous. This soon subsides, and complete insensibility is established, the muscles being relaxed, and the reflexes abolished. The cerebral functions are suspended, the lower centres in the medulla continuing to carry on the processes of respiration and circulation. If the inhalation be continued these too become paralyzed, death usually resulting from slow paralysis of respira- tion, the heart pulsating long after breathing has ceased. Atropine hypo- dermically is the best antagonist to the toxic effects of Ether. Nitrous Ether is a mild diaphoretic, a carminative, a most efficient diuretic, and a diffusible stimulant. Therapeutics. When diluted with Alcohol, as in the Spirit, Ether mixes readily with Water, and may be administered internally in— Indigestion of Fats, and to aid the digestion of Cod-liver Oil. Gastralgia, Colic, Flatulence, etc.,—the Compound Spirit is admirable. Hepatic Colic,—Durande’s solvent remedy consists of Ether and Turpentine, and is supposed to dissolve hepatic calculi, when given internally. With Opium,—to counteract the drying up effects of that drug. Syncope,—is promptly met by the Compound Spirit. Hysteria, the paroxysms and flatulence,—are quickly relieved by Ether. Cholera, the algid state,—Ether has been well used subcutaneously. Neuralgia,—Ether injected into the vicinity of the affected nerve. Local Ancesthetic by Ether-spray,—affords great relief in neuralgia of super- ficial nerves, lumbago, spinal irritation, chorea ; and in minor surgical operations it is a valuable method, but now displaced by Cocaine. As an Ancesthetic,—Ether is less prompt in action but much safer than Chloro- form, as it never paralyzes a healthy heart. It has its necrology, however, many deaths being reported as undoubtedly caused by it, besides several which occurred some hours after its anaesthesia. Ether should be inhaled in as concentrated a form as possible, and will then produce insensibility in 3 to 8 minutes. If a light be in the room it should be high above the patient. A grate-fire or gas-stove in the vicinity is very dangerous. [Compare the next article.] CHLOROFORM. 139 CHLOROFORMUM,—Chloroform. Chloroform is Methyl Ter-chloride, CHC13, prepared by the action of Chlorinated Lime upon Alcohol. It was discovered by Samuel Guthrie, of Sackett’s Harbor, N. Y., in 1831. Properties. It is a colorless, neutral fluid, practically non-inflammable, soluble in alcohol, ether, olive oil and turpentine, and in 200 of water. Its density and weight are about four times those of air, and its sp. gr. not below X.490 at 590 F. It consists of 99 to 99.4 p. c. by weight of absolute Chloro- form and 0.6 to I p. c. of Alcohol. It dissolves caoutchouc, gutta percha, oils, fats, resins, many of the balsams, and most of the alkaloids. Dose, inter- nally, npij-xx ; by inhalation, mixed with air and repeated until anaesthesia. Preparations. Aqua Chloroformi, Chloroform Water,—a saturated solution, containing one- half per cent. Dose, §ss-ij. Emulsum Chloroformi,—4 p. c. Dose, gj-^j. Spiritus Chlorofor?ni,—6 p. c. Dose HI*-g j, diluted. Linimentum Chloroformi,—30 p. c. in Soap Liniment 70. *Linimentum Chloroformi Compositum, Compound Chloroform Liniment,— Chloroform 1, Oil of Turpentine I, Laudanum *4, Tinct. Aconite Soap Liniment 2 parts by volume. An excellent anodyne application. *Chlorodyne, Chlorodyne,—A secret and very dangerous proprietary prepara- tion, supposed to contain Chloroform, Ether, Morphine, Cannabis Indica, Hydrocyanic Acid, Treacle, etc. Dose, Imitations are prepared by several manufacturing drug-houses, and are sold under the names Chlor- anodyne, Elixir Chloroformi Compositus, etc. A comparison of the pub- lished formulae of ten different samples, shows that they contain Morphine in various proportions, namely from gr. to 8}4 grains in the fluid ;— or, taking the average dose at Tt\xv, the contained quantity of Morphine would vary from gr. T to gr. lf per dose. A similar preparation was introduced into the last edition of the British Pharmacopoeia, under the title Tinctura Chloroformi et Morphine, of which each 10-minim dose con- tains of Chloroform, gr. of a Morphine salt, and of Dilute Hydrocyanic Acid, with other ingredients. * Anesthetic Mixtures. That of Nussbaum has of Ether 3 parts, Chloroform I, Alcohol I. Another, much used, contains of Ether 3 measures, Chloro- form 2, Alcohol I. Action of Chloroform compared with that of Ether. Chloroform is much more irritant to the mucous membranes, and causes violent gastro- 140 CEREBRAL DEPRESSANTS. enteritis if swallowed undiluted. It is less of a stimulant, and more depressant to the heart and circulation. It clots the blood outside the body, making a mass like sealing-wax. In dose of § j internally, it will cause death. By inhalation it is considered much more dangerous than Ether, its vapor requir- ing admixture with p. c. (?) of air to produce amesthesia with safety. Its vapor is less irritant, however, to the air passages, uninflammable, more pleasant, more prompt in action, has a shorter stage of excitement and a more profound narcosis, and does not cause so much vomiting. Its mortality is much greater, being about 1 in 3000, against 1 in 16,000 for Ether, and fatal cases are constantly reported, none of which, however, were in obstetrical practice. The results of the labors of the Hyderabad Chloroform Committee show that both these agents act in the same manner upon the heart and respiration, paralyzing the latter first, but Chloroform acting more quickly and powerfully than Ether in both directions. Prior to this investigation it was taught that death from Chloroform inhalation is almost always sudden, and by cardiac paralysis,—from Ether, slow and usually by paralysis of respiration. Modes of Dying from Anaesthetic vapors, (i) Death may occur early in the inhalation, from sudden paralysis of the cardiac ganglia. Or by a small quantity of Chloroform given for minor operations the cerebral hemis- pheres may be suspended, but not the basal or medullary ganglia, permitting the irritation of a sensory nerve (especially the 5th) to transmit reflex inhibi- tion over the pneumogastric upon the heart, thus arresting the action of its motor ganglia. The state of incomplete anaesthesia is always a dangerous one in which to perform any operation, especially when the 5th nerve is im- plicated therein, as in the extraction of teeth. (2) In the stage of rigidity, from fixation of the respiratory muscles, the blood backing up on the venous side and arresting the heart’s action. (3) In the stage of complete relaxation, by paralysis of respiration; or by paralysis of the tongue, causing obstructed respiration. (4) In the same stage, by paralysis of the cardiac ganglia. (5) From depression of the functions, or shock, in the anaesthetic state, or afterwards. Contra-indications for the use of Anaesthesia. Fatty degeneration or dilatation of the heart, kidney disease, emphysema of the lungs, very enlarged tonsils, tumor of the brain, and chronic alcoholism—particularly the first and last named. Treatment of Dangerous Symptoms. The vapor should be withdrawn and the patient inverted, head downwards, if cardiac failure occurs. Drawing CARBON DISULPHIDE. 141 the tongue forwards, artificial respiration, and faradization of the respiratory muscles, if breathing ceases. Warmth to the body and limbs. Atropine by hypodermic injection. If swallowed, the stomach should be evacuated, and the case treated as one of poisoning by an irritant. There is no chemical antidote. Therapeutics of Chloroform. It is used for the same conditions as is Ether, and is much employed locally in liniments, as a rubefacient and ano- dyne, as in— Rheumatic and Neuralgic Pains of chronic character,—with Oil of Turpen- tine or Camphor, in a soap liniment. See Linim. Chlorof. Comp. p. 139. Cholera,—The Spirit, or Chlorodyne, has been more efficacious in true cholera than any other single remedy. Respiratory Neuroses, as hay fever, spasmodic asthma, reflex cough, etc.—the vapor of gj of the Spirit inhaled from hot water. Sciatica, Tic-douloureux and other neuralgiae of important nerves,—the deep injection of (?) of pure chloroform into the vicinity of the nerve is most efficient treatment (Bartholow). In my only case it caused dangerous local disturbance (H. C. Wood). As an Anaesthetic its use is lessening every year in favor of Ether, except in obstetrical practice and for young children. Its vapor being four times denser and heavier than air, and its effective use requiring not more than 3 ]/2 per cent. (?) of Chloroform vapor, its administration requires most careful management. Dr. Sayre ignores the foregoing rule and always shuts off all atmospheric air, claiming a more complete anaesthesia from a very small quantity (TTLxv—xx) of Chloroform. An ounce of Brandy, and a subcutaneous injection of Morphine, gr. and Atropine, gr. twenty minutes before commencing the inhalation, are means of great utility in sustaining the heart and respiration, and in rendering the anaesthesia more profound. CARBONEI DISULPHIDUM,—Carbon Disulphide. Properties. Carbon Disulphide (CS2) is a clear, colorless, diffusive, neutral liquid, highly inflammable, vaporizes at ordinary temperatures; insoluble in water, but soluble in alcohol, ether, chloroform, and oils. It is an efficient anaesthetic, but of horribly offensive odor. It may be administered in doses of ffbss-j, internally. Physiological Action. Being largely used in the arts, its effects are often seen in the operative class. Its vapor produces headache, vertigo, emaciation, incoordination of movements, and depression of all the special 142 CEREBRAL DEPRESSANTS. senses, with impaired sensation and motility. Inhaled, it excites violent coughing, and produces anaesthesia, characterized by muscular rigidity, but it is a powerful cardiac paralyzant, and hence extremely dangerous as an anaes- thetic. In doses of gtt. iij it produces severe nausea and vomiting, with a sensation of heat in the stomach, and a rapid and weak heart. Therapeutics. It may be used in—Irritable Ulcers,—as a local applica- tion to set up a substitutive inflammation, which replaces the original disease. Gastralgia,—doses of rqss have been serviceable. Gastric Cancer,—it alle- viates the pain. Nausea and Vomiting are relieved by doses. Chloral itself is Tri-chlor-aldehyde, (C2HC130), an unstable, oily, colorless fluid, formed by the action of Chlorine upon Alcohol. Its Hydrate, the official Chloral, (C2HC130 -j- H20), is a white crystalline solid, soluble in Alcohol, Water, and Glycerin, and is decomposed by alkalies into Chloroform and a Formiate of the alkaline base. CHLORAL,—Chloral (Chloral Hydrate). Dose of Chloral Hydrate varies much with individual susceptibility and with the presence or absence of cardiac and pulmonary disease. An average dose for a healthy adult may be placed at gr. xv-xx,—for a child gr. j for each year of age, up to gr. vj. It is best given in Syrup of Tolu, and should be well diluted. Poisonous symptoms have followed the administration of gr. xxx, and in one case after only gr. vijss. When tolerance has been established by habitual use, as much as g iij have been taken daily, for months. Hypnotic Analogues of Chloral. Paraldehydum, Paraldehyde, C6H1203,—is a polymeric form of Aldehyde (C2H,0), obtained by treating the latter with dilute sulphuric acid. It is a pungent fluid, of somewhat unpleasant odor and taste, soluble in 8)4 of water, and miscible, in all proportions, with alcohol, ether and oils. It is a reliable hypnotic, fully equal to Chloral, but of shorter action, requiring more frequent repetition to produce sustained sleep. It is unquestionably safer than Chloral, as in medicinal doses it slows and strengthens the heart, and leaves no unpleasant after-effects, except a disagreeable odor to the breath. In very large dosage it is paralyzant to both heart and respiration. It occasionally causes an erythematous eruption, and may give rise to cerebral congestion and vaso-motor paralysis, if used for any long period. Dose, n\xxx~3 ij in water, syrup, etc.,— 3 j being about the average hypnotic dose for an adult. CHLORAL. 143 * Chloral Butylicum, Butyl-chloral Hydrate, Croton-Chloral, C4H5C130- -)-H20,—is a crystalline body formed by acting on Aldehyde with Chlorine. It is sparingly soluble in water, (1 in 100), but is readily so in glycerin (1 in 4). In action it closely resembles Chloral, but is feebler, less depressant to the heart, and generally less poisonous, but more disagreeable to the taste. It is said to specifically affect the fifth nerve, and to cause anaesthesia over its distri- bution long before producing general anaesthesia (Leibreich ). Dose, as hyp- notic, gr. v-xx. * Chloralamid, Chloral Formidate,—is a union of Chloral Anhydride with Formamide, occurring as colorless crystals decomposed in hot or warm solutions, soluble in 20 of water and in l |- of alcohol. Dose, gr. x-xlv; an average adult hypnotic dose being about 30 grains, given in a little brandy and water. Is a proprietary drug, having been patented and trade-marked, wherever possi- ble, by its manufacturer, Schering, of Berlin. * Urethan, Ethyl Carbamate, NH2C02C2H3,—occurs in crystals which are readily soluble in water, with scarcely any taste or odor. It is devoid of irritant action, and may be administered hypodermically. It is a pure hypnotic, but not so reliable as paraldehyde or chloral; neither does it affect the circu- lation nor depress (but rather stimulates) the respiration. It acts directly on the cerebrum, causing a sleep which closely resembles the normal, and has no unpleasant after-effects. In very large doses it slows the heart, lowers the temperature, and induces muscular resolution and general anaesthesia. In small animals it effectually antagonizes the action of Strychnine. Dose, gr. xv-3 j, an average hypnotic dose being gr. xxx ; but it is best given in 5-grain doses repeated frequently, as a large dose may cause vomiting. * Somnal,—is a liquid formed by the union of Chloral, Alcohol and Ure- than, occurring as a colorless liquid, resembling chloroform in its behavior with cold water, refusing to mix or dissolve, and forming globules therein. It is soluble in alcohol, in alcoholic solutions and in hot water. Doses of 45 and even 60 minims produced no depression of the circulation or respiration. In doses of 3 ss its action is usually very prompt, the dose is well borne always, easily taken (in a little syrup of tolu or whiskey), and entirely without deleterious effect. The effects are much more striking and certain than those of Urethan, and far less depressing than those of Chloral; and there is no vertigo or de- pression, as may follow the use of Sulphonal. * Sulphonal, Diethyl-sulphon-dimethyl-methane, C7H]6S204,—belongs to the group of Disulphones, and is a white, crystalline substance without odor or taste, very slightly soluble in cold water, more so in warm water, and still more so in alcohol, ether, etc. The dose is gr. xv-xlv, in hot soup or milkj, 144 CEREBRAL DEPRESSANTS. coffee, tea, etc., administered two hours before the effect is desired. Sulphonal is said to have no intoxicant or narcotic action, and no unfavorable effect on the heart or circulation, even in full doses. It is an admirable hypnotic in many cases, but its efficacy decreases with use. * Trional,—differs from Sul phonal only in the substitution of an ethyl for a methyl group, and occurs in lustrous, bitter, tabular crystals, sparingly soluble in water, readily so in alcohol and in alcoholic solutions. It is an efficient hypnotic, less liable than Sulphonal to cause ill effects, but must be given in doses fully as large, gr. xv-xl. A potent objection to its use is the fact that it is patented by its manufacturer. * Hypnone, Phenyl-methyl-acetone, C6H5(CO)(CH3),—a member of the Ketones, (see ante, page 133), occurring above 70° F. as a colorless, mobile liquid, having a strong almond and orange odor. It is insoluble in water or glycerin, and is best given in capsules. It is a hypnotic, of only moderate intensity, but said to be especially useful in the insomnia of alcoholism. Its use is devoid of danger, and leaves behind no unpleasant effects, except a disagreeable odor of the breath, the drug being eliminated by the lungs as well as by the kidneys. In very large dosage it has induced coma, followed by paralysis of the heart and respiration. Dose, rrpv-x, in capsule, Ttpvij to TTLviij being usually required. * Amylene Di-methyl-ethyl-carbinol, C5H120,—a tertiary alco- hol, occurring as a clear, colorless fluid, of peculiar odor, soluble in 8 of water and readily miscible with alcohol. It is one of the most valuable hypnotics, in power standing between chloral and paraldehyde, but being much more agreeable to the taste and safer than either of those agents. Its action is ex- erted chiefly on the cerebrum in doses sufficient to produce profound narcosis ; and in medicinal doses it leaves behind no unpleasant effects, and has no per- ceptible influence on the heart or respiration. By very large dosage the medullary centres are paralyzed, including those governing respiration and cardiac action. Dose, * Methylal, Methylene-di-methyl Ether, CH2(OCHs)2,—one of the products of the oxidation of Methylic Alcohol, occurring as a volatile, mobile liquid of pleasant, aromatic odor and taste, readily soluble in water, alcohol, etc. It is a local anaesthetic, and an efficient hypnotic, producing a deep sleep of short duration, with more or less general anaesthesia and lowered reflex excitability. It is depressant to the heart, respiration and body temperature, but in medici- nal doses does not leave any bad after-effects. Dose, Ttpiv-v, repeated thrice at short intervals. * Hypnal,—is a combination of Antipyrin and Chloral, occurring as taste- less and odorless rhombic crystals, soluble in 6 of water, and credited with CHLORAL. 145 simultaneous action as a hypnotic and analgesic. Dose, gr. xv-xxx in aqueous mixture with some alcohol, flavored with syrup of orange. It is said to cause no gastric disturbance. Although Chloral and Antipyrin are incom- patible with each other, they form, when heated together, the above-described compound, which resembles both and yet differs from each. Hyoscinae Hydrobromas, Hyoscine Hydrobromate,—(see ante, page 116) —is an efficient hypnotic, with the advantage of being tasteless, and having a very small dose, (gr. so that it may be given in tea, coffee, etc. It is apt to affect the head afterwards, and does not soon lose its power by repe- tition. In large doses it is a dangerous respiratory depressant. * Cannabini Tannas, Cannabin Tannate,—(see ante, page 124),—is not more reliable than the Extract of Cannabis Indica, though devoid of the exciting qualities of the latter preparation. Dose, as a hypnotic, gr. ij-x, the average being gr. v. Fronmiiller considers it a very useful hypnotic, powerful and not dangerous, not disturbing the secretions, nor leaving unpleasant after- effects, if used in proper doses. Physiological Action of Chloral. It is essentially a hypnotic, also a depressor of the cerebro-spinal centres, an antispasmodic, antiseptic, antifer- ment, counter-irritant, and prevents the coagulation of fibrin. It is more hypnotic than Chloroform, and less anaesthetic. Used hypodermically it is actively irritant, and produces extensive sloughing of the tissues. The taste of Chloral is hot and pungent; if used in large doses or in strong solutions it may excite gastritis, with nausea and vomiting. After a brief period of stimulation it depresses the heart and arterial tension, diminishes oxidation, and lowers the body temperature. On the brain it has a selective action ; by inducing cerebral ansemia it produces a deep sopor, very like nor- mal sleep, from which the patient may be awakened but immediately falls asleep again, and is not followed by headache or depression. In some persons instead of sleep it causes headache, insomnia and delirious excitement. It is not an anodyne, as it does not affect the conductivity of the sensory nerves, and does not interrupt the transmission of pain, but by overwhelming the centres prevents the consciousness of pain, and is, therefore, only indirectly an ansesthetic. A Large Dose produces profound narcotism, abolishment of the reflexes and of sensibility, and complete muscular relaxation, with a great fall of temperature. Death may result in the chloral sleep, from paraly- sis of the cardiac motor ganglia and the respiratory centre, or by sudden fail- ure of the heart in cases of fatty degeneration, or in old drunkards. The Chloral Habit. Chloralism is a state of marked anaemia, its subjects presenting a weak, irritable, often irregular heart, deranged liver function, 146 CEREBRAL DEPRESSANTS. jaundice, bileless stools, perhaps purpura and sloughing of a finger, from decreased blood supply. Its votaries are on the border of insanity, excitable, uncontrollable in speech and action, talking in a silly manner and very volubly. Many cases of insanity result from the chloral habit. Action of Chloral on the Blood. It diffuses rapidly into the blood, which, being an alkaline fluid, partially decomposes it, setting Chloroform free (?). It crenates the red corpuscles, and in large quantities destroys the leucocytes. It increases the fluidity of the blood, producing an anaemic condition. It is excreted by the kidneys, partly unchanged, but chiefly as Uro-chloralic Acid, producing some diuresis ;—also by the skin, causing various eruptions if long used. Toxicology of Chloral. Atropine antagonizes its cardiac, respiratory and spinal depression, and should be given in small doses, frequently repeated, until its effects are apparent. Morphine given with chloral prevents the ten- dency to cardiac failure, while synergistic to its hypnotism. Chloral is the antagonist to Strychnine, opposing the spinal action of that drug, but the reverse is only true to a limited extent. Chloral and Atropine, though antagonistic in their actions upon the spinal cord, both produce motor paralysis,—the former by paralyzing the cord, the latter by paralyzing the motor nerves. Therapeutics. Chloral is of great value as an hypnotic and antispasmodic, but must be cautiously used, if at all, in persons with weak or fatty hearts, atheromatous vessels, or advanced pulmonary disease. In combination with Potassium Bromide it is much used in asylum practice, and much abused; both drugs are cardiac poisons. It should never be given internally to relieve pain, but it is highly serviceable in— Neuralgia,—if triturated with Camphor and applied locally. Sea-sieiness,—gr. v two or three times a day, generally very efficient. Cholera in the algid stage, and in violent cases of cholera morbus,—gr. xv hypodermically every hour, of extraordinary efficacy. Fevers, when high temperature, excitement, restlessness, and sthenic condi- tion,—Chloral lowers the temperature, prevents the coagulation of fibrin, and is frequently of great utility. Diphtheria,—Chloral in the first stage, but not if weak heart. Obstetrics,—it is used to alleviate suffering, to relax the os uteri, to palliate puerperal convulsions, and to relieve after-pains. Delirium Tremens,—Chloral is much used and is highly efficient. It produces the best sleep in this condition, but is dangerous to old drunkards with damaged hearts. Tetanus,—the best treatment is by Chloral and Potassium Bromide. OPIUM. 147 Cancers and Ulcers,—a 25 per cent, solution locally, as an antiseptic and anodyne application. Tic-douloureux,—Croton-chloral is an efficient palliative, given in 5-grain doses every half hour, up to gr. xxx. Epilepsy,—for nocturnal attacks give Chloral in full dose, at bedtime. Strychnine Poisoning— Chloral is the antagonist par excellence. OPIUM,—Opium. Nature and Source. The concrete, milky exudation, obtained by incising the unripe capsules of Papaver somniferum, the white Poppy, an annual herb of the nat. ord. Papaveracese. In its normal, moist condition, it should yield not less than 9 per cent, of Morphine, when assayed by the official process. It contains 17 alkaloids, 2 neutral bodies, 2 organic acids,—also wax, gum, sugar, resin, extractives, odorous principles, etc. The six principal alkaloids of Opium are— Morphina, Morphine, Dose, gr. ;—hypnotic, anodyne and narcotic. Codeina, Codeine, Dose, gr. 1-j;—calmative, and less constipating. *Thebaina, Thebaine,—a tetanizer; not used medicinally. *Narceina, Narceine, gr. '/&-% probably the most hypnotic of the six. * Pap averina, Papaverine ;—action doubtful, narcotic and convulsant (?). *Narcotina, Narcotine, Dose, gr. j-v;—wrongly named, having no narcotic action ; is a tetanizer and highly antiperiodic. These principles are combined in the plant with Meconic and Lactic Acids. A Derivative of Morphine, obtained by the action of HC1 acid, is— Apomorphina, Apomorphine,—an artificial alkaloid and a powerful emetic; the Hydrochlorate of which is official, and may be administered in doses of gr- l/% by stomach, or gr. y hypodermically. Preparations of Opium. The principal are— Opii Pulvis, Powdered Opium. Dose, gr. }£-\) ;—gr. j is a medium dose. Extractum Opii,—has 18 per cent, of Morphine. Dose, gr. %-]■ Tinctura Opii, Tincture of Opium, (Laudanum),—Opium strength io p. c. (gtt. xxij) about equal gr. j of Opium, or gr. ]/(, of Morphine Sulphate. Dose, rt\v-xxx, as per effect desired. Tinctura Opii Deodorati, Tincture of Deodor- ized Opium. Vinum Opii, Wine of Opium (Sydenham’s Laudanum). Acetum Opii, Vinegar of Opium (Black Drop). All have Opium, strength io p. c., and Dose as the tincture. 148 CEREBRAL DEPRESSANTS. Tinctura Opii Camphorata, Camphorated Tincture of Opium, (Paregoric),— has nearly gr. j of Opium in 3 ss, therefore only the strength of the tincture. Dose, for an infant, TlLv-xx,—for an adult, 3 j-iv. * Tinctura Opii Composita, Compound Tincture of Opium, Squibb’s Diarrhoea Mixture,—has Tinct. Opii, Tinct. Capsici, Spt. Camphorae, aa §j, Chloro- formi Purif., g iij, Alcoholis, ad Dose, for infants, gtt. j-x; for chil- dren, gtt. x-xxx ; for adults, g j. Emplastrum Opii,—Ext. of Opium, Burgundy Pitch and Lead Plaster. Pilules Opii,—each pill has gr. j of powdered Opium with Soap. Pulvis Ipecacuanhes et Opii, Dover’s Powder,—Ipecac 1, Opium 1, Sugar of Milk 8 parts, triturated to a fine powder. Dose, gr. v—xv. Tinctura Ipecacuanhes et Opii,—intended to represent Dover's Powder in liquid form; has of Tinct. Opii Deod. 100 evaporated to 80, Ext. Ipecac FI. 10, Diluted Alcohol to loo. Dose, TTLv-xx. Preparations of Morphine, etc. Morphince Acetas,—soluble when fresh in 2 y2 of water. Dose, gr. j. Morphines Hydrochloras,—soluble in 24 of cold water. Dose, gr. j. Morphines Sulphas,—soluble in 21 of water and in of boiling water; con- tains about 80 per cent, of Morphine. Dose, gr. a medium adult dose being gr. 14. Pulvis Morphines Compositus, Tully’s Powder,—gr. x contains gr. *4 of Mor- phine Sulphate, with Camphor, Liquorice and Calcium Carbonate. * Tinctura Chloroformi et Morphines, (B.P.),—each 10-minim dose contains of Morphine Hydrochlorate, gr. of Chloroform, TT\jX> of Dilute HCN Acid, with ether, alcohol, oil of peppermint, liquorice, treacle and syrup. Intended as a substitute for Chlorodyne, (see ante, page 139). * Liquor Morphines Sulphatis, Magendie’s Solution,—has gr. xvj of Morphine Sulphate in of Distilled Water, or gr. in Morphine in solu- tion will change to Apomorphine if kept long. * Liquor Morphines Sulphatis, U. S. P., 1870,—has gr. j of Morphine Sulphate to the 2; of Distilled Water. Dose, TTLxxx—§ ss. Codeina, Codeine,—soluble in 80 of water, in 17 of boiling water, and in 3 of alcohol. Dose, gr. ; but gr. >4 has produced alarming symptoms in children. *Codeines Phosphas,—is sufficiently soluble for hypodermic use, I in 20 of water is the usual solution. Dose, as Codeine. Changes in Opium Preparations. The official dried Opium should now contain 13 to 15 per cent, of Morphine, instead of 10 per cent., as required by the Phar. of 1870. The liquid preparations, except Paregoric, OPIUM. 149 are required to be of the uniform Opium strength of 10 per cent, by weight, making the Wine 2 per cent, weaker, the Acetum weaker, and the others y2 stronger in Morphine than formerly. So that, if the former full anodyne dose of Tincture be taken at rtbxxiv, = gr. of Morph. Sulph., the corres- ponding dose under the new system will be Ttpxvj. Tests for Morphine. Nitric Acid produces a blood red, turning orange, then yellow, then disappearing. Ferric Chloride gives a rich blue with Mor- phine, a dark brown with Meconic Acid or any preparation of Opium. Iodic Acid liberates Iodine, which may be tested by starch. Minimum Fatal Dose of Opium. In a child one day old TT\j of Lauda- num was fatal; and in another aged nine months a few drops of Paregoric caused death. In the adult gr. ]/(, of Morphine, or gr. iv of Opium have proved fatal. Treatment of Opium Poisoning. The chief indications are—to evacu- ate the stomach, maintain respiration, and keep up the circulation. Potassium Permanganate, in dose one-half greater than the amount of Morphine in- gested, is said to be a perfect antidote to Opium or Morphine in the stomach. Atropine antagonizes its cerebral action, also its action on the pupil, respira- tion, heart and arterial tension (?), but if given too freely will endanger the case by substituting Belladonna narcosis for Opium narcosis; gr. T|7, hypo- dermically, every 15 minutes, for three doses, is generally sufficient. Strych- nine, Coffee, Caffeine, and Cocame are also physiologically antagonistic to Morphine. Faradization of the chest muscles, cold affusion and artificial respiration are of great value. Flagellation is a very dangerous procedure, from the exhaustion produced ; strong faradic currents are much more effici- ent. Evacuation of the bladder is important, to prevent reabsorption. Physiological Action. Opium is analgesic, hypnotic, diaphoretic, anti- spasmodic, narcotic, also a cardiac and respiratory depressant, after primary brief stimulation thereof. In medium dose (gr. j),—it dries all the secre- tions, except those of the breasts and the skin, the latter being increased; produces dryness of the mouth and throat, arrest of the gastric secretion, retarded digestion and anorexia; stimulates the brain by increasing the blood supply; and does not affect the conductivity of the nerves. The action of the heart is increased, and the arterial tension raised ; the pupils slightly con- tracted ; the mind, at first stimulated, becomes calm; sleep follows, disturbed by dreams; and headache, constipation and some depression result. In Full Dose (gr. v),—it arrests digestion ; causes nausea and vomiting ; greatly increases the sweat; prevents the conductivity of the nerves ; depresses the heart and circulation, impairing oxidation and lowering temperature ; con- 150 CEREBRAL DEPRESSANTS. tracts the pupil by stimulating the motor oculi; causes intense pruritus, espe- cially of the nose; often retention of urine; and soon profound sopor (in some cases coma-vigil, delirium); leaving as after-effects nausea, depres- sion, constipation, vertigo, anorexia, nasal pruritus, fetid pathological secre- tions. A Toxic Dose produces cold, clammy sweat, very slow heart, abolished re- flexes, coma; the pupil minutely contracted, but dilated as the end approaches; and death by suspension of respiration, due to the direct action of the poison on the respiratory centres in the medulla. Post-mortem shows only a wet brain, congested lungs, and engorgement of the venous trunks and the right side of the heart. Morphine and Codeine. As compared with the action of Opium, that of Morphine is more anodyne and hypnotic. It causes more intense pruritus, is less stimulant, less convulsant, less constipating and less diaphoretic. Codeine may be considered chemically a Methyl-morphine, and like all methyl com- pounds has an action similar to that of Curare, viz.—motor-paralyzant. It exalts the spinal cord more than Morphine, and affects the cerebrum less, pro- ducing muscular tremor in excess of sedation. It reduces the urinary sugar in diabetes, and has a selective sedative influence on the pneumogastric. Therapeutics. The chief indications for the use of Opium are—(i) to relieve pain ; (2) to produce sleep; (3) to allay irritation; (4) to check exces- sive secretions ; (5) to support the system; (6) as a sudorific. It is badly borne usually by women and children, and in some persons great nausea and depres- sion follow its use, which may usually be averted by the conjoined administra- tion of Potassium Bromide, Hydrobromic Acid, or Spirit of Ether, with each dose of the opiate used. It is especially valuable in— Pain from any cause except acute inflammation of the brain. Low Fevers when insomnia and low muttering delirium, and to support the system when sufficient food cannot be taken or retained. Irritation of the bronchi, bladder, stomach, as in acute severe vomiting. Peritonitis,—used freely, even to narcotism, it has often saved life. Diarrhoea, Dysentery, Enteritis, etc.,—it is a very efficient remedy. Acute Urczmia,—Loomis urges its use to control convulsions and promote diuresis; large doses required in this condition. Colds and Muscular Rheumatism,—Dover’s powder as a diaphoretic, con- joined with hot drinks and hot foot-baths. Gastralgia,—no remedy equal to Morphine and Bismuth Subnitrate. Colic,—rectal suppositories containing the Aqueous Extract of Opium. Spasm,—Morphine hypodermically in muscular spasm, is efficient. HUMULUS. 151 Cholera Morbus and Dysentery,—gr. y of Morphine with gr. T|ff of Atropine, promptly effective after ingesta removed by an active cathartic. Serous Lnflammation,—the Deodorized Tincture to slight narcotism. Cerebro-spinal Meningitis,—Opium the one remedy if given early, before exudation has set in. Superficial Inflammations,—Opium or Morphine locally, of great value. Diabetes Me llit us,—Codeine or Morphine per orem reduce the sugar promptly, but have little or no effect when used hypodermically. Dyspnoea from any cause is relieved by Morphine, especially that of cardiac disease. “ It gives the power to breathe ” (Huchard). Cardiac Disease, especially aortic stenosis or insufficiency, with dyspnoea, paroxysms of angina pectoris, or signs of cerebral anaemia,—Morphine hy- podermically presents the greatest advantages. Hemorrhages, especially uterine, due to fibroids or cancer,—the influence of Opium on the circulation is invaluable. Contraindications for the use of Qpi uni are—alcoholism, disease of the respi- ratory organs, advanced disease of the kidneys, and some forms of cerebral congestion and cardiac disease. Source and Composition. The strobiles (fruit-cones) of Humulus Lupu- lus, the hop vine, a cultivated climbing plant of the nat. ord. Urticacese. The glandular powder of the strobiles is also official, under the name Lupulinum (Lupulin). Humulus and Lupulin contain a liquid, volatile alkaloid, Lupu- line, also wax, resins, Lupulinic Acid and a Volatile Oil which consists in part of Trimethylamine and Valerol, the latter being changed into Valerianic Acid by long exposure, giving a disagreeable odor to old hops. HUMULUS,—Hops. Preparations. Tinctura Humuli, Tincture of Humulus,—20 per cent. Dose, gj-ij. Lupulinum, Lupulin,—a bright-yellow powder,—Dose, gr. ij—xv. Extractum Lupulini Fluidum,—alcoholic. Dose, vrpx-3 j. Oleoresina Lupulini, Oleoresin of Lupulin,—Dose, gr. ij—v. *Infusum Lupuli, Infusion of Hop, (B. P.),—I in 20. Dose, j-ij. Physiological Action. Humulus is a bitter tonic, a feeble hypnotic, also diaphoretic, anaphrodisiac and astringent. It increases the cardiac action and the cutaneous circulation. After slight cerebral excitement it produces calm, and a soporific disposition. Therapeutics. It is used as a tonic and calmative in— Delirium Tremens of mild form,—a mixture of the fluid extracts of 152 Lupulin and Capsicum is very efficient, and an excellent substitute for Alcohol. Dyspepsia, of atonic form,—Humulus is a very serviceable remedy. Inflammation,—a Hop poultice is a favorite domestic application. Nervous Irritability,—the Fluid Extract of Lupulin as a calmative and hyp- notic ; or the Hop pillow, which exercises considerable influence. CEREBRAL DEPRESSANTS. LACTUCARIUM,—Lettuce. Source and Composition. The concrete juice of Laduca virosa, the acid lettuce, (nat. ord. Composite). It contains Lactucin, a bitter principle ; Laducerin, a neutral substance; Laducic Acid, and other unimportant sub- stances. It is partly soluble in alcohol and ether, and when triturated with water it yields a turbid mixture. Dose, gr. v-xxx. Preparations. Tinctura Lactucarii,—5° P- c- Dose rrpx-^ij. Syrupus Lactucarii,—has 10 p. c. of the tinct. Dose, % j — 3 j. Physiological Action. Lactucarium is feebly hypnotic, sedative and diuretic. It is supposed to act similarly to Opium, but much more feebly, and without depressing after-symptoms. Therapeutics. It is used as a substitute for Opium, and as a remedy for cough. The syrup is best employed as a vehicle for more active agents of the same class. BROMINE,—BROMIDES. Bromum, Bromine,—is a liquid, non-metallic element, having the symbol Br., obtained from sea-water and from certain saline springs ; a dark, brown- ish-red, very volatile liquid, of strong and disagreeable odor. Its solution colors cold starch-water yellow. [Iodine colors it blue.] Bromine is only used by inhalation and locally as an escharotic. Bromides and their Preparations. Potassii Bromidum, Potassium Bromide, KBr,—colorless, cubical crystals, soluble in 1.6 of water, and in 200 of alcohol. Dose, gr. v-3 j. Sodii Bromidum, Sodium Bromide, NaBr,—colorless, monoclinic crystals, soluble in 1.2 of water, and in 13 of alcohol. Dose, gr. v-gj. Lithii Bromidum, Lithium Bromide, LiBr,—a white, granular, deliquescent salt, very soluble in water and in alcohol. Dose, gr. v-xx. BROMIDES. 153 Ammonii Bromidum, Ammonium Bromide, NH4Br,—colorless, prismatic crystals, soluble in I of water and in 30 of alcohol. Dose, gr. v-xxv Calcii Bromidum, Calcium Bromide, CaBr.,,—a white, granular, deliquescent salt, very soluble in water and in alcohol. Dose, gr. v— gj. Strontii Bromidum, Strontium Bromide, SrBr2,—colorless crystals, very de- liquescent, very soluble in water and in alcohol. Dose, gr. v—xxx. Zinci Bromidum, Zinc Bromide, ZnBiq,—a white, granular, deliquescent powder, very soluble in water and in alcohol. Dose, gr. ss-ij. Camphora Monobromata,—see Camphora, page 119. *Bromoformum, Bromoform, Tribromo-methane, CHBr3,—a clear and color- less liquid, of pleasant odor and taste, readily soluble in alcohol and in glycerin. Dose, rr^v-xx. Acidum Hydrobromicum Dilutum,—an aqueous solution containing 10 p. c. of absolute HBr Acid. Introduced into medicine as a substitute for the bromides. Dose, TT^x-^ij. Physiological Action of Bromine. It is an active and painful escharo- tic, a deodorant and an antiseptic, setting free ozone. Its vapor is highly irri- tant to the respiratory mucous membrane and the eyes, producing cough, hoarseness and dyspnoea. Internally, it is an active, corrosive poison, causing violent gastritis, depression and collapse. Physiological Action of the Bromides. They are pre-eminently de- pressants of the cerebral and spinal functions, also alterative, antispasmodic and hypnoticv The Potassium salt is especially a cardiac and muscular para- lyzant. They have a saline taste, and are very diffusible, but slowly elimi- nated. They are decomposed in the blood, and re-formed at the points of elimination (fauces, bronchi, intestines, skin and kidneys), where they irritate the mucous membranes. Continued for some time, they produce severe gastric catarrh. They reduce the number of the respirations, and the heart’s action and force; and though diminishing the calibre of the arterioles, they lower arterial tension. They lessen the activity of the brain cells, producing somnolence; diminish the sensibility of the peripheral nerves, causing anaes- thesia of the skin and mucous membranes., They impair motility and the sexual function, cause great pallor and emaciation, lowered body-temperature, acne on the face and upper extremities, fetid breath, dysphagia, sluggish re- flexes and defective coordination ; and if long continued may even impair the mental faculties, producing hallucinations in some cases, in others melan- cholia with suicidal tendency ; also incompetence of the sphincters and paral- ysis, beginning at the periphery and extending to the centres. The general result of their action is termed “ Bromism,” and is heralded by the acne and 154 lowered faucial sensibility. It is probably due to the sedative influence of these agents on the sympathetic system, causing general anaemia of the brain, spinal cord, sexual organs, and skin. CEREBRAL DEPRESSANTS. Differences in Action between the principal Bromides. Potassium Bromide is the most toxic to the heart and the muscular system, and is the least hypnotic. It contains 66 per cent, of Bromine. Sodium Bromide is the least toxic, but the most hypnotic, and acts most ener- getically on the circulation. It contains 78 per cent, of Bromine. Ammonium Bromide resembles the Potassium salt in action, except that it exerts less influence on the heart and muscular system, and is somewhat more stimulating. Lithium Bromide contains the most Bromine (92 per cent.), and resembles the Sodium salt in action. It has proved better than the others in some cases of epilepsy, and is considered the best hypnotic of the series. Calcium Bromide is an efficient hypnotic, but otherwise not very active. Strontium Bromide is said to be less apt than the others to produce the acne and other results of bromism. Zinc Bromide produces effects generally similar to those of the other bromides, but is violently irritant in large doses. Antagonists and Incompatibles. Vaso-motor stimulants, as Digitalis, Ergot, Belladonna, antagonize many of the effects of the Bromides, but Alor- phine is the most efficient antagonist, especially for the mental symptoms. Nitrous Ether is incompatible with Ammonium Bromide, and Acids and metallic salts are so with all the Bromides. Therapeutics. The Bromides are used as sedatives to the nervous system, to lower reflex activity, to produce sleep, to subdue excitement of the genital apparatus, and to antagonize congestion of the brain. Their use is terribly abused, by patients, nurses, and even by physicians,—as Dr. Hammond well elucidates in his book on Nervous Diseases. They should not be used in anaemic conditions, and never for any length of time without the daily super- vision of a physician. The combination of Potassium Bromide with Chloral is very unsafe in cases where fatty or weak heart exists, both drugs being active cardiac depressants. In— Convulsive and Spasmodic Affections,—the Bromides are very efficient. Epilepsy, especially diurnal seizures,—Sodium Bromide in sufficient quantity to maintain anaesthesia of the fauces, for three or four years. Purgation occasionally, to prevent its accumulation in the system, and Arsenic to antagonize the acne. Diabetes Mellitus,—the Ammonium and Arsenic Bromides in cases of nerv- BROMIDES. 155 ous origin, have proved curative when long used, probably by their sedative influence on the medulla oblongata. Acute Rheumatism,—Ammonium Bromide is an excellent alkali. Muscular Rheumatism,—the Lithium salt gives very good results. Nervous Erethism,—the Bromides are much used, and with good effect. Insomnia with congestion, as from cerebral overwork,—they are useful. Infantile Colic,—Sodium Bromide in five-grain doses, with a little Oil of Anise, is considered excellent. Cholera Infantum,—the Bromides check the vomiting and purging. Vomiting of cerebral origin,—they are extremely useful. Cardiac Irritability, when not due to anaemia,—is calmed by the Bromides. Melancholia,—occasionally the Bromides give great relief. IVhooping-cottgh, and other reflex coughs,—the Bromides as palliatives, or Bromoform in daily doses of 5 to 20 minims, administered in glycerin or alcoholic solutions. Diphtheria,—inhalations of Bromoform have been used successfully. Ozcena and tuberculous and other ulcers of the larynx,—Bromoform locally, as a deodorizer, disinfectant and analgesic. Seminal Losses, if plethora exists,—are well treated by bromides. Nymphomania,—these agents have almost a unique power. Tetanus,—Potassium Bromide is antagonistic in large doses. Subinvolution of the Womb, and Menorrhagia,—the Potassium salt is consid- ered to have specific power thereon. Therapeutics of Bromine. It is not much used. In— Chancre, Hospital Gangrene, etc.,—Bromine locally is the best escharotic. Diphtheria and Membranous Croup,—a solution containing 8 drops to the 3, used internally, and inhalations of the vapor, have been used successfully in the most severe cases. Hydrobromic Acid may be used as an alternate substitute for the Bromides in almost all their affections, except epilepsy. In— Neurasthenia and post-hemiplegic convulsions,—it should entirely supersede the Bromides, being more efficient in these conditions. Coughs of spasmodic and reflex character,—it is excellent, but is best employed in conjunction with other remedies. Tinnitus Aurium and similar subjective noises, whether due to Quinine or Salicylates or not,—are removed by this acid. In Quinine Solutions, n\ij to each grain,—it aids the solubility, and neutral- izes the effects of the alkaloid upon the ears. Cerebral Disturbances of continued fevers,—it does good service ;—also in subjective cerebral symptoms, as “ swimming of the head,” etc. 156 MOTOR DEPRESSANTS. MOTOR DEPRESSANTS. CONIUM,—Hemlock. Source and Composition. The full-grown fruit of Conium maculatum, the Spotted Hemlock, (nat. ord. Umbelliferte), gathered while yet green. It contains a liquid, volatile alkaloid, Coniine,—also Methyl-coniine in varying proportion,—a solid alkaloid, Conhydrine,—a volatile oil, and Coniic Acid. Preparations. The Extracts are usually inert., Extractum Conii, Extract of Conium,—Dose, gr. ij-v-xl. Extractum Conii Fluidum,—Dose, rrpij-v-xl. All Conium preparations are uncertain, the active principle being very vola- tile. Each sample should be tested before fixing on its dose, and should have the characteristic mouse-like odor. *Coniina, Coniine, C8H15N, the active alkaloid,—Dose, rtpyff-iij, or gr. 0. If given hypodermically, it must be neutralized by acetic acid, as shown by the use of litmus paper, otherwise it is too irritant; or the Hydrobromate in solution, gr. viij ad gj,—of this = gr. 14. This salt may be used in doses of gr. gr. j, as it is not actively toxic. * Methyl-Coniine, C8H14NCH3,—affects the action of the plant, but is not used in medicine. Physiological Action. Conium is a gastric irritant, producing nausea and vomiting. The main action of Coniine is that of a paralyzant to the motor nervous system, beginning at the peripheral end-organs and extending upwards, involving the nerve trunks and finally the Methyl-coniine acts similarly but reversely, affecting the centres first; especially those in the spinal cord, causing paralysis of reflex Conium also blunts the com- mon sensibility. Its prominent symptoms are—numbness and weakness of the legs, drooping eyelids, diplopia, slightly dilated pupils, vertigo, impaired utterance, slow and labored breathing, and death by paralysis of the muscles of respiration. The heart is not affected; and the mind is clear until C02 narcosis sets in, but is torpid and indifferent. Socrates was poisoned by the juice of Conium, which was the state poison of the Athenians. As the action of Coniine and Methyl-coniine vary considerably, and as the relative quantity of each alkaloid in the plant also varies, the results obtained from different samples of Conium differ in marked degree, and are often con- tradictory of each other. Toxicology. The antidote is Tannic Acid, which is chemically incom patible. ATux Vomica and its alkaloids, also Picrotoxin and other tetanizers, are antagonistic. Active exercise will antagonize the full development of its toxic action. GELSEMIUM. 157 Therapeutics. Conium is used as a sedative to pain and to correct excessive motility. Large doses are required, as some physiological action is necessary. Children bear it well. In— Chorea,—it palliates by depressing the motor nervous system. Whooping-cough and other spasmodic affections,—it is usefully employed. Acute Mania,—to quiet motor excitement and prevent exhaustion, Coniine, trpss-iij, or hypodermically, rrpT(y, increased until some physiological effects are produced. Morphine given conjointly acts well. Pain and Spasm coexisting,—are well met by Conium. Cancer,—Conium is used locally and internally, to relieve the pain. Tetanus,—for its sedative action, Conium has been much used, but is inefficient. Blepharospastn,—is relieved by it, in 10-minim doses of the fluid extract. Epilepsy, Hyste7'ia, Hystero-epilepsy, and most convulsive disorders,—it is of decided value, and can be given without fear of inducing a drug habit. Source and Composition. The rhizome and rootlets of Gelsemium sem- pervirens, a climbing plant of the nat. ord. Loganiacese, indigenous in the Southern States. It contains an alkaloid, Gelsemine, in combination with Gelsemic Acid, also a volatile oil, and a resin. Dose, gr. ij-xx.^ GELSEMIUM,—Yellow Jasmine^ Preparations. Only two are official, viz^— Tinctura Gelsemii, ttpx— g j. Extractum Gelsemii Fluidum, Ttpij-xxx. * Gelsemina, Gelsemine,—with acids forms soluble Dose, gr. Physiological Action. Gelsemium is an antispasmodic, a diaphoretic and nervous depressant, paralyzing motility and sensibility by central action on the spinal cord. It is also anaphrodisiac. In moderate doses it causes languor, slowing of the cardiac rate, feebleness of muscular action, impaired sensibility, drooping eyelids and dilated pupils, with some diaphoresis*, A Toxic Dose (a teaspoonful of the fluid extract) produces vertigo, diplopia, drooped eyelids, dilated pupils (paralysis of 3d nerve), labored breathing, slow and feeble heart, dropped jaw, staggering gait, great muscular weakness and almost complete general anaesthesia, profuse sweats, loss of articulation, and death by asphyxia (paralysis of muscles of respiration.) „ Consciousness is preserved until C02 narcosis sets in. Convulsions do not occur in man, but do in lower animals, the convulsive movements being backward. Motion is affected before sensibility in warm-blooded animals, sensibility before motion in frogs. Gelsemium, though it lowers the heart rate, is not an arterial depressant, and does not irritate the gastro-intestinal tract* The effects of a moderate 158 MOTOR DEPRESSANTS. dose pass off in about three hours. It produces a decided lowering of body temperature. Antagonists. Morphine is the most complete antagonist, but Digitalis, Ammonia and Alcohol are also antagonistic. Emetics, heat to the body, arti- ficial respiration and faradism of the muscles of respiration are measures of prime importance in poisoning by this drug. Therapeutics. Gelsemium is indicated in conditions of exalted nerve function, and contraindicated when there is weak heart. It is well used in— Cerebrospinal Meningitis,—Tl\y of the fluid extract every 2 hours. Mania, with great motor excitement and persistent insomnia. Delirium Tremens, and many forms of Insomnia,—it is efficient. Pneumonia and Pleuritis,—rqv-x of the fluid extract every 2 hours, to main- tain a physiological effect, give excellent results. If the heart be weak this remedy must not be used. Cough of convulsive or spasmodic character,—it is useful. Neuralgia of the 5th Nerve has been successfully treated by Gelsemium. Remittent Fever,—it usually exercises a very beneficial influence. After-pains,—are frequently suspended by moderate doses of the tincture. Ovarian Neuralgia,—there is no better remedy, in full doses. Dysmenorrhcea,—Gelsemium often greatly alleviates the pain. Irritable Bladder of women, and incontinence of urine from spasm of the vesical muscular fibres,—this remedy is often very efficient. Source and Composition. Curare is a vegetable extract, obtained from various plants (Slrychnos toxifera, Paulinia curare, etc.) of the nat. ord. Loganiacete, and used in S. America as an arrow poison. Its active principle is the alkaloid Curarine, which contains no oxygen. The drug contains no Strychnine, nor any tetanizing principle. *Curare,—Dose, gr. hypodermically. *Curarina, Curarine,—Dose, gr. (j-jf; hypoder., or gr. -fa by the stomach. * Car oval, Vao,—are names of native preparations. * CURARE,—Woorara. Physiological Action. Curare paralyzes the end organs of the motor nerves, but does not at first act directly on the brain or spinal cord; though if life be prolonged by artificial respiration, the cord, sensory nerves, and even the muscular tissues become implicated. The limbs are paralyzed first, death occurring by paralysis of respiration. The heart, at first quickened, becomes depressed, the blood pressure lowered, the eyelids droop, the eyeballs protrude, JABORANDI. 159 vision is disordered, intestinal peristalsis and sensibility to stimuli are greatly increased, an artificial glycosuria (curare-diabetes) is set up, and all the secre- tions are increased, especially the saliva. The absorption of Curare by the stomach is very slow, but its elimination, which takes place by the kidneys, is more rapid and complete than that of any other alkaloid. The urine of a curarized animal will poison another, and that of the second animal will paralyze a third. Actions of Curare, Coniine and Gelsemine. Curare and Coniine paralyze the end-organs of the motor nerves, Gelsemine and Methyl Coniine paralyze the motor centres. Antagonists. Artificial respiration, to maintain life until elimination occurs. Evacuation of the bladder repeatedly is an important measure. Strychnine, though from a member of the same family, is antagonistic as to the effects on the heart and respiration. Therapeutics. Curare is effective in— Tetanus, both idiopathic and traumatic,—injections of gr. repeated hypo- dermically, have proved curative in many cases. In Hydrophobia, Epilepsy and Chorea it has apparently effected cures. PILOCARPUS,—Jaborandi. Source and Composition. The leaflets of Pilocarpus Selloanus and of Pilocarpus Jaboi'andi, Brazilian plants of the nat. ord. Rutacese, containing two alkaloids,—Pilocarpine and Jaborine, which though isomeric are antago- nistic in action ;—also a volatile oil and probably a peculiar acid. Preparations. Extraction Pilocarpi Fluidum,—Dose, rrpv- g j, but generally inert. Pilocarpince Hydrochloras, gr. jq—I - • Hypodermically, gr. may be given. Physiological Action. Pilocarpus is a paralyzer of the vaso-motor sys- tem, and a stimulant of the peripheral terminations of nerves supplying glands and involuntary muscular fibre, subsequently paralyzing the latter. It is there- fore a powerful diaphoretic and sialogogue, a cardiac depressant by stimulation of the vagus ends,—also myotic, emetic, and under some circumstances aborti- facient. Its taste is hot and pungent. It causes prompt and profuse perspira- tion ix-xv, in quantity) and salivation (!| x-xxvij), after a preliminary flushing of the skin. The nasal, bronchial and lachrymal secretions are much increased ; sometimes watery diarrhoea occurs ; the action of the heart, at first increased, is afterwards lowered, the arterial tension is reduced, and the tem- perature falls from 1° to 40. Drowsiness, pallor, chilliness and debility suc- 160 MOTOR DEPRESSANTS. ceed, and last several hours ; the pupil is contracted and accommodation impaired. The elimination of urea is greatly increased, but not the quantity of urine. The respiratory power is lowered, and apnoea may occur, from increase of the bronchial mucus. Pilocarpus is rapidly diffused, and is eliminated by the skin and the salivary glands. Its effects pass off usually in from three to six hours. Children are less affected than adults, by proportionate doses. It causes contractions of the bladder, uterus and spleen, in the latter case whether the organ is enlarged or of normal size. Antagonists. Atropine is a complete physiological antagonist in dose of gr. Ti-0- for gr. J of Pilocarpine. The antagonism extends over their whole range of action, and is the most complete known to physiological experiment- ation. Conversely, the same is true, but Jaborine acts similary to Atropine, and is antagonistic to Pilocarpine. Strychnine, though from a member of the same family, antagonizes the effects on the heart and respiration, and Morphine controls the nausea and vomiting. Artificial respiration, to maintain life until elimination occurs, and repeated evacuation of the bladder, are important measures in poisoning by this drug. Therapeutics. Pilocarpus is well used in— Ptyalism—a minute dose of Pilocarpine (gr. acting on the same gland will antagonize the morbid action and relieve the excessive secretion (Bartholow, Piffard). Perspiration of profuse character is checked by gr. A- of Pilo- carpine given thrice daily (Ringer). Diphtheria and Erysipelas,—are diseases in which it proves efficient, but in which its depressant action on the heart must be remembered. Amblyopia from alcohol and tobacco, keratitis, choroiditis, chronic iritis, de- tached retina, and many other eye affections,—Pilocarpus is very beneficial. Pleuritis, Meningitis and other inflammations of serous membranes,—it is re- markably efficient in removing exudations. Dropsy is its chief field of action, especially renal dropsy; but it is contra- indicated when the heart is weak from any cause. Diabetes Insipidus,—it reduces the quantity of urine remarkably, relieving the kidneys by throwing the work on the skin. Agalactia,—Pilocarpus promptly stimulates the secretion of milk. Uraemia and Puerperal Eclampsia of renal origin,—it has been used with marked success. Parotitis is promptly relieved by it. Bright's Disease,—Pilocarpine has been used with great advantage in both the acute and chronic forms, but is so depressing that it must be employed with extreme caution in this disorder. MUSCARINE. 161 Source and Composition. It is an active toxic alkaloid of syrupy con- sistence, from Agaricus muscarius, (Amanita muscaria), the fly-agaric, a poisonous mushroom, used in Kamschatka as an intoxicant. The alkaloid is freely dissolved out by water and dilute acetic acid, so that a doubtful fungus may be easily rendered innocuous. Its formula is C5H15N03. *Muscarina, Muscarine,—Dose, gr. ij. *Muscarince Nitras, Dose, gr. Jg—|. * MUSCARINA,—Muscarine. Physiological Action. Muscarine is a powerful respiratory and cardiac depressant, paralyzing the respiratory centre, and arresting the heart in dias- tole by paralyzing the cardiac muscle while stimulating its inhibitory appara- tus. It lowers the arterial tension, produces profuse salivation and sweating ; contracts the pulmonary vessels, causing intense dyspnoea ; and increases the intestinal, hepatic and pancreatic secretions, but markedly diminishes the renal. It disturbs the gastro-intestinal tract, causing severe colic, vomiting and purging. It produces spasm of the accommodation, and marked myosis, contracting the pupil when given internally, but dilating the pupil widely when locally applied. (Gelsemium does so also.) Under its action the body tem- perature is decidedly reduced, and the excretion of waste-products lessened. On the cerebrum Agaricus acts as an intoxicant, producing more vertigo and delirium than Alcohol, followed by profound sopor with lowered reflexes, perhaps coma and death. Antagonist. Atropine exactly opposes Muscarine, and vice versa ; no example of physiological antagonism being so complete in all particulars. When a frog’s heart is arrested by the topical action of a minute quantity of Muscarine, the application of a little Atropine will immediately restore the pulsations (Ringer). An equally prompt antagonism runs through their entire spheres of action. Therapeutics. Clinical experience with Muscarine is wanting. It has been used with considerable benefit in— Night-sweats of Phthisis,—in which it is found extremely efficient. Chorea,—Agaricus has proven a potent remedy in the idiopathic form. Ataxic Typhus, with great restlessness and tremor, a tincture of Agaricus in drop doses has often been effectively employed. Chilblains,—have been cured by the same preparation, locally applied. Inflammations characterized by copious exudation,—Muscarine promises to be of great service, especially in Eye Inflammations with exudation,—as it permits of the contraction or dilatation of the pupil at will, according as it is used internally or locally. 162 MOTOR DEPRESSANTS. Constipation due to torpor of the intestines and deficient secretion, accom- panied by a torpid liver and difficult digestion of fats,—Muscarine is ex- actly indicated in doses of gr. thrice daily. Catarrhal Jaundice, and Diabetes of both forms,—are conditions in which Muscarine promises to be of especial service. Source and Composition. The seeds of Physostigma venenosum, (nat. ord. Leguminosse), a woody creeper of Calabar, West Africa, where it is used by the natives as an ordeal for witches, etc. It contains an alkaloid, which is variously named Eserine, Calabarine and Physostigmine,—also albuminous matters, starch and oil. ■'v PHYSOSTIGMA,—Calabar Bean. Preparations. Extractum Physostigmatis,—alcoholic. Dose, gr. J-jt Tinctura Physostigmatis,—15 per cent. Dose, rqv-xx* Physostigmince Salicylas,—Physostigmine (Eserine) Salicylate,—bitter crys- tals, soluble in 150 of water and in 12 of alcohol. Dose, gr. xire-sV Physostigmince Sulphas,—Physostigmine (Eserine) Sulphate,—a bitter pow- der, deliquescent, soluble in water and in alcohol. Dose, gr. xffinV * Lamellce Physostigmina;,—Disks of Physostigmine (B. P.),—Medicated disks, used locally on the eye, each containing gr. xtjtnr- Physiological Action. Physostigma is a muscular stimulant and a direct spinal paralyzer, producing complete general paralysis, and abolishment of the reflexes, but does not affect muscular irritability or the brain. It stimulates secretion, excites nausea and vomiting; and is laxative by stimulating the muscular coat of the intestines, as well as by increasing the intestinal secre- tions. It first lowers, then raises the arterial tension; increases the heart- beat in frequency, but depresses the power of the cardiac muscle, though not destroying it. It produces dyspnoea by a tetanic action on the respiratory muscles, causing C02 poisoning, and death by paralysis of respiration. It contracts the pupils (how, is disputed) and the ciliary muscle, producing marked myosis. It is eliminated chiefly by the kidneys, the urine of the ani- mal affected poisoning another.. Antagonists. Atropine as to the respiration, heart and pupil. Chloral is also antagonistic, but to be effective must be administered some time before the ingestion of the Physostigma. Therapeutics. Physostigma has but a small field of action. In— Constipation, due to torpor of the bowels,—combined with Belladonna and Nux Vomica, it is sometimes very effective. 163 Tetanus,—it has been used with great advantage to diminish reflex excitabil- ity ; grain doses of the extract repeated every two hours. Progressive Paralysis of the insane—this drug seems to retard it* Strychnine and Atropitie Poisoning,—Physostigma is antagonistic. Eye Diseases, Physostigmine (Eserine) is now used by ophthalmologists for. almost every indication, just as a few years ago they used its exact antagon- ist—Atropine. It is useful to break up or prevent adhesions of the iris, to relieve tension, to prevent suppuration after operations, as well as to con- tract the pupil and the vessels of the eye, thereby relieving pain and pho- tophobia. ACONITE. Source and Composition. The tuber of Aconitum Napellus, a perennial plant of the nat. ord. Ranunculaceae, (Monkshood), found in mountainous regions. Its active principle is the alkaloid Aconitine, which it contains in the proportion of .03 per cent., together with Aconitic Acid. Other varieties of Aconite are said to contain several other principles, concerning which the authorities are much divided, viz.—Napelline, Aconine, Pseudaconitine, Lyctonine, etc., but it is generally conceded that Aconitum ferox, from Nepaul, contains Pseudaconitine, which is much more active than Aconitine; —also that a Japanese variety contains an alkaloid which is more powerful than even Pseudaconitine. ACONITUM,,—Aconite. Preparations^ Extractum Aconiti, Extract of Aconite,—Dose, gr. / Extractum Aconiti Fluidum,—alcoholic. Dose, Tindura Aconiti, Tincture of Aconite,—strength 35 per cent. Being a prep- aration of the root, it is about 25 times more powerful than the former tincture of the leaves, which is still to be found in the shops. Fleming’s Tincture has 79 per cent., the Br. 16, the French 20, the German 101 so that great care must be used not to mistake one for another,* Dose, Ttbss-iij. *Aconitina, Aconitine,—Dose, gr. difficult to obtain of constant strength, some samples being all but inert, others extremely active. The “Aconitine Cristalisee” of Duquesnel (a Nitrate of Aconitine, Squibb), is considered the most active of the samples in the market. *Oleatum Aconitine, Oleate of Aconitine,—2 per cent., for external use. *St. Jacob's Oil,—is a weak Aconite Liniment which also contains Ether, Alcohol, Turpentine, red coloring matter, and Water (Squibb Physiological Action. The taste of Aconite is bitter, acrid, and pun- gent. Soon after the ingestion of even a small quantity, a sensation of numb- ness and a persistent tingling are felt in the tongue and lips. Full medicinal doses cause a sense of constriction in the fauces, irritation of the gastrointes- tinal mucous membrane, with increased secretion sometimes nausea and vomiting, and severe pains in the joints and muscles; always more or less salivation, diaphoresis and diuresis, reduced respiratory power, decreased car- diac rate and force, lowered arterial tension and A Toxic Dose produces great muscular weakness, dimness of sighjjjJilated (sometimes con- tracted) pupils, shallow, irregular and labored respiration, a slow and weak pulse, coldness of the surface, clammy sweat, great anxiety, numbness and tingling in the extremities ; lowering of the body temperature (20 to 3°)1 abolishment of sensation, reflexes and motility; and finally deafly from paralysis of the heart and respiration, with or without convulsions, consciousness being preserved until near the end, when CO,2 narcosis sets inv Aconite is a powerful sensory, cardiac, respiratory, and spinal depressant, also diaphoretic, diuretic and antipyretic. It chiefly affects the peripheral ends of the sensory nerves, but paralyzes both motor and sensory nerves,— the sensory being affected first and from the periphery inwards, while the motor nervesareaffected from the centres outwardsjT~lt relaxes tlfe inhibitory apparatus of the heart, and paralyzes Jlie cardiac its contained ganglia, the respiratory centres and the spinal cord in all its functions, (sen- sory, reflex and motor), but does not affect the brain. Aconite is rapidly diffused and slowly excreted ; the effects of a full medicinal dose continuing for three or four hours. Applied externally it paralyzes the sensory nerves of the part, producing its characteristic numbness and tingling. 164 MOTOR DEPRESSANTS. Toxicology. Caffeine, Atropine, Morphine, Ether, Ammonia and Amyl Nitrite antagonize its effects on the heart and respiration. Digitalis counter- acts its heart action and the relaxation of cardiac inhibition. (See ante, page 106.) In aconite poisoning, the stomach should be evacuated, warmth applied to the extremities, stimulants administered, artificial respiration if neces- sary, and the recumbent posture strictly maintained. Therapeutics. Aconite antagonizes the fever process, and rightly used is, therefore, one of the most valuable drugs we possess. It has been called the “ therapeutic lancet,” and certainly is responsible to a great extent for the dis- use into which venesection has fallen. Its power over the circulation, respira- tion and transpiration renders it of the greatest value in all affections character- ized by high resisting pulse, dry, hot skin, and elevated body-temperature. It is especially useful in— PULSATILLA. 165 Acute Throat Affections, as tonsillitis, pharyngitis, etc.,—drop-doses of the tincture every hour are remarkably efficient in these conditions. Acute Inflammations of the Respiratory Organs, as bronchitis, coryza, pneu- monia, etc.,—Aconite is efficient in the early stage, when there is present a sthenic febrile action, with high temperature. Acute Pleuritis and Peritonitis, previous to the stage of effusion,—Aconite combined with Opium is considered to be the best treatment. Simple and Eruptive Fevers, particularly scarlet fever and measles,—are best treated by small repeated doses of Aconite, which in measles is particularly efficient from its power to arrest the catarrhal pneumonia. Puerperal Fever,—Aconite steadily used, with an occasional dose of Castor Oil, is one of the best agents in the metritis form of this disease. Surgical Fever is promptly met by Aconite, which is especially useful in preventing chill after the passage of the urethral sound or catheter. Erysipelas Faciei,—Aconite is highly serviceable, and usually curative. Acute Rheumatism,—has been extensively treated with Aconite, and always with the best results. It lessens the duration of the fever, mitigates the pain and swelling of the joints, and prevents the occurrence of organic heart disease, if used from the commencement (Phillips). Cardiac Affections characterized by over-action or hypertrophy, without valvu- lar lesions,—are benefited by Aconite in small doses repeated. Diarrhoea and Dysentery, from cold or exposure,—Aconite is unquestionably beneficial. It also relieves Constipation in patients of plethoric habit, with dry, hot skin, and a feverish tendency. Menstrual Suppression from chill,—Aconite often relieves promptly. Neuralgia, especially of the face or brow,—Aconite is very efficient, having a selective influence on the 5th nerve. It may be used internally and also applied locally over the seat of pain ; for the latter purpose a reliable Aconi- tine should be used, mixed with Chloroform and Oleic Acid, the Chloroform aiding the inward osmosis of the drug. PULSATILLA,—Pasque-flower. Source and Composition. Pulsatilla is the herb, collected soon after flowering, of Anemone Pulsatilla and Anemone pratensis, small, herbal plants of the nat. ord. Ranunculacece, to which Aconite also belongs. They inhabit Europe and Siberia, have large, purple flowers, and though inodorous are very acrid, containing an acrid, yellow oil, which in the presence of water is gradu- ally changed into Anemonin, which is a volatile camphoraceous principle, and Anemonic Acid, which seems to be inert. 166 MOTOR DEPRESSANTS. Preparations. The herb is alone official, but a tincture may be made according to the pharmacopoeial directions for Tinctures of Fresh Herbs, which may be used in doses of tt\,TV-x. *Anemoninum, Anemonin,—Dose, gr. in pill. Physiological Action. Pulsatilla is a paralyzer of motion and sensation, a gastro-intestinal and cutaneous irritant, a cardiac, respiratory, and spinal depressant. It dilates the pupil, produces diaphoresis and diuresis, and is believed to possess emmenagogue power. Locally applied it produces numb- ness and tingling in the part, and may even excite violent inflammation. Its action is due to Anemonin, and strongly resembles that of Aconite. Therapeutics. Pulsatilla is a very efficient drug if a fresh preparation be employed. It is excellent in— Uterine Affections,—as functional amenorrhoea, dysmenorrhoea, suppression of the menses from fright or chill, and leucorrhoeal discharges. Epididymitis and Orchitis,—are often controlled and dissipated by very small doses of Pulsatilla, a few drops of the tincture in a glass of water, and of this a teaspoonful every two hours (Piffard). Dyspepsia, or sub-acute gastritis, with white-coated tongue, no taste or a greasy sensation in the palate, nausea, flatulence, heartburn, etc.,—Pulsatilla in 5-drop doses of the tincture every four hours. Coryza, Otitis, Rhinitis, Conjunctivitis, and other inflammations of mucous membranes with mucous or muco-purulent discharge,—Pulsatilla internally and locally of the tincture to 3; iv aquae as lotion). Coughs of irritative character, whooping cough, etc.,—Anemonin in doses of gr. ss-j has been found very useful. Tape-worm,—an extract of the root has proved an efficient taeniafuge. Cutaneous Affections, especially the eczematous forms, ulcers of indolent char- acter, and syphilitic eruptions,—Pulsatilla locally and internally. Acute Meningitis, cerebral and spinal,—it is said to have been efficient. Forms of Veratrum. Veratrum viride, American Hellebore or Poke- root, (nat. ord. Liliacese);— Veratrum album, European Hellebore; and Veratrum sabadilla, or Asagrcea officinalis, the Mexican variety. Of these the first alone is official in the U. S. Phar., though an alkaloid or mixture of alkaloids from the Veratrum sabadilla is recognized under the name Veratrine. VERATRUM,—Hellebore. Alkaloids in each plant, are as follows,— In Veratrum viride,—Jervine, Pseudo-jervine, Cevadine, Rubijervine. VERATRUM. 167 In Veratrum album,—Jervine, Pseudo-jervine, Veratralbine, Rubijervine. In Veratrum sabadilla,—Veratrine, Cevadine, Cevadilline. Veratroidine is now considered a mixture of Rubijervine and a toxic Resin. Preparations. Extractum Veratri Viridis Fluidum,—from the root. Dose, try-v. Tinctura Veratri Viridis,—40 per cent, of the root. Dose, Tryj-x./- * Norwood's Tincture of Veratrum Viride,—has a very high reputation for efficiency. Dose, rtpv, increased by Try every three hours, until the pulse is down to 65, when the original dose will keep it there. Veratrina, Veratrine,—a mixture of alkaloids, prepared from the seeds of Asagrcea officinalis. Dose, gr. Oleatum Veratrina!,—strength, 2 per cent, in Oleic Acid. Unguentum Veratrince,—strength, 4 per cent. For local use. Physiological Action. The action of Veratrum Viride is closely allied to that of Aconite, being a powerful and spinal paralyzant. It differs from Aconite in affecting the respiration to a much less degree,—in being a systemic emeto-cathartic—in paralyzing the mot<2r system centrally, impairing the reflexes, but leaving sensation unimpaired,—and in having little or no diaphoretic or diuretic action. It causes great depression, but is seldom fatal; when death does result from its use it usually occurs by paralysis of the heart. In small doses it reduces the force the pulse, but does not at first affect its rate. If continued for some time, the pulse becomes very slow, soft and compressible; rising, on the least exertion, to be very rapid and feeble. At the same time there is great muscular weakness, and frequently nausea and vomiting. Large doses increase these symptoms very much, the pulse becoming very rapid and so small as to be almost imperceptible; the skin is cold and clammy, and constant vomiting, extreme debility, giddiness, impaired vision, and partial unconsciousness ensue. Jervine represents in part the depressant action on the circulation and on the central nervous system. It does not, however, affect the vagus, and but very slightly the voluntary muscles or the motor nerves. It irritates the motor centres in the brain, causing convulsions ; and lowers the functions of the cord, of the centres in the medulla, especially the vaso-motor, and those of the cardiac ganglia,—slowing the heart by direct depression either of the cardiac muscle or its motor apparatus. It always causes salivation, but never vomit- ing or purging; and kills by asphyxia, the heart beating after respiration has ceased. Veratroidine, on the contrary, always causes emeto-catharsis, and produces less violent convulsions. It stimulates the vagus centre and paralyzes the 168 MOTOR DEPRESSANTS. vagus ends, depresses the cord, and paralyzes the respiratory centre,—but at the same time increases the excitability of the vaso motor centre. The result is great slowing of the pulse-rate and of respiration, and lowering of blood pressure, until the carbonized blood irritates the vaso-motor centre, when the blood-pressure rises greatly. It probably consists of Rubijervine and a toxic resin. Veratrum Album contains a very powerful alkaloid, Veratralbine, and also an irritant poisonous resin (?). Its general action is similar to that of its con- but it is much more irritant to the gastro-intestinal mucous membrane, causing violent vomiting and purging, intense abdominal and oesophageal pain, greatly reduced temperature and pulse, collapse, and death from cardiac and respiratory paralysis. Veratrine is an acrid, intensely irritant powder, consisting of a mixture of alkaloids. It causes violent sneezing, a burning sensation, and free saliva- tion. It affects the heart and circulation similarly to the other Veratrise, and in addition seems to be a direct poison to muscular tissue, and to cause violent convulsions before the muscular paralysis sets in. The alkaloids Jervine and Rubijervine both depress the circulation, while the latter produces the emeto- catharsis. Treatment in Veratrum Poisoning,—is similar to that for Aconite. Morphine and Atropine antagonize the cardiac depression,—also Alcohol, Ammonia, etc. The recumbent position should be maintained, and dry heat applied to the general surface. Therapeutics. Veratrum Viride is inferior to Aconite in fevers and in- flammations, by reason of its lack of power over excretion, but is used as an arterial sedative with excellent results in— Aneurism,—to depress the circulation to the lowest point; the recumbent posture must be strictly observed, to secure safety to the heart. Cardiac Disorders, such as simple hypertrophy, irritable heart,—Veratrum Viride is often used with great benefit. Acute Mania and Puerperal Convulsions, it has frequently been employed with remarkably good results, but has often failed. Parenchymatous and Serous Inflammations, in their early stages,—Veratrum Viride renders good service, especially ir Pneumonia. Superficial Neuralgia,—the Oleate or Unguentum Veratrinse externally. Myalgia and Headaches may often be relieved by the same application. Puerperal Fever,—when due to metritis Veratrum Viride is highly extolled by Fordyce Barker and other authorities of standing. Cholera, during the algid stage, Veratrum Album has been used, but other agents are far more efficient. ARNICA. 169 ARNICA AND TRIMETHYLAMINE. Source and Composition. Arnica is the plant Arnica montana, the Leopard’s Bane, a perennial of the Composite order growing in mountainous districts throughout the northern hemisphere. It contains a principle, Arnicin, which is insoluble in water, and has some of the properties of a glucoside ; also about 1 per cent, of an Essential Oil, with Inulin, Tannin, mucilage, resins, Capronic and Caprylic Acids. It also contains Trimethylamine, which is supposed to be the active principle, and to be yielded by the essential oil. Both the Root and Flowers are official. * Trimethylamine, is an ammonia compound of the group styled amines, in which the three atoms of hydrogen are replaced by some organic radical, in this case by Methyl, (CH3), dissolved in water. It is a clear, colorless fluid, containing 10 to 20 per cent, of the absolute ammonia compound, has a disagreeable, fishy odor and taste, is strongly alkaline, and is miscible in all proportions with water. It is found also in Cod-liver Oil, in Humulus and Ergot, and may be obtained from codeine, fish-brine, human urine, herring- pickle, beet-sugar residue, and other decomposing albuminous substances. It behaves like an alkaloid, has strongly basic qualities, and has the formula (CH3)3N, or C3H9N. An impure, commercial trimethylamine is often called Propyla7nine erroneously, the latter being the name of an isomeric and allied compound. Preparations. Tinctura Arnica Florum, Tincture of Arnica-flowers,—strength 20 per cent. Dose, -xxx. For local use, ss to the pint. Tinctura Arnica Radicis, Tincture of Arnica-root,—strength, 10 per cent. Dose, TThv-xxx. Is locally irritant, unless greatly diluted. Exlr. Arnica Radicis Fluidum, Fluid. Extr. of Arnica-root,—Dose, tt\v-xx. Extractum Arnica Radicis, Extract of Arnica-root,—Dose, gr. j-iij. Emplastrum Arnica, Arnica Plaster,—has of the Extract. * Infusum Arnica Florum, Infusion of Arnica-flowers,—20 parts of the flowers to 100 of water, is thought by some to be the best preparation for local use, as it never excites dermatitis, probably by reason of its being devoid of the Essential Oil and the insoluble principle Arnicin. * Trimethylamina Hydrochloras,—is powerfully antipyretic in doses of gr. ij every three hours. Dose, gr. j-v. Physiological Action. Arnica is irritant, stimulant, depressant, antipy- retic, diuretic, and a vulnerary. It irritates the gastro-intestinal tract, and in alcoholic solution excites erysipelatous inflammation of the skin in some 170 persons. In small doses it increases the action of the heart, raises the arterial tension, and stimulates the action of the skin and kidneys. Large doses produce a transient excitement, followed by depressed circulation, respi- ration and temperature; violent headache, dilated pupils, and muscular paresis. A Toxic Dose paralyzes the nervous system of animal and organic life, causing collapse and death. Trimethylamine is an active escharotic, and a gastro-intestinal irritant; lowers the rate and force of the heart, decreases the body temperature, and diminishes (sometimes increases) the excretion of urea. MOTOR DEPRESSANTS.' Therapeutics. Arnica may be used with benefit in— Typhus and Typhoid Fevers,—5-minim doses of the Tincture as a stimulant; larger doses as an antipyretic when patient is of sthenic reaction. Delirium Tremens with depression,—the Tincture is serviceable. Rheumatism and Rheumatic Gout,—Arnica or Trimethylamine in the acute forms, to moderate the fever, subdue the joint inflammation, and lessen the danger of cardiac implication. Sprains, Bruises, etc.,—the dilute Tincture locally has a popular reputation. Ecchymoses are rapidly dispersed by its use locally and internally. An in- fusion is better for local use, as the tincture may excite dermatitis. Internal Bruises from shocks or concussions,—its internal use has proven very efficacious in many instances (Phillips). Cuts, Wounds, etc.,—the aqueous preparations locally used promote the rapid union of cut surfaces. Hemorrhages, Epistaxis, Hcemoptysis, etc.,—it is undoubtedly effective. Concussion of the Brain,—Arnica is highly recommended (Phillips). Chronic Dysentery, with slimy and bloody stools, tormina and cutting pains, —the Tincture internally is often a very efficient remedy. Paralysis of the Bladder has been cured by Arnica, used internally. Chorea,—Trimethylamine has been successfully used. Chronic Rheumatism,—Trimethylamine as a liniment, 1 part to 3 of glycerin, gives relief to the pains, equal to that produced by any anodyne. TABACUM,—Tobacco. Source and Composition. The commercial dried leaves of Nicotiana Tabacum, (nat. ord. Solanacese), a native of tropical America. It contains a powerful liquid alkaloid Nicotine,—together with Malic Acid, alkaline salts, and a peculiar camphor named Nicotianin. Its combustion gives rise to several empyreumatic products, of which Pyridine is the most powerful. TOBACCO. 171 Tobacco-smoke contains little or no Nicotine; in that from pipes Pyridine preponderates, in that from cigars Collidin, which is much less active. Liquid Alkaloids besides Nicotine,—Lupuline, Coniine, Lobeline, Pi- peridine, Pyridine, Muscarine, Sparteine, and the alkaloidal compound Tri- methylamine. Preparations. Tabacum (as above) is the only official preparation. *Infusum Tabaci ( 3j to the pint),—Dose, 3 ss—iij, as enema. Dangerous. *Vinum Tabaci, (!|j to the pint),—Dose, Must be used cautiously. *Oleum Tabaci, an empyreumatic product, obtained by distillation. *Nicotina, Nicotine,—Dose, UP to NlU *n strychnine-poisoning. *Pyridina, Pyridine, C5H5N,—a colorless liquid alkaloid of powerful odor, evaporating when exposed to air, mixing with water in all proportions, and forming salts like Chinolin. Dose, allowed to evaporate in an open dish in a small room, in which the patient is exposed for 20 to 30 minutes thrice daily for the relief of asthma (See). Physiological Action. Tobacco is a very depressant nauseant, an emetic by systemic and irritant action, a sternutatory, diuretic, diaphoretic, cathartic, sedative, antispasmodic, and narcotic. It first stimulates and afterwards para- lyzes the motor nerves of involuntary muscles, and the secreting nerves of the glands, also the spinal cord and the vagus; at first stimulating both the vagus- roots and its ends in the heart (slowing the pulse-rate), but afterwards para- lyzing the latter (causing high pulse-rate). It produces increased salivary and intestinal secretions, diuresis, tremor, clonic spasms, and a tetanic stage pre- vious to its paresis. It contracts the pupil?, slows and depresses the heart, first lowers and then raises the arterial tension, and reduces the body temper- ature ; causes profuse sweating, cold and clammy skin, collapse, and death usually by paralysis of respiration, sometimes by paralysis of the heart. It does not impair the muscular irritability, nor does it act on the cerebrum directly. The empyreumatic products of Tobacco are similar in action but less powerful. Fatal results have followed the inhalation of the vapor. The continued use of Tobacco by smoking or chewing to excess produces granular inflammation of the fauces and pharynx, atrophy of the retina, dys- pepsia, lowered sexual power, sudden faints, nervous depression, cardiac irri- tability and occasionally angina pectoris. Used by the young it hinders the development of the higher nervous centres, and impairs the nutrition of the body by interfering with the processes of digestion and assimilation. Nicotine is almost as rapidly fatal as Prussic Acid, death having occurred from a toxic dose in three minutes, with no symptoms except a wild stare and a deep sigh. 172 MOTOR DEPRESSANTS. Antagonists and Antidotes. Strychnine is the true physiological antago- nist to Nicotine (or Tobacco) and vice versa. Alcohol, Ammonia, Ergot, Digitalis, Belladonna, etc., antagonize its action on the circulation. Evacua- tion of the stomach, Tannin, Iodides, and artificial respiration, are the means resorted to in Tobacco-poisoning. Therapeutics. Tobacco is now but little used in medicine. The chief indications for it are (1) to relax spasm, (2) locally, to relieve pain. But the danger attending its employment, either internally or externally, has caused its supersedence by other agents of less violent action. It may be employed in— Habitual Constipation,—the wine is a good remedy, at bedtime. Smokers rarely suffer from constipation, but frequently experience an immediate lax- ative result after their morning cigar. Lniestinal Affections, as impaction of the caecum, intussusception, and strangu- lated hernia,—not over iv of the Infusion as an enema has often been very effective in relaxing spasm, but it is a dangerous expedient. Asthma,—emphysematous, cardiac and nervous forms, are all benefited by the use of Pyridine (as described above); which has a powerfully sedative action upon the respiratory centre. Tetatius,—no remedy more effective than minim-doses of the alkaloid every two hours by the stomach, or by the rectum; or § iv of the Infusion as an enema, repeated for effect; or still better, the Wine, in ten-minim doses, repeated for effect. Dropsy, especially in the renal form,—Tobacco is an efficient diuretic. Nymphomania, Chordee, etc,—are easily conquered by Tobacco. Strychnine Poisoning,—Tobacco is an effective antagonist,—gr. ss of Nico- tine in 3 ij Aquae destil. hypodermically ; of this contain gr. fa. The Infusion has also been used successfully, but the alkaloid permits of more precise administration. Fatigue,—Tobacco, moderately used, aids to support the system, when under excessive exertion, food and rest being deficient. LOBELIA,—Indian Tobacco. Source and Composition. The leaves and tops of Lobelia inflata, (nat. ord. Lobeliacese), a North American weed. It contains a liquid alkaloid, Lobeline,—also Lobelic Acid, Lobelacrin, resin, wax, etc. Preparations and Doses. Tinctura Lobelia, 20 p. c.—Ttbv-xxx. * Infusum Lobelia,—Dose, gj—i|j. Extractum Lobelia Fluidum,—Tt\j-x. *Lobelin (a resinoid),—gr. ss-gr. j. NITRITES. 173 Physiological Action. Lobelia has an acrid, nauseous taste, and a very unpleasant odor. It is expectorant, diaphoretic, purgative, emetic, anti-spas- modic and narcotic. It excites an abundant flow of saliva, much gastric mucus, and profuse urination and sweating; with nausea, vomiting, and great depression. The action of the heart is enfeebled, the blood pressure, at first increased, soon falls; muscular debility, reduced temperature ensue, then coma and death by paralysis of the respiratory centre. The motor nervous system is chiefly affected, especially the medulla oblongata and the nucleus of the pneumogastric contained therein. Antagonists. Strychnine, Picrotoxin and Thebaine antagonize its action on the nervous system; the vaso-motor excitants, as Alcohol, Digitalis, Belladonna, oppose its effects on the circulation. Therapeutics. Lobelia has gone out of fashion, yet it is useful in— Asthma,—a teaspoonful of the Tincture every 15 minutes until nausea ensues, gives decided relief in the paroxysm. Cough of dry, harsh character, with tickling in the throat and spasmodic dyspnoea,—Lobelia is an extremely effective expectorant. Constipation, from atony and deficient secretion,—a ten-minim dose of the Tincture at bed-time is excellent. Impaction of the Ccecum, before inflammation occurs,—two-drop doses of the Tincture every hour will often relieve the obstruction. Strangulated Hernia,—The Infusion as an enema is much safer than Tobacco, and fully as efficient; but other laxatives are better. Poison-oak- Eczema,—an infusion ( 25 j to the pint) locally, is efficient. As an Emetic,—Lobelia is entirely too depressant to be given to children. Amyl Nitris, Amyl Nitrite, C5HuN02, is a clear, yellowish, oily liquid, of a powerful and ethereal odor, extremely volatile, insoluble in water, but soluble in alcohol, ether, etc. It is produced by the action of Nitric or Nitrous Acid upon Amylic Alcohol, and may be administered by inhalation or inter- nally, in doses of nyj -v, but larger doses are probably safe..* THE NITRITES. Glonoinum, Glonoin, Glyceryl Trinitrate, C3H5(N03)3—is produced by the action of nitric and sulphuric acids upon glycerin, and is the dangerous explosive known by the name “ Nitroglycerin.” Official in the following— Spirit us Glonoini, Spirit of Glonoin (Nitroglycerin,)—contains I per cent, in alcohol. Dose, TT\ss-x. The strong tincture official in the Homoeopathic 174 MOTOR DEPRESSANTS. Pharmacopoeia (2d ed., Phila, 1883, page 235), is a 10 per cent, solution, and an extremely dangerous preparation, both as a medicine and an explosive. *Tabellce Nitroglycerini (B. P.),—each tablet contains gr. T^. Sodii Nitris, Sodium Nitrite, NaN02,—deliquescent in the air, gradually oxidizing to sodium nitrate. Dose, gr. ss-iij, according to individual suscep- tibility. Ethyli Nitris, Ethyl Nitrite, C2H.N02,—constitutes about 5 p. c. of Spiri- tus /Etlreris Nitrosi. (See ante, page 137.) Physiological Action. The Nitrites agree in their general action, pro- ducing great vascular dilatation and consequent lowering of blood-pressure, by paralyzing eitTier the sympathetic system, the vaso-motor centre, or the muscular coat of the arterioles ;—tufffilltuous action of tlTcTheart, by of its'inKibitory apparatus^—diminished sensation, motion anti reflexes; a sensation of heat, but lowered body temperature ; lowered respiration, from paralysis of the respiratory muscles and impairment of the ozonizing function of the blood; throbbing pain in the head, beating carotids, flushed face and vertigo. They are all muscle poisons* Amyl Nitrite is the most prompt, but less enduring in action, and is best given by inhalation. Sodium Nitrite acts similarly, but less promptly. Nitroglycerin is less prompt and less violent, has a more enduring action, and is therefore more suitable for internal administration. Its headache is of intense frontal character, and persists for hours after the other effects have passed off. Therapeutics. The Nitrites are well used in— Angina Pectoris, especially when characterized by a great rise of arterial ten- sion,—Amyl Nitrite inhaled, to lessen the arterial spasm and palliate the agony of the attack, is usually very efficient. Epilepsy,—when the aura is felt, the inhalation of a drop or two of Amyl Nitrite will generally abort the paroxysm. Respiratory Neuroses, as spasmodic asthma, whooping-cough, laryngismus stridulus, etc.,—are relieved in many cases by these agents. Tetanus,—is palliated by Amyl Nitrite, especially during the period of fixation of the muscles of respiration. Neuralgic Dysmenorrhoea,—has often been benefited by Glonoin. Vomiting and Nausea, also Sea-sickness,—are benefited by the Nitrites. Cold Stage of Intermittents and pernicious remittents,—may be aborted by the inhalation of Amyl Nitrite, preventing internal congestions. Syncope, and in Chloroform Poisoning,—Amyl Nitrite to aid the circulation, conjoined with artificial respiration, etc. HYDROCYANIC ACID. 175 High Arterial Tension, from any cause,—the Nitrites are exceedingly useful, especially Glonoin. Chronic Interstitial Nephritis,—Glonoin has proved of great value, by redis- tributing the blood supply to the kidneys, cut off by degeneration of the renal ganglionic centres. Migraine, of the pale face form,—Amyl Nitrite is indicated, or Glonoin. Convulsions, of various kinds, including puerperal,—the Nitrites are useful. HYDROCYANIC ACID. Preparations. Acidum Hydrocyanicum Dilutum, Diluted Hydrocyanic (Prussic) Acid,— has 2 per cent, of absolute HCN and 98 of water. Dose, TT\J-vof a recent preparation. Forty minims have caused death. It is a constituent of the secret nostrum Chlorodyne, also of its various imitations, including the B. P. preparation Tinctura Chloroformi et Morphinse, recently introduced therein. * Scheele's Dilute Hydrocyanic Acid,—is a 4 or 5 per cent, solution, and is highly dangerous, even by inhalation, Oleum Amygdala: Amarce, Oil of Bitter Almond,—contains a varying quantity of Hydrocyanic Acid, due to the reaction between the principle Amygdalin and the ferment Emulsin. Dose, tip %—), in mixture. Potassii Cyanidum, Potassium Cyanide, KCN,—is soluble in 2 of water, spar- ingly soluble in alcohol. Dose, gr. 3*3-Locally, a solution of gr. j-v to the is as strong as should be used. Physiological Action. Hydrocyanic Acid and Nicotine are the most powerful poisons known, gr. ss of the former having caused deaths Its inhala- tion produces rapid insensibility and almost immediate exhaustion, death probably occurring from sudden paralysis of the heart in the more rapid cases and of the respiration in the slower ones. * Some volitional movements may be made before death, unless the dose be very large. Its paralyzant action is expended on the brain centres, the peripheral afferent nerves, then on the spinal cord, the motor nerves and the muscular tissue, the muscles being fixed in tetanic rigidity after death. The blood is found, on post-mortem examina- tion, to be dark and fluid, and the venous trunks and cerebral sinuses gorged therewith. The odor of Prussic Acid is fragrant, resembling that of bitter al- monds or peaches. The effects of a medicinal dose pass off in an hour, at most. Potassium Cyanide, has similar action, and, in addition, possesses some peculiar to itself. Locally, it causes inflammation of the skin, with an ecze- matous eruption, and if applied in quantity to an abraded surface will pro- duce fatal effects. Toxicology. Atropine has antagonistic action to Hydrocyanic Acid, but is too slowly diffused to be of any value. Ammonia by inhalation, by the stomach, and by intravenous injection, with cold affusion to the spine and artificial respiration, are the measures most likely to avail in cases of poison- ing, where there is time to do anything. In poisoning by Potassium Cyanide, the antidote is Ferrous Sulphate, producing Prussian Blue (Ferrocyanide of Iron). Then evacuation of the stomach, artificial respiration, and Ammonia by intravenous injection. MOTOR DEPRESSANTS. Therapeutics. Hydrocyanic Acid is a very useful and pleasant remedy. It is well employed in— Coughs of spasmodic character, whooping-cough, hiccough, laryngismus stri- dulus, and other neuroses of the respiratory organs, or affections involving the pneumogastric nerve. Gastralgia,—it is one of the most efficient remedies, also in Headache and Vertigo due to stomachal derangement; and in Nervous Vomiting. Acute Mania and Melancholia,—it has been successfully employed. Round Worms (.Lumbricoides), are promptly killed by doses of 2 or 3 minims every 2 hours for 24 hours, followed by calomel. Both agents, being taste- less, are useful for children. Skin Diseases, Pruritus, etc.—Hydrocyanic Acid is a very grateful applica- tion to allay itching. Or Potassium Cyanide in ointment, gr. v or vj to the § , carefully avoiding abraded surfaces. Headache, of reflex type,—Potassium Cyanide in solution, gr. iij-v to the 3, applied locally on a compress, gives great relief. Stains from Silver Nitrate,—are removed by a similar solution. GRIND ELI —Grindelia. Source and Composition. The leaves and flowering tops of Grindelia robusta and Grindelia squarrosa, herbaceous Californian plants of the nat. ord. Composite. Its composition has not yet been definitely ascertained; but it probably contains an alkaloid, a resin, and a volatile oil. Preparations. Only one is official,— Extractum Grindelice Fluidum,—Dose, upv— g j. Is extremely nauseous. Physiological Action. Grindelia is not actively toxic, large doses being required to kill small animals. Taken in quantity it excites nausea and vom- iting, depresses the heart, respiration and temperature, dilates the pupils, and causes sleep with lowered cutaneous sensibility and reduced reflexes., Finally QUEBRACHO. 177 it produces motor paralysis, beginning in the legs, and causes death by paralysis of the muscles of respiration. It is slowly eliminated by the kidneys and the lungs, imparting to the urine and breath a peculiar violaceous odor. It is markedly diuretic. Therapeutics. Grindelia is especially indicated in spasmodic affections of the respiratory organs. In— Spasmodic Asthma,—as a palliative; 3-grain doses of the extract to avert the attack, or trpxx-xxx of the fluid extract every half hour, beginning at the very onset. The dried leaves may be smoked in cigarettes, or the plant may be steeped in a saturated solution of potassium nitrate, dried and ignited, the patient inhaling the fumes. Hay Fever,—is amenable to Grindelia in many instances; the fluid extract 4 parts, with I part each of the fluid extracts of Rhubarb and Senna, of which 3 ij every half hour during the paroxysm, and afterwards at intervals of three hours. Chronic Bronchitis and Emphysemai—it is of real utility; also in acute bron- chitis after the subsidence of the acute symptoms. Whooping-Cough, Coughs of Imitation and Habit, and those of spasmodic character,—are helped by Grindelia. Spasmodic Dyspnoea, accompanying various pulmonary and cardiac diseases,— Grindelia is often a very efficient remedy. Chronic Pyelitis and Cystitis, and other genito-urinary catarrhs—Grindelia is serviceable, being deposited as an oleo-resin along the urinary tract. Rhus Poisoning,—the fluid extract of Grindelia is said to be one of the most efficient local applications in poisoning by Rhus toxicodendron. ASPIDOSPERMA,—Quebracho. Source and Composition. The bark of Aspidosperma Quebracho-bianco, (nat. ord. Apocynacese), an evergreen tree growing in Chili and the Argentine Republic. It is supposed to contain six alkaloids, the most important of which are named Aspidospermine and Quebrachine. Preparations* Extractum Aspidospermatis Fluidum,—Dose, irpv-gj. * Tincture Quebracho,— 5J j-iv. * Vinum Quebracho,— 3 j-.o j- Physiological Action. Quebracho has a bitter taste, and in large doses causes severe salivation, nausea, vomiting, vertigo and headache. It lessens the rate of respiration, and seems to decrease the sensation of need for air after active exercise. Of the alkaloids Quebrachine is the most active, but 178 MOTOR DEPRESSANTS. both act similarly upon the lower animals,—affecting the central nervous sys- tem, at first by stimulation, which is soon followed by paralysis. The heart and respiration are chiefly affected ; at first the fulness and rate of breathing is increased, and the cardiac action slowed; but finally both functions are para- lyzed, the cardiac first in warm-blooded animals, the respiration first in cold- blooded ones. Reflex excitability, at first increased, is soon lowered, and the spinal cord is also paralyzed. Locally used these alkaloids paralyze voluntary muscular fibre also, and some of them similarly affect the motor nerve endings. Therapeutics. Quebracho is extensively used for— Dyspnoea, from any cause, in which it is said to be palliative, but as often fails. It may relieve the dyspnoea of asthma, emphysema, bronchitis, etc., but is useless in that due to organic disease of the heart, or in aged subjects of atheroma. PHYTOLACCA,—Poke. Source and Composition. The berry and root of Phytolacca decandra, (nat. ord. Phytolaccaceoe), a N. American plant. It contains a neutral prin- ciple, Phytolaccin ; also Phytolaccic Acid, tannin, starch, a fixed oil, etc. Preparations. Phytolaccce Fructus, Poke Berry,—Dose, gr. x-xxx. Phytolaccce Radix, Poke Root,—Dose, gr. j-v as alterative,—gr. x-xxx as emetic. Extractum Phytolaccce Radicis Fluidum,—Dose, TPj-xxx. Physiological Action. Phytolacca depresses the heart-rate and the respi- ration, and is a paralyzer of motion by central action on the spinal cord. It is a slow and depressant emeto-cathartic, also somewhat narcotic and altera- tive. It irritates the throat and tonsils ; produces tetanic convulsions in ani- mals, and death by paralysis of respiration. Several cases of poisoning by this plant have occurred. Its action is antagonized by Alcohol, Ether, Opium, Digitalis. It promotes the absorption of adipose tissue. Therapeutics. Phytolacca is useful in— Mastitis, to arrest the inflammation and prevent suppuration,—the extract may be applied locally and the fluid extract given internally. Varicose Ulcers, and other ulcers of the leg,—it promotes healing. Eczema of obstinate character,—has been cured by Phytolacca extract applied locally; also Tinea Capitis, and other shin affections. Chronic Rheumatism of fibrous tissues,—used internally, it acts efficiently. Obesity,—a resinoid preparation of the berries is sold as an “ anti-fat” remedy, under the name Phytoline. CINCHONA ALKALOIDS. 179 Tonsillitis, Diphtheritic Sore Throat and Chronic Follicular Pharyngitis,—are affections in which Phytolacca has been much employed with good results, especially when high fever and pains in the head, back and limbs. In true adynamic Diphtheria it will do little good. Antizymotic Drugs are those which arrest the fermentative processes, (see ante, page 44), including the Antiseptics, the Disinfectants and the Deodor- ants, etc. Many of these agents are also endowed with other qualities of great therapeutical value, due indirectly to their power over ferments; such ones being Antipyretics and Antiperiodics, as well as Antiseptics. [See also pp. 38 and 39, ante.] The members which stand at the head of this triple-crowned group, are the four— ANTIZYMOTICS, ANTIPYRETICS, ANTIPERIODICS. CINCHONA ALKALOIDS, Quinine, Quinidine, Cinchonine and Cinchonidine; and of these the chief, the king of antizymotic, antipyretic, antiperiodic agents, is Quinine, which has already been described on page 64. The composition of Quinine is represented by the formula C20II24N2O2; it is soluble in about 1670 parts of water and in 6 of alcohol at 590 F. ; but it is rarely employed in its uncom- bined form, its various salts being much more soluble. The salt generally employed is the Sulphate, but the Bisulphate, Hydrobromate and others, are frequently used. The Carbamide Hydrochlorate is the most soluble and the least irritating of its salts, and therefore the best one for hypodermic adminis- tration. Substiiutes for Quinine. The synthetical production of Quinine has been the “philosopher’s stone” of the modern chemists, who have prosecuted with untiring energy the search for an artificial product possessing all its properties. In this search they have discovered several organic bodies, which closely resemble each other and also quinine, both in chemical constitution and physiological action. These sub- stances belong to the aromatic series of carbon compounds, all of which are derivatives of Benzene or Benzol, C6H6, the Hydride of the organic radical Phenyl, C6H5. The distinctive action of the lower members of this series is their antiseptic and antipyretic powers,—as that of the fatty series of carbon compounds is stimulant and ancesthetic (Brunton). Many of these agents are obtained from coal-tar oil (petroleum) by fractional distillation, etc.,—and they are all derivatives of Benzene (Benzol), either directly or from some of the pro- 180 ANT1ZYMOTICS, ANTIPYRETICS, ANTIPERIODICS. ducts formed therefrom by substitution ; various radicals replacing the differ- ent constitutent atoms of H and C. Thus, by the ring-arrangement of atoms peculiar to this series, there are formed from Benzene, (C6He), the following substances, viz :— Phenol, or Carbolic Acid, C0H5OH—by replacing H by OH, (hydroxyl). Pyrocatechin, or Ortho- Resorcin, or Meta- Hydroquinone, or Para- C0H4(OH)2. di-hydroxy-benzene,—by replacing 2H by 2OH. C6H4(OH)2. Pyrogallol, Pyrogallic Acid, Tri-hydroxybenzene C6H3(OH)3,—3H by 3OH. Amido-benzene, or Anilin, CeH5.NH2—by replacing H by NH2 (amidogen). Nitro-benzene, C0H5.NO0—by replacing H by N02 (nitroxyl). Benzoic Acid, C6H5CO.OH—by replacing H by CO.OH (carboxyl). Salicylic Acid, HC7Ha03—by replacing 2H by OH and CO.OH. Naphtaline, CioHg—by uniting two Benzenes in an overlapping ring. Pyridin, C5H5N—by replacing tetrad C by triad N. Chinolin, C9H-N—uniting Benzene (C6H6) and Pyridin (C5H5N). Derived from Chinolin is the hypothetical base— Chinicin or Quinicin, C9H9N2,—represented in Antipyrin. Also Kairin, Thallin, and other compounds. The members of the Chinolin series of compounds destroy life either by exhaustive convulsions or gradual paralysis of the respiratory centre,—the lower ones acting chiefly on the sensory centres of the brain and reflex centres of the cord, destroying voluntary and reflex movement; while the higher ones act principally on the motor centres, first as irritants, causing violent convulsions, and afterwards producing paralysis (Brunton). ANTIPYRINUM,—Antipyrin. Source and Composition. Antipyrin is a synthetical base, which forms salts analogous to those of Ammonium, and is a product of the destructive distillation of coal tar, though it may also be prepared synthetically. It has the formula C20H18N4O2—and the chemical name Dimethlyphenyl-pyrazolon. In the British pharmacopoeia it has the title Phenazone. / Characteristics. It occurs as a whitish, crystalline powder, which com- bines with acids to form salts, is somewhat bitter, and soluble in one-half its weight of hot water, and in its own weight of cold water ; but is still more so if the water is acidulated with dilute nitro-hydrocliloric acid. It is less soluble in alcohol, chloroform or ether, gives an intensely red color with Ferric Chloride, and a beautiful green with Nitric Acid. It is not irritant to either the stomach or the tissues, and may be administered hypodermically. Dose and Administration. An average adult dose is about gr. x, which for antipyretic effect may be repeated hourly for 3 doses. For children, gr. i per year of age between 2 and 5, gr. | per year from 5 to 10, not exceeding ANTIPYRINrf 181 gr. v at a dose for any child under 15. If vomiting result, the same dose may be dissolved in half its weight of hot water, and injected hypodermically while warm. Antipyrin has but little flavor, is not unpleasant, and is therefore readily taken by children, in which respect it is greatly superior to quinine. It may be administered in compressed tablets, each having 3, 5 or 10 grains. Preparations. The only important salt is— *Antipyrini Salicylas, Antipyrin Salicylate, (Salipyrin),—formed by com- bining Salicylic Acid 57.7 and Antipyrin 42.3; a white, crystalline, odor- less powder, very soluble in alcohol, insoluble in water. Its claims to pre- ference are based upon its comparative harmlessness (gijss having been taken within 3 or 4 hours without the slightest ill effect); also its freedom from unpleasant after-results. Dose, gr. x-xxx every hour or 2 hours until 3 ij have been taken* * Chinolinum, Chinolin, C9H7N,—is a constituent of coal tar, but may be obtained from Quinine or Cinchonine by destructive distillation, or prepared artificially from Anilin or Nitrobenzol. It is a powerful antiseptic and anti- pyretic, closely resembling Quinine in its action, but of very disagreeable taste and odor. In moderate doses it lowers the pulse-rate and reduces the body- temperature ; in large ones it diminishes reflex excitability, and causes dyspnoea, paralysis and collapse. It has been used in typhoid fever, acute rheumatism and erysipelas, also in typhus, diphtheria, etc., with varying success. In the latter disease, a 5 per cent, solution in weak alcohol is painted over the affected surface with great benefit. The Tartrate has been used with benefit in neu- ralgia and whooping-cough, and as an antiperiodic in intermittents. Dose of the Tartrate, gr. v-xx, in aqueous solution. Analogues of Antipyrin * * Kairinum, Kairin, C10H)3NO.HCl.H2O,—is the Hydrochlorate of Oxy- ethyl-chinolin-hydride, an artificial substance prepared from Chinolin; occur- ring as a white, crystalline powder, freely soluble in water, but is best administered in wafer-paper or in capsule. It is a powerful antipyretic, pro- ducing however profuse sweating and vomiting; a severe rigor ushering in the subsequent rise of temperature, when its influence has worn off. In some cases of typhus it has caused cyanosis and collapse, but has not proven fatal, though 220 doses have been given in one case. It stains the urine a deep green color. By many authorities this drug is considered the most certain, most powerful and most rapid antipyretic which we possess,—but it has not been em- ployed to any great exte-nt since the advent of Antipyrin. Dose, gr. iij-gr. xxx. 182 ANTIZYMOTICS, ANTIPYRETICS, ANTIPERIODICS. As antipyretic, gr. viij hourly for four doses, or until loo° F. is reached, then gr. iv, hourly during the period of defervescence. *Thallinum, Thallin (Parachinanisols),—has the chemical name Tetra- hydro-paramethyl-oxychinolin, and is a synthetically prepared substance, oc- curring as a colorless powder, soluble in water, and forming salts with acids, of which the Sulphate is the most eligible. It is an antipyretic of very great power, but induces profuse sweating and a dangerous degree of depression. Dose, gr. ij—x, in tablets; a mean average dose being about gr. v. Physiological Action. Antipyrin is a powerful antipyretic, a local anaes- thetic and a general analgesic, and also possesses diaphoretic, mydriatic, anti- septic, disinfectant and slightly hypnotic powers. After the ingestion of a full medicinal dose, (gr. xx-xxx), there is a stimulant stage of short duration, in which the heart’s action is increased, and a subjective sense of heat is ex- perienced, with flushing of the face. This is soon followed by profuse sweat- ing, coldness of the surface, slowed pulse, considerable depression, and if fever be present by lowered temperature ; the latter coming on within half an hour after taking the drug and its degree being in direct ratio to the quantity administered, as also its continuance,—the former being usually from 3 to 5 degrees, and the latter from 1 to 10 hours, a fair average being about 2 hours. In one case a fall of 120 F. was observed. When given with Kairin, the mixture of the two drugs has been found to produce a much greater fall of temperature, with longer continuance down, than that produced by an equal quantity of either drug given alone. After the antipyretic effect of the dose lias passed off, the temperature (in fever) commences to rise again,—the onset being usually preceded by a chill, which is of slight degree when compared with the severe rigors and dangerous depression occurring under the action of Kairin, Chinolin, and other members of the group. In health its administration gives rise to slight nausea, singing in the ears, and a reduction of the body temperature of scarcely any extent, about y1^0 F. It slightly raises the arterial tension and blood-pressure ;—sometimes (but seldom) induces vomiting, also a peculiar eruption on the skin;—and (very rarely) such a degree of depression as to amount to collapse. It has no effect upon the respiration, but acts as a sedative upon the cerebrum, leaving behind a somewhat depressant influence on the brain. It dilates the pupils and is elimi- nated by the kidneys, appearing in the urine some three hours after its ingestion. The profuse sweating which it causes may be prevented by giving in advance a small dose of Atropine or Agaricine. In toxic dose its principal influence is exerted upon the blood, altering the shape of the red corpuscles, separating the hematin, and causing decomposition of that fluid. ACETANILID, 183 As an Antipyretic, Antipyrin, like Alcohol, acts by a double mode of opera- tion,—(1) by diminishing oxidation, and (2) by promoting The latter is attained by dilating the cutaneous vessels, allowing free radiation from the surface, and by the refrigerant action of the evaporation of the sweat. As an Analgesic, Antipyrin has a very considerable degree of power, in common with all the Chinolin derivatives ; but its property in this respect is found to act almost entirely upon pain due to manifestations of the rheumatic diathesis. In general anodyne action, it is not to be compared with the derivatives of Opium. Its hemostatic power is claimed to be superior to that of Ergo tin Therapeutics. One of the most popular of the modern antipyretics, Anti- pyrin deserves its high rank, being one of the most certain depressants of pyrexia, though somewhat dangerous, and at the same time being devoid of any other influence upon the course of any febrile disorder. Its principal applications are as follows, viz. £— In Hyperpyrexia from any cause, it is efficient. Acute Rheumatism,—it has held the first place as a remedy, for some time 5 a claim which is now disputed in favor of Salol. In this affection Salipyrin. has been used with much satisfaction. Typhoid Fever and other febrile conditions, wherein hyperpyrexia occurs,—as phthisis, erysipelas, pleuritis, pneumonia, surgical fever, etc. Neuralgice, Neuritis, and other painful affections, especially when of rheumatic origin, as lumbago, sciatica, hemicrania, supra-orbital neuralgia, etc.,—iri- which 10-grain doses are generally sufficient, and may be given hypodermi- cally. Salipyrin is herein remarkably efficient. Painful Affections of hysterical persons ; pain from cerebral tumors and from cardiac diseases, also painful menstruation;—all of which are promptly relieved by it in most cases. Influenza,—Salipyrin was extensively employed during the epidemic of 1891, and was highly extolled for its efficient action therein, as also for its freedom from cardiac disturbance. ACETANILIDUM,—Acetanilid. Source and Composition. Like the major number of the newest antipy- retics, which are related either to Chinolin or to Phenol, Acetanilid is a deriva- tive of Anilin, from which it is obtained by the action thereon of glacial acetic acid, substituting the organic radical Acetyle for an atom of hydrogen. Chemi- cally, it has the name Phenyl-acetamide, and the formula C6H5NHCaHsO. The name Antifebrin is copyrighted by its original promoters for trade purposes, and therefore should be dropped from professional usage. 184 ANTIZYMOTICS, ANTIPYRETICS, ANTIPERIODICS. Characteristics. A pure white and crystalline powder, of neutral reaction, odorless, but of slightly burning taste. It melts at 2350 F., and distils at 557° F.,—is soluble freely in alcohol, wine, etc., but very sparingly (1 in 190) in cold water, and a little more readily in hot water. It is a neutral substance, being unaffected by hydrochloric or sulphuric acids, and ordinarily so by alkalies. Dose and Administration. The dose ranges from gr. ij to gr. x, re- peated twice, but not exceeding gr. xxx in the 24 hours. It may be adminis- tered in compressed tablets ;—also in powders, or in dilute alcoholic solution. As an antipyretic, gr. iij may be administered every to ]/2 hour, until 12 or 15 grains have been given, which will usually be a sufficient quantity, especially if given at the acme of the febrile movement. Analogues of Acetanilid. * Phenacetinum, Phenacetin, ( Oxyethyl-acetanilid), C10H13NO2—also designated Para-acet-phenetidin,—is produced by the action of glacial acetic acid on para-phenetidin, a body obtained from phenol. It is closely allied in chemical composition to Acetanilid, and occurs in colorless, glistening scales, soluble in about 16 of alcohol, sparingly in water. It is probably the safest of the new synthetical antipyretics, reducing pyrexia gradually, and causing perspiration, without producing collapse. It is also anodyne and hypnotic, soothing pain and producing sleep. Dose, gr. ij-xx ; as an antipyretic, gr. viij-x hourly or every 2 hours, in powder or tablets ;—against neuralgia and rheumatism gr. xv, repeated if necessary, up to 3 jss in 24 hours. * Phenocoll Hydrochloride,—is another synthetical antipyretic, closely allied to the preceding, both chemically and medicinally, and distinguished by its comparatively free solubility, gr. xv dissolving readily in of water. It has decided power as an antipyretic, antirheumatic and analgesic, with the decided advantage that it has no injurious effect upon the blood corpuscles, even when in direct contact with them. Dose, gr. v-xxx, an average dose being about gr. xij, three or four times a day. Physiological Action. Acetanilid is a very efficient antipyretic, besides being strongly analgesic and antispasmodic, lessening the reflex action of the spinal cord, and inhibiting the sensibility of sensory nerves. It raises the arterial tension somewhat, and slows the heart in a corresponding degree. Compared with the action of Antipyrin, the effect of Acetanilid on the body-temperature is manifested more slowly (i hour against hour),-*—but lasts a longer time (6 against 2 hours). It is markedly diuretic, somewhat diaphoretic; is a cerebral, muscular and vaso motor stimulant, and leaves no NAPHTALIN. 185 ill after-effects ;—while Antipyrin is powerfully diaphoretic, a cerebral seda- tive, and produces great depression. Furthermore, Acetanilid produces the same degree of reduction of body-temperature as Antipyrin, with the ingestion of but the dose;; and, like the latter agent, it has little or no effect on the normal temperature, and its continued use begets tolerance of its action. Its antipyretic action corresponds, in degree and in duration, to the size of the dose,—the pulse is slowed, and quiet sleep often follows. There is neither vomiting nor diarrhoea afterwards, but there is a tendency, in some few cases, to collapse, with chills and cyanosis, especially the latter, during the period of depressed temperature. A toxic dose destroys the ozonizing function of the blood, forming methyl-hsemoglobin. The heart, liver and kidneys are found in a state of acute fatty degeneration, in animals poisoned thereby. Therapeutics. Besides being one of the most efficient antipyretics, Ace- tanilid has marked analgesic and antispasmodic powers ; and these, together with its great advantages of a small dose, efficiency and safety, and the absence of the severe rigors and cardiac depression which mark the chinolin deriva- tives, combine to make it one of a wide therapeutical range. It is especially useful in— Phthisis and Typhoid Fever,—for the hyperpyrexia, and thereby relieving wakefulness, lessening delirium, and upholding a failing heart; but it should not be used continuously for any great length of time in these affections. Pains of Locomotor Ataxia,—and in those of rheumatic origin, sciatica, lum- bago, etc., it is a most efficient remedy. Acute Rheumatism,—it is highly praised ; though its efficiency is herein dis- puted by Salol, as also by Salipyrin. Epilepsy,—it is being tried, with a view of moderating reflex excitability. Epidemic Influenza,—both as a prophylactic and a remedy, Phenacetin has proved highly efficient. Migraine,—has been treated with benefit by Phenacetin in 2-grain doses with gr. ss of Citrated Caffeine. NAPHTALINUM,—Naphtalin. Source and Composition. Naphtalin, C10Hg, is a hydrocarbon product formed during the manufacture of ordinary coal gas. Chemically, it is one of the benzene derivatives, being formed by the union of two benzene groups in an overlapping ring. (See ante, page 180.) When redistilled it crystallizes in colorless, rhombic plates, of tarry odor, and burning, aromatic taste, insoluble in water, dilute acids or alkalies, and but sparingly so in alcohol. 186 ANTIZYMOTICS, ANTIPYRETICS, ANTIPERIODICS. The Dose of Naphtalin is from gr. ij-viij, up to gr. lxxx per diem for adults ;—and for children gr. j-iij, every three hours. Being quite insoluble in water it must be given in emulsion, or as a powder with sugar in wafers or capsules. It is best flavored with oil of bergamot. Derivatives. From Naphtalin we have— Naphtol, Beta- or Iso-naphtol, C10H,OH,—one of several kinds of Naphtol: is sparingly soluble even in hot water, but is soluble in alcohol, ether, chloro- form, olive oil and vaseline. Used as ointment, I to 5 for adults, but. for children not over 2 per cent. *Hydronaphtol, C16H7OH,—glistening, micaceous scales, sparingly soluble in water, freely soluble in alcohol, oils, etc. Used as an antiseptic, and in ointment or powder locally, diluted with oxide of zinc, 1 to 50. Physiological Action. Naphtalin is destructive to all forms of low life, and hence is antiseptic in a high degree, but must be intimately mixed with the substances upon which it is to act. Internally it is a stimulant expectorant of decided power, and disinfects the contents of the intestinal canal. Being so sparingly soluble, but little of it is absorbed, and hence it does no injury to the organism. What is taken up by the blood is excreted by the urine, partly unchanged, partly as naphtol and perhaps some as phenol. Naphtol is more easily absorbed, and causes vomiting, hematuria, convulsions, and uncon- sciousness. Hydronaphtol is a powerful and non-irritating antiseptic, non- poisonous, non-corrosive, freely soluble in alcohol, glycerin, fixed oils, etc., in cold water, 1 to 2000 ; and in hot water 1 to 100, precipitating as the water cools, but leaving a saturated solution of 1 to 1000, which is perfectly inhibitive of the germs of putrefaction in all putrescible fluids (Levis). The claims made for it are that it is 12 times as effective as carbolic acid, 30 times as potent as salicylic acid, 60 times as efficient as boric acid, 600 times as anti- septic as alcohol, and that it is entitled, as a true antiseptic, to stand next to mercuric chloride in the comparative tables (Levis). Therapeutics. Naphtalin is employed as an antiseptic for the intestinal canal in typhoid fever, diarrhoea, both acute and chronic, tubercular diarrhoea, etc. It renders the urine aseptic and may be employed in vesical catarrh. It is also used internally for humoral asthma, verminous affections, and the chronic pulmonary catarrh of the aged. Locally, it has high value as an anti- septic, for indolent ulcers, sloughing wounds, open cancers, pus cavities, etc. Painted over organic remains it effectually prevents the ravages of insects. Naphtol is employed like tar for a therapeutic action upon the skin, in hyperi- drosis, scabies, eczema and local sweating, in ]/2 to 5 per cent, alcoholic solu- tion, or as a 10 per cent, ointment. Hydronaphtol is also highly esteemed for CARBOLIC ACID. 187 antiseptic purposes generally, by those who have used it, and is of benefit as an external application in many skin diseases. Its non-toxic and non-irritant qualities render it the most useful and most generally available of the three. Source and Composition. Carbolic Acid, C6H5HO, or C6H60,—also known by the names Phenyl Alcohol, Phenic Acid and Phenol,—is a constitu- ent of coal tar, obtained by fractional distillation and subsequently, purified. Its claims to be considered an acid are very feeble, as, though it has a faint acid reaction and combines with salifiable bases, it is incapable of neutralizing alkalies, and its combinations are decomposed by the feeblest acids, sometimes even by water. Considered as the hydroxyl derivative of Benzene, it might be classed with the alcohols, but as it does not yield the same products on oxida- tion (yielding finally oxalic instead of acetic acid), it is taken as the type of a class called Phenols, which are simple hydroxyl (HO) derivatives of the aro- matic hydrocarbons. CARBOLIC ACID,—Phenol. Official Forms are two, viz. :— Acidum Carbolicum, Carbolic Acid, (Phenol),—colorless, interlaced crystals, sometimes acquiring a reddish tint, of characteristic odor, deliquescent in damp air; soluble in about 15 of water, very soluble in alcohol, ether, chloroform, oils, etc., almost insoluble in benzin. Dose, gr. well diluted. Acidum Carbolicum Crudum, Crude Carbolic Acid,—consists of various con- stituents of coal tar, chiefly Cresol and Phenol, obtained by fractional dis- tillation. Is used only as a disinfectant. Characteristics. Peculiarities about Carbolic Acid are that the addition of about 8 per cent, of water liquefies it, a further addition of water produces a turbid mixture, until about 15 of water are added, when a stable and clear solution is formed. One volume of the liquefied acid, containing 8 per cent, of water, forms with one volume of Glycerin a clear mixture, which is not rendered turbid by the addition of three volumes of water (absence of Creosote and Cresol). Carbolic acid coagulates albumen or collodion (Creosote does not), and by the addition of nitric acid it is converted into Picric Acid, etc., (Creosote into Oxalic Acid). Preparations. Only two are official, viz. :— Unguentum Acidi Carbolici, Carbolic Acid Ointment,—io per cent. Glyceritum Acidi Carbolici, Glycerite of Carbolic Acid,—I to 4 of Glycerin. * Liquor Acidi Carbolici, Solution of Carbolic Acid,—for local use in antisep- 188 ANT1ZYMOTICS, ANTIPYRETICS, ANTIPERIODICS. tic surgery, of various proportions in water, per cent, for sponges, hands, etc., 5 per cent, as spray, etc. Derivatives. Two are official, viz. :— Sodii Sulpho-carbolas, Sodium Sulpho-carbolate,—prepared by dissolving car- bolic in an equal part of sulphuric, to form sulpho-carbolic acid, and neu- tralizing this with barium and sodium carbonates. Occurs in rhombic prisms, soluble in 5 of water. Dose, gr. x-xxx. Salol, Phenyl Salicylate,—the salicylic ether of phenol, (see under Salicin, next title). *Phenol Iodatum, Iodized Phenol,—a mixture of Iodine and Carbolic Acid, in various proportions, for local use in gynecology. Also called Carbolated Iodine. Analogues of Carbolic Acid. Creosotum, Creosote,—is a mixture of phenols, chiefly Guaiacol and Creo- sol, obtained during the distillation of wood-tar, preferably of that derived from the beech. Dose, rt\j-iij. A colorless or yellowish, oily liquid, of strongly empyreumatic odor, burning and caustic taste, and neutral reaction ; freely soluble in alcohol, ether, acetic acid, etc., sparingly in water (1 in 150), more readily in boiling water. It does not coagulate albumen or collodion (difference from Carbolic acid, which does). By the action of nitric acid it is converted into Oxalic Acid chiefly, (Carbolic into Picric Acid, etc.). Aqua Creosoti, Creosote water,—strength 1 per cent., is the only official prepa- ration. Dose, gj— *Guaiacolutn, Guaiacol, (Methyl Pyrocatechin),—is the most active ingredient of Creosote, of which it constitutes from 60 to 90 per cent. Occurs as a colorless, inflammable liquid, soluble in alcohol. Dose, TT\j-xv. * Benzosolum, Benzosol,—is prepared by heating Guaiacol with Benzoic Acid, and occurs in small, tasteless crystals, insoluble in water, containing 54 per cent, of Guaiacol. Dose, gr. v-xv. Resorcinum, Resorcin, [Meta-dioxy-benzol), C6H4(OH)2—is a diatomic phenol, and one of the three isomeric substances formed by substituting two atoms of hydroxyl for two of hydrogen in Benzene (Benzol), as the substitu- tion of one produces Carbolic Acid. The relative positions of the hydroxyl atoms in the ring are for Resorcin I and 3, for Pyrocatechin 1 and 2, and for Hydroquinone 1 and 4, the two latter having the respective prefixes “ Ortho,” and “ Para,” with the composition name “ Dioxy-benzol,” and the same for- mula as the first. Resorcin occurs in colorless, rhombic prisms or plates of neutral reaction, soluble in water, also in alcohol, ether, etc. Dose, gr. v—xv ; as an antipyretic 3 ss-j not repeated for several hours, or gr. v every 2 hours. CARBOLIC ACID. 189 *Hydroquinone occurs in plates of sweetish taste, and is about four times stronger than Resorcin, having the same action and uses. *Pyrocatechin also occurs in plates or crystals, is three times stronger than Resor- cin, but otherwise the same ; is readily soluble in water, alcohol and ether. Pyrogallol, Pyrogallic Acid, C6H3(OH)3—is a triatomic phenol obtained chiefly by the dry distillation of gallic acid. It has the same form of com- position as the preceding substances, except in it 3 atoms of Hydroxyl are substituted for 3 of Hydrogen in the Benzene-ring, instead of I as in Carbolic Acid, and 2 as in Resorcin. It occurs in light, glistening crystals, which are readily soluble in water and in alcohol, and combine rapidly with oxygen, becoming of a dark color. Dose, gr. ss to gr. jss. Physiological Action. Carbolic Acid is a powerful antiseptic and antiferment, deodorizer and disinfectant, being very destructive to low forms of life when used in sufficient strength. It prevents the decomposition of albu- minous fluids by bacteria, the fermentation of sugar by yeast, the conversion of starch into sugar, of albumen into peptones, and the decomposition of amygdalin with formation of hydrocyanic acid (Brunton). As ordinarily used in solutions its action upon low organisms is inhibitive rather than de- structive, its safe solutions being only sufficient to prevent their development. Locally it is styptic, anaesthetic and superficially escharotic, coagulating the albumen of the part, and the blood also when outside the body. It is powerfully poisonous to the tissues, and when applied directly to muscle or nerve, it paralyzes them at once without previous stimulation. When swallowed undiluted, Carbolic Acid produces violent gastro-enteritis, with vomiting and purging, followed by collapse, delirium, and often by con- vulsions and death. After absorption it acts by selection upon the medulla, especially on the respiratory and vaso-motor centres therein, which it first briefly stimulates and then completely paralyzes. It stimulates the cardiac inhibition, first slowing the heart, then depressing and finally paralyzing it. Respiration, at first increased, is soon depressed, the pupils are contracted, and the brain and spinal cord are directly affected,—stupor, coma, suspended reflexes, impaired motility and sensibility being produced. It is rapidly absorbed and diffused, many fatal cases having occurred from its local use in full strength. It is partly oxidized in the body, and partly eliminated by the lungs and kidneys, imparting to the urine a smoky appearance. of the pure acid have pro- duced dangerous symptoms. Death from a medium dose occurs by paralysis of respiration, from a large dose by paralysis of the heart. The blood, after death, is very dark in color, and is almost non-coagulable. Creosote has similar properties, but is not so actively toxic as Carbolic Acid; it causes increased coagulability of the blood, and does not produce 190 ANT1ZYMOTICS, ANTIPYRETICS, ANTIPERIODICS. convulsions. It is largely eliminated by the bronchial mucous membrane, which it stimulates, and is therefore a good expectorant. In small doses it seems to have a selective sedative influence on the terminal nerve-filaments in the gastric mucous membrane. It explodes when combined with Oxide of Silver in pill, unless previously diluted with an inert powder. Resorcin is not irritant to the skin or the submucous tissue, and but slightly so to mucous membranes. It is equally powerful as an antiseptic and antiferment, arresting decomposition and destroying low organisms. 3 ss to 3 j causes a sense of heat, discomfort and oppression, followed by profuse perspiration and languor; if fever has existed the temperature is lowered several degrees, but rises again, after a rigor, in from two to four hours. Pyrogallic Acid is exceedingly poisonous, the symptoms coming on in rapid succession, with headache, vomiting and purging, collapse, etc. It de- composes the red blood-corpuscles, causing thrombi in the venous radicles, hemorrhagic infarcts in the kidneys, and hematuria, also melansemic discolora- tion of the skin and mucous membranes. Its antiseptic action is doubtful. Antidotes and Antagonists to Carbolic Acid. Any soluble sulphate is the chemical antidote, forming a sulpho-carbolate. Magnesium Sulphate used in one case, (nearly 3 ounces), where half-an-ounce of 95 per cent, acid had been swallowed, with full recovery from an all but hopeless condition of collapse. Liquor Calcis Saccharatus or Syrupus Calcis, are also antidotal, but are less efficient than the sulphates. Cider Vinegar removes the local effects of the application of the strong acid, and may prove a good antidote. Atro- pine is said to be a very complete physiological 'antagonist, maintaining the heart and respiration until elimination occurs, which should be promoted by diluents, used freely. Vegetable Demulcents, (but no oils or glycerin), to pro- tect the mucous surfaces. Therapeutics. Carbolic Acid owes its past prominence to its having been the principal agent used in Lister’s Antiseptic Method; but its use in that connection has become greatly restricted, many surgeons having aban- doned it altogether in favor of other germicides. Locally, it has many uses, relieving pruritus of almost any form if applied in a 5 per cent, solution over the itching surface, and making an excellent gargle (1 per cent.) for the pain- ful sore throat of diphtheria, tonsillitis, etc. Internally, in -grain doses it is an excellent remedy for nausea and vomiting, and it may be advantageously administered in dilute solution (2 to 5 per cent.) by spray, in many chronic pulmonary affections ; also locally and by injection in— Catarrhs,—acute and chronic. Parasitic Skin Diseases. Uterine and other Ulcers. Erysipelas. Synovitis. Hydrocele. Endo-metritis. Abscesses. Pulmonary Phthisis. SALICIN AND SALICYLIC ACID. 191 Exanthematous Fevers, and other Septic diseases,—Sodium Sulpho-carbo- late internally in 5-grain doses every two or three hours, has been much praised by many practitioners. - Creosote is more suitable for internal administration, and is used with benefit for vomiting from many causes, that due to abnormal gastric fermenta- tion, ulceration of the stomach, cancer, sea sickness, Bright’s disease, and even pregnancy. It is also useful in the irritative diarrhoea of children, and its vapor is well employed by inhalation in phthisis and bronchitis. Being a very complex substance of varying composition, Creosote is being supplanted by Guaiacol, its principal ingredient, for internal administration. Resorcin has been used as a local antiseptic in diphtheria, cystitis, facial erysipelas and syphilitic sores; also in 5-grain doses internally to prevent gastric fermentation. As an antipyretic it has been employed in typhoid fever and in phthisis, but its short antipyretic power, and the profuse perspirations which it induces, are objections to its ever being a favorite remedy. Pyrogallol is employed locally in skin diseases ; a 20 per cent, ointment being used as a caustic in lupus, cancer and chancres. It is said to destroy the diseased tissue without affecting the healthy tissue in the vicinity (Brun- ton). A 10 per cent, ointment is applied in psoriasis, lupus erythematosus, etc., but the dangers of absorption must be borne in mind. SALICIN AND SALICYLIC ACID. Salicinum, Salicin, C13H1807,—is a neutral principle obtained from several species of Salix (willow) and Populus (poplar), also found in Gaultheria procumbens (wintergreen) and in Betula lenta (sweet birch), the volatile oils of which consist almost entirely of methyl salicylate. It occurs in white, silky, crystalline needles ; soluble in 28 of water and in 30 of alcohol. Dose, gr- x~3j- Acidum Salicylicum, Salicylic Acid, HC7H503,—is an organic acid, exist- ing in various plants, but most largely prepared synthetically from carbolic acid. Occurs in fine, prismatic needles or a crystalline powder; soluble in about 450 of water and in of alcohol, but readily soluble in water con- taining 8 per cent, of borax or 10 of sodium phosphate. Dose, gr. v-^j. Salicylic Acid is a derivative of Salicin, probably by double oxidation ; but may also be considered as a substitution-derivative of Benzene, formed by replacing 2 atoms of its hydrogen, the one by hydroxyl, and the other by carboxyl. (See page 180, ante.) It is obtained, therefore, either synthetically by combining the elements of Carbolic Acid with those of Carbonic Acid, and subsequent purification,—or from natural Salicylates as the oils of wintergreen and sweet birch,—or from Salicin, by heating 192 with caustic potash and treating the mass with hydrochloric acid. The acid prepared from natural sources is purer and more efficient than that prepared artificially, and will often be tolerated by a patient who cannot bear the latter. ANTIZYMOTICS, ANTIPYRETICS, ANTIPERIODICS. Preparations. Sodii Salicylas, Sodium Salicylate,—soluble in of water and in 6 of alcohol, also in glycerin. Dose, gr. v-^j. Lithii Salicylas, Lithium Salicylate,—very soluble in water and in alcohol. Dose, gr. v— 3). Salol, Phenyl Salicylate,—is the salicylic ether of phenol, obtained by heat- ing salicylic acid, the air being excluded. Warmed with an alkali Salol splits up into Salicylic Acid 60, Carbolic Acid 40. It is soluble in 10 of alcohol, nearly insoluble in water. Dose, gr. v-xv. Oleum Gaultherice, Oil of Wintergreen,—consists almost entirely of methyl salicylate. Dose, tr^v-xv. * Salipyrin, Antipyrin Salicylate,—See under Antipyrin. * Salopken, Para-amidophenol Salicylate,—contains nearly 51 per cent, of Salicylic Acid. Dose, gr. v-xv, up to or jss in 24 hours. Physiological Action. Salicin is a bitter tonic, an antipyretic, antiferment, and antiseptic, being destructive to low organisms. It prevents the reaction between amygdalin and emulsin, and that of ptyalin on starch. It seems to be devoid of toxic power on man, and is probably excreted as Salicylic and Salicyluric acids. It has some slight power as an antiperiodic. Salicylic Acid has properties similar to the above, but acts with greater energy. In small doses it stimulates the stomach, heart and respiration, but large doses derange the stomach, causing nausea and vomiting, depress the heart and respiration, lower the arterial tension, and reduce the temperature in fever. It causes vertigo, dilated pupils, tinnitus aurium, a sensation of tension in the frontal cerebrum, delirium, and occasionally collapse, from sudden de- pression of the circulation. A lethal dose produces death by paralysis of the respiration. During its administration bed-sores are frequently observed, being due to the depressed state of the circulation which it induces. During its excretion it oflen irritates the kidneys and causes albuminuria. It colors the urine green by transmitted and brown by reflected light, and under its use the urine contains a substance which reduces copper solution—(Brunton). It is destructive to the torula, prevents alcoholic fermentation and that caused by the organic ferments (pepsin, ptyalin, etc.). In solutions containing bacteria it will prevent their development, if in the proportion of one per cent., and in that of i in 60 it will destroy them though in full activity. Sodium Salicylate is remarkably antipyretic in doses of gr. xv, given 4 or 5 times in 24 hours. It is a powerful diaphoretic, and an efficient chola- THYMOL AND MENTHOL. 193 gogue, and it is supposed to possess the curious property of increasing the fluidity of the bile, at the same time that it promotes its secretion,—other chola- gogues increasing the proportion of solids therein (Brunton). It has no anti- septic power unless with a strong mineral acid to liberate the salicylic acid. Salol is antiseptic, antipyretic and germicide, in a higher degree than either of its constituents. As an antipyretic in fever it stands next after Antipyrin, and it acts with such force as to frequently depress the temperature a degree or two below normal. It is sedative to the cerebro-spinal system, and somewhat analgesic. It causes profuse sweating, and in a few cases considerable depres- sion has accompanied its antipyretic employment; but it is not toxic, and may be used freely in its proper dosage, which ranges from 5 to 60 grains, up to 2 or 3 drachms in the 24 hours. Therapeutics. Salicin and its derivatives are chiefly used in Acute Rheu- matism, to lower temperature, relieve pain, and reduce articular swelling. They are most suitable to strong, vigorous patients, and if not promptly effi- cient they should be abandoned. Salicylic Acid is much used as an anti- pyretic in fevers, especially those of the septiccemic kind. It is a useful local application to Corns and Warts, also in— Eczema of hands and feet. Cancer. Fetid Pespirations,—in which it is Gangrenous Wounds. Burns. used in solution with Borax. Sodium Salicylate is employed in 3 to 5-grain doses internally after meals, to arrest gastric fermentation, and to prevent acidity and flatulence. It is used instead of the acid in acute and chronic rheumatism, to relieve head- aches, and ioxphlegmasia alba, in which it is considered very efficient,—also in cases where there is a tendency to the formation of gall-stones. Salol is a most efficient remedy for duodenal catarrh, catarrh of the bile- ducts and catarrhal jaundice ; also in the bilious form of sick-headache, and in some forms of neuralgia. Its greatest power is manifested over acute rheu- matism, in which disease many clinicians maintain that it has no superior, if given in 15 to 30-grain doses, up to 2 drachms in the 24 hours, and continued for some time after the acute symptoms have subsided. It should prove an efficient disinfectant in catarrh of the bladder, as its constituents are excreted with the urine, and come in contact with the vesical mucous membrane for a considerable period of time. THYMOL AND MENTHOL. Thymol, C10HuO,—is a phenol contained in Oil of Thyme and in the volatile oils of several other plants. It occurs in large, hexagonal crystals of aromatic odor; soluble in 1200 of water and in I of alcohol, freely in fats 194 and oils. It liquefies when triturated with about equal quantities of camphor, menthol or chloral. Dose of Thymol, internally gr. ss-gr. ij;—as a spray I part in Soo of hot water;—as an ointment, gr. v-xxxtothe of petrolatum ; — as inhalation, gr. vj to 3j of warm water. ANTIZYMOTICS, ANTIPYRETICS, ANTIPERIODICS. Menthol, Peppermint Camphor, C10H19OH,—is a stearopten obtained from Oil of Peppermint by deposit on exposure to cold. It occurs in colorless crystals or masses, having the taste and smell of peppermint oil, soluble in alcohol, ether, etc., but sparingly in water. It forms an oily liquid when rubbed up with an equal quantity of thymol, pure carbolic acid, or chloral hydrate, or ]/2 of croton-cliloral, or %rds of camphor. Dose, gr. ss-iij in pill or alcoholic solution, several times a day. Mints and ilieir Preparations. Mentha Piperita, Pepper-mint,—the leaves and tops of Mentha piperita, a plant of the ord. Labiate, cultivated everywhere. Oleum Menthce Piperitce, Oil of Peppermint,—is the volatile oil distilled from the fresh herb, consisting of Menthol (see above), and a liquid terpene. Dose, rqj-v. Aqua Menthce Piperitce, Peppermint Water,—2 per 1000. Dose, ad lib. Spiritus Menthce Piperitce, Essence of Peppermint,—has io per cent, of the oil and I per cent, of the powdered herb. Dose, rrpx-xxx. Trochisci Menthce Piperitce, Peppermint Troches,—each has of the oil I per cent., with Sugar and Mucilage. Dose, ad libitum. Mentha Viridis, Spearmint,—the leaves and tops of Mentha viridis, the well-known “ mint ” of the gardens, a cultivated plant of the ord. Labiate, having properties and constituents identical with those of Peppermint, but differing therefrom in odor and taste. Its preparations are as follows,— Oleum Menthce Viridis, Oil of Spearmint,—Dose, rtpij-v. Aqua Menthce Viridis, Spearmint Water,—Dose, indefinite. Spiritus Menthce Viridis, Essence of Spearmint,—Dose, IT\x—xl. Physiological Action. The Mints are aromatic stimulants, carminatives and antispasmodics, their oils possessing these qualities in greater degree, and being also local anodynes and anaesthetics, especially if their evaporation be prevented after their application to a surface. The Chinese oil is especially efficient as an anodyne, and contains a large quantity of Menthol. Menthol acts as a local vascular stimulant when applied to the skin ; and is also a local anaesthetic, but not corrosive, causing first a sensation of burning, which is replaced by a feeling of coldness when the part is blown upon. It ANTISEPTIC OILS. is a powerful antiseptic, the Oil of Peppermint being found to destroy comma bacilli in solution of 1 to 2000;—but its slight solubility in water prevents its use becoming general in this respect. Administered internally it stimulates the secretory nerves and the cardiac muscle, and causes a periodic increase in arterial tension (like camphor), but does not affect the pulse-rate. It increases the respiratory rate, and lessens the depth of the respirations. It lessens sensation and reflex sensibility, in large doses destroying both, and paralyzing the cerebro-spinal system. 195 Thymol resembles both Carbolic Acid and Oil of Turpentine in its action, being a powerful antiseptic and germicide, like the former, and like the latter an irritant to the organs of elimination and a paralyzant. When absorbed in toxic quantity it paralyzes the nerve-centres in the spinal cord and medulla from the first, with no preliminary stimulation ;—slowing respiration, lowering the arterial tension, blood-pressure and body-temperature, and lessening reflex excitability. It is eliminated by the urinary and respiratory organs, which it irritates during its excretion. Autopsies on animals poisoned by it show fatty degeneration of the liver, (as with phosphorus), and great congestion of the bronchial and pulmonary mucous membranes and of the kidneys. Therapeutics. The Oils of the Mints are employed chiefly as carmina- tives and stimulants, to relieve flatulence and colic; also as corrigents to purgatives, to lessen griping. Menthol is used locally as an antiseptic and analgesic, and Thymol as an antiseptic application to wounds and skin-diseases, also as a spray or inhalation in chronic affections of the lungs and bronchi. Insects, as mosquitoes, gnats, etc.,—are effectually repelled by the odor of the oils of mint, and attracted by that of thyme. Neuralgia, Odontalgia, etc.,—are relieved by the application of the menthol pencil over the surface, or the oily liquid resulting from its trituration with chloral, camphor, etc., on cotton in the cavity of a carious tooth. Diabetes and Cystitis have been treated with Thymol, as an internal remedy; also Phthisis, Diphtheria, and Typhoid Fever. Intestinal Affections, and ulcerated conditions of the mouth and fauces,—are satisfactorily treated with Thymol, as an internal antiseptic and mouth-wash. ANTISEPTIC OILS. Oleum Caryophylli, Oil of Cloves,—contains the Light and Heavy Oils of Cloves, the latter containing Eugenol, and Caryophyllin, a camphor, also Caryophyllinic and Salicylic Acids. Dose, tTpij-v. Oleum Gaultheriae, Oil of Wintergreen,—consists of Methyl Salicylate, 90 per cent., and Gaultherilene, a hydro-carbon, 10 per cent. Dose, n\v-x. 196 ANTIZYMOTICS, ANTIPYRETICS, ANTIPERIODICS. Oleum Cajuputi, Oil of Cajuput,—contains Cajuputol or the Bihydrate of Cajuputene, % ; the other being another oil. Dose, rqj-v. Oleum Eucalypti, Oil of Eucalyptus,—contains a volatile oil which consists of Eucalyptol, an oxygenated oil, and two other products named Turpene and Cymol. [See ante, page 62]. Dose, npij-xx. Oleum Thymi, Oil of Thyme,—contains Thymol (see ante, page 193), also a hydro-carbon which is resolvable into Cymene and Thymene. Dose, try— iij. * Oleum Myrti, Oil of Myrtle,—a volatile oil distilled from the leaves of Myrtus communis, the Myrtle, (nat. ord. Myrtacese). Dose, rt\J—iij, in cap- sule. It contains Myrtol, isomeric with Oil of Turpentine. Physiological Action. The general action of these oils and their deriva- tives agrees with that of Thymol. Alyrtol is a very active antiseptic and parasiticide, and sufficiently irritant on a raw surface to excite inflammation. It is eliminated by the lungs and kidneys, acting as a stimulating expectorant, and as an antiseptic and stimulant to the mucous membranes at the points of elimination. Eucalyptol is one of the most powerful antiseptics, and the Oil of Eucalyptus is nearly as efficient, either of them ranking above Quinine in hindering the development of anthrax bacilli (Koch). The latter is a local irritant, and if applied to the skin, and its evaporation prevented, it acts as a vesicant or as a pustulant. In the stomach it is highly irritant, doses of 20 minims causing burning sensations and great pain. Absorbed in large quan- tity it is a powerful poison to the nerve-centres, depressing the spinal cord, brain, medulla, and heart, abolishing reflex action, lowering the blood-pressure and temperature, and causing death by paralysis of respiration. It is excreted by the pulmonary and renal mucous membranes, imparting a smell of violets to the urine, acting as a stimulating expectorant and a renal and urinary anti- septic. It arrests the movements of the white blood corpuscles, causes con- traction of the spleen, and has considerable power as an antiperiodic, in all of which qualities it resembles Quinine, though much less efficient. Therapeutics. These oils are not as much used in medicine as they de- serve to be. The Oil of Cloves is often employed in domestic practice, as a local anaesthetic in toothache and superficial neuralgia. Dissolved in alcohol, any of these oils will promptly correct flatulence, if administered internally, in small doses. Their most important applications are in the following affec- tions, viz. :— Bronchorrhcea, fetid bronchitis, gangrene of the lung, etc.,—Myrtol is an effi- cient disinfectant and alterative. BENZOIN AND BENZOIC ACID. 197 Choleraic Vomiting, and that due to nervous derangement,—the Oil of Caju- put, with Spt. Chloroformi, and Tinct. Cinnamomi. Parasitic Skin-diseases,—favus, herpes and pityriasis, are cured by Myrtol ; and Cajuput Oil is a very effective local application in tinea, scabies, pity- riasis, etc. Worms, both ascarides and the round worm,—are effectually expelled by Myrtol or Cajuput Oil, as enemata. Rheumatism, Gout, and allied affections,—are exceedingly well treated by Oil of Gaultheria, in emulsion with other similarly acting agents. Cystitis and Urethritis,—Myrtol and Eucalyptol are used with benefit, admin- istered internally so as to act on these mucous membranes through the urine. Septiccemia and Pycemia,—the Oil of Eucalyptus has been used successfully; especially in three cases of septicaemia, in one of which Quinine had proved useless (Brunton). Uterine Catarrh, and after parturition,—Oil of Eucalyptus is well used in an injection or on pessaries, as a local disinfectant and stimulant. Sponge-tents,—are most effectually disinfected and deodorized by being dipped into the Oil of Cloves. Benzoinum, Benzoin,—is a balsamic resin obtained from Styrax Benzoin, a Siamese tree (nat. ord. Styraceae). It occurs in agglutinated tears, or a brownish mass, of little taste, but agreeable odor, soluble in alcohol and solu- tion of potassa ; and consists of Benzoic Acid, 10 to 20 per cent., together with Resins 80 per cent., and a trace of a volatile oil. Dose, gr. x-xxx. BENZOIN AND BENZOIC ACID. Acidum Benzoicum, Benzoic Acid, HC7H502,—occurs in light, feathery plates and needles, and is obtained from Benzoin by sublimation. Soluble in 2 of alcohol, and in 500 of water ; but with Borax, 1 part of each are soluble in 100 of water. Dose, gr. x—xxv, in wafers. Preparations,—including the salts of Benzoic Acid, or Benzoates. Adeps Benzoinatus, Benzoinated Lard,—has of Benzoin 2 per cent. Tinctura Benzoini, Tincture of Benzoin,—20 per cent. Dose, 3 ss~j- Tinctura Benzoini Composita, Compound Tincture of Benzoin, (Friar’s Bal- sam),—has of Benzoin 12, Aloes 2, Styrax 8, Balsam of Tolu 4, and Alco- hol to 100 parts. Dose, g ss-ij, but generally used locally. Ammonii Benzoas, Ammonium Benzoate,—soluble in 5 of water, and in 28 of alcohol. Dose, gr. v-xxx. 198 Lithii Benzoas, Lithium Benzoate,—soluble in 4 of water, and in 12 of alco- hol. Dose, gr. v-xxx. Sodii Benzoas, Sodium Benzoate,—soluble in about 2 of water, and in 45 of alcohol. Dose, gr. v-gj. Is efflorescent. ANTIZYMOTICS, ANTIPYRETICS, ANTIPERIODICS. Physiological Action. The action of Benzoin is due to Benzoic Acid, which is stimulant and irritant to mucous membranes and raw surfaces, also highly antiseptic and disinfectant, a stimulating expectorant, and a diuretic. Taken internally it causes epigastric heat, increases the pulse-rate, and stimu- lates the action of the skin, the salivary glands, and the bronchial mucous membrane. It acidifies the urine, and increases its quantity, and is chiefly excreted by the kidneys, in part unchanged, and partly as hippuric acid after uniting with glycocoll. Benzoin acts as an irritant to the mucous membrane of the fauces and nasal passages ; its powder inhaled causing sneezing and coughing. Therapeutics. The uses of Benzoin and Benzoic Acid are chiefly local, but. they may be used with benefit internally in several affections of the respi- ratory and urinary passages. In— Chronic Bronchitis of the aged,—Benzoin as a stimulating expectorant. Laryngeal and Bronchial affections,—Benzoin by steam atomization. Chlorosis and several Uterine disorders,—Benzoin internally is of benefit. Chaps and Sore Nipples,—the compound tincture I, to 4 of glycerin and water. Freckles, etc.,—either tincture with 20 of water, locally as a cosmetic. Wounds of foul character,—the tinctures are excellent applications. Cystitis with alkaline urine and phosphatic deposits,—Benzoic Acid or its salts are extremely valuable, being the only certain means of neutralizing morbid alkalinity of the urine. Phosphatic Calculi,—a long course of the Ammonium Benzoate. Gout and Uric Acid Diathesis,—the Lithium Benzoate is very efficient. Diphtheria, Scarlet Fever, and other septic diseases,—the Sodium Benzoate is largely used instead of the salicylates, as an internal antiseptic and antipy- retic, and has rendered good service. Phthisis and Whooping-cough,—the Sodium salt by inhalation with atomizer. CHLORUM,—Chlorine. Chlorine, Cl,—is a greenish-yellow gas, belonging to the Halogen group of elements ; and though not official itself, it is represented in medicine by several of its compounds, as well as by several preparations which furnish it. The so-called Halogen Elements derive their title from a As, the sea,—because the most important members of the group are obtained, directly or indirectly, from the CHLORINE. 199 ocean, viz :—Chlorine, from sea-salt; Bromine, from sea-water; and Iodine, from sea- weed. They are all noted for their affinity for hydrogen, and consequent power as decomposers of organic matter. Chlorine Compounds, described under the titles of their respective bases, are—the Chlorates of Potassium and Sodium ; the Chlorides of Ammonium, Calcium, Potassium, Sodium, Mercury, Gold, Iron and Zinc, etc.;—also Hydrochloric Acid, classed with the mineral acids (see page 50), and Chloral, Croton-chloral, and Chloroform. Preparations. Aqua Chlori, Chlorine Water,—is an aqueous solution, containing at least 0.4 per cent, of the gas. Dose, rrpx-xx, in water. For local use 3j-iv, well diluted, as a lotion or spray. Calx Chlorata, Chlorinated Lime, “ Chloride of Lime,” (not Chloride of Cal- cium),—contains at least 35 percent, of available Chlorine. Dose, gr. iij-vj in water ;—externally a I to 3 per cent, solution. * Liquor Calcis Chlorates, Solution of Chlorinated Lime, (B. P.),—has of the preceding 1 pound in 1 gallon of Water. Liquor Sodes Chlorates, Solution of Chlorinated Soda, (Labarraque’s Solution), —is an aqueous solution of several chlorine compounds of sodium, and con- tains at least 2.6 per cent, of available chlorine. Dose, in 20 parts of water. Physiological Action. Chlorine is the most powerful of all the disin- fectants and deodorants, and an antiseptic and antifermentative agent of the highest activity; its power in these respects being due to its affinity for hydro- gen, decomposing all bodies which contain hydrogen as a molecular constitu- ent, forming hydrochloric acid and setting oxygen free in its nascent form (ozone). Administered internally, it is converted, on reaching the stomach, into hydrochloric acid and chlorides, losing all action on the organism in its own character. Locally applied, it is irritant to the skin and mucous mem- branes, producing a sense of heat, with burning sensations and even vesica- tion. Inhaled in any quantity, it causes cough, sneezing, and spasm of the glottis, also inflammation of the mucous lining of the air-passages, and of the lungs. The Chlorides generally resemble, in their actions, their basic constituents rather than Chlorine ; but one of them possesses qualities of its own which render it of prime importance, namely, Sodium Chloride, or Common Salt. This substance is one of the most important and abundant of the saline con- stituents of the animal organism, existing normally in the blood, where it keeps the fibrin and albumin in solution ; hence in inflammation, being thus 200 ANTIZYMOTICS, ANTIPYRETICS, ANTIPERIODICS. needed, it accumulates at the seat of the morbid action, disappearing tempo- rarily from the urine ; its reappearance therein being considered one of the surest signs of the patient’s improvement. In very dilute solution it enables water to dissolve both albumins and globulins, and renders water non-irritant to the animal tissues and harmless to the red blood-corpuscles. For these purposes the solution employed is one of 0.65 per cent., known in experi- mental physiology as the “ normal salt solution.” In substance, however, or in concentrated solution, it is very irritant to cut surfaces, mucous membranes, muscle and nerve tissues. Taken into the stomach in quantity it irritates that organ, and induces vomiting; and, when absorbed in excess of the normal requirements of the body, it causes, in great intensity, the peculiar nervous irritation which is expressed by the sense of thirst; and this is only relieved by the ingestion of water in sufficient quantity to enable the excess to be dis- solved and excreted by the kidneys. It is rapidly absorbed, and equally rapidly excreted; and, when consumed in excess, it increases tissue-change, and consequently the excretion of urea,—and also the excretion of potassium salts. On the other hand, the excessive ingestion of potassium salts, (as in the cases of herbivorous animals, and vegetarian cranks), increases the excre- tion of sodium chloride, by a double decomposition between them in the blood, forming potassium chloride and sodium phosphate, which, being foreign to the blood, are constantly excreted. In this way, by a continuous vegetable diet, the normal amount of sodium chloride in the organism may be greatly reduced; and the animal will feel the want of it, and will travel hundreds of miles to visit a salt-lick. Besides being emetic, when given internally, Sodium Chloride also acts as a hemostatic, decreases the secretion of mucus, is a vermifuge against ascarides, promotes the absorption of pleuritic serous exuda- tions and of dropsies, and has considerable power as an antiperiodic and an antiseptic. Ammonium Chloride is alterative, expectorant, cholagogue, and purgative, also anti-neuralgic, and refrigerant,—the latter property being exhibited when locally used, as by the process of its being dissolved in water a considerable degree of cold is produced. Ferric Chloride is one of the most valuable compounds of Iron, with which it is generally classed,—its action being mainly that of a chalybeate. Being a chloride, however, it must possess high antiseptic energy in the organism ; and it is doubtless its combination of the quality of an active, yet safe internal antiseptic, with its power as a blood-restorer, which makes it so valuable a remedy in the septic diseases. The other Chlorides (of Mercury, Gold, Zinc, etc.) and the Chlorates of Potassium and Sodium, are described under the titles of their respective bases. EMETICS. 201 Antidotes. Ammoniacal vapors inhaled to form Ammonium Chloride. Albumen if Chlorine preparations have been taken into the stomach; also a little Aqua Ammonia sufficiently diluted, may be given with advantage. Therapeutics. The Chlorinated preparations are used as disinfectants and deodorizers of rooms, drains, and discharges from the body ; but rarely about the person or clothing, as they are too irritant to be inhaled with impunity, and they destroy the color of fabrics. In very dilute solution they are employed with great benefit as local applications in— Diphtheria, and other septic diseases,—to destroy fetor chiefly. Gangrenous Ulcers and wounds, foul discharges, etc.,—as deodorizers. Bites of serpents and insects,—a strong solution of Chlorinated Soda. Throat Affections,—an excellent gargle is the mixture of Potassium Chlorate with the Tincture of the Chloride of Iron, in which the former is decom- posed by the free HC1 always present, and the resulting solution contains Chlorine, Euchlorine, Potassium and Ferric Chlorides,—perhaps the best and most innocuous mixture of antiseptics known. Silver Nitrate Poisoning,—Sodium Chloride as an antidote. Migraine,—both Sodium and Ammonium Chlorides are efficient. Interifiittent Fever,—has been cured by Sodium Chloride, in 8 to io-drachm doses, given during the apyrexia. • Bilious Diarrhoea,—Sodium Chloride, gr. x-3 j, thrice daily. Ascarides,—Sodium Chloride, in solution by enema, two tablespoonfuls of the salt to a pint of water,—will effectually destroy them. EVACUANTS. This division of the Materia Medica includes the remedies which promote some Evacuation from the body,—as the Emetics, Cathartics, Anthelmintics, Diuretics and Emmenagogues, for a discussion of which see the Introduction, pages 34 to 41. EMETICS. Cupri Sulphas, Copper Sulphate,—gr. vj, in water, every 15 minutes until emesis occurs; gr. xij may be given at one time in narcotic poisoning. Zinci Sulphas, Zinc Sulphate,—gr. vj or viij, in water, every 15 minutes until emesis. Is less irritant than the copper salt. Hydrargyri Subsulphas Flavus, Yellow Mercuric Subsulphate, Turpeth Mineral,—gr. iij-v, in powder, with Sugar of Milk. The best emetic in croup, being tasteless. (See page 78 et seq.) 202 EVACUANTS. Alumen, Alum,—a teaspoonful in honey, every half hour. Is safe and effi- cient, but slow. (See page 97.) Sinapis Alba, vel Nigra, White or Black Mustard,—as emetic, 3 j or more, in water. Is stimulant to the heart and circulation, also a condiment and carminative in small doses. Described under Topical Agents. Apomorphina, Apomorphine,—an alkaloid derivative from Morphine by the action of strong acids or zinc chloride. Emetic dose by stomach, gr. l~\, hypodermically, gr. y’g, in a fresh solution. Is very depressant to the heart, and has caused death by cardiac failure. Is the best emetic when swallow- ing is difficult, but is useless in narcotic poisoning after narcosis has blunted the vagus centre. Has convulsant action on animals, and some expectorant power. (See ante, page 147.) Apomorphince Hydrochloras. Dose, gr. —jL hypodermically. Antimonii et Potassii Tartras, Antimony and Potassium Tartrate, (Tartar Emetic),—Dose, as emetic, gr. j-ij; but it is too slow and depressant for general use. (See page 71.) Physiological Action. The first five are local emetics, the last two are general or systemic emetics. (See ante, page 34.) The Local Emetics act chiefly by irritating the end organs of the nerves in the pharynx, oesophagus or stomach ; the General or Systemic Emetics by direct irritation of the vomiting centre in the medulla, acting through the medium of the circulation wherever introduced. Some agents act both ways, e. g., Tartar Emetic; also Zinc and Copper Sulphates, but in the cases of the two latter, their action on the stomach preponderates so much over their general action, that they are classed with the local emetics. The action of local emetics does not continue long,—does not extend beyond the act of producing emesis, ceasing after the emetic has been evacu- ated,—and is not accompanied by much general depression. Therapeutics. Emetics are employed for several purposes, among which may be mentioned the following :— (1) To cause the expulsion of foreign bodies from any part of the oesopha- geal tract, or from the air-passages. (2) To remove or evacuate the contents of the stomach. (3) To remove an obstruction from the gall-duct. Contraindications for their use, are—-aneurism, atheroma, hemorrhagic dia- thesis, hernia, prolapsus uteri, and tendency to abortion (when subject is pregnant). They are especially indicated in— IPECACUANHA. 203 Narcotic Poisoning,—the Copper Sulphate or the Zinc Sulphate, the latter being usually preferred. Croup and Diphtheria,—to dislodge false membrane. Indigestion,—to relieve the overloaded stomach. IPECACUANHA,—Ipecac. Source and Composition. Ipecac is the root of Cephaelis Ipecacuanha> a Brazilian shrub of the nat. ord. Rubiacese. It contains a crystalline alkaloid Emetine, a glucoside Ipecacuanhic Acid, also gum, starch, etc, and a trace of a volatile oil. Dose, of the powdered root as an expectorant, gr. ss-ij;—as an emetic, gr. xv-xxx. Preparations. The principal ones are— Extractum Ipecacuanha Fluidum, Fluid Extract of Ipecac,—Dose, tt\j-v. Vinum Ipecacuanha, Wine of Ipecac,—io per cent.,—Dose, rqj-3 j. Syrupus Ipecacuanha, Syrup of Ipecac,—7 per cent.,—Dose, gj-iv. Pulvis Ipecacuanha et Opii, Dover’s Powder,—has of Ipecac 10, Pulvis Opii 10, Sugar of Milk 80 parts. Dose, gr. ij-xv, or xx. Tinctura Ipecacuanha et Opii, Liquid Dover’s Powder,—has of Tinct. Opii Deod. 100 evaporated to 80, Fluid Extract of Ipecac 10, Diluted Alcohol to 100. Dose, tipp—xv, or xxx. *Emetina, Emetine,—a crystalline alkaloid, odorless, bitter, white, nearly insoluble in water, but with acids forming salts which are readily soluble. An energetic poison in large dosage. Dose, as an expectorant, gr. > as an emetic, gr. Physiological Action. Ipecac is nauseant, emetic, expectorant, chola- gogue, diaphoretic, hemostatic, sternutatory and counter-irritant. Locally, applied to skin or mucous membrane, it acts as an irritant, and may cause pustulation. Inhaled as a powder, it excites violent sneezing and reflex mucous secretion ; on some persons having an especially irritant action, so that the most infinitesimal quantity by inhalation will in them induce an asthmatic paroxysm. In the stomach it irritates the mucous membrane and the vagus terminations, and causes prompt emesis. Absorbed into the blood it excites the vomiting centre in the medulla, producing the same result. In medicinal doses it increases the mucous secretions in a marked degree, and is slightly diaphoretic. Small doses (gr. act as a stomachic tonic and stimulant to the gastric secretions. Emetic doses repeated result in tolerance on the part of the stomach, when catharsis is set up, the stools having a peculiar “ grass-green ” color, a bilious character, and looking as if they were fer- 204 EVACUANTS. mented. By continuance of the drug the intestinal canal will also acquire tolerance,—the cathartic action ceasing. Emetine causes death in animals by cardiac paralysis; the autopsies show- ing evidences of intense gastro-intestinal irritation, also hypersemic lungs with patches of hepatization. Antagonists, Antidotes, etc. The emetic action is antagonized by the Narcotics generally, also by Bismuth, Carbolic and Hydrocyanic Acids. Incompatibles are salts of Lead and Mercury, Vegetable Acids and astringent infusions. Therapeutics. As an emetic Ipecac is much used, being safe, non-depres- sant, and sure, though somewhat slow. It is also employed as an expectorant in bronchitis when the secretion is scanty, and as an antihemorrhagic and an antidysenteric. It is generally administered in— Bilious Headache, acute indigestion, and similar conditions,—gr. iv of the powder in warm water, or a teaspoonful of the syrup, every hour until emesis occurs,—to empty the overloaded stomach. Fevers, at their commencement,—an Ipecac-vomit is very serviceable in the eruptive, continued and malarial fevers. Laryngismus Stridulus, Spasmodic Croup, etc.,—the Syrup is a favorite emetic, which generally cuts short an attack if given early and freely. Dysentery, of the tropics especially,—is best treated by Ipecac in large doses (gr. xx-xxx every 4 hours) pushed to tolerance. Vomiting, especially when of nervous origin,—small doses (rr\j) of the wine, frequently repeated, will relieve in many cases, perhaps through a sedative influence on the vagus. Coughs at night, also in Acute Catarrh and Bronchitis,—it is a very efficient remedy;—also in Hay Fever and Spasmodic Asthma, in all of which slight nauseation must be produced before relief will be experienced. The wine, as a spray, is highly recommended in winter cough and bronchial asthma. Jaundice from catarrh of the bile-ducts,—Ipecac to lessen the viscidity of the mucus stopping up the ducts. Rheumatism, muscular or acute,—Dover’s powder is useful. CATHARTICS. Cathartics are subdivided into Laxatives, Simple, Saline, Drastic, Hy- dragogue and Cholagogue Purgatives. (See ante, page 35.) CATHARTICS. 205 Sulphur Lotum, Washed Sulphur. (See page 73.) Dose, 3j-iij, as a laxative. Laxatives. Manna,—the concrete exudation of Fraxinus Ornus. Dose, 3 j” o T Con- tains Mannit, a sugar; also a Resin, probably the laxative principle. Tamarindus, Tamarind,—the preserved pulp of the fruit of Tamarindus Indica. Used in Confedio Sennce. Dose, indefinite. Magnesii Carbonas, Magnesium Carbonate,—Dose, 3j-j|j. A mild laxa- tive and antacid, but if long used it may form intestinal concretions. Mistura Magnesite et Asafcetidce, Dewees’ Carminative,—for flatulent colic and diarrhoea of infants,—Dose, gtt. xx- 3 ss as per age. Has Mag. Carb. 5, Tinct. Asaf. 7, Tinct. Opii I, Sugar 10, Water to 100. Oleum Ricini, Castor Oil,—is a laxative in small doses, (3 j), though classed with the simple purgatives. (See below). Also all the Simple Purgatives in minimum doses may be classed as laxatives. Fruits of various kinds,—particularly Figs, Prunes, Stewed Apples, Rasp- berries and Strawberries,—many of which act through the mechanical stimu- lation of intestinal peristalsis by their small, indigestible seeds. Simple Purgatives. Senna,—the leaflets of Cassia acutifolia and Cassia angustifolia. Contains a glucoside, named Cathartic Acid, which is probably the active principle ; also Sennacrol, Sennapicrm, bitter glucosides, and Catharto-mannit, a peculiar unfermentable sugar. Extractum Sennas Fluidum,—Dose, 3j— §ss. Syrupus Sennce, Confedio Sennce, Tamar-Indien, Tropical Fruit-Laxative, 3j-iv. Infusum Sennce Compositum, Black Draught,— 3 j-iv. Contains in ioo parts, Senna 6, Manna 12, Magnesii Sulphas 12, Fennel 2. Senna is a constituent also of the Pulvis Glycyrrhizce Compositus, of which it forms 18 per cent., with Liquorice, Oil of Fennel, Sulphur and Sugar, all triturated together. Dose, a teaspoonful. Rheum, Rhubarb,—the root of Rheum officinale. Contains Phceoretin, a purgative resin ;—also Chrysophan, Rheo-tannic and Rheumic Acids, and the glucoside Erythroretin. Extractum Rhei, gr. v-x. Pilulce Rhei, j-iij. Extr. Rkei FI., Tt\,x— 3j. Pilulce Rhei Composites, ij-iv. 206 EVACUANTS. Aloe, Aloes,—the inspissated juice of the leaves of Aloe vera (Barbadoes Aloes), and Aloe Perryi (Socotrine Aloes). Contain Aloin, a neutral prin- ciple common to all varieties of the plant. Aloinum, Aloin,—soluble in 60 of water. Dose, gr. ss-ij. Aloe Purificata,—gr. j-v. Pilulce Aloes,—pills j-v. Pilulce Aloes et Asafoetidce,—ij-v. • Extr. Aloes,—gr. ss-vj. Tinctura Aloes,— 3 ss-ij. Tinct. Aloes et Myrrhce,— 3 ss-ij. Oleum Ricini, Castor Oil,—a fixed oil expressed from the seeds of Ricinus communis,—Dose, 3J-Jj- The purer it is the less purgative. It consists mainly of Ricinoleic Acid, combined with glycerin. Castor Oil is a con- stituent of Linimentum Sinapis Compositum, and Collodion Flexile. Rhamnus Purshiana, Cascara Sagrada, (Chittem or Sacred Bark),—is the bark of Rhamnus Purshiana, the California Buckthorn, and contains several Resins, also a volatile oil, much tannin, etc. Extractum Rhamni Purshiance Fluidum,—Dose, 3 ss-ij. * Cascara Cordial,—a trade preparation. Dose, 3 j—ij. Frangula, Buckthorn,—is the bark, collected at least one year before being used, of Rhamnus Frangula, or Alder buckthorn, a European shrub (nat. ord. Rhamnese). It contains a cathartic glucoside named Frangulin, or Rhamnoxanthin, insoluble in water, and but sparingly so in alcohol or ether, and thought to be identical with the active principle of Senna. Extractum Frangula Fluidum,—Dose, 3 ss-ij. Saline Purgatives. Magnesium Salts. The chief ones are the following,— Magnesii Sulphas, Epsom Salt,—Dose, 3 j- 3 j. Is very soluble in water. Magnesii Citras Effervescens,—soluble in 2 of water. Dose, 3 j- 3 j in plenty of water, drank while effervescing. Potassium Salts. The principal ones are— Potassii et Sodii Tartras, Rochelle Salt,—Dose, 3 ss-j. (See page 66.) Pulvis Effervescens Compositus, Seidlitz Powder,—(See page 68.) Potassii Pitartras, Potassium Bitartrate, (Cream of Tartar),—is sparingly soluble in water. Dose, 3j-s;j as a purgative ; gr. xx- 3 j as a diuretic. Is a constituent of Pulvis Jalapse Compositus (see next page). Potassii Sulphas, Potassium Sulphate,—Dose, gr. XX-3SS, well diluted. Sodium Salts. Those generally employed are as follows :— Sodii Sulphas, Glauber’s Salt,—Dose, 3 ij- 3 j. Soluble in water. CATHARTICS. 207 Sodii Phosphas, Sodium Phosphate,—Dose, 3 ij- 5 j, as a purgative ; gr. xx-xl as an alterative. Has some pronounced cholagogue action, especially on children in 3 to 10-grain doses. Acts gently, and has little or no taste. Drastic Purgatives. Jalapa, Jalap,—the tuberous root of Ipomcea Jalapa, a Mexican plant of the nat. ord. Convolvulacese. Contains 15 to 20 per cent, of the official Resin, which is composed of two resins, Jalapin and Convolvulin, the latter being the most active of thb two. Extractum Jalapec,—gr. ij-x. Resina Jalapee,—gr. ij-x. Pulvis JalapcB Compositus, (Pulvis Purgans),—has of Jalap 35, Potassium Bitartrate 65. Dose, gr. x-gj. Scammonium, Scammony,— a resinous exudation from the root of Convol- vulus Scammonia. Contains a Resin, which consists chiefly of Jalapin, the active principle, probably identical with the Convolvulin of Jalap. Resina Scammonii, Resin of Scammony,—Dose, gr. iij-x. Is a constitu- ent of the Compound Extract of Colocynth. (See below.) Oleum Tiglii, Croton Oil,—a fixed oil expressed from the seeds of Croton Tiglium. Contains several fatty and volatile acids, one of which is called Tiglinic Acid. Dose, in pill of bread-crumb, emulsion or tincture. Cambogia, Gamboge,—a gum-resin from Garcinia Hanburii, Pilules Cathartices Composites, Compound Cathartic Pills. (See under Colocynth, below.) Colocynthis, Colocynth,— the fruit of Citrullus Colocynthis, the “bitter cucumber,” a vine of the nat. ord. Cucurbitacese, which also includes Ecballium Elaterium, Cucurbita Pepo, and Bryonia alba. (See below.) Colocynth contains an active, purgative glucoside, Colocynthin ;—also Colo- cynthitine, which is soluble in ether, insoluble in water, and not purgative. Extraction Colocynthidis,—Dose, gr. Not used alone. Extractum Colocynthidis Compositum,—has of the Extract 16, Aloes 50, Cardamom 6, Resin of Scammony 14, Soap 14, and Alcohol 10 parts. Dose, gr. v-xx. Pilules CatharticcB Composites, Compound Cathartic Pills,—have of the preceding 8, Calomel 6, Ext. of Jalap 3, Gamboge lj£, Water to make 100 pills. Dose, j-iij. Elaterinum, Elaterin,—a neutral principle from Elaterium, a substance deposited by the juice of the fruit of Ecballium Elaterium, the “ squirting cucumber,” nat. ord. Cucurbitacese. (See above.) Dose, gr. 35—tV 208 EVACUANTS. Trituratio Elaterini, Trituration of Elaterin,—10 per cent., with Sugar of Milk. Dose, gr. ss-j. Cholagogue Purgatives. Podophyllum, May-apple,—the rhizome and rootlets of Podophyllum pelta- tum, the Mandrake, (nat. ord. Berberidese). Its active principle is a Resin which is official, and is a compound of several resins. It probably contains also the alkaloid Berberine. Extractum Podophylli,—gr. v-x. Ext. Podophylli FI.,—trpj-xxx. Resina Podophylli, Podophyllin,—Dose, gr. yi~] in pill. Leptandra, Culver’s Root,—the rhizome and rootlets of Veronica virginica. Contains a Resin, and a glucoside, also Saponin, tannin, etc. The Lep- tandrin of the shops is an impure resin. Extractum Leptandrce Fluidum,—Dose, tt^xx-^j. Iris, Blue Flag,—the rhizome and roots of Iris versicolor. The Iridin of the shops is an impure oleo-resin precipitated from an alcoholic solution. Extractum Iridis Fluidum,—Dose, "iv-3 j • Extractum Iridis,—Dose, gr. j-v. *Iridin,—Dose, gr. j-iij or v. Hydrargyri Chloridum Mite, Calomel,—Dose, gr. j-x. (See page 78). Hydrargyrum cum Creta, Gray Powder,—Dose, gr. ss-iv. (See p. 78). Massa Hydrargyri, Blue Mass, Blue Pill,—Dose, gr. ij-x. (See page 78.) Aloes, Rhubarb, Jalap, Scammony, Sodium Sulphate and Phosphate, and many other hepatic stimulants, may be classed with the cholagogue purgatives: —as also all cathartics which act upon the duodenum, and prevent the absorp- tion of the once-secreted bile ;—such being Baptisin, Colocynth, etc. Action of the various Cathartics. The Laxatives simply relax and unload the intestinal canal, without causing active purgation, or increase of the intestinal secretions. Saline Purgatives produce watery stools, by increas- ing secretion and stimulating peristalsis. Drastic Purgatives cause violent action of the bowels, in large doses setting up enteritis and symptoms of irri- tant poisoning. Those which excite a copious flow from the intestinal mucous membrane are called Hydragogue. (Purgatives, some of which belong to the drastic group (Elaterium, Gamboge), and some to the saline (Potassium Bitar- trate. Cholagogue Purgatives are those which remove bile from the body, chiefly by causing increased peristalsis of the duodenum, and thus preventing the reabsorption of the bile therein. The Mercurial Purgatives are now BRYONIA. 209 believed not to affect the secretion of bile, but they markedly stimulate the excrementitious glands situated in the lower part of the ileum. Therapeutics. Cathartics are indicated for the purposes of—unloading the bowels of fecal matter or offending materials,—depletion of the vascular system in many diseases,—promotion of absorption in general dropsy, ascites, etc.,—revulsion in inflammation of the brain, etc.,—elimination of the products of the retrograde metamorphosis,—lowering of the temperature in fever,— lowering of the blood-pressure,—and excitation of the pelvic circulation. For the last purpose Aloes is the only agent used. Castor Oil is much used, and abused, especially in the puerperal state, where it is very apt to produce hem- orrhoids. The leaves of the plant applied to the breasts, as a poultice, are said to promote the secretion of milk. Croton Oil, though a powerfully drastic agent, is one of the most manageable and easily administered purgatives, by reason of the smallness of the dose required. The various agents, enumerated under this title, have other actions and uses besides that of catharsis, but the limitations of this volume prevent their discus- sion. Two, which seem to merit separate consideration, are Bryonia and Baptisia, which are described in the following pages. BRYONIA,—Bryony. Source and Composition. The root of Bryonia alba and of Bryonia tiioica, European perennial vines of the nat. ord. Curcurbitacese. Its active principle is the bitter glucoside Bryonin. Dose of the root, gr. x-xxx. Preparations. Only one is official, viz.:— Tinctura Bryonice,—Bryonia-root I, Alcohol 9. Dose, R\y-5ss. *Bryonin,—as a drastic purgative, gr. Poisonous in dose of gr. iij-iv. Physiological Action. Bryonia is violently irritant to the mucous and serous membranes ; taken internally it has caused fatal gastritis and enteritis; introduced into the pleura it has produced fatal pleurisy with fibrinous effusion. It is a drastic purgative, a powerful diuretic, and very depressant to the heart. It produces cerebral, hepatic and renal congestion, with bilious symptoms, (even severe jaundice,) and vesical tenesmus. Therapeutics. Bryonia was formerly used as a hydragogue cathartic, but in that respect it is now superseded by Jalap. By many practitioners it is highly praised in the second stage of serous inflammations, to limit the extent of the effusion and to promote its absorption. For this, small repeated doses are required. In— 210 EVACUANTS. Pleuritis and Pericarditis,—it is useful, (after Aconite has reduced the pyrexia,) to check the effusion and aid its absorption. Rheumatism,—for the painful and stiff joints, after their swelling has been reduced by other measures, it is often an efficient remedy. Headaches, of “bilious” type, with vomiting,—it is an efficient remedy. Dropsies,—an infusion of Bryonia will remove the accumulated fluid, by its cathartic and diuretic action. Epilepsy, Mania and Hysteria,—Bryonia is of ancient repute. Source and Composition. The root-bark of the indigenous plant Baptisia tindoria, or Wild Indigo, a member of thenat. ord. Leguminosse. It contains an alkaloid and a resin, neither of which have been examined critically. Baptisin, so-called, is an impure resinoid, obtained by precipitation from the alcoholic extract. *BAPTISIA,—Wild Indigo. Preparations. *Tinctura Baptisia:, Tincture of Baptisia,—Dose, rqv-xxx. *Baptisinum, Baptisin,—the resinoid. Dose, gr. j-v. Physiological Action. Baptisia, in full doses, is an energetic emeto- cathartic, and may excite severe inflammation of the gastro-enteric mucous membrane. Its taste is acrid and bitter; and in small doses it acts as a cholagogue laxative. Having decided power as a hepatic stimulant, thus promoting the secretion of bile,—and also increasing, as it does, the peristaltic action of the small intestine, and the secretions of the intestinal glands, thereby preventing the reabsorption of bile, through the entero-hepatic circulation, by sweeping it onward,—Baptisia has all the qualities necessary for an efficient cholagogue. It has considerable power as an antiseptic, and also as an alterative vulnerary. Therapeutics. The use of Baptisia in medicine is based chiefly on its cholagogue and alterative action. It may be employed both locally and internally. In— Gangrenous Ulcers and Sores, also in obstinate wounds and ulcers,—it is an excellent application, either in decoction or as a poultice. Low Fevers form its chief field as an internal remedy,—especially in the first stage of typhoid, and in those continued fevers of no particular type, but usually considered mild cases of typhoid, or “ gastric fever ” by the laity. In these affections, drop doses of a fresh tincture hourly, have proven of signal benefit. ANTHELMINTICS. 211 Feverish Colds of aged people, and in incipient febrile conditions, where the tongue is coated, and there is a sensation of sinking at the stomach, with entire anorexia,—Baptisia does good service,—cleaning the tongue and restoring the appetite. Hectic Fever of phthisis,—it is reported to be of service in reducing the fever. Variola, Epidemic Dysentery, Scarlet Fever, and Typhus,—are diseases in which Baptisia has been employed with benefit. ANTHELMINTICS. Santonica, Levant Wormseed,—the unexpanded flower-heads of Artemisia pauciflora. Contains Santonin, a crystalline neutral principle. Santoninum, Santonin,—Dose, gr. as per age, with Calomel. Trochisci Santonini,—each troche contains gr. ss of Santonin. Dose, j-v, as per age. Spigelia, Pinkroot,—the root of Spigelia marilandica, the Carolina Pink. It contains a bitter principle, a volatile oil, tannin, etc. Extractum Spigelia Fluidum,—Dose, rqx-3 ij, as per age. Aspidium, Filix-mas, Male Fern,—the rhizome of Dryopteris Filix-mas and D. marginalis. Contains Filicic Acid, a green, fatty Oil, a Volatile Oil, etc. Oleoresina Aspidii,—Dose, g j. ij iss has caused death. Chenopodium, American Wormseed,—the fruit of Chenop. ambrosioides. Oleum Chenopodii,—Dose, thrice daily, then a cathartic. Granatum, Pomegranate,—the bark of the root of Punica granatum. Con- tains Punico-tannic Acid and an active liquid alkaloid, Pelietierine. *Decoctum Granati ( ij ij ad Oj),—Dose, ij ij-iv every hour, up to Oj. *Pelletierince Tannas,—Dose, gr. v-xx, followed by a cathartic. Cusso, Kousso, (Brayera),—the female inflorescence of Hagenia abyssinica. Contains a principle, Koussin, which by itself is apparently inert. Extractum Cusso Fluidum,—Dose, -jij-Jjj, in water. Oleum Terebinthinae, Oil of Turpentine,—(See under its own title),—Dose, 3 ss—ij, combined with a purgative, as Castor Oil. Kamala, Rottlera,—the glands and hairs from the capsules of Mallotus Philip- pinensis. Dose, Pepo, Pumpkin-seed,—the seed of Czictirbita pepo. Dose, £ ij in emulsion, or three half- doses of the Expressed Oil, followed by a cathartic. Quassia, Aloe, also Carbolic Acid, gr. xx ad Oj aquse,—as injections against the Oxyurus Vermicularis (thread-worm). 212 EVACUANTS. The Anthelmintics used against the Ascaris Lumbricoides (round-worm) are Santonin, Chenopodium, andSpigelia ;—those against the Oxyurus Verttii- cularis (thread-worm) are the same, aided by injections of weak decoctions of Quassia or Aloe, or Carbolic Acid, gr. xx ad Oj aquae;—those against the Tcenice (tape-worms) are Aspidium, Granatum, Cusso, Kamala, Pepo, and Turpentine. Chloroform is sometimes used as a taeniafuge, and with very great success, in gj doses in Jj of mucilage, for an adult, followed by 3j of Castor Oil. DIURETICS. Refrigerant Diuretics. Potassium Salts, (See page 66),—especially the Acetate, Bitartrate, Car- bonate, Citrate and Nitrate. They should be largely diluted with water, that fluid of itself having very considerable diuretic power. Potassii Acetas, Potassium Acetate,—Dose, gr. x-xxx. Spiritus .iSEtheris Nitrosi, Spirit of Nitrous Ether, Sweet Spirit of Nitre,— (See page 137) ;—is diuretic in a dose of 3 ij—iv, but is generally employed as an adjuvant to more powerful agents of the same class. Mistura Glycyrrhizce Composita,—contains 3 per cent, of it. Hydragogue Diuretics. Digitalis, Foxglove, (See page 104),—as a diuretic, gr. iij of the powdered drug daily, in divided doses, increased by a grain daily. The infusion may be used in corresponding doses. A poultice of of the fresh leaves, over the abdomen, for eight hours, will also be efficient. Infusum Digitalis, Infusion of Digitalis,—Dose, 3 ss-j, twice daily. Scilla, Squill, (See page 112),—Dose of the powdered drug, gr. j-iij. Tinctura Scillce,—Dose, T»\v -xxx. Acetum Scillce,—Dose, £ j. Scoparius, Broom, (See page III),—also its alkaloid Sparteine. *Decodum Scoparii, (5j to the pint),—Dose, §j every 3 hours. *Sparteincc Sulphas, Sparteine Sulphate,—Dose, as a diuretic, gr. j-iij, thrice daily ; for cardiac action, gr. xV~i- Strophanthus, (See page 107),—Dose, of the tincture (1 in 20) or frequently repeated; of Strophanthin, gr. xio-sV- Cimicifuga, (See page 109),—Dose of the tincture, rt^xv-^j. Convallaria, (See page no),—Dose of the infusion, 3 ss-ij. Cocaine, (See page 126),—Dose of the Hydrochlorate, DIURETICS. 213 Caffeine, (See page 128),—the Citrated Caffeine in doses of gr. v. Hydrargyrum, (See page 78). The Mild Chloride a very efficient diuretic, especially in cardiac affections; dose, gr. ss-j. The Hydrarg. cum Creta, with Pulv. Digitalis and Pulv. Scillae, gr. j of each, in pill thrice daily, is a classical and efficient diuretic. Stimulant Diuretics. Apocynum, Canadian Hemp,—the root of Apocynum cannabinum. Is a valuable diuretic in doses of gr. xv ; in larger doses it is a hydragogue cathartic and an emetic. It has been used with benefit in anasarca and ascites. The active principle, Apocynin, is a good expectorant in to grain doses. Buchu, the leaves of Barosma betulina and other species of Barosma. Con- tains a Volatile Oil, and perhaps Barosmin, a bitter principle. Extractum Buchu Fluidum, *Infusum Buchu, £ ss-ij. Capsicum, Cayenne Pepper,—the fruit of Capsicum fastigiatum. Contai"* Capsicin, a peculiar liquid principle ; also a Volatile Alkaloid. Oleoresina Capsici, TT\j—v. Extractum Capsici FI., TTJv-^ss. Tinctura Capsici, TT^x—3 j. Emplastrum Capsici. Chimaphila, Pipsissewa,—the leaves of Chimaphila timbellata. Contain Chimaphilin, a crystalline principle, also Arbutin, Tannin, etc. Extractum Chimaphllce Fluidum,—Dose, sjss-ij. Copaiba, Balsam of Copaiba,—the oleo-resin of various species of Copaifera. Contains a Volatile Oil and a Resin composed chiefly of Copaibic Acid. Differs from the true balsams in that it contains no Cinnamic Acid. Massa Copaibce, Dose, gr. Oleum Copaibce, Dose, TT\y-xv. Cubeba, Cubeb,—the unripe fruit of Piper Cubeba. Contains Cubebin, a neutral principle, a Volatile Oil which may be separated into Cubebene, a camphor, and Cubeben; also a Resin which contains Cubebic Acid. Oleoresina Cubebce, rtjv-xxx. Tinchira, Cubebce, 3 ss—ij. Oleum Cubebce, Trochisci Cubebce, j-iij. Extractum Cubebce Fluidum, Tljy—xxx. Juniperus, Juniper,—the fruit of Juniperus communis. Contains Juniperin, a non-crystalline principle, also a Volatile Oil, etc. Oleum Juniperi, Spiritus Juniperi, Dose, 3 j-iv, or j. Spiritus Juniperi Compositus, Gin,—Dose, j—iv, or j. Oleum Cadini, Oil of Cade, Empyreumatic Oil of Juniper,—locally. 214 EVACUANTS. Matico, the leaves of Piper angustifolium. Contain a Volatile Oil and a Resin, also Artanthic Acid, and Tannin. Extradum Matico Fluidum, gss-ij. Tindura Matico, ss-ij. Pareira, Pareira Brava,—the root of Chondodendron tomentosum. Contains Buxine, an alkaloid principle, also called Cissa??ipeline, or Pelosine. Extradum Pareira: Fluidum,—Dose, gss-j. Piper, Black Pepper, the unripe fruit of Piper nigrum. Contains Piperin, a feeble principle (official), also a Resin and an Essential Oil. Oleoresina Piperis, Piperinum, Piperin,—Dose, gr. j-x. Taraxacum, Dandelion,—the root of Taraxacum officinale. Contains two principles,— Taraxacin, bitter, amorphous ; and Taraxacerin, crystalline- The French call it “ Pissenlit.” Extradum Taraxaci,—gr. v-xxx. Extr. Taraxaci FI.,— 3 j ~ ,0 J • Uva Ursi, Bear-berry,— the leaves of Ardostaphylos Uva-ursi. Contain Tannic and Gallic acids, and three principles—Arbutin, neutral, bitter, crystalline; Ericolin, bitter, amorphous; and Ursone, neutral, tasteless, and crystalline. Dose of the powdered leaves, gr. x-gj. Extradum Uvce Ursi Fluidum,—Dose, 3 j. Zea, Corn Silk, (Stigmata Maydis),—the styles and stigmas of Zea Mays, the Maize or Indian Corn. It is diuretic, demulcent and antiseptic, and is highly recommended in cystitis, as a mild diuretic in cardiac and renal affections, and as a corrective of nocturnal incontinence of urine. Dose, of the fluid extract, gj-ij. Physiological Action of Diuretics. The Refrigerant Diuretics modify rather than increase the urine, and exercise a sedative action upon the heart and circulation. Used to excess they depress the heart and impoverish the blood. Potassium Chlorate is a decided renal irritant, and should never be used as a diuretic. Hydragogue Diuretics increase the water of the urine largely, and in general act by raising arterial pressure, either—(a) throughout the body, or (b) locally in the kidneys. This they accomplish in various ways, direct and indirect,—increasing the action of the heart,—contracting the effe- rent vessels so as to raise the pressure in the glomeruli,—dilating the afferent vessels, etc. The Stimulant Diuretics are largely eliminated by the kidneys, and act upon the entire genito-urinary mucous membrane by local irritation, which in excess causes inflammation and symptoms of a violent character, as strangury, bloody urine, etc. All the members of this group should be used with great caution. TURPENTINE, PITCH, TAR. 215 Therapeutics of Diuretics. These agents are employed in medicine for certain definite purposes, viz. :—(i), to remove fluid from the tissues and cavi- ties of the body in cases of dropsy ;—(2), to promote the elimination of waste- products and other poisons from the blood ;—(3), to maintain the action of the kidneys;—and (4), to dilute the urine, and to alter morbid conditions of that excretion. For the last-named purpose, the best agent is Distilled Water, acidulated with C02. For use in— Dropsies from Cardiac Disease,—the most efficient diuretics are Digitalis and its congeners, also Caffeine, Squill, etc., which act on the general vascular system. Their action is always aided by a little Massa Hydrargyri. Dropsy from Renal Disease,—Broom, Juniper and Nitrous Ether, are the most reliable diuretics. Dropsy from Cirrhosis of the• Liver,—Copaiba is the best of the diuretics, when the kidneys are healthy. Elimination of Waste-products from the blood,—Potassium salts, especially the Nitrate and Bitartrate,—also Juniper, Caffeine, etc. As Adjuvants to Diuretics, when pressure on the uriniferous tubules, or venous congestion, prevent their action,—paracentesis abdominis, purgation, cup- ping over the loins, and even venesection, are often necessary to start the action. TURPENTINE, PITCH, TAR, ETC. A Turpentine is an oleo-resinous exudation, liquid or concrete,—consist- ing of a Resin combined with a particular Oil, named Oil of Turpentine, (C10H16),—and generally procured from various species of the nat. ord. Coni- fene, (cone-bearers). Two Turpentines are official, viz.:— Terebinthina, Turpentine,—a concrete oleo-resin obtained from Pinus australis, the “ yellow pine,” and from other species of Pinus (nat. ord. Conifene). Tough, yellow masses, of terebinthinate odor and taste. Dose, as a stimulant, antispasmodic or diuretic, gr. v-xxx;—as an anthelmintic, 5 ij-iy. Terebinthina Canadensis, Canada Turpentine, Balsam of Fir,—is a liquid oleoresin, obtained from Abies balsamea, the “ silver fir ” or “balm of Gilead,” (nat. ord. Conifene). A viscid, yellowish liquid, on exposure drying into a transparent mass, completely soluble in ether, chloroform or benzol. Dose, gr. x-xxx. Unofficial Turpentines. ♦Chian Turpentine,—from the Pistacecs Terebinthus, a small larch, growing in Chio and Cyprus. Dose, gr. iij-v. 216 EVACUANTS. Turpentine,—from the Larix Europcea, or European larch, procured as a viscid liquid in Switzerland. ' Is not the “ Venice Turpentine ” of commerce, which usually consists of resin dissolved in oil of turpentine. *Thus Americanum, Common Frankincense, (B. P.),—the concrete turpentine which is scraped off the trunks of Pinus Australis and Pinus Tceda, Southern States of N. America. An ingredient of the Emplastrum Picis of the B. P. Preparations of Turpentine. Oleum Terebinthince, Oil of Turpentine,—commonly called “ Spirits of Tur- pentine.” Is soluble in 3 volumes of alcohol, and takes fire when in con- tact with a mixture of nitric and sulphuric acids. It is a mixture of several hydrocarbons, each having the same formula as itself, viz.—C10H16. Oleum Terebinthince Rectificatum, Rectified Oil of Turpentine,—is the prepa- ration which should be dispensed for internal use. Dose, as a stimulant or diuretic, rrpv-xv, in emulsion, 3 to 6 times daily; as a cathartic or anthel- mintic, lessor more, combined with other cathartics. A little glycerin and Oil of Gaultheria will disguise the taste. Linimentum Terebinthince, Turpentine Liniment,—has 35 of the oil with 65 of Resin Cerate. * Oleum Pini Sylvestris, Oil of Scotch Fir, (B. P.),—a colorless liquid obtained by distilling the fresh leaves of Pinus sylvestris (nat. ord. Coniferse). Used externally, and by inhalation. Derivatives of Turpentine. Resina, Resin, Colophony,—is the residue left after distilling off the volatile oil from turpentine; the portion of turpentine which is fixed by oxidation ; consisting in greater part of Abietic anhydride, (C41I I6204). Ceratum Kesince, Resin Cerate, Basilicon Ointment. Emplastrum Resina, Resin Plaster, Adhesive Plaster. Terebenum, Terebene, C10H16,—is a hydrocarbon obtained by the oxidation of oil of turpentine by means of sulphuric acid. A colorless liquid, of hot taste, soluble in alcohol. Dose, on sugar, or suspended in g ss of water by the aid of gr. xx of light carbonate of magnesium. Terpini Hydras, Terpin Hydrate,—is the hydrate of the diatomic alcohol Terpin (Terebinthene), obtained by distilling oil of turpentine with an alkali. Dose, gr. v-x. Analogues of Turpentine. Juniperus, Juniper,—the fruit of Juniperus communis, a shrub of the nat. ord. Coniferse. (See ante, page 213). TURPENTINE, PITCH, TAR, ETC. 217 Sabina, Savine,—the tops of Juniperus Sabina, a shrub of the nat. ord. Coniferae, resembling Red Cedar (Juniperus virginiana), but of smaller size and having larger fruit. Dose, gr. v-x. Extractum Sabina Fluidum,—Dose, TT^v-xv. Oleum Sabina, Oil of Savine,—C10H16,—isomeric with oil of turpentine, Dose, tl\j—v. Thuja, Arbor Vitae,—'the fresh tops of Thuja occidentalis, or Arbor Vitae, a tree of the nat. ord. Coniferae. Contains a volatile oil, which is given in doses of ny-v. A saturated tincture may be used in drachm-doses. *01eum Succini, Oil of Amber,—a volatile oil obtained by the destructive distillation of Amber (Succinum), which is a fossil resin, occurring in alluvial deposits in Bohemia, etc., and thought to be the exudation of Pinites succi- nifer, an extinct coniferous tree. Dose, gtt. v-x. Pix, Pitch,—is a resinous exudation from the stem of certain trees of the genera Pinus (Pine) and Abies (Fir and Spruce) ;—and may also be obtained by the evaporation of wood-tar. [See Pix Liquida below]. The two follow- ing varieties are official, viz.:— Pix Burgundica, Burgundy Pitch,—the prepared, resinous exudation of Abies excelsa, Norway spruce, nat. ord. Coniferae. Hard, brittle, opaque masses, very fusible, readily soluble in glacial acetic acid. Used for plasters. Is composed of an amorphous Resin, mixed with Oil of Turpentine, and other isomeric oils, and Abietic Acid. Pix Liquida, Tar,—is an empyreumatic oleoresin, (a “ bituminous liquid,” B. P.), obtained by the destructive distillation of the wood of Pinuspalustris, and of other species of Pinus, (nat. ord. Coniferae). A thick, viscid, semi-fluid, of brownish-black color, acid reaction, slightly soluble in water, soluble in oils, alcohol, and in solution of potassa or soda. It consists of Pyroligneous Acid, methyl alcohol, acetic acid, Creosote, toluene, xylene, and other hydro- carbons; also oily bodies, especially the Oil of Tar;—and Pyrocatechin, a crystalline principle, which gives it its granular appearance. Dose, gr. x, several times daily, up to 3 ij in the 24 hours. *Pix Canadensis, Canada or Hemlock Pitch,—the prepared, resinous exudation of Abies Canadensis, the hemlock spruce of theU. S. and Canada, nat. ord. Coniferae. It is somewhat softer than the preceding. [For Extract of Pinus Canadensis, see page 89.] Preparations of Tar and Pitch. Oleum Picis Liquidce, Oil of Tar,—a volatile oil distilled from tar, and con- taining a great variety of compounds, including hydrocarbons, phenols, 218 EVACUANTS. paraffin, etc., among the phenols being Creosote and Carbolic Acid. Is used locally and as an atomized inhalation. Syrupus Picis Liquidce, Syrup of Tar,—strength 7per cent, of Tar. Dose, gj-iv. Is merely a sweetened tar-water. Unguentuin Picis Liquidce, Tar Ointment,—has 50 per cent, of Tar. Emplastrum Picis Burgundica,—has 80 p. c. of Burgundy Pitch. Emplastrum Picis Cantharidatum, Cantharidal Pitch Plaster, Warming Plaster, —has of Cerate of Cantharides 8, Burgundy Pitch to 100. Physiological Action. The agents enumerated in the foregoing list belong to the nat. ord. Coniferse, (cone-bearing), and resemble each other very closely in their general actions. The Turpentines are all diuretic, stimulant, antispasmodic, rubefacient, hemostatic and anthelmintic ; in large doses irri- tant, producing gastro-enteritis and ulceration of the intestinal mucous mem- brane ; and in toxic dose they are paralyzant to the nerve-centres in the cere- brum, cord and medulla. Externally applied they are rubefacient, and highly antiseptic. Their virtues are wholly due to their volatile oil, the Oil of Tur- pentine, which is extremely active. Its vapor inhaled causes nasal and bron- chial irritation, headache, and perhaps bloody urine and strangury, sneezing, a tight sensation about the eyes and dyspnoea. In small doses internally, it stimulates the vaso-motor centres, causing a rise of arterial tension;—but larger doses paralyze the same and lower the blood-pressure accordingly; affecting the nerve-centres in the cerebrum, spinal cord and medulla, in the order stated, causing diminution of voluntary movement, then lowered reflex action, and lastly slowed respiration. It is excreted by the various channels of elimination, especially by the kidneys and the lungs, which are stimulated to increased action by small doses; but after large ones the kidneys suffer par- ticularly, the urine being suppressed, pain in the lumbar region, burning in the urethra, hematuria and strangury. Tar resembles the turpentines in its action, and as it contains both Creosote and Carbolic Acid, it has some qualities which are referable thereto. Pitch is a cutaneous stimulant. Thuja and Savine are irritant and may produce abortion, their oils being frequently used for that purpose. Savine is supposed to congest the pelvic viscera in women. Juniper is a stimulant diuretic of considerable activity in disease, but does not seem to increase the flow of urine in health. Its oil acts similarly to turpentine, but is more efficient upon the kidneys. Therapeutics. The external uses of these agents will be considered under the title Rubefacients further on. Internally, they have many applications ; but, on account of their great activity as internal remedies, they are not very manageable, and hence are not popular medicines. In— EMMENAGOGUES. 219 Hemorrhages from the mucous membranes, as that of the intestines in typhoid fever,—Oil of Turpentine is a very efficient hemostatic, in doses of rtbx-3j every hour or two, and the action carefully watched. Phosphorus Poisoning,—the oldest Oil of Turpentine, (containing ozone), is an efficient antidote, preventing the formation of phosphoric acid, and con- verting the phosphorus into an insoluble substance resembling spermaceti. The new oil is useless. Hysterical Affections,—Turpentine is an efficient antispasmodic, especially when used in combination with Ether (1 part to 3). Tape-worm,—Oil of Turpentine is an efficient tseniafuge, if given in large doses with Castor Oil to insure its rapid passage through the intes- tinal canal, in order that it may not be absorbed. Septic Fevers, as puerperal, erysipelas, etc., also in yellow fever, and pneu- monia,—Oil of Turpentine is a valuable stimulant to the cardiac and vaso- motor centres. Pulmonary Affections, such as bronchitis, acute and chronic; laryngitis, em- physema, phthisis with tendency to hemorrhage, etc.,—Turpentine, Terpin, Terebene, and Tar, are very useful agents, being employed by inhalation as well as internally, as stimulating expectorants and antiseptics. Dropsy,—Juniper as a diuretic, cautiously when kidneys are diseased, and generally combined with other diuretics. Papillomata in general are specifically controlled by Thuja, especially warts having a narrow base and a pendulous body; a strong tincture being applied locally, and used internally, in five-drop doses twice daily, at the same time. EMMENAGOGUES. Manganum, Manganese (see page 56)—the Black Oxide (Dioxide), in doses of gr. ij, also Potassium Permanganate, gr. j thrice daily. Tanacetum, Tansy,— the leaves and tops of Tanacetum vulgare. *Oleum Tanaceti, Oil of Tansy,—Dose, try-iij. *Infusum Tanaceti, Tansy Tea,—% j ad Oj. Dose, j-ij. Hedeoma, Pennyroyal,—leaves and tops of Hedeoma pulegioides. Oleum Hedeoma, Oil of Pennyroyal,—Dose, Ttyj-x. Sabina, Savine,—the tops of Juniperus Sabina. (See page 217.) Oleum Sabina, Oil of Savine,—Dose, try-v. *Ruta, Rue,—the leaves of Ruta graveolens. Oleum Rutce, TT\j-v. 220 EVACUANTS. Thuja,—the tops of Thuja occidentals,—(See ante, page 217),—Dose, tr\j-v of the Oil, thrice daily. Caulophyllum, Blue Cohosh,—is the rhizome and rootlets of Caulophyllwn tkalictroides, an indigenous plant, known to the Indians as “ squaw-root. ’ ’ It is said to produce intermittent contractions of the gravid uterus, and to have diuretic, emmenagogue and antispasmodic powers. It is highly re- commended in rheumatism of the hands and fingers, spasmodic dysmenor- rhoea, and pain about the uterine region. Dose, gr. v-xx. Caulophyllin is an impure resin, precipitated by water from an alcoholic extract. Ferrum, Iron (See page 54 et seq.),—is used as a tonic emmenagogue. Cantharis, Cantharides, Spanish Flies,—the insect Cantharis vesicatoria. (See under next title, Rubefacients, etc.) Quinine, has considerable emmenagogue power, by direct action as a stimu- lant upon the uterus itself. Dose, gr. xx-xxx, as ecbolic; smaller doses, (gr. v), frequently repeated, as an emmenagogue. Acidum Boricum, Boric (Boracic) Acid,—also Sodium Borate (Borax), the latter in doses of ten grains thrice daily. Strychnina, Strychnine,—as a spinal stimulant, and equalizer of the circula- tion. (See page 99.) Dose, of the sulphate, gr. -fo-rfo. Purgatives,—among which Aloes is the most efficient, determining the blood to the pelvic viscera. (See page 206.) Sinapis, Mustard, (See under next title),—as poultices, hot baths, or hot stupes, to pelvic region, and thighs. Baths,—Hot foot, thigh and hip-baths at time of the expected period, in connection with medicinal treatment. Action and Uses of Emmenagogues. As explained on page 41, agents which promote menstruation may be arranged in two groups, accord- ing as they act by Direct stimulation of the uterine and ovarian apparatus,—or by Indirect means, as the correction of anaemia, of disturbed pelvic circula- tion, etc. The latter group is the one which should receive preference in the treatment of amenorrhoea, with occasional aid from the direct agents, which work by irritation, and must, therefore, be employed with great caution. The Essential Oils of Tansy, Pennyroyal, Rue, Thuja, Savine, etc., are much employed by the laity, for emmenagogue and abortifacient purposes; and with great danger, for they can only set up uterine contractions by reflex action from the irritation they produce in the gastro-intestinal tract. Sabina is believed to have more specific action on the uterus than the other agents RUBEFACIENTS AND EPISPASTICS. named with it. It is supposed to congest the pelvic viscera in women, and is held by some authorities to be the most powerful, and at the same time the safest emmenagogue in the materia medica (Phillips). The Black Oxide of Alanganese has been recently announced as an emmenagogue, as have also Potassium Permanganate, Indigo, the Biniodide of Mercury, and Oxalic Acid, each one being highly praised by its advocates. TOPICAL AGENTS. RUBEFACIENTS AND EPISPASTICS. Sinapis, Mustard,—the seeds of Sinapis alba and Sinapis nigra. Oleum Sinapis Volatile, Tt\_ ]/%—%. "j Linimentum Sinapis Compositum. >- All made from Black Mustard. Charta Sinapis, Mustard paper. J Sinalbin. My rosin, a ferment. Composition of the Mustards. Acrinyl Sulpho - cyanate is the rubefacient principle, — produced Sinapis Alba contains— Sinapine, an alkaloid. by reaction between these two in A bland, fixed Oil. the presence of water. Erucic or Brassic Acid. Allyl Sulpho-cyanide, the Vola- tile Oil of Mustard, pro- duced by reaction between these two in the presence of water. Sinigrin (Pot. Myronate). My rosin, a ferment. Sinapis Nigra contains— Sinapine, an alkaloid. A bland, fixed Oil. Erucic or Brassic Acid. Pix Burgundica, Burgundy Pitch,— 1 *Pix Canadensis, Hemlock Pitch,— J See ante, page 2x7. Emplastrum Picis Burgundicce, Burgundy Pitch Plaster. Emplastrum Picis Cantharidatum, Cantharidal Pitch Plaster. Pix Liquida, Tar,—an empyreumatic oleo-resin. (See ante, page 217.) Oleum Picis Liquidce, Oil of Tar,—soluble in alcohol. Camphora, Camphor. (See page 119.) 222 TOPICAL AGENTS. Linimentum Camphorce, Cotton-seed Oil 8, Camphor 2. Linimentum Saponis, Soap-liniment,—Soap 7, Camphor A'/z, Oil Rosemary I, Alcohol 75, Water q. s. ad 100. Terebinthina, Turpentine. (See page 215.) Oleum Terebinthince, Oil of Turpentine, Spirits of Turpentine,—is soluble in 3 volumes of alcohol. (See ante, page 216.) • Linimentum Terebinthince, Turpentine Liniment,—has of the oil 35 parts with Resin Cerate 65. Cantharis, Cantharides, Spanish Flies,—the beetle Cantharis vesicatoria, an insect of the order Coleoptera. Tindura Cantharidis, "U -xx. Ceratum Cantharidis. Collodium Cantharidatum. Emplas. Picis Cantharidatum. Capsicum,—is the fruit of Capsicum fastigiatum, Cayenne Pepper, a plant of the nat. ord. Solanacese, to which Belladonna, Stramonium, Hyoscyamus and Dulcamara also belong. Contains an alkaloid resembling Coniine in odor, and a thick, red liquid, Capsicin, which is the active principle. Cap- sicum in powder is often adulterated with red lead. Tindura Capsici,—Dose, n\v-3 j, Extr. Capsici FI., Tty-xxx. as a gargle 3 ss-ij in 3 vj. Emplastrum Capsici,— is a most Oleoresina Capsici,—Dose, Try-v. excellent plaster. Menthol, Peppermint Camphor,—(See ante, page 194). Epispastics. Cantharis, Cantharides, (See above), in some one of its forms, is the agent in general use for the purpose of blistering. Other efficient epispastics are— Mezereum. Glacial Acetic Acid. Volatile Oil of Mustard. *Euphorbium. Stronger Ammonia Water,— the confined vapor. PUSTULANTS. Oleum Tiglii, Croton Oil,—(See ante, page 207). Antimonii et Potassii Tartras, Tartar Emetic,—(See page 71). Physiological Action. The action of irritants upon the circulation of an inflamed part is very similar to that of heat or cold, in that the result of either application is the relief of tension in the vessels, and consequently the relief of pain and decrease of inflammation. Heat acts directly, dilating the capil- laries of the collateral circulation, and thereby diverting the current from the RUBEFACIENTS AND EPISPASTICS. 223 inflamed area. Cold acts indirectly, causing reflex contraction of the afferent vessels, and diminishing the supply of blood to the inflamed part. Irritants cause dilatation of the vessels of the part to which they are applied, but con- traction of the vessels in other parts of the organism, especially in those parts or organs which have a nervous connection with the part or organ irritated. Counterirritation acts upon this principle, and to be most effectual, should not be applied directly over the organ inflamed, or even too near it, lest it should increase the congestion instead of diminishing it. By increasing the activity of the circulation in their immediate vicinity, counterirritants also promote the reabsorption of inflammatory products ; and when employed for this purpose they should be applied directly over the organ or tissue affected. Therapeutics. Counterirritation, when intelligently employed in accord- ance with the above-mentioned principles, is an exceedingly efficient and valuable measure for (a) the relief of pain,—(b) the decrease of local inflam- mation,—and (r) the reabsorption of inflammatory products. Hence its appli- cations are very numerous, and its area of employment a very wide one, ad- mitting only the citation of a few instances to serve as illustrations. In— Pericarditis,—a blister upon the thoracic wall, at some distance from the prsecordia, will help to lessen congestion and consequently to lower the inflammation. Pericardial Effusion,—to promote absorption, the blister should be placed directly over the praecordia. Pneumonia,—to promote reabsorption after consolidation, a blister directly over the affected part, or an energetic rubefacient. Neuralgia, of superficial nerves,—may be controlled by blisters over the painful nerve ;—or over the spinal column at the “tender point ” corresponding to the intercostal nerve affected ;—or to the heel in sciatica. The actual cautery is often still more efficient. Vomiting from any cause,—is always helped by a blister or a rubefacient application over the epigastrium. Chronic Ulcers,—vesicants locally, about the site of the ulcer, have a curative influence in many cases resisting ordinary treatment. Joint Effusions, or thickening,—the only treatment of any value is that by vesicants or the actual cautery, in the vicinity of the affected part. Acute Rheumatism,—blisters around the joints are of great value not only for the local inflammation, but also for the general disease, upon which they often have a curative influence. Chronic Bronchitis and Pleurisy,—pustulants over the chest, in order to keep up a continuous moderate irritation. 224 TOPICAL AGENTS. EMOLLIENTS AND DEMULCENTS. Petrolatum, Petrolatum, (commonly called Vaseline, Cosmoline, Petroleum Ointment, etc.),—is a mixture of hydrocarbons, chiefly of the marsh-gas series, obtained from petroleum by distilling off the lighter portions and purifying the residue. It is insoluble in water, soluble in boiling alcohol, ether, chloroform, oils, etc., and is official in three forms, viz. :— Petrolatum Liquidum, Liquid Petrolatum. Petrolatum Molle, Soft Petrolatum,—melts at 104°-! 130 F. Petrolatum Spissum, Hard Petrolatum,—melts at II3°-I25° F. Mel, Honey,—is a saccharine secretion deposited in the honey-comb, by Apis mellifica, the honey bee, an insect of the order Hymenoptera. Honey consists of a strong aqueous solution of mixed dextrose and levulose, the sum of which, known as “ glucose,” amounts generally to 70 or 80 per cent. Mel Despumatum, Clarified Honey,—is Honey warmed, skimmed and strained, with 5 per cent, of Glycerin added. Mel Rosce, Honey of Rose,—contains 88 per cent, of clarified honey. *Oxymel (B. P.), —Honey 40, Acetic Acid 5, Water 5. Linum, Linseed, Flaxseed,—the seed of Linum usitatissimum, Flax, a culti- vated plant of the nat. ord. Linese. Contains much mucilage in the covering of the seeds, and in the seed itself to by weight is the oil, Oleum Lini, Flaxseed or Linseed Oil, which is obtained by expression without the use of heat. Linseed-meal is the powdered cake, remaining after the oil has been expressed. Oleum Lini, Linseed Oil, (See ante, page 52),—Dose, ad libitum. *Infusum Lini, Linseed or Flaxseed Tea, (B. P.),—has of Linseed 150 grains, Liquorice-root 50 grains, infused in 10 ounces of boiling water for 2 hours, and strained. Dose, indefinite. Linimentum Calcis, Lime Liniment (Carron Oil),—has equal vols. of Limewater and Linseed Oil, shaken together. Adeps Lanae Hydrosus, Hydrous Wool Fat (Lanolin),—See ante, page 52, under Oils and Fats, for this and Cod-liver Oil, Cotton-seed Oil, Cacao- butter, and others. *Ichthyolum, Ichthyol,—See ante, page 73, under Sulphur. Physiological Action and Therapeutics. The substances, of which the above are only a few examples, have a medicinal action which is chiefly mechanical, forming a smooth and soft coating to an inflamed mucous mem- brane or to a portion of the skin denuded of its epidermis, protecting it from irritation by the air, and permitting the process of repair to proceed unchecked NEW REMEDIES. 225 by any external interference. Some of them, in addition, soften and relax the tissues (emollients), thereby lessening tension, and consequently relieving pain. Flaxseed is the favorite material for poultices, which are simply local baths, conveying heat and moisture to the part. It has the additional quality of being emollient, due to its mucilaginous and oleaginous constituents; and hence is one of the most efficient agents of the class to which it belongs. Linseed Oil is frequently applied to burns, scalds, eczematous eruptions, etc., either by itself, or with lime-water, as in the old-fashioned “ Carron Oil,” now replaced by Linimentum Calcis. Internally, in doses of 3 ij morning and evening, it has been highly spoken of as a cure for hemorrhoids. Honey is chiefly used as a vehicle, and as an ingredient of gargles. It is laxative in full doses. A mixture of honey and vinegar (official in the B. P. as Oxymel) is a favorite remedy for colds and sore throats. Petrolatum, known commercially as Cosmoline, Vaseline, etc., is a valuable protective, and an excellent basis for ointments, having no acridity, and no liability to turn rancid. It mixes readily with the alkaloids, the phenol compounds, and many other active agents ; but it does not penetrate the skin as readily as animal fats and fixed oils, (for which see page 5 2, ante.) MEMORANDA ON NEW REMEDIES and other agents not mentioned in the preceding pages. *Adonis Vernalis,—is a plant of the nat. ord. Ranunculaceae, (which con- tains Aconite, Pulsatilla, Podophyllum, etc.). It contains a glucoside named Adonidin, which acts almost exactly like Digitalin, but is much more power- ful, and without any cumulative property. It has been used largely in Europe for cardiac failure due to organic lesion, but is thought to be less certainly beneficial in valvular diseases than Digitalis. Besides its power as a cardiac tonic, it is also diuretic, and is very liable to produce vomiting and diarrhoea. The Infusion (3 ss-ij of the root to § vj of water) may be given in doses of % ss every 2-4 hours, or Adonidin itself, in doses of gr. four to six times daily. * Apiolum, Apiol,—is a non-volatile, oily liquid, of green color, acid reac- tion, and pungent taste, extracted from the fruit of Petroselinum sativum, Pars- ley (nat. ord. Umbelliferoe). It is probably a mixture of several substances, and is used in France as a remedy for intermittents and the amenorrhcea of anaemia, in one dose of gr. xv. As sold here it is generally inert as an em- menagogue, but very active as an article of commerce. 15 NEW REMEDIES. * Boldus, Boldo,—the leaves and stems of Peumus Boldus, a Chilian shrub. It is chiefly used as a substitute for quinine, and as a tonic for cases of chronic hepatic torpor. In S. America it is used for gonorrhoea and chronic cystitis. Dose of tincture (l/&) tr^x-xx. * Cascara Amarga, Honduras bark,—is the bark of a Mexican tree used as an alterative in syphilis and various skin affections. It is certainly a very powerful tonic, but the use of alcohol and tobacco is said to counteract its usefulness. Dose, of the fluid extract, ss-j. *Cereus, (Cactus Grandijlorus,')—is highly recommended in functional disorders of the heart, and in cardiac dyspnoea. Dose of fluid extract, gtt. x-xx. * Chaulmoogra Oil, from seeds of Gynocardia odorata,—is credited with a few cures of leprosy, and is recommended as an external application in scaly eczema, psoriasis, syphilitic skin diseases, chronic rheumatism, rheumatic arthritis, and tabes mesenterica. Dose, gtt. v-x, in capsules, or Gynocardic Acid, which is less nauseous, in doses of gr. ss-iij. Chrysarobinum, Chrysarobin,—is a mixture of proximate principles ex- tracted from Goa-powder, a substance found in cavities of decay in the trunk of Andira Araroba, a Brazilian tree of the nat. ord. Leguminosse. It is often improperly named “ Chrysophanic Acid,” and, used locally, it produces diffuse dermatitis, often followed by follicular and furuncular inflammation. It is a useful application in psoriasis and vegetable parasitic diseases, but should not be used over a large surface at one time. Unguentuvi Chrysarobini,—strength 10 per cent. * Damiana,—the leaves of the Mexican plant Turnera aphrodisiaca, is the popular aphrodisiac now with the charlatans who advertise “ manhood restorers.” It is probably a stimulant diuretic, a bitter tonic, and, in sufficient doses, a purgative. Reports vary much as to its aphrodisiac powers. Dose, of fluid extract, 3 j-ij, up to l|j daily. Eriodictyon, Eriodictyon (Yerba Santa),—the leaves of Eriodictyon glutinosum, a Californian shrub of the nat. ord. Hydrophyllacese. It is an excellent expectorant, usefully employed in bronchial and laryngeal affections, and covers the taste of Quinine in a remarkable manner. Dose, of the fluid extract, 3 ss-j; of an elixir or Syrup, % j-ij. When employed as a vehicle for the cinchona alkaloids, about 3 j is necessary for each 10 or 15 grains. * Erythrophlceum, Casca Bark, (Sassy Bark, Ordeal Bark),—is the bark of Erythrophlceum Guineuse, an African tree of the nat. ord. Leguminosse; used by the negroes as an ordeal in witchcraft trials. When used in quantity, NEW REMEDIES. 227 it causes severe cephalalgia, nausea and vomiting, narcosis and death. It is used in Africa as a remedy for intermittents, dysentery and colic;—and in England it is believed to resemble Digitalis in its action on both the circulation and the renal secretion. It contains an alkaloid, Erythrophloeine, which seems to combine the properties of both Digitalin and Picrotoxin, causing convulsions like the latter agent. It has been used with benefit in dilated heart, and in mitral disease and dropsy. Dose of the tincture (1 in 10), ; of the watery extract, gr. ss-j. * Fuchsin, Magenta, Rosanilin Hydrochlorate,—is an anilin dye occurring in brilliant crystals with a green lustre, and is said to have a remarkable influ- ence in albuminuria with cedema, diminishing the quantity of albumen in all cases, and arresting it entirely in many. Dose, gr. j-iij thrice daily, in pill. Full doses have produced salivation, vomiting, diarrhoea, etc., and when thrown into the veins it has caused tremor, staggering gait, albuminuria, and even fatty degeneration of the kidneys,—symptoms possibly due to the pres- ence of arsenic or anilin as impurities. * Hydrangea, (.Hydrangea Arborescens).—The root of this plant has long been used by the Cherokee Indians in calculous affections, and is of decided utility in these disorders, promoting the removal of gravel, relieving pain, etc. Dose of fluid extract, ; of decoction, i^j-ij. Hydrogen Dioxide, H202,—is official in the aqueous solution, Aqua Hydrogenii Dioxidi, which contains about 3 per cent, of the pure dioxide, corresponding to about 10 volumes of available oxygen. When fresh, it is one of the most powerful oxidizing agents known. In contact with a suppu- rating surface it generates a white foam, the result of its action on pus. Used internally it imparts oxygen to the blood, improves digestion and relieves spasm of the respiratory apparatus. Dose of the Aqua, gj-iij diluted with 3 to 4 of water. *Jequirity,—the seeds of Abrus precatorius, an Indian plant of the nat. ord. Leguminosce, which are made into a lotion by macerating 155 grains of them in powder in 17 fluid ounces of cold water, and filtering. It rapidly produces a purulent or croupous conjunctivitis, in severity proportionate to the number of applications, which, on subsiding, is found to have destroyed old granulations, and other formations, as pannus, corneal ulcers, etc. The seeds are very poisonous, and their application to the eye is a dangerous procedure, the resulting inflammation being often incontrollable. * Kava- Kava, root of Piper viethysticum,—is intoxicant, diuretic and motor-depressant. A moderate dose is tonic and stimulant. It is highly NEW REMEDIES. 228 recommended in gout, gonorrhoea, chronic gleet and obstinate cystitis. Dose, of root or fluid extract, sj ss-j. *Lippia Mexicana,—is recommended as a sedative expectorant in various bronchial affections, especially in coughs due to catarrhal inflammation of the respiratory passages. It is a creeping shrub of the nat. ord. Verbena- cese, and contains a volatile oil named Lippiol. Dose, of the tincture, 3 SH- *Manaca, Franciscea unijlora,—is advertised as a purgative, diuretic, emmenagogue and anti-syphilitic, but especially as a remedy for acute and chronic rheumatism. Dose of fluid extract, several times a day. * Myrtus Chekan, a Chilian plant;—is recommended as an expectorant in bronchitis, winter cough, etc., also in chronic cystitis and catarrhal affec- tions of other mucous membranes. Dose, of the fluid extract, 3 j- ss. * Piperazinum, Piperazin, C4H10N2,—is a synthetical basic compound formed by the action of Ammonia upon Ethylene Bromide, and occurs as a white, crystalline powder, readily soluble in water. It liquefies when exposed to the air, from which it greedily absorbs water and C02. With uric acid it forms the most soluble known urate, requiring but 50 parts of water for its solution, while lithium urate requires 368 of water to dissolve it. Piperazin is non-toxic, non-irritant to mucous membranes, is readily absorbed from the stomach and circulates in the blood unchanged. It readily neutralizes and dissolves gouty deposits, facilitating their removal from the tissues. Dose, gr. v-x,—in gout a minimum of gr. xv daily in carbonated water, with an equal quantity of Phenocoll Hydrochloride added thereto when there is much pain and fever. * Piscidia Erythrina, Jamaica Dogwood,—has been introduced as a sub- stitute for Opium, being anodyne, hypnotic and narcotic, sialogogue, diapho- retic and mydriatic. It lowers reflex action, and arterial tension after a brief rise, weakens the heart and causes death by asphyxia. It is a good hypnotic and anodyne. Dose, of the fluid extract, 3 ss-j cautiously. * Saccharinum, Saccharin,—is a derivative of Toluene, a coal-tar product, from which it is prepared by a complicated process. Its chemical title is Benzoyl-sulphonic-imide, and it occurs as a white, amorphous powder, of very sweet taste, soluble in alcohol and in ether (difference from Sugar), sparingly in cold water, more so in hot water. It is an efficient antiseptic, and is said to be 220 times sweeter to the taste than sugar. It has no injurious action on man, and is a useful substitute for sugar in cases of diabetes, but has no cura- tive action upon that disease. PRESCRIPTION WRITING. 229 * Sanitas,—is a disinfecting solution obtained by the action of water upon oxidized turpentine, its active principle being Hydrogen Dioxide. It is not poisonous, and does not stain the linen,—two qualities which strongly recom- mend it. * Tonga,—is a preparation imported from Fiji, consisting of root-fibres, leaves and inner bark of some plants, believed to be Raphidophora vitiensis and Premna tatiensis. From this a fluid extract is prepared which has proved very efficient in gj doses ter die, for neuralgia. * Verbascum Thaspus, Mullein Plant,—is being highly praised as a sub- stitute for Cod-liver Oil in phthisis and other wasting diseases. It is used in infusion, j|ivof the fresh leaves in a pint of fresh milk, thrice daily. Viburnum Prunifolium, Black Haw, (nat. ord. Caprifoliaceae),—is a sedative and tonic to the uterine and ovarian nerve-centres. It is used as an anti-abortive, and in uterine congestion, ovarian irritation, irregular menstrua- tion with dysmenorrhoea and menorrhagia. The fluid extract is official, and may be given in doses of TT^xx-3 ij, with aromatics, nervous sedatives, Can- nabis Indica or Morphine. Viburnum Opulus is highly valued by those who have used it as a remedy for uterine and other abdominal pains. Its prepara- tions are used in the same doses as the other. Though not generally classed among emmenagogues, being rather uterine sedatives, these agents often pro- mote the menstrual flow by relieving pain and irritation of the ovaries at the period. PRESCRIPTION WRITING. Extemporaneous Prescriptions are formulae written by the physician on the instant (ex tempore'), to meet the requirements of individual cases. A prescription should begin with the name of the person for whom it is de- signed, and the date on which it is written. Then follows the Latin word Recipe, usually abbreviated by the sign R, and signifying “ Take,” or “ Take thou;” next the names and quantities of the ingredient to be used, which are also expressed in Latin; then the directions to the compounder, followed by the directions to the patient, the last being now usually expressed in English ; and finally the signature of the prescriber. A prescription then has four component parts, viz. : — Superscription,—which consists of the name of the party for whom it is designed, the date, and the sign R—signifying “Take thou.” Inscription,—the body of the prescription, consisting of one or more of the following subdivisions, viz.—the 230 PRESCRIPTION WRITING. Basis,—or chief ingredient. Adjuvant,—to assist the action of the basis. Corrective,—to correct some injurious quality of the other ingredients. Vehicle or excipient,—to give it a suitable form. Subscription,—the directions for the compounder, usually expressed in contracted Latin. Signature,—the instructions for the administration of the medicine, in English or Latin, followed by the signature of the prescriber. A prescription may, however, contain the basis alone, or the basis with the adjuvant, or the basis with a simple vehicle or diluent. A single ingredient may serve a double or a treble office, as the Aromatic Syrup of Rhubarb with Quinine, in which the syrup serves an an adjuvant to increase the action of the quinine, as an excipient to cover the taste, and as a vehicle to facilitate the administration of the dose directed. Again, the basis may need no aid in doing its work, and may require no corrective of its action, nor any special vehicle. On the other hand, there is no limit to the number of ingredients that may be used, provided that the prescriber has a clear idea of something to be accomplished by each one, and also provided that there is no chemical or medicinal incompatibility between them. Formerly prescriptions were very complex, and contained a great many curious and incongruous ingredients. As Dr. Phillips well says, “ the tendency of the present age is toward mono- rather than poly-pharmacy, and prescriptions with the orthodox adjuvans and corrigens are less frequently seen than formerly.” There is danger, however, in carrying this simplicity too far, for there is no doubt but that proper combi- nations of medicines will often produce effects for the patient’s good, which could not be obtained from the use of any one remedy. Procedure in Writing a Prescription. The first step is to write the name of the patient, the date, and the sign 1£. Then the title of each ingre- dient should be written in Latin and in the genitive case, except when only a certain number of an ingredient is to be used the ingredient should be in the accusative case, as for example, “ Vitellum unum,—one Yolk-of-egg.” Next the quantity of each ingredient sufficient for one dose should be mentally determined, and multiplied by the number of doses which the mixture, etc., is to contain, and the result set down in signs and Roman numerals opposite the designation of each article. Directions to the phar- maceutist and for the patient being added, and the prescribe!’s name or initials being affixed, the prescription is completed. Frequently, the ingre- dients and their quantities for but one dose, in pill, powder, suppository, etc., are named, with instructions to make a certain number after the formula pre- scribed. When an unusually large dose of any poisonous drug is prescribed, PRESCRIPTION WRITING. 231 it is customary to underline the quantity, so as to call the attention of the compounder to the fact that the large dose is ordered intentionally. An Example will perhaps make the foregoing more comprehensible, and at the same time serve to indicate the style of writing usually employed. The following formula is that ordered in the U. S. Pharmacopoeia for the prepara- tion known as “ Black Draught,’ ’ but officially styled the Coynpound Infusion of Senna ; approximate weights and measures being substituted for the phar- macopoeia! metric weights. For Mrs. Gray. Recipe, Take,— July 7th, 1894. Superscription. Sennce, semiunciam, Of Senna, half an ounce, Magnesii Sulphatis, Of Magnesium Sulphate, (Basis.) (Adjuvant.) Mannce, and unciam unam, Manna, of each an ounce, Inscription. (Corrective.) Fceniculi, drachmam unam, Of Fennel, one drachm, Aquce Bullientis fluiduncias octo, Of Boiling Water, eight fluid- ounces. (Vehicle.) Macera per hor am in vase clauso, deinde cola. Macerate for an hour in a closed vessel, then strain. . Subscription. Signa,—Mark or Write, thus—A wineglassful every four hours 'till it operates. T. F. Wood, M. D. Signature. Abbreviated in the style usual among physicians, the above prescription would read as follows, viz.:— For Mrs. Gray. July 7th, 1894. Sennce, Sss. Magnesii Sulph., Mannce, aa Sj. Fceniculi, Sj. Aquce Bull., fSviij. Mac. per hor. in vase clauso, deinde cola. Sig.—A wineglassful every four hours, 'till it operates. Wood. As the result of the above is nearly identical with the official preparation, we might write the same prescription more simply, as follows,— Infusi Sennce Compos., "5, viij, with the proper superscription and signature; this being the manner of pre- scribing the official preparations. 232 PRESCRIPTION WRITING. It will be noticed that in the above analysis the term “basis” covers two ingredients; but it is obvious that either of them might be considered the principal agent, and the other one classed as an adjuvant. * ‘ These four parts of a formula are intended to accomplish the object of Asclepiades, curare cito, tute et jucunde ; in other words, to enable the basis to cure quickly, safely and pleasantly.” (Pareira.) Another Example will illustrate the mental operations which should always be followed by a prescriber; for no matter how good a memory he may have, he will surely make a grievous mistake some day if he follow the practice of writing prescriptions from memory. Furthermore, the unscientific character of the latter habit will, when appreciated, prevent any educated physician from indulging in it. Every prescription should be written with a definite purpose in view, consequently the mind of the prescriber should weigh each step carefully, and should avoid all slavish subjection to ready-made formulae. Suppose, then, that we wish to order for Miss Graham an emulsion of Cas- tor Oil, flavored and sweetened so as to make it less disagreeable to the taste than it naturally is. If the ingredients were simply mixed together, as in the previous example, the result would be an unsightly preparation, consisting of sweetened and flavored water with the oil floating on top. So we require that the process of emulsification be first accomplished, by which the oil is minutely subdivided and suspended in the water, by the aid of the emulsifier, which may be any viscid excipient, as gum, soap, or yolk-of-egg. Taking the last- named for the emulsifying agent, we would begin by writing down in order the following terms, as stated in italics, viz.:— For Miss Graham. June 10th, i894- Jji. (Take thou—) Olei Ricini, (of Oil of Castor), Vitellum, (Yolk-of-egg), Tere bene simul: dein adde— (Rub well together; then add—) Having gone so far, we begin to think of an agreeable vehicle, and choos- ing from the many Syrups at our disposal that of Ginger, and from the flavored Waters that of Cinnamon, we write further for these as the ingredients to be added, thus— Syrupi Zingiberis, (of Syrup of Ginger), Agues Cinnamomi, (of Cinnamon-Water). The ingredients are now all entered upon the prescription, but their respec- tive quantities have not yet been decided on. We proceed, then, by first taking into consideration the total quantity of the medicament required,— which, in this case, as the preparation is intended to purge the patient, need not embrace more than one or two doses. As it is well to provide for a repe- PRESCRIPTION WRITING. 233 tition of the dose, in case the medicine should not act sufficiently, we will decide upon two doses in all. Now, the average adult dose of Castor-oil is about a tablespoonful, or half-an-ounce, and as we want two such doses we insert the sign and numeral f3 j, or simply §j, opposite the title of the oil, which is written in the genitive case. But to emulsify it properly we need about one-half as much of the emulsifying agent, and we may express this by writing for half-an-ounce of yolk-of-egg, or for the yolk of one egg, or for one yolk-of-egg, which weighs about half-an-ounce. This would be expressed in Latin by either of the following methods, viz.: — Vitelli semi-unciam, (Sss). One half-ounce of Yolk-of-egg. Vitellum ovi unius, (j). The Yolk of one egg. Vitellum unum, (j). One Yolk-of-egg. As the word Vitellus means Yolk-of-egg, we may omit the word Ovi, and accepting the latter as the best style, insert the numeral j opposite the word Vitellum, which is properly in the accusative case. The whole quantity so far specified is one ounce and a half, and if we add two and a half ounces of diluent, we shall have a four-ounce mixture, or the full of a regular-sized bottle, as found in the shops. There being considerable viscidity already pres- ent in the emulsion we do not need much syrup, so we assign to the Syrup of Ginger the odd half-ounce, leaving two ounces of the Water to make up the total bulk of four fluid-ounces. The prescription now only requires for its completion that the subscription and signature be added. We proceed to admonish the dispenser by telling him to mix the ingredients together, and therefore write the word “ misce,” or the abbreviation “M” commonly used therefor; and to further point out the nature of the preparation we add, “ let be made an emulsionor in Latin. “fiat emulsum—the passive verb taking as predicate-nominative the thing into which the making is to be. The final words “Label ”—or “ Write thus” —are expressed by the term “Signa,”—followed by the directions for the patient or the person who is to administer the medicine, which should be in English, though they may also be written in Latin. Our completed prescrip- tion will stand thus,— For Miss Graham. June ioth, 1894. V Olei Ricini, 5j. Vitellum j. Tere bene simul, dein adde— Syrupi Zingiberis, Sss. Aquce Cinnamomi, Sij. M. fiat emulsum. Sig.—“ One-half at once, to be repeated next day if required." Potter. PRESCRIPTION WRITING. 234 The last entry of the inscription might also be written thus—'■'■Aqua Cin- namomi, quantum sufficiat ad 5 iv,” meaning “ of Cinnamon-Water as much as may be necessary to [bring the whole quantity to] four ounces,”—usually expressed in contracted style, thus— This style is preferred when any of the quantities are approximations, and the final item cannot be exactly stated to secure a certain total. In the fore- going case, the one yolk-of-egg might measure a little more than the half-ounce assigned to it; but by using the q. s. ad style at the end, we make sure of getting a total of exactly four fluid-ounces. In more complicated prescriptions, the mode of reasoning is precisely the same ; practice, care, and knowledge of the whole subject being necessary to the production of those elegant prescriptions which are correctly termed ‘ ‘ magistral,’ ’ as the work of a magister, or master of his business. Aq. Cinnamomi, q. s. ad 3 iv. Metric Prescriptions are written or read with sufficient accuracy, by con- sidering a gramme as equal to 15 Troy grains, and a cubic centimeter (or milliliter) as being equal to 15 minims or one-fourth of a fluid-drachm. All other terms, units or prefixes, belonging to the metric system, may be wholly ignored by both physician and pharmacist. The decimal point after the gramme or the cubic centimeter should always be replaced by a line, so as to avoid errors, which in many cases might prove serious, from the misplace- ment of a point, the dropping of an ink-spot, or the intrusion of a fly-speck. The simplest method of writing a prescription in metric terms, is to first write it as though prescribing but one dose of each ingredient in grains or minims and decimals thereof; then by substituting the term ‘ ‘ grammes ’ ’ or “ cubic centimeters ” for the grains and minims the prescription is correct for fifteen doses in metric terms. For example,— Jfc. Quininse Sulpliatis j 1 Strychninse Sulphatis gr. or 0.016 Ext. Glycyrrhizse FI., rfliv 4 Syrupi, flfix 60 One Dose. 15 Doses Metric. oi6 This gives a two-ounce mixture approximately, of which the dose would be " a teaspoonful thrice daily.” The above rule will answer for all liquids except those which are very heavy (as Syrups and Chloroform), or very light (as Ether). Measures may be entirely discarded and all fluid quantities expressed in grammes. The average drop of water may be taken as equal to 0.05 c.c., the teaspoonful to 5 c.c.,the tablespoonful to 20 c.c., the § to 30 c.c (or grammes), and 5 viij to 250 c.c. INCOMPATIBILITY. 235 Renewals.—It would be advisable for physicians to always write the words “ Non Repetaturf or some similar direction, on all prescriptions which should not be repeated without their sanction. By so doing they would doubtless cut off a good many renewal charges from the receipts of druggists who would fear the legal consequences of disobeying the mandate. This incon- venience to the drug-seller would be more than compensated for in the pro- tection to the drug-taker, who too frequently carries in his pocket-book a stock of recipes for his various complaints ; and in protection to the physician, who by giving up the dispensing of his own medicines has placed it in the power of the druggist to connive at a direct robbery of the just reward of professional skill and knowledge. Principles of Combination include certain maxims wdiich should never be lost sight of. To prescribe as few remedies as possible, and to order no pow- erful drug without a distinct idea of its office in the prescription, are, perhaps, the chief; to which may be added another, namely—to give powerful agents by themselves when required for impression on the system. Medicines are combined for several purposes,—(i), to increase, correct or modify the action of another medicine ; (2), to obtain the joint action of two or more diverse remedies; (3), to obtain by chemical reaction a special com- bination, which is either a new remedy, or which acts as a new remedy; (4), to give a suitable form for administration, or for preservation. INCOMPATIBILITY. Incompatibility may be Chemical, Pharmaceutical or Therapeutical, ac- cording as the incompatible combination results in chemical decomposition, physical disassociation, or antagonistic physiological action. The first kind may be intentional, for the purpose of obtaining a new substance as the result of the chemical action;—for example, the prescribing Calomel or Corrosive Sublimate with Limewater, to produce respectively the black and yellow Oxides of Mercury. The Dangers of Incompatibility may in a great measure be avoided by the use of the utmost simplicity in prescribing. The subject can only be glanced at within these pages, but the following simple rules may help the burdened memory of the student and the practitioner. Never use more than one remedy at a time, if one will serve the purpose. Never use Strong Mineral Acids with other agents, unless you know exactly what reaction will ensue. They decompose salts of the weaker acids, and form ethers when combined with alcohol. Never combine free acids with hydrates or carbonates. 236 PRESCRIPTION WRITING. Select the simplest solvent, diluent or excipient you know of, remembering that the solvent power of alcohol and of water for their respective substances decreases in proportion to the quantity of the other added. Generally do not combine two or more soluble salts ; for such salts in solution, when brought together, usually exchange their radicles, thereby forming an insoluble compound. The following more or less insoluble salts will be formed whenever the materials of which they are composed are brought together in solutions; the Hydrates, Carbonates, Phosphates, Borates, Arsenates and Tannates of most earthy and heavy metals and alkaloids, and the metallic Sulphides; the Sulphates of Calcium, of Lead, and the subsalts of Mercury; the Chlorides, Iodides, and Bromides of Bismuth, Silver, Lead, and Mercury ; the Iodides of Quinine, Morphine and most alkaloids. Never prescribe a Glucoside (as Santonin, Colocynthin, etc.), in combination with free acids or with a substance containing Emulsin, as these agents will decompose it. Never order a drug in combination with any of its Tests or Antidotes. Aconite should be ordered in water alone, Corrosive Mercuric Chloride by itself in water or in simple syrup. The latter drug is incompatible with almost everything, even the Compound Syrup of Sarsaparilla being said to decom- pose it. Potassium Iodide decomposes most of the metallic salts, and is one of the drugs which are best administered alone. Resinous Tinctures or Fluid Extracts, [e.g., Tinct. Cannabis Indies;) when combined with aqueous solutions, should always have Acacia or some other emulsifying agent added, to prevent the separation of the resin, which otherwise will be deposited on the sides of the bottle or will float on top of the mixture. Silver Nitrate and the Acetate and Sub-acetate of Lead, though incom- patible with almost everything, may be combined with Opium, the latter form- ing with Opium a compound, which, though insoluble, is therapeutically active as an astringent and anodyne lotion. Silver Nitrate with Creosote forms an explosive compound. Tannic and Gallic Acids, and substances containing them (as the Astrin- gent Bitters), precipitate albumen, alkaloids and most soluble metallic salts. They may be prescribed with the proto-salts of Iron, but not with its per-salts. Calumba is the best vegetable tonic to use with Iron salts, as it contains neither tannic nor gallic acid. Tannic Acid precipitates gelatin. Iodine and the soluble Iodides are incompatible with the alkaloids and substances containing them, also with most metallic salts. Alkalies neutralize free acids, and precipitate the alkaloids and the INCOMPATIBILITY. 237 soluble non-alkaline metallic salts. Oxides of the Alkalies decompose salts of the metals proper, and salts of the alkaloids, precipitating their bases; but the base may be soluble in an excess of the alkali. Poisonous Compounds may be formed by the admixture of several sub- stances in solution, such as— Potassium Iodide or the Syrup of the Iodide of Iron,—with Potassium Chlorate. Potassium Cyanide or Dilute Hydrocyanic Acid,—with Calomel, Bismuth salts, metallic hydrates, carbonates, subnitrates or subchlorides, forming poisonous cyanides. Explosive Compounds result from mixing powerful oxidizing agents with others which are readily oxidizable. The chief members of these two classes are as follows— Oxidizers. Nitric Acid. Chromic Acid. Free Hydrochloric Acid. Nitro-hydrochloric Acid. Potassium Chlorate. Potassium Permanganate. Oxidizable or Combustible. Glycerin, Sugar, Alcohols. Oils and Ethers. Sulphur and Sulphides. Dry Organic Substances. Phosphorus. Table of Precipitant Solutions. The following table shows the most important instances of solutions which mutually precipitate each other, the letter P meaning “ forms a precipitate with ”— Solutions of— Alkaloidal Solutions (generally). Metallic Solutions (generally). Solutions of Lead Salts. Solutions of Silver Saits. Solutions of Calcium Salts. Solutions of Magne- sium Salts. Solutions of Albumen. Solutions of Gelatin. Alkalies, P P P P P P Tannic Acid, P P P P P P Carbonic Acid and Carbonates, . . . P P P P P P Sulphuric Acid and Sulphates, . . . P P P Phosphoric Acid and Phosphates, . . P P P P P P Boric Acid and Borates, P P P P Hydrochloric Acid and Chlorides, . . P P Hydrobromic Acid and Bromides, . . P P Hydriodic Acid and Iodides, .... P P P Sulphides, P P P Arsenical Preparations P P P Albumen P P P 238 PRESCRIPTION WRITING. Pharmaceutical Incompatibility differs from chemical incompatibility in the absence of chemical action, and is generally produced by adding one sub- stance to another which, through differences in solubility, causes a precipitation of solid matter or a separation of part of the liquid. The constituents sepa- rated may be active and hence important, or inert and therefore unimportant. Instances of this are—the addition of an acid to a Quinine and Liquorice mixture, resulting in precipitation of the Glycyrrhizin (relied on to cover the taste of the Quinine) by the acid;—or the use of Quinine, Tincture of Ferric Chloride and Liquorice together ;—or the prescribing of solutions of Chloral and Potassium Bromide with an alcoholic preparation, the Chloral separating to the top as an alcoholate, and therefore dangerously in excess for the first few doses. When a fluid extract is diluted with a liquid differing in composition from those used in the fluid extracts, the gum, albumen, resin, and mucilage are often separated. In such a case as Fluid Extract of Cannabis Indica the active resin would be thrown out of solution, and floating on top might cause serious symptoms ; but in many other instances the precipitate would be inert and filtration would be in order. Water is the solvent for albuminous, gelati- nous, gummy, and saccharine bodies and for a large number of inorganic salts; while Alcohol is the solvent for volatile oils and resins, gum-resins, resinoids, balsams, and all drugs containing these as their active principles. The solvent power of either Alcohol or Water for their particular substances decreases in proportion to the amount of the other added. Instances of Pharmaceutical Incompatibility. Resinous Tinctures or Fluid Extracts with Aqueous solutions. Tincture of Guaiac with Spirit of Nitric Ether. Compound Infusion of Gentian with Infusion of Wild Cherry. Compound Infusion of Cinchona with Compound Infusion of Gentian. Essential Oils with Aqueous liquids in quantities exceeding i drop to 5j. Fixed Oils and Copaiba with Aqueous liquids (except excipients). Tinctures made with Alcohol with those made with Diluted Alcohol. Alcoholic Tinctures and Fluid Extracts with Aqueous preparations. Spirit of Nitrous Ether with strong Mucilages. Infusions generally with Metallic salts. Therapeutical Incompatibility arises when two agents are administered together which oppose each other in their action on the human system,—as for instance Belladonna in any form with Physostigma. But in many cases physiological antagonists are designedly prescribed together, one as a guard against the action of the other, as in the hypodermic administration of Mor- phine guarded by Atropine. The antagonists to each of the active medicinal agents may be found in the preceding pages under their various titles. Pages 239-240 missing ABBREVIATIONS. 241 Abbreviations are in general use in prescription writing, but should be avoided as much as possible. Their lavish use is a sign of the prescriber’s ignorance of Latin, they confound the compounder, enhance the chances for error, and are therefore a frequent source of danger to the patient. In the larger works on pharmacy, very full lists of the commonly used abbreviations are given. The following table gives a few examples of the dangers of carelessness in their employment. Aconit.—may mean either Aconitum or Aconitina. Amnion.—Ammonia or Ammoniacum. Ac. Hydroc.—Acidum Hydrochloricum or Acidum Hydrocyanicum. Aq. Font.—might easily be read Aqua Fortis. Chlor.—Chlorum, Chloral, or Chloroformum. Hyd. Chlor.—Hydrate of Chloral, Hydrargyri Chloridum. Sulph.—Sulphur, Sulphas, Sulphidum, Sulphitum. Zinc. Phos.—Zinci Phosphas or Zinci Phosphidum. i6 INDEX. ABBREVIATIONS, 241 Abietic acid, 217 Abies, 217 Aceta, 12 Acetanilid, 183 Acetic acid, 72 Acetum, 72 Acid, acetic, 72 arsenous, 58 benzoic, 180, 197 boric, 220 carbolic, 180, 187, 211 citric, 72 gallic, 87 hydriodic, 75, 78 hydrobromic, 153, 155 hydrochloric, 50. hydrocyanic, 175 lactic, 49 mineral, 50 nitric, 50 nitro-hydrochloric, 50 phenic, 187 phosphoric, 50 pyrogallic, 87, 180, 189 salicylic, 180, 191 sulphuric, 50 sulphurous, 73 tannic, 87 tartaric, 72 vegetable, 72 Acids, their action, 33, 72 Aconite, 106, 163 Aconitine, 163 Acrinyl sulpho-cyanate, 221 Actea racemosa, 109, 212 Adeps, 51 lanse hydrosus, 224 Adonidin, 225 Adonis vernalis, 225 .