HANDBOOK OF MATERIA MEDICA, PHARMACY, AND THERAPEUTICS. POTTER. NOTICES OF THE PRESS OF PREVIOUS EDITIONS OF DR. POTTER’S HANDBOOK. From the New York Medical Journal. “ Dr. Potter’s Handbook will find a place, and a very important one, in our colleges and the libraries of our practitioners. It contains almost everything that can be found in the larger works in a more concise form and brought up to a rather more recent date. . . . The section on pharmacy and prescription writing is very carefully prepared, all the phar- maceutical processes are described, and the composition of the official preparations is given. Under the head of prescription writing considerable attention is paid to the subject of incompatibilities, and the student will here find many valuable hints for his guidance in this difficult subject. Besides this there are, under the head of special therapeutics, very many formulas for the treatment of particular diseases and abnormal conditions, arranged alphabetically for easy reference. This will be especially valuable to young practitioners, and will frequently save the trouble of looking through large works and monographs for suitable formulae in the treatment of special cases. This department is fuller in this book than in any with which we are acquainted.” From the Therapeutic Gazette. “ The author has aimed to embrace in a single volume the essentials of practical materia medica and therapeutics, and has produced a book small enough for easy carriage and easy reference, large enough to contain a carefully-digested, but full, clear and well- arranged mass of information. He has not adhered to any pharmacopoeia, as is the case of certain recent manuals, thereby limiting his work, and in this day of new remedies causing constant disappointment, but has brought it up to date in the most satisfactory way. No new remedy of any acknowledged value is omitted from this list. Under each the section on physiological action and therapeutics has been written with care. ... In the enumeration of drugs suited to different disorders a very successful effort at discrimi- nation has been made, both in the stage of disease and in the cases peculiarly suited to the remedy. It is no mere list of diseases followed by a catalogue of drugs, but is a digest of modern therapeutics, and as such will prove of immense use to its possessor.” From the Pacijic Medical and Surgical Journal. “ In looking over the work, we are not surprised that it has taken the author the best part of two years in its preparation, for it shows on every page great labor and careful research; and as no good work goes unrewarded, we feel that he will be compensated by the favor with which his book will be received by the profession. We have been indeed pleased with the examination made, and have already used it for reference. As the title informs us, it is not materia medica alone—in fact, this is the least important part of the book—but it contains the essentials of therapeutics, pharmacy and the physiological action of drugs, besides many points of information which are useful to the student and a con- venience to find in one and the same book.” From the A merican Practitioner and News. “ Dr. Potter’s work contains what is worthy to be preserved of the materia medica and therapeutics of times old and new, and sets it to the physician’s hand in admirable shape.” From the Buffalo Medical and Surgical Journal. “ This work, as seen by its title, embraces much that is new to the profession, delud- ing, as it does, well-written and concise articles on extemporaneous pharmacy, as well as official. The part on physiological action of medicines is well written and comprehensive. The portion of the book relating to special therapeutics of disease is especially valuable, as it is so concise and to the point. Taking it all in all, this is a book well worth having.” *** The price of this book is $4.00 in cloth binding, or $5.00 in full leather. It may be had through any bookseller, or upon receipt of price will be sent, postpaid, to any address by the publishers. HANDBOOK OF Materia Medica, Pharmacy, and Therapeutics, INCLUDING THE PHYSIOLOGICAL ACTION OF DRUGS, THE SPECIAL THERA- PEUTICS OF DISEASE, OFFICIAL AND PRACTICAL PHARMACY, AND MINUTE DIRECTIONS FOR PRESCRIPTION WRITING. BY SAM’L O. L. POTTER, A.M., M.D.(Jeff’n), M.R.C.P. (Lond.), •*l PROFESSOR OF THE THEORY AND PRACTICE OF MEDICINE IN THE COOPER MEDICAL COLLEGE OF SAN FRANCISCO I AUTHOR OF “ QUIZ-COMPENDS " OF ANATOMY AND MATERIA MEDICA, “AN INDEX OF COMPARATIVE THERAPEUTICS/' AND *CA STUDY OF SPEECH AND ITS DEFECTS/' LATE A. A. SURGEON, U. S. ARMY, AND BRIGADE-SURGEON, N. G. OF CALIFORNIA. THIRD EDITION. REVISED PHILADELPHIA: P. BLAKISTON, SON & CO., 1012 Walnut Street. 1891. Copyright, 1891, By P. BLAKISTON, SON & CO. Press of Wm. F. Fell & Co., 1220-24 SANSOM ST., PHILADELPHIA. TO MY WIFE WHOSE UNFAILING AND DEVOTED CARE AND PATIENT ENCOURAGEMENT, DURING THE PAST THIRTEEN YEARS, HAS SUPPORTED THE AUTHOR IN EVERY EXIGENCY OF HIS PROFESSIONAL LIFE. PREFACE TO THE FIRST EDITION. The book, which this preface completes, has occupied the writer’s leisure hours during the past two years, and in a measure has grown out of some less pretentious volumes previously written by him. The con- tinued favor shown by teachers and students, both in this country and in England, to his three manuals in the “ Quiz-Compend ” series for students, and particularly to the volume on Materia Medicaand Therapeu- tics, has encouraged their author to hope that a handbook from him on the same subject, but embracing a wider scope, might meet wfith a corres- ponding degree of appreciation. The fact that quite a number of new manuals on Materia Medica have lately appeared, has not deterred him from entering the field, nor diminished his confidence in the approbation of his readers; but has rather seemed a proof that most of the older text- books on this branch of medical knowledge are no longer satisfactory, even with the regular revisions which they undergo at stated periods. Hence he expects for this handbook a position, among the recent manuals of its class, as high as its merits and demerits may entitle it to receive in the estimation of those for whose use it has been prepared. The author’s intention has been to produce a book which would embrace in a single volume the Essentials of practical Materia Medica and Therapeutics, treating of each subject in as concise phraseology as possible consistent with the delineation of every important feature. He has also endeavored to formulate such minute and definite directions for the framing of Prescriptions as might elucidate what to many is a very difficult problem. Furthermore, he has tried to present as much infor- mation upon the subject of Pharmacy as every physician should possess, in order to handle the implements of his profession with confidence, and to direct their use by others with pharmaceutical accuracy. The complete fulfilment of these aims would be realized if the book should take rank as a working companion to the advanced student and the junior practitioner ; and be deemed by them a reliable guide through the forest of observations and experiments on drug actions and uses, which makes progress slow for the already over-burdened mind, when ploughing through the more exhaustive and exhausting text-books. Although this book is essentially a compilation, as all books of its class must be, there will be found in its pages much original matter derived PREFACE. from the writer’s own experience in professional life. The arrangement of the matter will be found to be in some respects unique. After full consideration of the many arrangements of the Materia Medica in vogue, a modified alphabetical plan was adopted, by which the advantages of the alphabetical order might be retained, while permitting the grouping together of agents which are closely related, physiologically and thera- peutically, under the title of the principal member of the class—the chief, as it were, of that particular clan. Thus, under the title Amyl Nitris (Nitrite of Amyl), will be found mention also of the Nitrites of Ethyl, Sodium and Potassium, and their congener Nitro-Glycerin, all of which are closely allied to the first-named and to each other, in respect of their actions and uses. A very elaborate section on Drug Classifica- tion is placed before the Materia Medica, in order to supplement such deficiencies in grouping as are inevitable in an alphabetical arrangement. In detailing the characteristics of an important drug, its physical pro- perties and chemical constituents are first briefly enumerated, then its preparations are described in the official language of the pharmacopoeia, usually somewhat abbreviated ; any important unofficial preparations being also noted, and all the compounds into which it enters enumerated. Next the physiological action is taken up, its characteristic features being first described; then the actions resulting from an ordinary medicinal dose, next those produced by small doses continued, and finally those from a toxic dose. These are followed by a brief account of its antago- nists, antidotes and incompatibles, if any ; and a concise summary of its therapeutical applications closes the article ;—the whole presenting, it is hoped, a clearly defined word-picture of the drug under consideration. Every article and preparation comprised in the last edition of the U. S. Pharmacopoeia is fully noticed, while all the prominent unofficial agents receive such mention as their respective importance seems to demand. The second part of the book is devoted to Pharmacy, and has been written from the standpoint of a conviction that many young practitioners would gladly dispense their own medicines, if provided with a few practi- cal directions on the subject; thereby saving many a dollar from the drug store, preventing in their own practices at least the “renewals” which constitute so bad a feature of modern pharmaceutics, and gaining for themselves a practical acquaintance with their professional weapons which cannot but make them better physicians and more accurate prescribers. In this section of the book Prescription Writing receives full consideration, and many standard formulae are given as samples of prescriptions of each kind in extemporaneous use. In the third part the subject of Special Therapeutics is treated of elabo- rately, and in the form of an alphabetically arranged Index to the treat- ment of diseases, as laid down by the most recent authorities. Every PREFACE. IX indication for the use of a drug is referred to its author by his initial, and to the most prominent articles are appended a few selected formulae, to serve as guides to the neophyte in prescribing. The Appendix contains numerous tables, comprising diagnostic hints, Latin terms and phrases, formulae for hypodermic use, metric equivalents, specific gravities and volumes, and obstetric memoranda; as also Notes on temperature in disease, the use of the clinical thermometer, the treat- ment of poisoning, and the examination of urine ; also formulae repre- senting the most noted patent medicines. The Index has received special attention, from a conviction that, if well made, it is the best part of a good book. Every title, synonym and other reference of importance is included therein, double and treble entries being made in every instance which seemed to require such repetition. Nearly all the regular text-books have been laid under contribution in the preparation of the book, but especial use has been made of the works of Bartholow, Ringer, Wood, Phillips, Piffard, Waring and Brunton, in their latest editions; as well as of the writer’s verbatim notes of two courses of didactic and clinical lectures delivered by Professors Bartholow and Da Costa in the Jefferson Medical College and Hospital and in the auditorium of the Pennsylvania Hospital. On pages 479 and 480 will be found a full list of the authorities referred to by initials in the section on Special Therapeutics. The term “officinal,” as applied to drugs recognized by the pharma- copoeia has been discarded, the word “official” being used instead; for the simple reason that the idea to be conveyed is expressed more correctly by the latter term than by the former one. When none but official drugs and preparations were kept in the officina or drug store, it was eminently proper to call them “officinal,” but inasmuch as this class does not nowadays constitute much over one-fourth part of the officinal stock, it is a wilful debasement of our professional weapons, as well as an inexcu- sable misnomer, to apply the shop-title to them any longer. Cooper Medical College, San Francisco, December, 1886. For this, the third edition, the text has been thoroughly revised, many articles have been entirely re-written, much new matter has been incor- porated throughout, including such of the new remedies as seem to have established themselves in professional regard. Several changes have been made in the arrangement of the material, to facilitate the use of the book for daily reference. Greek words are expressed phonetically and in the X PREFACE. familiar English alphabet, for the benefit of those who are not familiar with the Greek letters. In every division of the book the author has endeavored to improve without destroying the characteristic features which have proven so acceptable to students and practitioners of medi- cine. SAM’L O. L. POTTER. London, September, 1891. TABLE OF CONTENTS. PAGE INTRODUCTION, 17 Materia Medica, 17 Pharmacy, ' 17 Empirical Therapeutics, 18 Rational Therapeutics, iS Administration of Medicines, 20 Classification of Medicines, 23 Stimulants and Sedatives, 23 Agents acting chiefly on the Nervous System, 24 Agents acting on the Organs of Special Sense, 28 Agents acting on Respiration, 30 Agents acting on the Circulation, 33 Agents acting on the Digestive System, 34 Agents acting on Metabolism, 41 Agents acting on Excretion, 43 Agents acting on the Generative System, 47 Agents acting on the Cutaneous Surface, 49 Agents acting on Microbes, P'erments, etc., 51 Agents acting upon each other, 52 Dosage of Medicines, 54 PART I.—MATERIA MEDICA AND THERAPEUTICS, 55 Abrus to Zingiber, 55-406 PART II.—PHARMACY AND PRESCRIPTION WRITING, .... 407 Constituents of Vegetable Drugs, 408 Official Operations, 410 Official Preparations, 419 Extemporaneous Pharmacy, 434 Weights and Measures, 435 Metric System, 436 Approximate or Domestic Measures, 438 Specific Gravity and Specific Volume, 439 Prescriptions, 439 Analysis of a Prescription 439 Principles of Combination, 441 Prescription Writing, 442 Abbreviations, 443 Prescription Blanks, 443 Renewals, 444 Filling a Prescription, 445 Stock Solutions, 447 Rules for the Pharmaceutical Student, 447 TABLE OF CONTENTS. PAGE Incompatibility, 448 Chemical Incompatibility, 448 Pharmaceutical Incompatibility, 450 Therapeutical Incompatibility 451 Rules for Avoidance of Dangers, 452 Extemporaneous Preparations and Formulae, 453 Excipients for Mixtures, 455 Excipients for Emulsions, 458 Excipients for Pills, 463 PART III.—SPECIAL THERAPEUTICS, 479 References and Bibliography, 479 Abdominal Plethora to Yellow Fever, 480-690 APPENDIX, 691 Latin Terms, Phrases, etc., used in Prescriptions, 691 Verbs, Participles, Prepositions, etc., 699, 700 Genitive Case-endings 700 Hypodermic Formulae 701 Chlorodyne, Comparisons of Ten Formulae therefor, 703 Patent Medicines, 704 The Treatment of Poisoning, 707 Tables of Differential Diagnosis, 712 Notes on Temperature in Disease, 717 Clinical Thermometry, 717 Obstetrical Memoranda, 719 Signs of Pregnancy, 719 Signs of Labor, 719 Average Pelvic Diameters, 720 Development of the Foetus, 720 Diameters of the Foetal Skull at Term, 720 Asphyxia and Apncea, 721 Clinical Examination of the Urine, 722 Ethics, the Hippocratic Oath, etc., 724 Table of Specific Gravities and Specific Volumes, 725 Table of Drops in, and Weights of, a Fluid-drachm of Various Liquids 726 Table of Weights and Measures 726 Table for Converting Apothecaries’ Weights and Measures into Grams, 727 INDEX, 729 INTRODUCTION. Pharmacology, (pharmakon, a drug, logos, a discourse,)—is a gen- eral term which properly includes all matters pertaining to the study of medicinal agents in the widest possible sense, embracing all of Materia Medica and Pharmacy, with so much of Therapeutics as relates to drugs. The term is however frequently employed in a more restricted sense, including only the physiological action of drugs; a subject to which the title Pharmacodynamics is much more appropriately applied. Materia Medica is that branch of medical science which treats of the substances used as medicines, their origin, composition, physical characteristics, chemical properties, modes of preparation and adminis- tration, physiological and toxicological actions. Pharmacodynamics, (pharmakon, a drug, dunamis, power,)—is the proper title for that portion of the Materia Medica which relates to the physiological action of drugs, that is, the influence of drugs upon the healthy human body to modify its physiological activity. Toxicology is another subdivision, and includes the effects of drugs when adminis- tered in poisonous doses, together with the study of the drug-antagonists for the most dangerous symptoms produced, and the appropriate chemical antidotes. Pharmacy is the art of preparing medicines for use and dispensing them on the order of the therapeutist. It includes a knowledge of the Materia Medica, an acquaintance with the theories and manipulations of chemistry, and an intimate practical knowledge of many special opera- tions peculiar to itself. Therapeutics, (therapeuein, to attend upon,)—includes all that re- lates to the science and art of healing; and embraces the application, not only of medicines to the alleviation or cure of disease, but of all other agents which may aid in the accomplishment of the same result. The operations of Nature herself, as well as of the substances described in the Materia Medica, and those of all other remedial measures, as food, climate, clothing, heat, cold, electricity, etc., are all embraced in the general 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 spon- taneous decline and cure of disease. There is no more completely established dogma in science, than that—The Living Organism is in itself adequate to the cure of all its curable disorders. This Natural Law enables the homoeopath to relate his sugar cures, aids the medical skeptic to hold to his infidelity, and helps all physicians out of more close places than most of them are willing to acknowledge before their clientele. This part of the subject is not taught in the schools except in connection with pathology, and by the chair of Theory and Practice of Medicine. It is deserving of a special chair and of more systematic treatment than it receives. 18 INTRODUCTION. Applied Therapeutics embraces the application by Art of agents foreign to the living organism, for the purpose of aiding Nature to restore the body to a healthy condi- tion. This division is the portion of the subject which is taught separately and systemati- cally in the schools, and therefore is alone considered in the following pages. Other divisions of the general subject of Therapeutics employed in professional literature and conversation are those entitled “Empirical” and “ Rational Therapeutics.” Empirical Therapeutics is a term applied to the use of medicinal or other therapeutical agents for the sole reason that they have been tried previously with successful results in cases apparently identical with the one under treatment. By those who advocate this method it is styled the Therapeutics of Experience, and claimed to be an accumulation of means of combating disease simply by observation and experiment, independ- ently of physio-pathological reasoning (Hartshorne). It was necessarily the original method in Therapeutics, has conferred many rich gifts upon medical science, and has been advocated by many great physicians, its latest and ablest expounder being the eminent and lamented Niemeyer. The use of Opium to relieve pain,—that of Cinchona for malarial fevers,—of Colchi- cum in gout,—of Potassium Iodide in syphilis,—of the Bromides in epilepsy,—of Cod- liver Oil in phthisis,—are examples of the empirical use of remedies. But, after all has been said for it that can be said, the fact remains that it is essentially an unscientific method, a mere elaboration of the prevailing popular habit of recommending Mrs. A. to use pepper tea, because it cured Mrs. B. of “ the very same trouble.” Permitted to reign supreme it would be destructive to all exactness in therapeutical progress. The so-called “ experience ” of one observer is too often overbalanced by the experience of another equally competent and trustworthy; and as few are encouraged to record their failures with remedies, there can be no scientific comparison of the failures with the reported suc- cesses. For this reason empirical methods wmuld tend to a minimum degree of accuracy in a science which, in the very nature of things, can never be an exact one;—though undoubtedly such methods will always prevail to some extent. Rational Therapeutics embraces the use of remedies for reasons based on a knowledge (x) of the pathological conditions present in the subject, and (2) of the physiological action of the agent employed. This method is the very antithesis of empiricism, and has been the lead- ing idea in every revolt against empirical therapeutics in the past. Humor- alism, Chemicism, Solidism, Stimulism, Galenism in the 2d century, Paracelcism in the 16th, and Hahnemannism in the 19th, all originated in efforts to find a more rational system of administering medicines than the prevailing empiricism of the day. The illustrious Albrecht von Haller, the father of Physiology and the author of the doctrine of Irritability, was the real originator of modern physiological therapeutics. In the preface to his Swiss Pharmacopoeia {area A.D. 1755), occur the following remarkable directions,—the first recorded of their kind :— “Nempe primum in corpore sano medela tentanda est, sine peregrina ulla miscela: odoreque et sapore ejus exploratis, exigua illius dosis ingerenda et ad omnes quae inde contingunt affectiones, quis pulsus, quis calor, quae respiratio, quaenam excretiones, attend- endum. Inde adductum phenominorum in sano obviorum, transeas ad experimenta in corpore segroto.” INTRODUCTION. 19 “ In the first place the remedy is to be tried on the healthy body, without any foreign substance mixed with it; having been examined as to its odor and taste, a small dose is to be taken, and the attention directed to all effects which thereupon occur; stich as upon the pulse, the temperature, the respiration, the excretions. Having thereby adduced their obvious phenomena i?i health, you may pass on to experiment upon the sick body." Forty or more years after these rules were laid down ex cathedra by Haller, the central idea contained in them was incorporated as one of the main pillars, into a medical edifice then being erected in Germany. In the course of construction this pillar became so hidden beneath a super- structure of palpable absurdities, that the medical profession, in its anxiety to steer clear of the whole mass, almost forgot the corner-stone of truth, appropriated from the teachings of one of its own greatest teachers. While, however, the masses of the profession, blinded by prejudice, turned away from everything which savored of drug-experiment, a few in every country were quietly working on the lines of Haller’s dogma that Drug- proving is the only true basis of Drug-using. As a result of their labor, the present generation sees the development of an idea, announced 130 years ago, but now inspiring the minds of teachers and students all over the civilized world. Medical Colleges are recognizing physiological drug-experimentation as a part of their regular curricula ;—laboratories are fitted up in many of the schools with costly instruments of precision, for the more exact prosecution of this study ; and under the direction of such men as Wood, Ringer, Murrell, Brunton, Hildebrandt, Lieber- meister, Husemann, Schmiedeberg, etc., systematic researches are being conducted upon animals to ascertain the physiological action of every agent hitherto used in medicine. The alkaloids, and other component principles of vegetable drugs, are being subjected to the same rigid obser- vation,—as also every new compound which chemistry gives to medicine. Journals, in every civilized country, teem with the results of these labors ; and no medical student is permitted to pass the graduating ordeal until he has mastered the essential characteristics of the physiological action of the important medicaments so far as established. What has hitherto been the conviction of but a few, is daily growing into a fixed canon of professional belief,—that physiological experimentation with drugs must be the basis of their therapeutical employment, and that all real advance towards the establishment of Therapeutics as a science, must be made upon the lines laid down by Haller, i. e., drug-proving upon the healthy human organism. Still, in the words of Brown-Sequard, “ Therapeutics will cease to be empirical, only when this last kind of knowledge shall be fully obtained; ”—but its fulness will never be fully realized, unless the results have been thoroughly considered with full regard to the differ- ences due to the action of drugs in different doses on the human organism in health and disease. [ Compare pages fig, 54., infra.'] 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 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. Col- loidal 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 form 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 medicated nasal douche, are methods whereby this channel may be utilized. The Veins are only used as a route of medication in emergencies, where 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, Hydro- cyanic-acid poisoning, Opium narcosis, Chloroform asphyxia, etc., are the instances admitted in practice. INTRODUCTION. 21 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 circu- lation, an occurrence which causes instant death in the human subject. The Hypodermic Method is the introduction of medicines into the organism by injecting them into the subcutaneous areolar tissue, from which they are quickly absorbed by the lymphatic and capillary vessels. The great advantage of this method is the absolute certainty as to the quantity of drug actively affecting the organism, a very essential question when using small quantities, as with powerful alkaloids. Another is the avoidance of reactions between the drug and the secretions of the stomach, which may destroy the activity of the former, or seriously change its character. 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 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 the 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 uppermost, the excess of solution over the amount required should be ejected, thus expelling air-bubbles and filling the needle itself. A portion of skin should be grasped by the thumb and fore- finger at the site selected for the injection, into which 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 so gradually as to avoid rupturing the tissue. If the solu- tions 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 producing abscesses with the agents ordinarily employed. Tablets for hypodermic use are prepared by the prominent manufacturers, each containing one dose. They may be readily dissolved in a teaspoon at the bedside, and are very convenient for the pocket, if put up in a case with a good hypodermic syringe, as may be obtained from Parke, Davis and Co., of Detroit. Their regular line of Hypodermic Tablets includes the agents named in the following list, put up in tubes of 25 each. 22 INTRODUCTION. List of Hypodermic Tablets. Aconitine (crystals), . . . gr.T|7. Apomorphine Muriate, . . . gr.ylj. Atropine Sulphate, .... Atropine Sulphate, .... gr. Cocaine Hydrochlorate,. . . gr.^. Conine Hydrobromate, . . . gr.£. Colchicine, gr.^. Corrosive Sub. and Urea, . . gr.-jC. Digitalin (soluble), . . . . gr.-j^. Gelsemine Muriate, . . . gr.-^. Hyoscine Hydrobromate, . . gr.T^7. Hyoscyamine, gr.^. Morphine Sulphate, . . . gr.^. Morphine Sulphate, . . . gr.^. Morphine & Atropine, No. I. Morphine Sulph., . . . gr. J. Atropine Sulph., . . . , gr.ji0. Morphine & Atropine, No. 2. Morphine Sulph., . . . gr. Atropine Sulph., .... Picrotoxin, ..... Pilocarpine Hydrochlor., . . gr. Pilocarpine Nitrate, . . . gr. Physostigmine Sulph., . . . gr.y^. Sodium Arseniate, .... gr.y Strychnine Sulphate, . . . gr.^. Strychnine Sulphate, . . . gr.y£ff. [For Formulae for Hypodermic Solutions, see Appendix.] 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, and Salts of Cocaine for local anaesthesia. The Skin is an active absorbent of crystalloidal substances when its epidermis or cuticle is removed. By this route there are four methods of introducing 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. Chloroform and Oleic Acid solutions of the alkaloids 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 passage of the medicament between the cells of the epidermis. Mer- curial Ointment, 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 powdering 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 evapo- ration. 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. CLASSIFICATION OF MEDICINES. In the present state of knowledge respecting the actions and uses ot medicinal agents, no really scientific classification of these substances is possible. Some writers have adopted a system based on the natural rela- tions of the various articles to each other, while many classify them according to their effects on the human system, and others make no attempt at arrangement but treat of them in alphabetical order. The latter method has been followed in this work, from a conviction that every medicine should first be studied as an individual, both with respect to its physiological actions and its therapeutical applications. When the student has thus made himself familiar with the characteristic features of each article of the Materia Medica, he may begin, by comparing one with another, to seek acquaintance with their more delicate lights and shades. Some system of classification then becomes imperative as an aid to the memory, and as the titles of the groups to which the various agents belong in any physiological classification are also used to express their actions and uses, the following synopsis is inserted as an appropriate introduction to the section on Materia Medica and Therapeutics. These are general terms employed in various classifications with very little discrimination. Stimulants and Sedatives. Stimulant (Stimulus, a goad),—is a term which is used in various senses when applied to medicinal agents. Alcoholic preparations, which are true narcotics, are commonly termed “stimulants,” and the same expression is employed to designate any agent which excites the organic action of a part of the economy. Diffusible Stimulants are those which have a prompt but transient effect, such as Alcohol, Ammonia, Camphor, etc. Spinal Stimulants exalt the functions of the cord, as Strychnine, Picrotoxin, Ergot, Atropine, Phosphorus. Cardiac Stimulants increase the action of the heart, as Alcohol, Atropine and Morphine in small doses, Strychnine, etc., also Squill, Convallaria, Cimicifuga and Digitalis, which slow but strengthen the cardiac action. Vaso-motor Stimulants, as Alcohol, Chloroform, Ether, Ammonia, Strychnine, Digitalis and Squill, acting on the vaso-motor centre; and the Nitrites, Belladonna, Elec- tricity, Volatile Oils, etc., acting as local dilators of the vascular system. Cerebral Stimu- lants, as Alcohol, Opium, Belladonna, Caffeine, Cocaine, Theine, Cannabis, Chloroform, Ether, Tobacco, etc. Renal Stimulants, as the diuretic group. Stomachic Stimulants, 24 AGENTS ACTING CHIEFLY ON THE NERVOUS SYSTEM. as the Aromatics, Volatile Oils, Vegetable Bitters, Mineral Acids, Nux Vomica, Mustard, Capsicum, etc. Hepatic Stimulants, as Nitro-muriatic and Nitric Acids, and the chola- gogue purgatives Podophyllum, Jalap, Leptandra, Euonymin, Iridin, etc. Intestinal Stimulants, as Mercurials, Elaterium, Colocynth, Jalap, Scammony, Podophyllum, etc., which affect the glandular apparatus,— and Belladonna, Physostigma, Nux Vomica, Rhu- barb, Senna, Aloes, Frangula, Cascara, etc., which chiefly affect the muscular fibres and the intestinal nerves. Cutaneous Stimulants, as the diaphoretic group, and the rubefa- cients Mustard, Capsicum, Turpentine, Ammonia, etc. All stimulation reacts into depression, and most of the agents which stimulate the nerve centres at first soon depress and finally paralyze them. Sedatives (Sedo, I allay),—are agents which exert a soothing influ- ence on the system by lessening functional activity, depressing motility and diminishing pain. General Sedatives include the narcotics and anaesthetics. Local Sedatives include Aco- nite, Opium, Ice, etc. Pulmonary Sedatives, as Hydrocyanic Acid, Veratrine, and the nauseants and emetics. Spinal Sedatives, as Physostigma, Gelsemium, Potassium Bro- mide. Stomachic Sedatives include Arsenic, Bismuth, Nitrate of Silver, Bicarbonate of Sodium. Vascular Sedatives, as Digitalis, Tobacco, Aconite, Veratrum, and the emetics. Nervous Sedatives, among which are Potassium Bromide, Tobacco, Lobelia, and the group of spinal depressants. Agents Acting Chiefly on the Nervous System. Motor-Excitants are agents which increase the functional activity of the spinal cord and the motor apparatus, producing disturbances of motility, heightened reflex excitability, and tetanic convulsions when given in large doses, their ultimate effect being motor paralysis from over- stimulation. The most important members of this class are Nux Vomica and Ignatia, with their alkaloids Strychnine and Brucine, also Thebaine, the tetanizing alkaloid of Opium. It also includes Morphine and Atropine, which, though at first sedative, when given in large doses produce convulsions. The respiratory centre in the medulla is stimulated by Strych- nine, Atropine, Ammonia, and small doses of Alcohol, Ether and Chloroform. The motor convolutions in the brain are stimulated by Alcohol in moderate doses, as also for a brief period by Ether and Chloroform. The end-organs of the motor nerves are stimulated by the local use of Electricity, Strych- nine and friction; and are irritated by the internal administration of Aconitine, Nicotine, Camphor, Pilocarpine and Pyridine. Other members of this class are embraced in the following list:— Nux Vomica. Ignatia. Strychnine. Brucine. Thebaine. Morphine.* Atropine.* Alcohol.f Ether.f Chloroform.f Ammonia. Absinthe. Buxine. Calabarine. Ergot. Ustilago. Gossypium. Picrotoxin. Aconitine. Nicotine. Camphor. Digitalis. Con vail aria. Cimicifuga. Pilocarpine. Pyridine. Rhus Toxicoden. Electricity. Motor-Depressants lower the functional activity of the spinal cord and motor apparatus, and in large doses paralyze them. Some act indi- rectly by reducing the spinal circulation, as Digitalis, Aconite and large * In large doses. f In small doses. AGENTS ACTING ON THE NERVOUS SYSTEM. 25 doses of Quinine; others by a directly paralyzant action on the centres. The principal members of this class may be enumerated as follows, viz.: — Opium, Morphine. Gelsemium. Muscarine. Pulsatilla. Grindelia. Phytolacca. Physostigma. Belladonna. Stramonium. Hyoscyamus. Pilocarpus. Quebracho. Camphor. Aconite. Tobacco. Lobelia. Curare. Conium. Chloral. Ergot (at last). Arnica. Ailanthus. Veratrum. Alcohol.* Ether.* Chloroform.* Bromides. Potassium. Lithium. Zinc. Prussic Acid. Potass. Cyanide. Amyl Nitrite. Sodium Nitrite. Methyl Strychnine. Ethyl Strychnine. Methyl Thebaine. Methyl Veratrine. Methyl Conine. Other Methyl Compounds. Ammonium Cyanide. Ammonium Iodide. Ethyl Ammonium Chloride. Amyl Ammonium Chloride. Amyl Ammonium Iodide. Amyl Ammonium Sulphate. Other Compound Ammonias. • Galvanism. The motor centres in the medulla are powerfully depressed by Opium, Morphine, Aco- nite, Conium, Chloral, Physostigma, and large doses of Alcohol, Ether and Chloroform. The three last named are also paralyzers of the motor convolutions in the brain, arresting all voluntary movements when administered in sufficient quantity. The anterior cornua of the cord are greatly depressed by Physostigma and other agents, and the motor nerves by Conium, Methyl-Strychnine, etc., both actions resulting in paralysis of the limbs. Ctt- rare, even in small doses, paralyzes the end-organs of the motor nerves, and Belladonna, the compound Ammonias, Methyl compounds, etc., exercise a similar but less powerful influence. Galvanism is also an effective local depressant of motor activity. Local Stimulants increase common sensibility to the extent of pro- ducing pain, chiefly by direct action upon the end-organs of the sensory nerves in the skin, though some act probably by stimulating the local circulation, as in inflammation. The principal members of this group are— Faradism. Heat. Cold. Alcohol. Ether. Chloroform. Carbolic Acid. Creasote. Mineral Acids. Ammonia. Volatile Oils. Acrid Essential Oils. Metallic Salts. Veratrine (at first). Cantharis (at first). Local Anaesthetics and Anodynes {an, without, aistheysis, percep- tion, odunay, pain),—reduce the functions of the sensory nerves until they lose the power of receiving or conducting sensations. Some act by direct depression of the end-organs in the skin, etc., others by impairing the conductivity of the sensory nerves, while some act indirectly by reducing the local circulation. The Anodynes diminish, and the Anaes- thetics destroy, for a time, the sensibility of the skin or mucous membrane. The chief agents of this class are— Local Anodynes. Aconite, Aconitine. Belladonna, Atropine. Opium, Morphine. Local Anesthetics. Extreme Cold, Ice. Ether Spray. Carbolic Acid. * In large doses. f In small doses. 26 AGENTS ACTING ON THE NERVOUS SYSTEM. Local Anodynes. Carbolic Acid. Chloroform. Chloral. Veratrum, Veratrine. Volatile Oils. Galvanism. Local Ancesthetics. Erythroxylon. Cocaine. Hydrocyanic Acid. Creasote. Oil of Turpentine. Iodoform. Cerebral Excitants,—are remedies which increase the functional activity of the cerebrum, without producing any subsequent depression, or any suspension of the cerebral functions. They act partly by increasing the action of the heart and consequently the rapidity of the circulation, partly by a direct action upon the gray matter of the brain. The chief members of this group are— Alcohol (at first). Ammoniac. Asafetida. Camphor. Cannabis. Valerian. Ammonia (inhaled). Coffee, Caffeine. Tea, Theine. Guarana, Guaranine. Erythroxylon, Cocaine. Tobacco. Strychnine. Acetic Acid (inhaled). Deliriants excite the functions of the higher brain to such a degree as to disorder the mental faculties, producing intellectual confusion, loss of will-power, delirium and even convulsions. They are all narcotics (though all narcotics are not deliriants), and may be listed as follows, viz.— Alcohol. Belladonna. Stramonium. Hyoscyamus. Cannabis Indica. Chloral. Lupulus (at first). Opium (at first). Cerebral Depressants lower or suspend the functions of the higher cerebrum after a preliminary stage of excitement. Under this head may be included the Narcotics, General Anaesthetics, and several of the Anti- spasmodics, all acting on the cells of the convolutions, at first stimu- lating the brain-functions, they produce after a time stupor, coma and insensibility. The most useful of this class are the Bromides, Zinc and Caffeine, as they also diminish reflex excitability and thus secure rest of the nervous system. Some of them are decidedly dangerous, as they may paralyze the heart or the medulla and its centres of organic life before the consciousness is much disturbed; such being Chloroform, Aconite, Opium, and the irritant poisons. Narcotics ('narkay, stupor),—are agents which, at first excitant to the higher brain, produce profound sleep, characterized by stupor, and if the dose be sufficient, coma, insensibility and death by paralysis of the medul- lary centres governing respiration and other functions of organic life. They are closely related to stimulants, Opium and Alcohol being good AGENTS ACTING ON THE NERVOUS SYSTEM. 27 illustrations, in the different stages of their action, of both stimulant and narcotic effects. They give us the power of lowering perception, inducing sleep and soothing the vital functions by rest, all of which are means of great therapeutical value. The chief narcotics are— Alcohol. Opium, Morphine. Belladonna, Atropine. Hyoscyamus. Stramonium. Cannabis Indica. Humulus. Chloroform, Ether, etc. Chloral-hydrate. Croton-chloral. Hypnotics (heupnos, sleep),—are remedies which produce sleep, and in this wide sense of the term the class would include the Narcotics and the Anaesthetics, as well as those agents which may be termed Pure Hypnot- ics, which induce sleep by bringing the brain into a favorable condition therefor, rather than by direct soporific action. In this sense the purest hypnotics are the Bromides, but artificial sleep may be produced by many other agents. The principal members of this class are the follow- ing Opium, Morphine, Narceine. Chloral-hydrate. Croton-chloral. Cannabis. Cannabin Tannate. Hyoscyamus. Paraldehyde. Hops. Sulphonal. Chloralamid. Methylal. Urethane. Sodium Bromide. Calcium Bromide. Lithium Bromide. Zinc Bromide. Potassium Bromide. Monobromated Camphor. Lettuce Lactic Acid. Amylene Hydrate. Piscidia Erythrina. General Anaesthetics. Analgesics (an, without, algos, pain), or Anodynes (an, without, odunay, pain),—are remedies which relieve pain either by direct depression of the centres of perception and sensation in the cerebrum, or by impair- ing the conductivity of the sensory nerve fibres. Opium is the most efficient of all analgesics, because it arrests the afferent impressions at every step of their track—at their formation, along the course of their conduction, and at the point where they impinge on the sensorium. The Local Anodynes have been described, and the list of General Anodynes includes the following-named agents, viz.— Opium, Morphine. Belladonna, Atropine. Cannabis Indica. Stramonium. Hyoscyamus. Gelsemium. Aconite. Chloroform, Ether, etc. Conium. Chloral-hydrate. Croton-chloral. Lupulus. Anaesthetics (an, without, aisthaysis, perception),—are agents which destroy sensation. Local Ancesthetics have been described. General Ancesthetics are certain volatile substances, mostly belonging to the class 28 AGENTS ACTING ON ORGANS OF SPECIAL SENSE. of alcohols and ethers, which when inhaled produce complete uncon- sciousness and loss of sensation (anaesthesia), with lessened motor power. Narcotics also produce anaesthesia, but the term is usually restricted to the effects of the volatile agents referred to. The principal members of this group are — Ether (Oxide of Ethyl). Chloroform. Bichloride of Methylene. Nitrous Oxide. Bromide of Ethyl. Bichloride of Ethylene. Antispasmodics (anti, against spasmos, a spasm),—are agents which prevent or allay spasm of voluntary or involuntary muscles in any portion of the organism. Some of the agents belonging to this class act by stimulation of the higher nervous centres, the coordinating power, and the circulation, as Alcohol and Ether in small doses, Camphor, Musk, Valerian, etc. ; others by a depressant influence on the motor centres, as the Bromides; and still others by paralysis of the end-organs of the vaso- motor nerves, as Amyl Nitrite. A few depress all the vital functions, as Aconite, Tobacco, Lobelia, Hellebore, and Prussic Acid; and a long list stimulate the bowels to expel gaseous accumulations, namely, Asafetida, Cajuput, Valerian, Musk, Aromatic Oils, etc. They are used in convul- sive affections, especially asthma and other spasmodic diseases of the respiratory organs, hysteria, chorea, angina pectoris, epilepsy, etc. The principal antispasmodics are as follows, viz.— Alcohol. Ether. Chloroform. Amyl Nitrite. Nitrites. Bromides. Potassium Iodide. Potassium Nitrate. Arsenic. Valerian. Conium. Aconite. Lobelia. Tobacco. Hellebore. Opium. Belladonna. Stramonium. Hyoscyamus. Prussic Acid. Physostigma. Curare. Ammoniac. Castor. Musk. Galbanum. Sumbul. Ipecac. Senega. Silver Salts. Zinc Salts. Copper Salts. Asafetida. The Cerebellum is affected by a few drugs, their action upon its several lobes producing various disturbances of equilibrium. Alcohol is the principal agent acting upon this portion of the brain, and different pro- ducts of the still seem to affect different portions of the cerebellum. For instance, intoxi- cation by wine or beer is said to cause lateral falling, that by whiskey an inclination to fall face downwards, cider a backward tendency (Brunton). Apomorphine in large doses produces a tendency to move in a circle, and therefore probably affects the cerebellum or the corpora quadrigemina. Mydriatics (meudos, moisture),—are agents which produce dilatation of the pupil of the eye (mydriasis). Some act locally, others when given internally, and the principal ones (Atropine and its congeners) act both locally and internally, producing at the same time paralysis of the ciliary Agents Acting on the Organs of Special Sense. AGENTS ACTING ON ORGANS OF SPECIAL SENSE. 29 muscle resulting in temporary loss of accommodation, the eye remaining focussed for distant objects, and the intra-ocular tension being increased. The dilating action of Atropine and its congeners is due to stimulation of the end- organs of the sympathetic nerve, increasing the power of the radiating muscular fibres of the iris, and also to paralysis of the end-organs of the motor oculi (3d cranial) nerve, lessening the power of the circular fibres or sphincter iridis. When administered inter- nally the drug is carried by the circulation to the eye, acting thereon locally as if instilled directly upon the conjunctiva. The principal mydriatics are those named in the following list, viz.: Belladonna, Atropine. Hyoscyamus, Hyoscyamine. Stramonium, Daturine. Duboisia, Duboisine. Belladonnine (internally only). Homatropine. Gelsemine (locally only). Anaesthetics (at last). Atropine, Duboisine and Homatropine are the mydriatics used by ophthalmologists. Cocaine. Myotics (meuo, I close),—are agents which produce contraction of the pupil. The alkaloid of Physostigma, Eserine, is the chief local myotic, and the only one used in ophthalmic practice. It acts by stimu- lating the circular 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 it exactly antago- nizes the action of Atropine. Muscarine, Pilocarpine and Nicotine are also local myotics, acting upon the end- organs of the oculo-motor nerve. Anaesthetics in the early stage of their action cause contraction of the pupil by lessening reflex action; later, when they begin to paralyze respiration the accumulation of venous blood irritates the centres and produces dilatation, which is a sign of failing respiratory power during anaesthesia. The myotic action of Opium is of central origin, probably the paralysis of the local reflex excitability. The chief myotics are as follows :— Physostigma, Eserine. Opium, Morphine. Pilocarpus, Pilocarpine. Muscarine. Gelsemine (internally). Lobeline (internally). Nicotine (locally). Anaesthetics (at first). The Sensibility of the Eye is increased by Strychnine, the field of vision becoming extended, and the vision rendered more acute. If the drug be administered hypodermically the improvement will be more marked in the eye corresponding to the side of the body where the iujec- tion was made. The sensibility for color is affected by drugs, Strychnine increasing the field for blue, Eserine diminishing it for red and green, and Santonin causing objects to appear at first of a violet and afterwards of a greenish-yellow color. Visions are produced by several drugs, their action being probably on the cerebral sight-centres (angular gyrus and occipital lobes) rather than on the eye. Alcoholic delirium is a familiar instance, while Canna- bis Indica often causes pleasant visions, and Sodium Salicylate in some persons produces very disagreeable ones. Digitalis may produce subjec- tive sensations of the continued presence of light. Bromides in excess 30 agents acting on respiration. may produce visions of such intensity that their subject remembers them distinctly for years afterwards. Amblyopia, or impairment of vision from nerve-changes, is produced temporarily by Quinine, and may be permanently induced by Tobacco, Alcohol, Lead and Urea. The Ear is affected by several drugs. Strycimine and Morphine increase the excitability of either the auditory nerve or the centre for hearing (superior temporo-sphenoidal convolution), making that faculty much more acute. Quinine, Antipyrine and Salicylates produce hyperse- mia of the auditory apparatus, causing subjective noises, as humming, buzzing or ringing, which are very unpleasant. Hydrobrotnic Acid and the Bromides, also Ergot, will diminish the congestion and to a great extent will neutralize or prevent these noises. Quinine in large doses is believed by some to have produced permanent injury of the sight and the hearing, but authentic cases of such action are extremely rare, if indeed they can be found at all. Temporary deafness is often caused by Quinine, but it usually disappears soon after the administration of the drug is stopped. The Sense of Smell is also increased by Strychnine, and decreased by all cerebral depressants and by those agents which produce changes in the nasal mucous membrane, e.g., Potassium Iodide. The cerebral centre for this faculty is situated at the tip of the temporo-sphenoidal lobe, and the terminal branches of the olfactory nerve are distributed upon the mucous lining of the upper portion of the nasal fossae. Strychnine probably stimulates the former, and all drugs acting upon the latter region would have more or less effect upon the power of distinguishing smells. The Taste is not much affected by drugs except as each makes its peculiar impression on the nerves of taste, and may overcome that of another agent. Smell has much to do with taste in many instances, the expedient of holding the nose while swallowing Castor Oil being familiar to every one. The “ after-taste ” of drugs is often different to their original taste ; thus Bitters are said to leave a sweet after-taste, and the same is claimed for Quinine if given in acid solution so as to be entirely dissolved, and if washed out of the mouth with water immediately after swallowing. Substances which are excreted from the system in the saliva (as Iodides) leave a very persistent after-taste. Agents Acting on Respiration. The Respiratory Centre is situated in the medulla oblongata, close to the termination of the calamus scriptorius. It probably consists of thoracic and diaphragmatic Inspiratory centres, the act of expiration being consid- ered normally a passive one, due to the natural contraction of the walls of the air-vesicles, and the return of the diaphragm and thoracic walls to the AGENTS ACTING ON RESPIRATION. 31 position from which they were moved by the inspiratory effort. An Expi- ratory Centre must also exist for the initiation of forced expiration, as in the production of voice, cough, sneezing, etc. The chief Inspiratory Nerves are the pulmonary branches of the vagus. The Expiratory Nerves are the nasal branches of the fifth, the superior and inferior laryngeal, and the cutaneous nerves of the chest and abdomen. Respiratory Stimulants exalt the function of the respiratory centre, quickening and deepening the breathing. Such agents, besides Opium in small doses, are— Chloralamid. Strychnine. Atropine. Duboisine. Brucine. Thebaine. Apomorphine. Emetine. Digitalis. Zinc salts. Copper salts. Ammonia. Quebracho. Tobacco (briefly). Alcohol (briefly). Ether (briefly). Strychnine also stimulates the vagus tract. Electricity applied to the nerve-trunks or to the inspiratory muscles, is a direct respiratory stimulant. Veratine, Eserhie, and Mus- carine stimulate the vagus terminations, quickening the respiration, but afterwards slow it by depressing the respiratory centre. Aconite stimulates the end-organs of the vagus when given in small doses. Respiratory Depressants lower the activity of the respiratory centre, rendering the respirations slow and shallow. The chief agents of this class are— Cold. Opium. Physostigma. Muscarine. Lobeline. Gelsemium. Aconite. Veratrine. Prussic Acid. Conium. Alcohol. Ether. Chloroform. Chloral. Saponine. Caffeine. Colchicine. Nicotine. Quinine. Camphor. The ten last named first excite the centre for a brief period and then depress it. Pulmonary Sedatives diminish cough and dyspnoea by lessening the irritability of the respiratory centre or the nerves of respiration. Some act by directly depressing the respiratory centre, as those enumerated under the preceding head; others by removing some irritant from the passages, or by lessening local congestion, as the expectorant group; and others by lowering the excitability of the vagus end-organs in the lungs, and other afferent filaments throughout the respiratory tract. Opium has the most powerful influence as a sedative to the respiratory centre, and muci- laginous or saccharine substances soothe the local irritation, hence the latter are so fre- quently used as vehicles for the former in cough mixtures. Hydrocyanic Acid has a similar sedative action, hence the use in coughs of Prunus Virginiana and other substances containing it. Belladomta stimulates the respiratory centre, but at the same time lessens the excitability of the vagus terminations in the lungs, and completely arrests secretion from the bronchi. Stramonium acts similarly. The principal pulmonary sedatives may be enumerated as follows :— Opium. Belladonna. Stramonium. Hyoscyamus. Prussic Acid. Amyl Nitrite. Quebracho. Cannabis. Turpentine. Ethyl Iodide. Conium. Tobacco. 32 AGENTS ACTING ON RESPIRATION. Errhines and Sternutatories {en, in, rhin, the nose; sternuto, I sneeze),—are agents which produce increased nasal secretion and sneezing, when locally applied to the mucous membrane of the nose. The first term is usually applied to substances which cause increase of the mucus without sneezing, the latter to those which invariably produce sneezing. The drugs should be in powder for application. The stimulus produced by these agents is transmitted by the nasal branches of the fifth nerve to the respi- ratory centre, exciting the sudden and forcible expiratory effort called sneezing; also to the vaso-motor centre, contracting the smaller vessels throughout the body and producing a general rise in the blood-pressure. The principal agents of this class are— Tobacco, as snuff. Ipecacuanha. Sanguinaria. Veratrum Album. Euphorbium. Sassy Bark. Saponine. Ginger. Capsicum. Hellebore. Ammonia. Cubebs. The last two named may be used as simple Errhines, as the vapor of dilute Ammonia- water or the smoke of burning Cubebs do not excite sneezing generally. Expectorants {ex, out oi, pectus, the breast),—are remedies which modify the secretion of the broncho-pulmonary mucous membrane, and promote its expulsion. They may be divided into— Nauseating Expectorants,—in large doses act mechanically by expelling the mucus in the act of vomiting, in small doses by increasing osmosis from the inflamed mucous membrane. The members of this subdivision generally increase secretion and tend to lower the blood-pressure. The chief of them are the following named :— Antimony, Tartar Emetic. Ipecacuanha, Emetine. Lobelia, Lobeline. Pilocarpus (Jaborandi). Apomorphine. Quebracho. Potassium Iodide. Alkalies. Stimulant Expectorants,—are largely eliminated by the bronchial mucous membrane which they stimulate, altering the secretion and facili- tating expectoration. These remedies generally diminish secretion and increase blood-pressure. They are— Acids. Ammonium Chloride, and Carbonate. Ammoniac. Benzoin and Benzoic Acid. Balsams of Peru and Tolu. Wood Tar, and Tar. Oleum Pini Sylvestris. Turpentine. Squill. Garlic. Onion. Nux Vomica, Strychnine. Senga, Saponin. Sulphur. Liquorice. Saccharine Substances. Besides the above many other remedies may act as expectorants, some by relieving bronchial spasm, as Opium, Stramonium and Tobacco,—others by soothing the irritable respiratory centre, as Opium and Chloral,—and the ciliary excitants by reflex action through their impression on the nerves of the mouth. AGENTS ACTING ON THE CIRCULATION. 33 Ciliary Excitants,—promote the expectoration of bronchial mucus by their reflex excitation of the tracheal and bronchial cilia, when dis- solved in the mouth. Gum Acacia, Ammonium Chloride, Potassium Chlorate, and native Chloride of Sodium have this action. Cardiac Stimulants rapidly increase the force and frequency of the pulse in depressed conditions of the cardiac apparatus. One of the most useful agents of this class is Alcohol in some form, its action being largely due to a reflex influence excited through the nerves of the mouth and stomach. It should therefore be given in but slightly diluted form, and in small quantities frequently. Ether is next in value and still more rapid in action, and Heat is one of the most powerful and available of the class. Ammonia has an energetic action as a stimulant to the vaso-motor centre,, as well as a reflex one upon the heart similar to that of Alcohol. The list of cardiac stimulants includes the following, viz : — Agents Acting on the Circulation. Alcohol. Ammonia. Atropine. Nitroglycerin. Counter irritation. Cocaine. Ether. Chloroform. Heat. Continuous Galvanic Current. Sparteine. Camphor. Aromatic Oils. Turpentine. Opium, and Morphine, in small doses. Cardiac Tonics, when given in moderate doses, stimulate the cardiac muscle, slowing and strengthening its contractions. In large doses they are apt to produce irregular action of the heart, and some of them have more or less of a tendency to cause sudden death by syncope if pushed to any great extent. The most important of these agents are— Digitalis. Convallaria. Cimicifuga. Squill. Erythrophloeum. Caffeine. Strophanthus. Strychnine. Helleboreln. Adonis vernalis. Digitalis acts partly by stimulation of the vagus end-organs in the heart, thus increasing cardiac inhibition, and partly by direct stimulation of the cardiac centre in the medulla, as well as by a direct influence on the heart muscle itself. Convallaria, Erylhrophlceum, Squill and Cimicifuga act similarly but less powerfully, and are correspondingly safer. Strophanthus is still better, as it does not affect the vessels, and therefore does not raise the blood-pressure. Cardiac Sedatives lessen the force and the frequency of the heart’s action and are used to control palpitation of that organ, and to slow the pulse in febrile conditions in sthenic subjects, especially when local inflam- mation is the exciting cause. The chief cardiac sedatives are— Aconite. Antimony. Veratrum Viride. Muscarine. Pilocarpine. Digitalis. Senega, Saponin. Prussic Acid. Potassium Salts. Cold. 34 AGENTS ACTING ON THE DIGESTIVE SYSTEM. Aconite, Veratrum, Muscarine, Pilocarpine, Saponin and Prussic Acid are direct cardiac poisons, depressing the heart muscle and the cardiac motor ganglia; Muscarine and Pilocarpine also stimulate the inhibitory ganglia; Digitalis stimulates the vagus centre and the cardiac muscle, and acts as a sedative in many cases by slowing the rate and giving it a regular rhythm. Aconite is said by some authorities to relax inhibition, by others to stimulate the vagus centre. Antimony depresses the motor ganglia, Potassium the cardiac muscle. Vascular Stimulants produce dilatation of the peripheral vessels, and increase the rapidity of the circulation, thus equalizing the 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 dilatation. The chief members of this group are— Alcohol. Ether. Nitrous Ether. Nitroglycerin. Amyl Nitrite. Liq. Ammonii Acetatis. Opium, as Dover’s Powder. Heat, as Poultices, etc. The dilating action of Amyl Nitrite and other Nitrites is due to weakening either of the muscular walls of the arterioles or to paralysis of the vaso-motor ganglia in them. Alcohol, Ether and Opium probably depress the vaso-motor centre. Vascular Tonics produce increased contraction of the arterioles and consequently increased blood-pressure. The most important are— Digitalis. Squill. Iron. Ergot. Strychnine. Lead and Silver. Opium, in small doses. These agents act upon the local vaso-motor mechanism in the walls of the vessels, which are also directly stimulated by cold produced in any way, as by Ether spray, or evaporat- ing lotions containing Alcohol, Vinegar or Ammonium Chloride. Vascular Sedatives increase the contraction of the vessels and lessen the circulation through them. They are employed to check hemorrhage and to cut short a local inflammation. The chief agents belonging to this group are— Cold. Ergot. Hamamelis. Digitalis. Opium. Acetate of Lead. Dentifrices (dens, a tooth, frico, I rub),—are medicated powders or pastes employed to cleanse the teeth and gums. Chalk is the basis gener- ally used, for its mechanical action and its alkaline quality. Antiseptics, as Borax, Quinine, Carbolic Acid, etc., should also be employed so as to prevent the acid fermentation of food products between the teeth and the consequent decay of the dentine. Tincture of Myrrh is an excellent ingredient, being an aromatic local stimulant and disinfectant. Agents Acting on the Digestive System. Many drugs affect the teeth injuriously, such being the Mineral Acids, Persalts of Iron and Alum. The first two should be taken through a glass tube, and the mouth should AGENTS ACTING ON THE DIGESTIVE SYSTEM. 35 be afterwards rinsed with a weak alkaline wash. Opium, Chloral, Cocaine, Carbolic Acid, Creasote, Chlorate of Potassium and Aconite are the agents used as local anodynes in toothache from caries exposing a nerve filament. Chloral should never be used for this purpose, as in solution sufficiently strong to be of any service, it will cause sloughing of the gum, especially if injected thereinto with a hypodermic syringe, as is frequently done by ignorant dentists. Sialogogues (seealon, saliva, ago, I carry off)—are agents which in- crease the secretion and flow of saliva and buccal mucus, either by reflex action from the local irritation produced when anything is taken into the mouth, or by stimulating the glands during their elimination. The prin- cipal sialogogues are divided into two classes, the first (topical) acting by reflex stimulation, the second (general) acting through their systemic influence on the glands or their secretory nerves. They are as follows:— Topical Sialogogues. Acids and Alkalies. Ether, Chloroform, etc, Mustard, Ginger. Pyrethrum, Mezereon. Tobacco, Cubebs. Capsicum, Rhubarb. Horse-radish. General Sialogogues. Pilocarpus (Jaborandi). Muscarine. Physostigma. Mercurials. Iodine compounds. Antimonials. Tobacco, Ipecac. Antisialics (anti, against, seealon, saliva),—are remedies which dimin- ish the secretions of the salivary glands. Atropine is the principal agent of this group, acting by paralyzing the terminations of the nerves of secre- tion. Physostigma counteracts this paralysis, but in large doses acts as an antisialic by lessening the blood supply to the glands. Opium dimin- ishes the reflex excitability of the reflex centre and also diminishes the secretion. Others acting locally are— Borax. Potassium Chlorate. Insipid or nauseous articles of food or medicine. Soda. Lime. Lithia. Magnesia. Refrigerants (refrigero, I cool),—are remedies which allay thirst and impart a sensation of coolness. They include the Vegetable Acids, the Mineral Acids (greatly diluted), Ice, Water, if cold, Effervescing drinks, Fruit juices, and many diaphoretics. Gastric Tonics or Stomachics,—are agents which increase the ap- petite and promote gastric digestion. They include a number of sub- stances, dietetic and medicinal, some acting by stimulation of the produc- tion of gastric juice, others by stimulating the local circulation, and several by exciting the activity of the nervo-muscular apparatus of the stomach. The first indication is met by the use of dilute alkaline solutions before meals,—the second by administering any of the pungent carminatives, as the Aromatic Oils, Pepper, Mustard, etc., or by Alcohol and Ether in small doses, or by the Aromatic Bitters, as Gen- tian, Orange, etc., or the simple bitters, as Calumba;—while the third desideratum is 36 AGENTS ACTING ON THE DIGESTIVE SYSTEM. secured by the use of such agents as Nux Vomica, Hydrastis, Arsenic, the dilute Mineral Acids, and the Volatile Oils. Adjuvants to gastric digestion are the various digestion- ferments, Pepsin, Ingluvin and dilute HC1 Acid, which may be used to supplement the gastric juice when deficient in quantity or quality. Acids,—considered therapeutically and physiologically, are medicines which in concentrated form act usually as caustics, and when given in medicinal doses internally check the secretions of organs producing acid secretions with which they come in contact, and increase those of organs producing 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. The chief members of this group are the following, which should be given in very dilute form:— Acidum Aceticum. Acidum Citricum. Acidum Benzoicum. Acidum Hydrochloricum. Acidum Nitricum. Acidum Phosphoricum. Acidum Sulphuricum. Acidum Nitro-hydrochloricum. Ant-acids or Alkalies,—from the same stand-point, are remedies which neutralize acids, check alkaline secretions and stimulate acid secre- tions, when in contact with the ducts of the organs producing them. Thus a dilute alkali given before meals will stimulate 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. The principal articles which belong to this group are the following, which should always be administered in dilute solution : — Liquor Potassse, Liquor Sodse. Carbonates and Bicarbonates of Potassium, Sodium, Lithium, Magnesium and Am- monium. Calcined Magnesia (Magnesia). Lime-water, Chalk. Aromatic Spirit of Ammonia. Potassium Acetate. Potassium Citrate. Potassium Tartrate. Potassium Bitartrate. Sodium Acetate. Sodium Citrate. Lithium Citrate. The substances in the first list are direct antacids, lessening the acidity in the stomach, and many of them also acting as remote antacids, lessening the acidity of the urine, as Potash and Soda, and their Carbonates and Bicarbonates. Ammonia and its Carbonates after absorption are eliminated as urea, and do not lessen the acidity of the urine. The salts in the second list are remote antacids, do not lessen acidity in the stomach but do that of the urine, being oxidized in the blood and excreted as Carbonates. Emetics (eemeo, I vomit),—are agents which produce vomiting. They may be subdivided into two groups, (i) Local Emetics, or those which act by irritating the end-organs of the gastric, pharyngeal or oeso- phageal nerves, and (2) General or Systemic Emetics, which act through the medium of the circulation. Both these classes produce the emetic action by irritation of the vomiting centre in the medulla, the first by reflex, the second by direct stimulation. The principal emetics are the following named :— AGENTS ACTING ON THE DIGESTIVE SYSTEM. 3 7 Local Emetics. Alum, Mustard, Salt. Ammonium Carbonate. Zinc and Copper Sulphates. Subsulphate of Mercury. Tepid Water, in quantity. Vegetable Bitters, as Quassia, in strong infusions. General Emetics. Ipecacuanha. Emetine. Apomorphine. Tartar Emetic. Veratrine. Senega. Squill. Tartar Emetic, Ipecacuanha and probably Apomorphine, act locally as well as systemi- cally, for if injected subcutaneously they are excreted by the stomach in part, thus irritat- ing the gastric nerves as well as the vomiting centre. Pilocarpus is a local emetic, and Digitalis and its congeners, also Muscarine, are systemic emetics, but none of these agents are used medicinally for that purpose. Opium, Morphine and Codeine usually produce emesis as one of their after-effects. Anti-emetics,—are agents which diminish nausea and vomiting, some by a local sedative action upon the end-organs of the gastric nerves, others by reducing the irritability of the vomiting centre in the medulla. The most efficient of the local sedatives is Ice, swallowed in small pieces. Astringents are very useful when there is congestion of the gastric mucous membrane, as in the vomiting of alcoholism and phthisis, where Silver Nitrate and Alum are respectively effective. The most important anti- emetics are the following, viz. :— Alcohol. Alum. Arsenic. Belladonna. Bismuth. Carbonic Acid. Cerium Oxalate. Chloroform. Carbolic Acid. Potassium Nitrate. Local Gastric Sedatives. Creasote. Ether. Ice. Opium. Prussic Acid. Silver Nitrate. Calomel 1 small Ipecac / doses. Hot Water. Cocaine. General Sedatives. Opium. Morphine. Prussic Acid. Bromides. Chloral. Nitro-glycerin. Food. Alcohol. Amyl Nitrite. Vomiting being set up by irritation of many afferent nerves from various regions of the body, or by impulses from the brain excited through impressions on the nerves of special sense, the measures for combating it are very diversified. (Compare the title Vomiting in Part III.) Gastric Pain is best treated by such local sedatives as Bismuth, Hydrocyanic Acid, or small doses of Morphine, Arsenic and Belladonna. Cocaine is one of the most efficient agents of this class, in 5 to 6 minim doses of a 4 per cent, solution, every hour. As its general action is opposed to that of Opium, Bromides, etc., it must act locally, and therefore should be given by the mouth. Carminatives (Carmino, I soothe),—aid the expulsion of gas from the stomach and intestines, by increasing peristalsis, stimulating the circulation, and relaxing the cardiac and pyloric orifices of the stomach. They also act as diffusible stimulants, both of the bodily and mental faculties. The principal carminatives belong to the aromatic oils, alcohols or ethers, and are embraced in the following list:— Asafetida. Capsicum. Cardamom. Chloroform. Mustard. Pepper. Spirits. Oil of Anise. Oil of Eucalyptus. Oil of Fennel. Oil of Peppermint. Oil of Spearmint. 38 AGENTS ACTING ON THE DIGESTIVE SYSTEM. Ether. Fennel. Ginger. Horse-radish. Mace. Oil of Cajuput. Oil of Caraway. Oil of Cinnamon. Oil of Cloves. Oil of Coriander. Oil of Nutmeg. Oil of Pimento. Oil of Valerian. Camphor. Serpentaria. Cathartics or Purgatives (kaihairo, purgo, I cleanse),—are agents which increase or hasten the intestinal evacuations. According to their respective degrees and direction of action they are subdivided into several groups, as follows:— Laxatives (laxo, I loose), or Aperients (aperio, I open),—include those which excite moderate peristalsis, and produce softened motions without irritation. Sulphur is the typical laxative. Simple Purgatives,—increase peristalsis actively, and stimulate the secretions of the intestinal glands, producing one or more copious and semifluid motions with some irritation and griping. Senna is the type of this group. Drastic Purgatives (drao, I act),—act still more intensely, producing violent peristalsis and watery stools, with much griping pain, tenesmus and borborygmi. They irritate the intestinal mucous membrane, cause exos- mosis of serum from its vessels, and in large dose set up inflammation and symptoms of irritant poisoning. Jalap is a typical drastic. Saline Purgatives,—consist of the neutral salts of metals of the alkalies or alkaline earths. They stimulate the glands, increase peristalsis, promote osmosis and cause free watery evacuations. Magnesium Sulphate is a typical saline. Hydragogue Purgatives (heudore, water, ago, I bring away),—include the most active of the drastic and saline groups, those which remove a large quantity of water from the vessels. Elaterium is a typical hydragogue. Cholagogue Purgatives (kohlay, bile, ago, I bring away),—are those agents which stimulate the flow of bile and produce free purgation at the same time, the stools being green-colored, or “bilious,” and liquid. Podophyllin is the type of this group. The principal Cathartics are the following named :— Laxatives. Sulphur. Magnesia. Cassia. Manna. Figs. Prunes. Tamarinds. Honey. Olive Oil. Cascara Sagrada. Physostigma. Ergot. Belladonna. Stramonium. Hyoscyamus. Soap. Almond Oil. Taraxacum. Glycerin. Oatmeal. Bran Biscuit. Brown Bread. Simple Purgatives. Senna. Aloes. Rhubarb. Castor Oil. Laxatives. Simple Purgatives. Rhamnus Frangula. Ox-gall. Calomel. Small doses of drastics, sa- lines or cholagogues. Saline Purgatives. Magnesium Sulphate. Magnesium Citrate. Potassium Sulphate. Potassium Tartrate. Potassium Bitartrate. Sodium Sulphate. Sodium Phosphate. AGENTS ACTING ON THE DIGESTIVE SYSTEM. 39 Saline Purgatives. Sodium Chloride. Pot. et Sodium Tartrate. Manganese Sulphate. Drastics. Gamboge. Croton Oil. Cathartic Acid, hypodermi- cally. Hydragogues. Croton Oil. Salines in large doses. Cko/agogues. Drastics. Jalap. Colocynth. Elaterium. Scammony. Hydragogues. Elaterium. Gamboge. Potas, Bitartrate. Mercurials. Aloes. Rhubarb. Euonymin. Podophyllin. Iridin. Intestinal Astringents, contract the walls of the intestinal vessels, diminishing the exudation therefrom, and lessening the fluidity of the faecal discharges. The more powerful members of this group have also a constringing action on the intestinal mucous membrane. The principal agents of this class are the following :— Astringents. Phosphoric Acid. ) Nitric Acid. Sulphuric Acid. | Acetic Acid. Acetate of Lead. Nitrate of Silver. Constring enis. Tannic Acid. Vegetable Astringents. Alum. Oxide of Zinc. Sulphate of Copper. Persalts of Iron. Diluted. Hepatic Stimulants and Cholagogues (kohlay, bile, ago, I bring away),—are two groups of agents acting upon the biliary secretion, the first-named increasing the functional activity of the liver and the amount of bile formed, the second removing the bile from the duodenum and preventing its reabsorption into the portal circulation. Some hepatic stimulants are also cholagogues, others are not, while cholagogues proper generally act as hepatic stimulants by carrying off the bile and so indirectly urging the liver to secrete more. The discovery of the entero-hepatic circulation of bile has cleared up many of the discrepancies formerly existing with regard to the action of drugs upon this gland and its secre- tion. The following list includes the principal drugs belonging to both groups:— Hepatic Stimulants. Cholagogues. Aloes. Podophyllin. Mercuric Chloride. Sodium Benzoate. Phosphate. Salicylate. Nitro-hydrochloric Acid. Euonymin. Iridin. Phytolaccin. Sanguinarin. Antimony. Arsenic. Ipecacuanha. Colchicine. Colocynth. Rhubarb. Potassium Sulphate. Sodium Sulphate. Bicarbonate. Ammonium Benzoate. Chloride. Nitric Acid (dilute). Benzoic Acid. Baptisin. Hydrastin. Juglandin. Leptandrin. Jalapin. Scammony. Guaiac. Sarsaparilla. Physostigma. Rochelle Salt. Aloes. Podophyllin. Mercurous Chloride. Pil. Hydrargyri. Mercury with Chalk. Sodium Phosphate. Sulphate. Potassium Sulphate. Colchicum. Colocynth. Rhubarb. Arsenic. Euonymin. Scammony. Baptisin. Jalapin. Iridin. 40 AGENTS ACTING ON THE DIGESTIVE SYSTEM. Those in the first column are the most powerful of the stimulant group, the second column including the less efficient agents. To secure the best cholagogue effect it is advisable to combine an hepatic stimulant with an intestinal stimulant which shall pro- duce increased secretion from the intestinal mucous membrane and excite peristalsis. The Glycogenic Functioti of the liver, and the production of urea are stimulated by the following-named drugs :— Increasing Glycogen. Nitrite of Amyl. Sodium Bicarbonate. Nitro-hydrochloric Acid. Increasing Urea. Arsenic. Iron. Antimony. Phosphorus. Ammonium Chloride. Hepatic Depressants are agents which lower the functional activity of the liver, reducing the quantity of bile secreted, and lessening the production of glycogen and urea. They are as follows, viz. :— Lessening Bile. Opium. Morphine. Many Purgatives. Acetate of Lead. Quinine (?) Alcohol (?) Diminishing Glycogen. Opium. Morphine. Codeine. Phosphorus. Arsenic. Antimony. Lessening Urea. Opium. Morphine. Colchicum. Alcohol. Quinine. Many purgatives act as hepatic depressants and diminish the secretion of bile by lower- ing the blood pressure in the liver, and by carrying off the materials from which bile might be formed. Pancreatic Stimulation may be obtained by the administration of Ether, or by Galvanism of the gland itself. The secretion is depressed by Atropine and by inducing nausea and vomiting. Anthelmintics (anti, against, helmins, a worm),—are agents which destroy (vermicides) or cause the expulsion of intestinal worms (vermi- fuges). The chief vermifuges are Castor Oil, Jalap and Scammony, while the vermicides may be enumerated as follows, viz:— Thread Worms (Oxyuris Vermicularis.) Alum. Sulphate of Iron. Lime Water. Quassia. Eucalyptol. Sodium Chloride. Tannin. Veg. Astringents. Round Worms (A scar is Lumbricoides.) Santonica. Santonin. Spigelia. Chenopodium. Azedarach. Tape Worms (Tania, etc.) Filix Mas. Kamala. Kousso. Granatum. Pelletierine. Pepo. Turpentine. Chloroform. Senna. 1 Calomel. / with the above. The substances enumerated in the first column are all used locally by enema. Adjuncts to these remedies are such agents as prevent the excessive secretion of intestinal mucus, which affords a nidus for the worms. Such are Bitter Tonics and preparations of Iron, abo Ammonium Chloride and Sodium Chloride. agents acting on metabolism. Agents Acting on Metabolism. Restoratives,—are agents which promote constructive metamorpho- sis, including the Foods, Haematics, and Tonics, as well as many agents called Stimulants in other classifications. Foods,—are substances which, when introduced into the body, supply material to renew some structure or to maintain some vital process; being distinguished from medicines in that the latter modify some vital action but supply no material to sustain such. The food of man is derived from all three of the kingdoms of nature, viz., the mineral, vegetable and animal, and includes many substances treated of in the Materia Medica, as Oils and Fats, Sugar, Starch, Gum, Alcohol, Beverages like Coffee and Tea, Water, Phosphate of Lime, Chloride of Sodium, etc. Hcemalics (haima, the blood),—are medicines which augment the quan- tity of hgematin in the blood, and thus restore the quality of that tissue by enriching its red corpuscles. They consist chiefly of Iron and Man- ganese and their compounds. Tonics (tounos, tension),—are agents which improve the tone of the tissues on which they have specific action, restoring energy and strength to debilitated subjects, by a scarcely perceptible stimulation of all the vital functions, their effects being apparent in an increased vigor of the entire system. The chief tonics are enumerated in the foregoing lists under the heads of the organs or tissues particularly affected by them. (Compare the titles Stimulants, Respiratory Stimulants, Cardiac Tonics, Vascular Tonics, Gastric Tonics, etc.) The most typical medicinal agents which impart a general sense of tone and strength are Strychnine, Quinine, Iron and Vegetable Bitters. Those especially acting upon the stomach, are Arsenic, Bismuth, Cinchona, Hydrastis and Nux Vomica,—on the spinal cord and general circulation, Strychnine,—on the heart, Digitalis, Squill, Convallaria and Cimi- cifuga,—on the nervous system, Phosphorus, Quinine and the Valerianates,—on muscular tissue, Tannin,—on the blood, Iron, Manganese, Cod-liver Oil, and other fats. Alteratives,—are certain remedies which alter the course of morbid conditions in some way not yet understood, perhaps by promoting meta- bolism. They certainly modify the nutritive processes and thereby cure many diseases of chronic type. Mercury and Iodine are the most promi- nent agents of this class, the former being endowed with the power of breaking up newly deposited fibrin, and disorganizing syphilitic deposits, while the latter acts energetically upon the lymphatic system and promotes absorption. Arsenic also is almost specific in many chronic skin affec- tions, and has remarkable power over chronic pulmonary consolidations, probably producing fatty degeneration and softening of the effusion, so that it may be absorbed or expectorated. The principal alteratives are :— 42 AGENTS ACTING ON METABOLISM. Arsenic. Antimony. Aurum. Mezereum. Sulphur. Sulphides. Mercury. Colchicum. Guaiacum. Sanguinaria. Xanthoxylum. Calcium Chloride. Iodine. Iodides. Stillingia. Sarsaparilla. Cod-liver Oil. Phosphorus. Certain therapeutists of laboratory type have, of late years, seen fit to denounce the term Alterative as “ a cloak for ignorance,” but have never been able to present a better designation for a class of agents whose effects are among the most thoroughly established of clinical facts. A subdivision may be made of the Resolvents or Discutients {Resolvo, I unbind, Discutio, I dissipate),—agents which promote the absorption of inflammatory products or other materials of morbid origin, apparently by stimulation of the lymphatic system. They include Mercury, Arsenic, Iodine, and Cadmium, as well as such local measures as Poulticing and Counter-irritation. The Destructive Metamorphosis of the tissues is promoted by a number of agents, most of which are classed as Alteratives or as Astrin- gents, the most important of which are the following-named :— Alkalies. Vegetable Acids. Metals and their salts. Colchicum. Sulphides and Iodides. Sarsaparilla. Stillingia Xanthoxylum. Tannic and Gallic Acids, and substances containing them. On the other hand, Metabolism may be diminished by many substances, the following named being the chief ones :— Alcohol. Glycerin. Oils and Fats. Salicin. Salicylates. Quinine. Resorcin. Chinoline. Kairine. Antipyretics {anti, against, peuritos, fever), are agents or measures which reduce the body-temperature when abnormally high. This may be done by two principal methods, and the agents doing either accomplish the result by different actions, as follows, viz. :— r, T . n , .. t tt i / By Lessening the Production of Heat, by f 1 • Diminishing tissue-change. 12 Reducing circulation. or by Promoting the Loss of Heat, by * J ’ 7 f 3. Dilating cutaneous vessels, and producing increased \ radiation. . I 4. Producing perspiration, and its evaporation. [_ 5. Abstracting heat from the body. The following list contains nearly all the antipyretics, the number following each referring to its proper method of action, as enumerated above:— Quinine.1 Quinidine.1 Cinchonine.1 Cinchonidine.1 Berberine.1 Chinoline.1 Resorcin.1 Kairine.1’4 Kairoline.1-4 Antipyrine.1’4 Acetphenitidin.1 >4 Aconite.2 Antimonials.2’4 Veratrine.2 Colcliicum.2 AGENTS ACTING UPON EXCRETION. 43 Benzoic Acid.1 Carbolic Acid.1 Picric Acid.1 Salicin.1 Salicylic Acid.1 Sodium Salicylate.1’4 Quinine Salicylate.1 Methyl Salicylate.1 (Oil of Gaultheria.) Trimethylamine.2 Antifebrin.1’4 Hydroquinone.1 Thallin.1.4 Pyrocatechin.1 Pheno-resorcin.1 Camphor.1 Eucalyptol.1 Thymol 1 Other Essential Oils.1 Alcohol.1’3 Digitalis.2 Salol.1 Leeching.2 Cupping.2 Blistering.2 Poulticing.2 Nitrous Ether.3'4 Dover’s Powder.4 Cold Bath.5 Cold Drinks.5 Ice to Surface.5 Cold Sponging.5 Wet Packing.5 Purgation and Venesection produce antipyretic results, but their mode of action is doubt- ful (Brunton). Antiphlogistics {anti, against, pfleggo, I burn),—are measures and medicines which are supposed to have some specific power in reducing inflammation. The term is becoming obsolete, but frequent references are seen yet to the influence of Mercury and Opium in inflammations of serous membranes, Antimony and Aconite in inflammations of the respi- ratory tract and organs, and to the power of Veratrum Viride over puer- peral metritis. The chief antiphlogistics are the following : — Aconite. Veratrum Viride. Tartar Emetic. Mercury. Opium. Gelsemium. Digitalis. Ergot. Ipecacuanha. Potassium Nitrate. Rest, recumbent position. Venesection. Local Depletion. Purgation. Counter-irritation. Cold. Antiperiodics are remedies which affect certain periodical febrile diseases, lessening the severity of their paroxysms or preventing their return. They act probably by arresting the development in the blood of successive crops of pathogenic organisms, upon which the disorders are supposed to depend. The principal antiperiodics are : — Cinchona Bark and its Alkaloids. Bebeeru Bark and its Alkaloid. Salicin, Salicylic Acid, Salicylates. Arsenic. Eucalyptol. Iodine. Agents Acting upon Excretion. Diuretics (deeouraysis, urination),—are remedies which increase the renal secretion. They may act in several ways, namely : — 1. By raising the general blood-pressure by contraction of efferent vessels or vessels in other regions of the body. 2. By dilating the renal arteries and increasing the renal blood-supply, raising the pres- sure in the glomeruli. 3. By stimulating the secreting nerves or cells of the kidney. 4. By simply washing out the kidneys, as by Water in quantity. The following list contains the most important agents of this class, which are usually subdivided into the two groups indicated by the sub- titles. The numbers refer to the action of the drug in the above synopsis : 44 AGENTS ACTING UPON EXCRETION. Refrigerant Diuretics. Potassium Acetate.3 Potassium Bitartrate.3 Potassium Citrate.3 Potassium Chlorate.3 Potassium Nitrate 3 Sodium Acetate.3 Calomel.1 Digitalis.1 Erythrophloeum,1 Caffeine 3 Broom 3 Squill.1'® Nitrites.2 Colchicum.3 Strychnine.1 Stigmata Maidis.1’2 Stimulant Diuretics. Alcohol.® Gin.® Cantharides 3 Carrot.3 Turpentine.3 Fennel.3 Juniper.3 Mustard.3 Savine.3 Asparagus3 Copaiba.3 Uva Ursi.3 Cubebs.3 Buchu.3 Pepper.3 Sarsaparilla.3 Matico.3 Pareira.3 Kava.3 Chimaphila.3 Guaiac.3 Santonica.3 Parsley.3 Lobelia.3 Taraxacum.3 Aconite.3 Jaborandi.3 Tobacco.1"3 Dulcamara.3 Volatile Oils.3 Bryonia.3 Oleo-resins.3 Diuretics are employed for the following purposes, namely, (i) to re- move the excess of fluid in dropsies,—(2) to hasten the elimination of waste products and other poisonous substances from the blood,—(3) to dilute the urine. In— Cardiac Dropsy,—or other dropsies due to venous congestion, the best diuretics are those which act on the general vascular system, as Digitalis, Squill, etc. Calomel is very efficient here. Dropsy from Renal Disease,—Broom, Nitrous Ether, Oil of Juniper, Digitalis and Squill are the most reliable diuretics in the order named. Hepatic Dropsy,—Copaiba is considered especially suitable. In this and the previous form a little Pil. Hydrargyri occasionally often aids the diuretic action of other agents. To Eliminate Solids,—Potassium Nitrate and Bitartrate, Turpentine, Juniper, Caffeine, etc., are the most efficient. [Compare Antilithics.J To Dilate the Urine,—Water is the best diuretic, and the most efficient form is Dis- tilled Water acidified with Carbonic Acid Gas. Renal Depressants,—are such agents as directly diminish the ac- tivity of the renal cells, and lessen or suspend the secretion of urine. • Morphine, Quinine and Ergot act in this way through the circulation, and Digitalis, instead of acting as a diuretic, may arrest the renal circu- lation by stimulating the vaso-motor centre and thus by contracting the vessels may stop the secretion altogether (Brunton). The same is true of Caffeine and Strychnine, hence it is well to combine these with other diuretics (Nitrous Ether, Alcohol), which dilate the renal arteries. Alkalinizers of the Urine,—are .agents which produce an alkaline reaction to the urine when taken internally. They include the alkalies, particularly Potassium and Lithium salts, but excepting Ammonia, which is broken up in the organism. Sodium salts, being partly excreted 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, are not as efficient in this regard as are other alkalies. Fruits, milk and fish also act in the same manner by means of the salts which they convey into the economy. AGENTS ACTING UPON EXCRETION. 45 Acidifiers of the Urine,—are Benzoic and Salicylic Acids, and Vegetable Acids in excess, also excess of proteids, sugar and starch in the food, and certain wines and spirits. The Mineral Acids have little or no influence on the acidity of the Urine, being excreted as neutral sul- phates, chlorides, phosphates, etc. Vesical Sedatives,—are substances which lessen irritability of the bladder, relieving pain and decreasing the desire to micturate. Opium, Belladonna, Hyoscyamus, Stigmata Maidis, Cannabis, etc., lessen the irritability of the nerves, Carbonate of lime that due to the presence of calculi,—and mucilaginous drinks, such as Barley-water or Linseed tea, also astringents like Buchu, Uva Ursi, Pareira, etc., diminish the irrita- tion due to chronic cystitis, and antiseptics, as Copaiba, and Cubebs, also act in like manner. Vesical Tonics,—increase the contractile power of the muscular fibres in the wall of the bladder. Cantharides, Potassium Bromide, Strychnine and Belladonna are the most prominent members of this class. Urinary Sedatives and Astringents,—act sedatively upon the whole extent of the urinary tract through the medium of the urine charged with them when administered internally. Some of the members of this class may be administered locally, but only to the urethral and vesical mucous membranes, which are accessible to direct local medication. Instances of the application of these agents are in the use of Potassium and Lithium Salts to diminish the acidity of the secretion,—Cubebs, Copaiba and Sandal-wood Oil as antiseptics and astringents,—and urethral injections of Alum, Acetates of Zinc and Lead, Boracic Acid, Chloral and Zinc Chlorides, etc., for a simple purpose. Copaiba is one of the most efficient agents for rendering the urine antiseptic, and should be more employed in cystisis and urethritis than it is. Oil of Eucalyptus is nearly as efficient, and Stigmata Maidis (Corn Silk), in tincture, is beginning to be well thought of for a general alterative influence on the urinary tract. Antilithics or Lithontriptics {anti, against, leethos, a stone, treebo, I wear down),—are agents supposed to prevent the formation of concretions in the excretory passages (antilithics) or to dissolve them when formed (lithontriptics.) The terms are generally restricted to remedies affecting the urinary calculi, but those directed against the biliary form are in- cluded in this arrangement for the sake of consistent classification. The chief agents coming under this title are— Biliary Calculi. Ether and Turpentine. (Durande’s Solvent.) Sodium Bicarbonate. Sodium Salicylate. Sodium Phosphate. Castile Soap. Alkaline Waters, especially Vichy. Uric Acid or Urates. Distilled Water. Alkalies, Potash or Lithia. Potassium Salts. Lithium Salts. Potassium Tartraborate. Magnesium Citroborate. 46 AGENTS ACTING UPON EXCRETION. Oxalate of Calcium. Dilute Nitro-Hydrochloric Acid. Carbonated Water. Lactic Acid (for digestion). Phosphatic Calculi. Ammonium Benzoate. Benzoic Acid. Dilute Nitric Acid. There is probably little or no solvent value to the agents recommended for biliary calculi. In the case of Uric Acid the administration of Potash or Lithia is based on their combining with the acid forming the calculus, and forming Urate of Potassium or Lithium, which salts are more soluble than the Uric Acid itself. Diluents (Diluo, I dilute),—are agents which, after their absorption dilute the excretory fluids and enable the latter to hold more solid ma- terial in suspension. Water is the one true diluent, whatever form it may be disguised in, as teas, weak fluid foods, acid drinks, etc. Diaphoretics and Sudorifics {deeaphohreeo, I carry through; sudor, sweat, facio, I make),—are remedies which increase the action of the skin and promote the secretion of sweat. When they act energetically, so that the perspiration stands in beads upon the surface they are known as Sudorifics. They may be subdivided into the following groups, viz.— X. Simple Diaphoretics, which enter the circulation and are eliminated by the sudori- ferous glands, which they stimulate to increased action. 2. Nauseating Diaphoretics, which produce relaxation and the dilatation of the super- ficial capillaries. 3. Refrigerant Diaphoretics, which reduce the circulation, at the same time acting directly on the sweat centres in the spinal cord and medulla. The principal diaphoretics are enumerated as follows, the figures refer- ring to their supposed mode of action as indicated above, viz. :— Jaborandi.1’3 Pilocarpine.1’3 Salicylic Acid.1 Salicylates.1 Ipecacuanha.2 Tartar Emetic.2 Sulphur.1 Opium. 2’3 (large doses) Camphor.1 Tobacco.2’3 Cocaine.3 Ether.2’3 Alcohol.2’3 Nitrous Ether.2-3 Ammonium Acetate.1 Ammonium Citrate.1 Dover’s Powder.2 Aconite.3 Veratrum Viride.3 Potassium Salts.3 Mezereon.1 Lobelia.2’3 Sarsaparilla.1 Guaiacum.1 Serpentaria.1 Sassafras.1 Senega.1 Vapor Bath.2 Turkish Bath.2 Wet Pack.2 Warm Drinks.2 Anhidrotics {an, without, hidroce, sweat), are agents which check per- spiration. They may act— 1. By depressing the action of the sweat-glands. 2. By depressing the excitability of the sweat-centres. 2. By reducing the circulation in the skin. The most important agents of this class are the following-named, the figures indicating their mode of action as above arranged, viz. : — Belladonna.1 Atropine.1 Hyoscyamus.1 Stramonium.1 Muscarine.2 Agaricus Albus.2 Salvia (Sage). Acids, locally.3 Jaborandi. Pilocarpine. Nux Vomica. Strychnine. Ergot.3 Sulphuric Acid. Chloralamid. Quinine ? Picrotoxin. Dover’s Powder. Opium.2 (small doses) Zinc Salts.3 Local Cold.3 AGENTS ACTING ON THE GENERATIVE APPARATUS. 47 Strychnine, Atropine, Dover’s Powder, Jaborandi, Picrotoxin and Zinc Salts are all respiratory stimulants, and very efficient against the sweating of phthisis, though most of them are classed as diaphoretics. This is explained on the theory of accumulation of Carbonic Acid in the blood by depressed respiration caused by severe coughing, this stimulating the sweat centres, and being opposed by agents which stimulate the respiratory centre. Agents Acting on the Generative Apparatus. Aphrodisiacs (Aphrohdeetay, Venus), are medicines which stimulate the sexual appetite and power. They act by reflex or central action upon either the cerebral or the spinal genital centre. Tonics are indirectly aphrodisiac, as are all measures which promote the general bodily nutri- tion. The chief agents used as direct aphrodisiacs may be enumerated as follows, viz. : — Nux Vomica. Strychnine. Cannabis. Cantharis. Phosphorus. Aurum. Cimicifuga. Serpentaria. Sanguinaria. Opium (at first). Camphor (at first). Damiana (?). Ergot. Iron. Alcohol. Bitter Tonics. Flagellation. Meat Diet. Strychnine acts by increasing general nutrition and exalting the reflex excitability of the genital centres. Hemp probably only causes a mild delirium which may or may not take a sexual direction. Cantharides acts by direct irritation of the mucous lining of the urethra, and is dangerous in aphrodisiac doses. Alcohol in small doses excites the genital centre in the brain; so, also Opium and Camphor, the latter being decidedly anaphro- disiac after a time. The power of Da?niana is doubtful. Urtication and Flagellation of the nates produce priapism by irritation of the genital centre in the cord through the sensory nerves of the part. Ergot is considered useful by contracting the dorsal vein of the penis, preventing its emptying too rapidly. Anaphrodisiacs (an, without Aphrohdeetay, Venus),—are medicines and measures which lower the sexual function and diminish the sexual appetite. They act by lessening the excitability of the nerves of the genital organs, by depressing the genital centres in the brain and cord, or by decreasing the local circulation. The principal anaphrodisiacs are enumerated as follows, viz : — Potassium Bromide. Ammonium Bromide. Potassium Iodide. Camphor (at last). Opium (at last). Lupulin. Cocaine. Tobacco. Digitalis. Conium. Belladonna. Stramonium. Gelsemium. Nauseants. Purgation. Venesection. Ice, locally. Cold Baths. Vegetable Diet. Emmenagogues (emmayneeah, the menses, ago, I move)—are reme- dies which restore the menstrual function, either directly by stimulation of the uterine muscular fibre, or indirectly by improving the blood and toning up the nervous system. The direct emmenagogues are ecbolic in large doses. The principal members of this class are enumerated in the following list, viz.:— 48 AGENTS ACTING ON THE GENERATIVE APPARATUS. Direct Emmenagogucs. Ergot. Rue. Quinine. Apiol. Savine. Borax. Digitalis. Myrrh. Cantharis. Guaiacum. Pulsatilla. Polygonum Hydrop. Asafetida. Potass. Permang. Alcohol. Cimicifuga. Indigo. Oxalic Acid. Hydr. Biniod. Hedeoma. Caulophyllum. Origanum. Tansy. Viscum Flavescens. Indirect Emtfienagogues. Iron. Manganese. Cinnamon. Strychnine. Aloetic Purgatives. Cod-liver Oil. Hot Hip-baths. Leeching the genitals. Rubefacients to thighs. Tonic Remedies. Oxytocics or Ecbolics (ockseus, quick, tokos, childbirth; ekbolay, abortion),—are agents which stimulate the muscular fibres of the gravid uterus to contraction, and produce abortion. In small doses the same remedies are emmenagogue as a rule. Their mode of action has not been clearly made known, but it is generally believed to be due in some cases to direct stimulation of the uterine centre in the cord, in others to con- gestion of the uterus producing reflex stimulation. The principal oxytocics are those enumerated in the following list, viz. :— Ergot. Ustilago. Savine. Quinine. Borax. Cotton-root Bark. Oil of Rue. Pilocarpine. Viscum Flavescens. Any drastic purgative, or gastro-intestinal irritant, may produce abortion by reflex action. The Volatile Oils act in this manner, also Colocynth and many other agents used by women to produce abortion, as Tansy, Pennyroyal, etc., all of which are dangerous to life in doses sufficient to excite the action of the gravid uterus. Uterine Depressants lower the activity of the nervo-muscular appa- ratus which controls the uterine contractions. The most important of these agents are :— Opium. Bromides. Cannabis. Viburnum Prunifolium. Chloral. Chloroform. Tartar Emetic. Tobacco. Sulphate of Copper. Emetics. Piscidia Erythrina. Uterine Tonics and Alteratives,—are medicines which are con- sidered to have such specific influence over the uterus. Authorities differ very much regarding the value of these agents, but those enumerated in the following list are generally considered to have considerable value in uterine therapeutics, viz. :— Uterine Tonics. Potassium Bromide. Potassium Chlorate. Pulsatilla. Helonias Dioica. Cimicifuga. Savine. Astringents (locally. Uterine Alteratives. Iodine. Iodoform. Iodized Phenol. Glycerin. Hydrastis. Silver Nitrate. Galvanism. Those in the first list, except Astringents, are used internally; those in the second col- umn as topical applications to the uterine cavity or cervix. agents acting on the cutaneous surface. 49 Galactagogues (galla, milk, ago, I bring away),—are medicines which increase the lacteal secretion, as Ricinus, Tea, Anise, Fennel, Potassium Chlorate, etc. The value of many so-called galactagogues is extremely doubtful, the best being the local application of the leaves of the Castor-oil plant {Ricinus communis), and a good black Tea internally, with Milk, Beer or Porter as a beverage. Pilocarpus comes the nearest to being a true galactagogue, but its influence is very transient. (Com- pare Lactation in Part III.) Irritants are substances which, when applied to the skin, produce a greater or less degree of vascular excitement. When used to produce a reflex influence on a part remote from their site, they are termed Coun- ter-Irritants, and may be subdivided into the following groups, viz.:— Rubefacients (Rubefacio, I make red),—produce temporary redness and congestion of the skin, unless left too long in contact with the surface, when they may cause exudation between the cuticle and the true skin (vesicants), or may destroy the tissue and form a slough (escharotics). They may induce muscular atrophy. Vesicants, Epispastics or Blisters,—produce decided inflammation of the skin, and outpouring of serum between the epidermis and derma. Cantharides is the agent generally used for this purpose. Pustulants,—affect isolated parts of the skin, as the orifices of the sudo- riferous glands, giving rise to pustules. The following list embraces the principal agents and measures belong- ing to these groups, viz. :— Agents Acting on the Cutaneous Surface. Rubefacients. Mustard. Capsicum. Camphor. Ammonia. Mezereon. Arnica. Alcohol. Ether. Chloroform. Iodine. Menthol. Rubefacients. Oil of Cajuput. Oil of Turpentine. Volatile Oils. Pitch. Friction. Hot Water. Pustulants. Croton Oil. Tartar Emetic. Ipecacuanha. Silver Nitrate. Vesicants. Cantharides. Euphorbium. Mezereon. Iodine. Rhus Toxicodendron. Ammonia (the confined vapor). Glacial Acetic Acid. Volatile Oil of Mustard. Rem / Boiling Water. \ Corrigan’s Hammer. Escharotics or Caustics (eskahrah, a slough or scab; kaioh, I burn), are agents which destroy a tissue to which they are applied, and produce a slough. They act usually in one of three modes, viz. : — 1. By abstracting the water of the tissue. 2. By combining with the albumen of the part. 3. By corrosive oxidation. 50 AGENTS ACTING ON THE CUTANEOUS SURFACE. The principal escharotics are enumerated in the following list, the numbers affixed to each pointing out its mode of action as stated above. Mineral Acids.1 Glaciaf Acetic Acid.1 Carbolic Acid.1 Chromic Acid.3 Arsenious Acid.1 Antimony Chloride.1 Caustic Potash.1 Caustic Soda.1 Lime.1 Dried Alum.2 Silver Nitrate.2 Copper Sulphate.2 Mercuric Chloride.2 Mercuric Oxide.2 Mercuric Nitrate.2 Zinc Sulphate.2 Zinc Chloride.2 Bromine.3 Astringents (ad, to, stringo, I bind),—are agents which produce contraction of muscular fibre and condensation of other tissues, the first probably by direct irritation, the second by precipitating its albumen and gelatin. They also lessen secretion from mucous membranes. The principal astringents may be enumerated as follows, viz. : — Acids. Alcohol. Alum. Chalk. Lime. Creasote. Carbolic Acid. Tannic Acid. Gallic Acid. Catechu. Galls. Kino. Oak-bark. Uva-Ursi. Bismuth Subnitrate, etc. Cadmium Sulphate. Copper Sulphate. Ferric Chloride. Lead Acetate. Silver Nitrate. Zinc Sulphate. Sulphuric Acid, Gallic Acid and Acetate of Lead are examples of Remote Astringents, acting on internal organs through the blood. Those which affect the part to which they are applied are Local Astringents, and include most of those enumerated above. Styptics and Hemostatics (steuphoh, I contract; haimah, blood, stahsis, a standing),—are agents which arrest hemorrhage, Styptics being those which are applied locally, and Hemostatics those which are ad- ministered internally. Some of the former act mechanically, by promoting the formation of a clot in the mouths of the bleeding vessels; others cause the vessels themselves to contract, checking the flow of blood. The principal members of this class are the following-named :— Acids. Alum. Cautery. Collodion. Ferric Chloride. Ferric Sulphate. Silver Nitrate. Styptics. Cold. Matico. Spider’s-web. Tannic Acid. Lead Acetate. Zinc Sulphate. Vegetable Astringents. Ergot. Digitalis. Gallic Acid. Lead Acetate. Dilute Sulphuric Acid. Ipecacuanha, Hamamelis. Oil of Turpentine. Hemostatics. Emollients (Emollio, I soften),—are substances which soften and relax the tissues to which they are applied. They relieve tension, dilate vessels, diminish pressure on the nerves, and protect inflamed surfaces from the air and from friction. The principal articles which may classed under this heading are the following :— Hot Fomentations. Poultices. Glycerin. Lard. Linseed Oil. Olive Oil. Spermaceti. Almond Oil. Petroleum. Soap Liniment. Starch. Cacao Butter. AGENTS ACTING ON MICROBES, GASES, FERMENTS. 51 Demulcents (.Demulceo, I soothe),—are substances generally of a mucilaginous nature, which soothe and protect the parts to which they are applied. This term is generally used for substances employed for mucous membranes, and the term Emollients for similar agents used on the skin. The chief agents belonging to this class are :— Acacia. Cetraria. Barley. Liquorice. Starch. Glycerin. Flaxseed. Gelatin. Honey. Marsh-mallow. White of Egg. Almond Oil. Olive Oil. Isinglass. Tragacanth. Bland Oils. Protectives,—are agents of a mechanical nature employed to cover and protect an injured part from the air, water, etc. Collodion and Gutta-percha are those in general use, but certain plasters, as the Adhesive, the Lead or the Soap Plaster, may be employed for this purpose, also Cotton Wool. Antizymotics (anti, against, zeumohsis, fermentation),—are agents which arrest fermentative processes, which may depend upon the action of organic ferments (enzymes), as disease, ptyalin, pepsin, etc., or upon that of organized ferments, as the yeast-plant, bacteria, etc. The Anti- zymotics may be subdivided into two groups, Antiseptics and Disinfectants. Antiseptics (anti, against, saypteekos, putrefaction),—prevent or retard septic decomposition, by destroying the bacilli which produce it, or by arresting their development. The chief antiseptics are : — Agents Acting on Microbes, Gases, Ferments, etc. Mercuric Chloride. Mercuric Iodide. Mercuric Oxide. Potassium Permanganate. Sulphurous Acid. Sulphites and Hyposulphites. Sulpho-carbolates. Potassium-Chlorate. Zinc Chloride. Carbolic Acid. Creasote. Alcohol. Eucalyptol. Quinine. Salicin. Thymol. Borax. Chlorine. Hydronaphthol, etc. Disinfectants destroy the specific germs of communicable diseases, many of which belong to the microbe class, hence many antiseptics are also disinfectants. They act in several modes, some as oxidizants, others by combining with albumen, others by chemical combination forming substitution-compounds, others by arresting molecular changes, and still others by altering the reaction of the media containing the germs. The principal disinfectants are :— Heat, 230°-250° F. Sulphurous Acid Gas. Nitrous Acid Gas. Chloride of Lime. Mercuric Chloride. Aluminium Chloride. Zinc Chloride. Carbolic Acid. Potass. Bichromate. Potass. Permanganate. ■ Iodine. Chlorine. Bromine. Lime. Osmic Acid. Ferrous Sulphate. Zinc Sulphate. Condy's Fluid is an aqueous Solution of Potassium Permanganate, 2 parts in 100, or gr. 176 in xx. Burnett's Fluid is a solution of Zinc Chloride, containing about 50 per cent, of the salt, and equivalent to the official Liquor Zinci Chloridi. Labarraque's Solution is the official liquor Soda; Chloratoe. 52 AGENTS ACTING UPON EACH OTHER. Deodorants,—are agents which destroy foul odors. The Volatile Deodorants are chiefly oxidizing and deoxidizing substances, acting chemically on the obnoxious gases; while the Non-volatile ones are mainly absorbents, which condense and decompose the effluvia. The deodorants in general use are the following named : — Chlorine Gas. Sulphurous Acid Gas. Nitrous Acid Gas. Peroxide of Hydrogen. Potassium Permanganate. Ozone. Charcoal. Earth, Lime. Ferrous Sulphate. Parasiticides (parrahseetos, a parasite, ccedo, I kill),—are agents which destroy the animal and vegetable parasites found upon the human body. They are generally applied in the form of lotions, ointments or oleates, and include the following substances, viz.:— Sulphur. Sulphides. Sulphurous Acid. Iodide of Sulphur. Iodine. Mercury. Ammoniated Mercury. Mercuric Chloride. Mercuric Nitrate. Mercuric Oxide. Carbolic Acid. Petroleum. Storax. Staphisagria. Balsam of Peru. Agents Acting upon Each Other. Antidotes and Antagonists are terms frequently confounded with each other, and rarely defined with sufficient lucidity to enable a clear distinction to be drawn between them. An Antidote is a substance which affects a poison either physically or chemically, or both, and in such a manner as to remove the poison from the body or to form with it an insoluble salt or an inert compound, with the object of preventing its toxic action upon the organism. Thus, Tannic Acid is an antidote to Digitalis, as it forms therewith a compound (tan- nate), which is soluble with difficulty and therefore comparatively innocuous. But as this tannate is not wholly inert, another antidotal measure must be employed, viz.:—evacu- tion of the stomach, which may be accomplished by the administration of Zinc Sulphate or any other emetic, or by the use of a stomach pump. Antagonists, on the other hand, are agents which directly oppose each other in some or all of their physiological actions, and may be used against each other to counteract their effects on the system. Antidotal action takes place in the alimentary canal, and is applicable to vegetable as well as mineral poisons. Antagonism takes place in the blood and tissues, and so far as antagonistic drugs are concerned, is applicable almost wholly to vegetable poisons, as these produce their effects after absorption. The heart and respiratory apparatus are the principal objec- tive points for the antagonism of drugs, but the spinal cord, the cerebrum, muscular tissue and the glandular system are also affected by most of them. Antagonistic Measures are such proceedings as may tend to antagonize certain effects of poisons, and include Artificial Respiration,—Faradism of the respiratory muscles,—Constant motion,—Douching,—Rest, etc. AGENTS ACTING UPON EACH OTHER. 53 Thus, to refer to the case of Digitalis again, Saponin and Senegin are its most complete physiological antagonists, their counteraction extending throughout the whole range of its effects. Aconite and Morphine antagonize its cardiac action, the former being considered the best antagonist to the effects of large doses, and the latter to those of its long-con- tinued use. Alcohol is also indicated in Digitalis-poisoning, and absolute Rest in the recumbent posture is an antagonistic measure of great importance, by reason of the liability of the heart to cease its action on assuming the erect position, when much lowered by the drug. In the treatment of poisoning, whether from mineral or vegetable sub- stances, the first indication is to administer the appropriate chemical anti- dote, so as to render the poison harmless or comparatively so. Next, the stomach should be emptied and washed out, lest the newly-formed com- pound be absorbed after a time, and to remove any of the poison which may have escaped the action of the antidote. Next, the antagonist should be administered, in order to counteract the effects of such portion of the poison as may have been absorbed. Lastly, the appropriate antagonistic measures should be employed to sustain the action of any organic function which may show signs of failure. In most cases of alkaloidal poisoning absorption has proceeded so far before assistance is obtained that antidotes are of no value, and reliance can only be placed upon the physiological antagonist and such supporting measures as will tend to maintain vitality until the poison has been eliminated by the natural channels. In the following pages the antidotes and antagonists for each poisonous substance in the Materia Medica are enumerated under their proper titles, and in the Appendix the same agents are tabulated in a suitable form for reference. A few examples are appended below, to illustrate the princi- ples above stated, and to point out some of the most prominent instances of physiological antagonism at present known. Atropine, Belladonna, etc. Antidotes,—Tannic Acid, to form an insoluble tannate. Zinc Sulphate, as an emetic, or Apomorphine hypodermically, or the stomach-pump. Purgation. Antagonists,— Muscarine. Physostigmine. Pilocarpine. Morphine. Quinine. Aconite. Antagonistic Measures,—Artificial respiration. Faradism of respiratory muscles. Strychnine, Nux Votnica and Ignatia. Antidotes,—Animal Charcoal suspended in water. Emesis, as above-mentioned. An- tagonists,—Chloral, or Chloroform, to muscular relaxation. Curare. Nitrite of Amyl. Bromide of Potassium. Antagonistic Measures,—Artificial respiration. Perfect quiet. Morphine and Opium. Antidotes,— Emesis or stomach-pump. Antagonists,—Atropine. Strychnine. Black Coffee. Caffeine. Ammonia, inhaled. Amyl Nitrite. Antagonistic Measures,—Cold douche. Artificial respiration. Continued movement. Potassium Cyanide. Antidotes,—Sulphate of Iron, to form Prussian Blue. Emesis. Antagonists,—Atro- pine. Ammonia. Alcohol. Antagonistic Measures,—Artificial respiration. Faradism. Arsenic and its Compounds. Antidotes,—Hydrated Oxide of Iron. Dialyzed Iron. Magnesia. Chalk. Lime-water. Emetics, or stomach-pump. Oil or Mucilage to protect the mucous membranes. Diluents. Iodide of Potassium, to promote elimination. Antagonists,—none. DOSAGE OF MEDICINES. The Doses given throughout this book 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 a fraction, the numerator of which is 1. Thus, for a child two years old, a*12 = 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 may be employed. Children bear Opiates badly:—but on the other hand they stand comparatively large doses of several other drugs; such being Arsenic, Belladonna, Calomel, Ipecacuanha, Squills, Rhubarb, and several other purgatives. For Hypodermic Injection, the dose should be two-thirds or three-fourths of that used by the mouth ; by rectum five-fourths of the same. Strychnine acts more actively when given per rectum than by the stomach. Conditions which modify the action of medicines, and therefore affect their dosage, are—age, body-weight, temperament and idiosyncrasy, drug-habits, intervals between doses, time of administration, condition of the stomach, temperature of the body, cumulative drug-action, mode and form of drug-administration, disease, climate, race, etc. The Dosage of Medicines is the weakest part of the therapeutic armament, the flaw in our weapons which may be the cause of their failure at any moment, perhaps the most critical one for a life. If the accumulated rubbish of ages, which has been called thera- peutical knowledge, is ever to be given scientific shape, ever placed in process of becoming a science, the question of dosage must form one of the principal corner-stones in the foundation. Drugs have widely differing actions on the human organism in health and in disease, according as they are administered in different doses, in different menstrua, and during different conditions of the subject’s health. This difference, when between extremes of dosage, is often so wide as to separate actions directly contrary to each other,— that of the very large one opposing the action of the very small dose :—a truth hidden by one set of dogmatists under their former “doctrine,” now “rule,” of “similars,” and avoided by the great mass of the medical profession, through dread of the bogy-name, “ irregular.” A thoroughly-prepared materia medica of half-a-dozen standard drugs, such as Aconite, Arsenic, Belladonna, Mercury, Opium and Quinine,—based upon their actions and uses in different doses and under different states of the organism,—would be of more real value to the physician, who wishes to do his work accurately and with his eyes open, than all the contents of the dispensatories, plus the entire literature of the “ new remedies,” and every symptom in the ten quarto volumes of the largely discredited and partly repudiated homoeopathic Materia Medica. If our medical students would each devote but one month, of his annual college vacation, to the personal investigation of some one feature of the action of some one drug, under such safe-guards against error as would secure the acceptance of the resulting observations,—what a mine of therapeutic gold would soon yield its solid truth to eager eyes! Formally laid down by Haller (see ante, page 18) in 1755, cultivated to some extent by Alexander in 1768, Crumpe in 1793, Thommassina, Curtis, etc.,—urged by John Hunter, Sir Thos. Watson, Dr. King Chambers, and many other luminaries of the medical profession,—the scientifically guarded proving of drugs on the human organism has lain, like the similar work of Jenner, neglected all these years, waiting for another Koch, to re-inaugurate the work. PART I MATERIA MEDICA AND THERAPEUTICS. ABRUS, Jequirity (Unofficial),—-is the seed of Abrusprecatorius, or Wild Liquorice, a plant of the nat. ord. Leguminosse, indigenous in India, but growing wild in most tropical countries. The seeds are small, hard, of a bright scarlet color, with a black spot around the hilum, and contain an alkaloid, some fixed oil, sugar, a principle resembling Gly- cyrrhizin, and Abric Acid, C12H24N30 ; but neither of these is believed to be the active principle. Preparation. Infusum Abri, Infusion of Jequirity (Unofficial),—prepared by macerating three pow- dered seeds in cold water for twelve hours, adding ss of boiling water, and filtering when cold. It should be used while fresh, as after two or three days it is worthless. Another formula contains gr. ix of Jequirity to the , with gr. iv of Boric Acid to prevent decomposition. Physiological Action and Therapeutics. Jequirity seeds, when moistened with water, become highly poisonous. If applied to the conjunctiva, a severe inflammation is set up, with oedema and false membrane, ulceration of the cornea, and extension to the lids, face, neck and submaxillary glands. Inserted into a wound in cattle, they cause death in a few hours. The irritant action is believed to result from the presence in the seeds of some ferment, or perhaps great numbers of gonidia, which develop rapidly on a suitable tissue. The infusion, in a short time, swarms with bacteria. Jequirity is used for the purpose of producing a purulent or croupous conjunctivitis, by which to destroy old granulations (trachoma) and pan- nus. A mild infusion is applied to the eye two or three times a day for two days, and followed by weak solutions of Alum or Borax. This should be repeated after three weeks if necessary. An emulsion of the seeds in water is a useful application to unhealthy ulcers and lupus. 56 ABSINTHIUM—ACETANILIDE. ABSINTHIUM, Wormwood,—the leaves and tops of Arte?nisia Absinthium, a perennial garden herb of the nat. ord. Compositse, indigenous in Europe, but cultivated in the United States. The leaves are about 2 inches long, hoary, silky-pubescent, petiolate, pinnately two or three-cleft; heads numerous, with small, pale-yellow florets, odor aromatic, taste persistently bitter. It contains a volatile oil and a bitter principle, Absinthin. Dose, gr. xx-xl, in infusion. There are no official preparations, except Vinum Aromaticum (see Alcohol), of which Absin- thium constitutes one per cent. Absinthe, the French liqueur, is an alcoholic solution of the oil, containing also extracts of Anise, Marjoram, and Angelica. Its continued use produces various nervous symptoms, morning nausea and vomiting, also a tendency to epileptiform convulsions. The bitter constituent of Absinthium is stimulant to the digestive organs, but the oil is a narcotic poison, increases the cardiac action, and produces tremor, stupor,epileptiform convulsions, involuntary evacuations, and stertorous breathing. It is but little used in medicine, and only as a stomachic tonic in dyspepsia. ACACIA, Gum Arabic,—is a gummy exudation from Acacia Verek, a small tree of the nat. ord. Leguminosae, indigenous in Africa—also from other species of Acacia. It occurs in spheroidal tears of various sizes, breaking with a glassy, sometimes iridescent fracture ; insoluble in alcohol, but soluble in water, forming a thick and mucilaginous liquid. It consists of Arabin or Arabic Acid, C]2H22On, combined with calcium, potassium, and magnesium. Preparations. Mucilago Acacia,—has of Acacia 34, Water to 100 parts. It should not be prescribed with tinctures or spirits except in very small quantity. Dose, indefinite. Syrupus Acacia,—has of the Mucilage 25, Syrup 75. Should be freshly made. Dose, indefinite. Acacia enters into the composition of Mistura Amygdalae, Mistura Glycyrrhizse Com- posita, Pulvis Cretae Compositus, Trochisci Cretae, Trochisci Cubebae, and Trochisci Glycyrrhizae et Opii. Gum Arabic has no activity except the negative one of a demulcent, and is chiefly used in coughs, sore throats, catarrhal inflammation of the stomach and intestines, and irritant poisoning. It is much employed in pharmacy to suspend insoluble powders in mixtures, for which purpose the mucilage is generally used. ACETANILIDE,—Antifebrin. Like the major number of the newest antipyretics, which are related either to Chinoline or to Phenol, Acetanilide is a derivative of Anilin, from which it is obtained by the action thereon of glacial acetic acid, substituting the organic radical ACETANILIDE. 57 Acetyle for an atom of hydrogen. Chemically, it has the name Acetani- lide or Phenyl-acetamide, and the formula C6H5. C2H3O.NH. The name Antifebrin is copyrighted by its original promoters for trade purposes, and. therefore should be dropped from professional usage. It is a pure white and crystalline powder, of neutral reaction, odorless, but of slightly burning taste. It melts at 2350 F., and distils at 5570 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 sub- stance, being unaffected by hydrochloric or sulphuric acids, and ordinarily so by alkalies. The dose ranges from gr. ij to gr. xv, repeated twice, but not exceeding gr. xxx in the 24 hours. As much as 3 j has been swallowed without ill effects supervening. It may be administered in the very convenient form of compressed tabletsalso in powders, or in dilute alcoholic solution, gj may be dissolved in ivss of brandy, to which, if we add 3 vj each of simple syrup and water, we get a six-ounce mixture, of which a table- spoonful ( 3; ss) contains 5 grains of Acetanilide, a fair adult dose. 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 move- ment. Physiological Action. Acetanilide is a very efficient antipyretic, besides being strongly anal- gesic 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 Antipyrine, the effect of Acetanilide on the body-temperature is manifested more slowly (1 hour against y2 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 ill after-effects;—while Antipyrine is powerfully diaphoretic, a cerebral sedative, and produces great depression. Furthermore, Ace- tanilide produces the same degree of reduction of body-temperature as Antipyrine, with the ingestion of but the dose; and, like the latter agent, it has little or no effect on the normal temperature, and its con- tinued 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, decolorizing it, and forming methyl-haemoglobin. The heart, liver and kidneys are found in a state of acute fatty degeneration, in animals poisoned thereby. Its continued use in large doses is highly injurious to the blood, especially in diseases (as typhoid fever) which are themselves destructive to the blood. 58 ACIDUM ACETICUM. Therapeutics. Besides being one of the most .efficient antipyretics, this drug 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 chinoline deriva- tives,—combine to make it one of a wider therapeutical range than most of its analogues. It is especially useful in phthisis and typhoid fever, for the hyperpyrexia, thereby relieving wakefulness, lessening delirium, and upholding a failing heart; but if long used in large doses in the latter disease it may increase the liability to serious sequelge, especially periostitis of the ribs, gangrene of tissues, etc. For the pains of locomotor ataxia, and in those of rheumatic origin, sciatica, lumbago, etc., it is a most efficient remedy. In acute rheumatism, it is highly praised ; though its efficiency is herein disputed by Salol. In epilepsy, it is being tried, with the view of moderating reflex excitability. ACIDUM ACETICUM, Acetic Acid,—is a liquid composed of 36 per cent, of absolute Acetic Acid, HC2H302, and 64 per cent, of water. It is a clear, colorless liquid, of a distinctly vinegar odor, a purely acid taste, and a strongly acid reaction; sp. gr. 1.048 at 590 F. ; miscible in all proportions with water and alcohol, and wholly volatilized by heat. It is prepared from wood by destructive distillation and purification. Acetic Acid is also official in two other degrees of concentration, viz. :— Acidum Aceticum Glaciate, Glacial Acetic Acid, HC2H302,—is nearly or quite abso- lute Acetic Acid, solid below 590 F., above that temperature a colorless liquid of sp. gr. 1.056 to 1.058. Is strongly escharotic and only used locally. Acidum Aceticum Dilutum, Diluted Acetic Acid,—consists of Acetic Acid 17, Dis- tilled Water 83 parts, contains 6 per cent, of absolute Acetic Acid, and has a sp. gr. of 1.0083. Dose, gj-ij. Acetum, Vinegar (Unofficial),—is an impure diluted Acetic Acid, produced by the acetous fermentation of any liquid susceptible of the vinous fermentation. Diluted Acetic Acid is used in the preparation of the four official Aceta (Vinegars). Physiological Action. Acetic Acid, like the other vegetable acids, in concentrated form is escharotic and produces gastro-enteritis if swallowed. In dilute form it acts as a refrigerant, diminishing thirst and allaying restlessness. It forms salts in the stomach, thus enters the blood, and is there oxidized, producing carbonic acid, and thereby increasing the acidity of the urine. It is also diuretic. Long used, it causes emaciation and poverty of the blood, producing a general scorbutic condition. It is hemostatic and anthelmintic, and the vapor inhaled causes reflex contraction of the vessels and raises the blood-pressure. Therapeutics. The glacial acid is used as a caustic in many skin affections, as warts, condylomata, etc., and to destroy the parasite in ringworm and pityriasis. ACIDUM BORICUM. 59 It has been employed locally in carcinoma, with the view of dissolving the supposed cancer-cells. The dilute acid is used locally in superficial inflammations of the skin, and may be sponged over the body to check perspiration and reduce the surface temperature in fevers. It is often administered internally to reduce obesity, which it does by impairing digestion. Locally, it may be employed to arrest slight hemorrhages, as epistaxis; and is occasionally used by enema for the destruction of ascarides. ACIDUM BORICUM, Boric or Boracic Acid, H2Bo3,—is a weak acid occurring in transparent, colorless, six-sided plates, of unctuous touch, odorless, of a cooling and slightly bitter taste, soluble in 25 of water and in 15 of alcohol at 590 F., in 3 of boiling water and in 5 of boiling alcohol. It is produced from Borax by the action of Sulphuric Acid. Dose, gr. v-xx. There is only one official Borate, viz. :— Sodii Boras, Borate of Sodium, Borax, Na2B407, ioH20,—colorless, transparent prisms, of cooling and sweetish, afterwards alkaline taste and alkaline reaction, soluble in 16 of water at 590 F., and in 0.5 of boiling water; insoluble in alcohol. Occurs native in ancient lake beds in various parts of the world. Dose, gr. v-xl. Unofficial Preparations. Boro-glyceride,—is a solid chemical compound, prepared by heating together Boracic Acid and Glycerin. It is soluble in water, but is generally used in solution of equal parts of pure Glycerin and Boro-glyceride. It combines readily with Chrysarobin, Carbolic Acid, Atropine and Morphine, and is used as a local application in eye diseases and skin affections. Boracic Ointment,—has of Boracic Acid 1, White Wax 1, Paraffin 2, Almond Oil 2, thoroughly mixed together. Boracic Lotion,—is a saturated solution of the acid in water. Boracic Lint,—prepared by steeping lint in a boiling saturated solution and drying. It contains nearly one-half its weight of the acid. Magnesii Boro-citras, Borocitrate of Magnesium,—prepared extemporaneously thus,— R. Magnesii Carbonatis gj, Acidi Citrici 3ij, Sodii Biborat. gij, Aquae Bullientis 3 viij. A tablespoonful three or four times daily as a solvent of uric acid calculi. Potassii Tartra-boras, Tartraborate of Potassium,—is a better solvent of uric acid calculi than the Magnesium salt, and is soluble in 2 parts of cold water. Prepared by heating together Boracic Acid 1, Potassii Bitrartras 4, Water 10 parts. Dose, gr. xx, largely diluted with water, three or four times a day. Physiological Action and Therapeutics. Boracic Acid is an efficient antiseptic, disinfectant and deodorant, arresting fermentation and putrefaction, and very destructive to low organisms. A solution of 1 in 133 arrests the activity of bacteria. It is feebly acid and but slightly irritant, and is used as a surgical dressing for its antiseptic and unirritating qualities. Its lotion and ointment have been successfully employed in ulcers, eczema, burns and scalds, pruritus ani, fetid perspiration, wounds, tinea tonsurans, and tinea circinata. 60 ACIDUM CARBOLICUM. The Borate of Sodium is antiseptic and disinfectant, as it also destroys low vegetable organisms. It removes the epidermis when locally applied, has power to increase uterine contraction, and aids the solution of Benzoic Acid. It is employed as a wash to remove the epidermis from the skin, and as a lotion in acne, freckles, chloasma, leucorrhoea, aphthae, etc., and to allay itching in urticaria, psoriasis, impetigo, and in pruritus pudendi, scroti et ani. It has been used internally in amenorrhoea, dysmenorrhoea, puerperal fever and puerperal convulsions, for its supposed specific action on the uterus. Boro-glyceride in solution (i to 40) is also a powerful antiseptic, and is used as a lotion in purulent ophthalmia and in the treatment of wounds, also as a local application to diphtheritic membranes. It is an efficient preservative of milk and food against putrefactive changes, and is entirely harmless. An elegant cosmetic cream may be made by dissolving Boracic Acid in Glycerin, and then incorporating it with White Wax and Almond Oil. ACIDUM CARBOLICUM, Carbolic Acid, Oxy-benzene, Phenic Acid, Phenylic Alcohol, Phenol, C6H5HO,—is an alcoholic product of the distillation of coal-tar between the temperature of 356° and 3740 F. It occurs in needle-shaped crystals of tarry odor and burn- ing taste, is liquefied by about 5 per cent, of water, soluble in 20 of water at 590 F., and very soluble in alcohol, ether, chloroform, glycerin, oils, etc. Peculiarities about Carbolic Acid are that about 5 per cent, of water liquefies it, a further addition of water renders it turbid, until 2000 parts of water to 100 of the acid have been added, when a stable and clear solution is formed. One volume of liquefied Carbolic Acid containing 5 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 Crea- sote and Cresylic Acid). It does not redden blue litmus paper, but combines freely with alkalies and other salifiable bases, the products having an alkaline reaction and being decomposed by the feeblest acids (carbonic, etc.) Dose, gr. %—]. Acidum Carbolicum Crudum, Impure Carbolic Acid,—is obtained as above stated, but at a lower heat (338° to 3740 F.), and contains Carbolic, Xylic and Cresylic Acids in varying proportions, together with other impurities. It is used as a disinfectant. Preparations. Unguentum Acidi Carbolici,—strength 10 per cent., Ointment 90. Glyceritum Acidi Carbolici (Unofficial),—Carbolic Acid 1, Glycerin 4- Aqua Acidi Carbolici (Unofficial),—has of the Glycerite 3 x to Aquae Oj. Dose 3 j- § ss. Carbolic Acid Gauze (Unofficial),—medicated with Ac. Carbol. I, Resin 5, Paraffin J. Carbolic Acid Plaster (Unofficial),—has of Carbolic Acid 25, Shellac 75, coated with Gutta-Percha dissolved in Carbon Disulphide. Carbolic Acid Solutions, for antiseptic surgery, are : — 5 per cent, in Water, as a spray or wash. per cent, in Water, for sponges, hands, or as a lotion. 5 per cent, or less in Olive Oil, as a special dressing. Phenol Sodique is composed of Carbolic Acid gr. 188, Caustic Soda gr. 31, Distilled Water 3 iv. ACIDUM CARBOLICUM. Official Derivative Salts. Sodii Sulpho-Carbolas, Sulpho-Carbolate of Sodium, NaCfiH5S04.2H20,—prepared by dissolving Carbolic Acid I, in strong Sulphuric Acid I, thus forming Sulpho-carbolic Acid, which is then neutralized with Carbonate of Sodium. Transparent, rhombic prisms, soluble in 5 of water at 590 F., less freely in alcohol and glycerin. Dose, gr. x-xxx. Analogues. Creasotum, Creasote,—is a similar product, obtained from wood-tar, but by the action of Nitric Acid it is converted into Oxalic Acid chiefly, while by the same reagent Carbolic is converted into Picric Acid. Creasote does not coagulate albumen (?) or collodion, Carbolic Acid does. Creasote is described under its own title. Resorcin (Unofficial), C„H602,—is also a phenol, obtained from certain resins by the action of fusing alkalies. [Described under its own title.] Physiological Action. Carbolic Acid is a powerful antiseptic and antiferment, being destruc- tive to all low forms of life. It is a local ansesthetic and a superficial escharotic, coagulating albumen and also the blood when out of the body. Taken internally undiluted it produces violent gastritis, vj of the pure acid having caused dangerous symptoms. It stimulates the cardiac inhibi- tion, first slowing, then depressing, and finally paralyzing the heart. Respi- ration, at first increased, is soon depressed, the pupils are contracted, and both 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 external use. It is partly oxidized in the blood, and partly eliminated by the lungs and kidneys, imparting to the urine a peculiar olive-green or smoky color. Locally applied Carbolic Acid produces on the skin or mucous membrane a white superficial eschar which succeeds to burning pain of short duration. Antidotes and Antagonists. Liquor Calcis Saccharatus, or the official Syrupus Calcis, given freely; or Sulphate of Sodium or Magnesium to form a Sulpho-carbolate, are the chemical antidotes. Vegetable demulcents (but no oils or glycerin) to protect the mucous surfaces. Atropine is a very complete physiological antagonist to the systemic symptoms, maintaining the heart and respiration until elimination occurs. Of Magnesium Sulphate nearly 3 ozs. were used in a case where oz. of 95 per cent, acid had been taken, resulting in full recovery from an apparently hopeless condition. Cider Vinegar may prove to be an antidote, as it removes the effects of the local application of the strong acid. Soap, in strong watery mixture (suds), is said to be almost a perfect antidote. Therapeutics. Carbolic Acid owes its prominence to its having been the principal agent used in the antiseptic method of treating wounds; but lately its employment in that connection has become much restricted, and many of the most prominent surgeons have abandoned it altogether in favor of other germicides. For nausea and vomiting it is an excellent remedy in -grain doses, and in many chronic pulmonary affections it is used with benefit by spray. It may be employed locally in acute and chronic 62 ACIDUM CHROMICUM. catarrhs, parasitic skin diseases, uterine and other ulcers, abscesses, boils, and carbuncles, endo-metritis, and perhaps in pulmonary phthisis. It has proven of temporary benefit in diabetes of hepatic origin. It has been injected parenchymatously (2 per cent, solution) in erysipelas, pleuro- pneumonia, intermittents, synovitis, lupus, chancroid, hydrocele, etc. The Sulpho-carbolates of Sodium, Potassium, Calcium, and Magnesium, have been employed advantageously in the septic diseases (as the exanthemata, diphtheria, puerperal fever), the object being to obtain the antiseptic and antipyretic actions of Carbolic Acid without its dangers. They may be used locally with good results in aphthae, tonsillitis, otorrhcea, gonorrhoea, and inflamed mucous membranes generally. ACIDUM CHROMICUM, Chromic Acid, Cr03,—is obtained by the action of Sulphuric Acid upon Potassium Chromate, and occurs in small crimson needle-shaped crystals, deliquescent and very soluble in water. Brought in contact with alcohol mutual decomposition takes place. A similar result and perhaps sudden combustion results when it is placed in contact with other easily oxidizable substances, such as Glycerin, Spirit of Nitrous Ether, etc. It is not used internally. Potassii Bichromas, Bichromate of Potassium, Iv2Cr207,—large, orange-red prisms of disagreeable, metallic taste and acid reaction, soluble in 10 of water at 590 F., and in 1 l/z of boiling water, insoluble in alcohol. Used locally in aqueous solution (gr. to the £), and internally in doses of gr. in trituration. Physiological Action and Therapeutics. Chromic Acid is a powerful escharotic, penetrating deeply, but slow of action and not very painful. It coagulates albumen and parts readily with its oxygen, oxidizing organic matter and decomposing ammonia and sulphuretted hydrogen. It is therefore an energetic disinfectant and deodorizer. When used as a caustic it is mixed with sufficient water to make a paste, which may be employed for the destruction of warts, hem- orrhoids and other superficial growths, the neighboring parts being pro- tected by cotton soaked in a strong alkaline solution. For syphilitic warts and condylomata, lupus, tinea tonsurans, etc., a solution of 100 grains to the 3 of distilled water is generally used. A solution of 1 in 40 is an excellent and inexpensive antiseptic lotion for putrid sores and wounds, syphilitic affections of the tongue, mouth and throat, ozsena, leucorrhcea, and gonorrhoea. In uterine catarrh and hemorrhages a solution of 120 grains to the 3 has been injected into the uterine cavity with good results. Bichromate of Potassium is a good antiseptic and an escharotic of milder action than the acid. In doses of 5ij-iv it has proved fatal to life in adults, with symptoms of gastro-enteritis, suppression of urine, and cardiac paralysis. It is chiefly employed as a local application in satu- rated solution to warts and venereal condylomata; and in dilute solution (gr. j-x to the 3) for catarrhal conditions of the nasal, buccal, or vaginal ACIDUM FLUORICUM ACIDUM GALLICUM. 63 mucous membrane. Internally it has been employed with benefit in loco- motor ataxia and in dyspepsia simulating gastric cancer ; also in chronic gastric catarrh, the tongue having a thick yellow coat, in chronic diarrhoea from intestinal ulceration, and in chronic ulcers of the pharynx and mouth. It is a good remedy in syphilitic sore throat, local rheumatism of the fibrous tissues, periosteal and syphilitic rheumatism, and acute catarrh and influenza, chronic nasal catarrh chronic laryngitis, and chronic catarrhal affections of the bronchial mucous membrane, especially when the expecto- ration is tough and stringy. It has also been used with some success in membranous croup and diphtheria. In pharmacy it is employed in the preparation of Chromic Acid and Valerianic Acid, and as a test solution. Most of the medical galvanic and faradic batteries are run by a mixture of this salt with Sulphuric Acid. Poisoning by it should be treated as directed for that by mineral acids. ACIDUM FLUORICUM, Fluoric Acid, HF (Unofficial),—is a strong escharotic, acting deeply and leaving a dry and painful slough. The dilute acid (i in 200) is prepared by acting on fluor spar by Sulphuric Acid, the resulting gas being dissolved in water. Its dose is npxx-xxx, well diluted. Dilute Fluoric Acid has been successfully used as an internal remedy in goitre, and the gas has been inhaled with benefit in diphtheria and mem- branous croup. ACIDUM GALLICUM, Gallic Acid, HC7H505.H20,—is a nearly colorless solid in long needles or triclinic prisms, having a slightly acid and astringent taste, soluble in too of water and in 4y2 of alcohol at 590 F., and in 3 of boiling water. It is prepared from a paste of pow- dered galls (see Galla), by fermenting for six weeks, boiling and reboil- ing in water, filtering and crystallizing. According to some authorities the Tannic Acid of the galls is split up into Gallic Acid and glucose by fer- mentation ; but according to others the glucose is an impurity and the Tannic Acid is simply converted into two parts of Gallic Acid, CuH10O9 -f- H20 = (HC7H505)2. Dose, gr. v-xv, in solution, pill or powder. Acidum Pyrogallicum, Pyrogallic Acid, Pyrogallol, Tri-hydroxv- benzene, C6H3(HO)3 (Unofficial),—is obtained from Gallic or Tannic Acid by careful heating. Dose gr. j-ij. Preparations. Unguentum Acidi Gallici,—is a 10 per cent, ointment, with a basis of Benzoinated Lard. 64 ACIDUM HYDROBROMICUM DILUTUM. Vegetable Astringents depend for their medicinal value upon the Gallic and Tannic Acids contained in them. Such are— Alnus, Alder Bark. Castanea, Chestnut Leaves. Catechu, Catechu. Diospyros, Persimmon. Galla, Nut Galls. Geranium, Cranesbill. Granatum, Pomegranate. Hamamelis, Witch Hazel. Hsematoxylon, Logwood. Heuchera, Alum Root. Kino, Kino. Krameria, Rhatany. Myrica, Wax Myrtle. Nymphaea, Pond Lily. Quercus Alba, Oak Park. Rosa Gallica, Red Rose. Rubus, Blackberry. Statice, Alarsh Rosemary. Gallic Acid, and its congener Tannic Acid, are astringents, the former being the more feeble of the two. They differ in that Tannic Acid coagu- lates albumen and gelatin, while Gallic does not. Tannic Acid is con- verted by the organism into Gallic and Pyrogallic Acids, in which forms it is absorbed and excreted. According to some authorities the difference between Gallic and Tannic Acids is one of oxidation, according toothers of hydration ; the latter assuming Tannic Acid to be simply Gallic Acid Anhydride. They 'constringe the muscular tissue in the walls of the minute vessels, thus checking secretion and hemorrhages and cutting short local inflammations. Except in enormous doses they are harmless. [Compare Acidum Tannicum.] Pyrogallic Acid may act as an intense poison, having been absorbed from the surface with fatal results, preceded by vomiting and diarrhoea, rigors, and fever, black urine full of globulin, and disorganization of the blood-corpuscles. It has great affinity for oxygen and may be used as an antiseptic and disinfectant in i to per cent, solutions. Physiological Action. Antagonists and Incompatibles. Mineral acids, alkalies, per-salts of iron, and salts of antimony, lead, and silver are chemically incompatible. Therapeutics. Gallic Acid is preferred to Tannic Acid when an astringent action is desired upon remote parts, as the lungs, kidneys, etc., which can only be reached through the circulation. In hematuria, distant passive hemor- rhages, albuminuria, diabetes insipidus, bronchorrhoea, night-sweats, chronic diarrhoea, and chronic cystitis, it is a most useful remedy. Pyrogallic Acid has been used internally in two-grain doses for inter- nal hemorrhages. As an ointment (5j~oj) it is next to Chrysarobin as an efficient palliative in psoriasis, and has been used with good results in lupus and epithelioma, being supposed to attack the diseased nodules only, leaving the adjacent skin uninjured. ACIDUM HYDROCHLORICUM. 65 ACIDUM HYDROBROMICUM DILUTUM, Diluted Hy- drobromic Acid,—is composed of 10 per cent, of absolute Hydro- bromic Acid (HBr), and 90 per cent, of water. It is a clear, colorless, and odorless liquid, of a pungent acid taste, produced by decomposing Potassium Bromide by Sulphuric Acid and distilling. Dose, every three hours. Hydrobromic Acid has identical action on the nervous system and cir- culation with that of the Bromides. Added to a mixture of Quinine and water (ttlij to each grain of Quinine) it will produce a clear solution. In hysteria, congestive headaches, neuralgia, and nervous exhaustion, Hydrobromic Acid has been found useful. Used as a solvent of Quinine it retards cinchonism, and prevents the headache resulting from the full action of Quinine and Iron. As a substitute for the Bromides of Sodium and Potassium it is highly recommended, being much less depressant. It has been especially recommended in tinnitus aurium. Fothergill uses it for coughs of reflex or spasmodic nature, also for simple continued fever where there is cerebral disturbance. ACIDUM HYDROCHLORICUM, Hydrochloric Acid, Muriatic Acid,—is a liquid composed of about 32 per cent, of absolute Hydrochloric Acid Gas, HC1, and 68 per cent, of water. It is colorless and fuming, of specific gravity 1.160, pungent odor, intensely acid reaction and taste, and is obtained by the action of Sulphuric Acid upon Sodium Chloride, the resulting gas being carried through water which dissolves it. It is sometimes used as a caustic. Its union with basic substances forms salts, called Hydrochlorates (Muriates), of which four are official, viz. : the Hydrochlorates of Apomorphine, Morphine, Pilo- carpine, and Quinine, described under the titles of their respective bases. Preparations. Acidum Hydrochloricum Dilutum,—is a io per cent, solution of the absolute acid in water. Dose, iij-x. Acidum Arilro-hydrochloricum,—see under Acidum Niiricum. Physiological Action of the Mineral Acids. The mineral acids (Hydrochloric, Sulphuric, Nitric, Nitro-hydrochloric, and Phosphoric) resemble each other in general action so closely that they may all be described in this place. The strong acids are escharotic, abstracting the water of the tissues, combining with the albumen and other bases, and destroying the proto- plasm. They are very diffusible, redissolving the albumen after precipi- tating it (except Nitric Acid). Sulphuric and Phosphoric have a strong affinity for water, completely decomposing tissues to which they are 66 ACIDUM HYDROCHLORICUM. applied, and are therefore the most powerfully escharotic. Nitric Acid does not readily redissolve the albumen precipitated by it, which thus forms a barrier against the deep action of the acid. Sulphuric Acid chars or carbonizes the tissues black, while Nitric and Hydrochloric tan them yellow. The dilute acids produce a peculiar taste in the mouth and a sensation of roughness on the teeth. They stimulate the flow of saliva from the parotid and submaxillary glands, but have no action on the sympathetic saliva. They promote the alkaline intestinal secretions and excite the flow from ducts having an alkaline secretion (bile, etc.), but check that from those whose secretion is acid (gastric, etc.). Secretion generally is promoted by Nitric Acid, and lessened by Sulphuric, Hydrochloric acting between the other two. Given before meals, in small doses, they relieve acidity of the stomach by checking the production of the acid gastric juice. At first they aid digestion, being synergistic to the action of pepsin, but if continued they impair digestion by lessening the produc- tion of the gastric juice. They check fermentation and constipate the bowels, except Nitric Acid, which relaxes them. They render the urine slightly more acid than its normal reaction, but do not acidify alkaline urine as the vegetable acids do. They are all astringent to the tissues, Hydrochloric being weakest and Sulphuric the strongest in this respect. Alkalies to neutralize the acid ; oil, albumen, or milk, to protect the mucous membrane ; stimulants, Opium, Ammonia (intravenously) to combat the resulting depression of the vital powers. Antagonists and Incompatibles. Therapeutics of the Mineral Acids. All the members of this group are useful in fevers, if well diluted, Hydrochloric being usually preferred, especially in typhoid. In atonic dyspepsia, acidity of the stomach, and locally in ulcerations of the throat, Hydrochloric Acid is best used. Nitric is the acid generally preferred as a caustic, its action being effectual and superficial. As such it is applied undiluted to phagedenic ulcers and sloughs, warty growths, and to the cavity of the womb in chronic inflammation thereof. Dilute Nitric Acid is used internally in oxaluria and lithemia, intermittent and remittent fevers, and aphonia of singers. Dilute Nitro-hydrochloric is more suitable in chronic hepatic disorders due to malaria; Sulphuric in hemorrhages, diarrhoeas, colliquative sweating, and as a prophylactic against lead- poisoning. Dilute Sulphuric Acid is used as an acid drink in fevers, and before meals in acidity of the stomach. It is very doubtful whether the latter has any special influence on the nervous or osseous systems. All these acids act injuriously on the teeth, by attacking the enamel. They should always be administered largely diluted, taken through a straw ACIDUM HYDROCYANICUM DILUTUM. 67 or glass tube, and the mouth should at once be thoroughly rinsed with an alkaline solution. ACIDUM HYDROCYANICUM DILUTUM, Diluted Hy- drocyanic Acid, Prussic Acid,—is a liquid composed of 2 per cent, of absolute Hydrocyanic Acid, HCN, and 98 per cent, of alcohol and water. It is colorless, faintly acid, of peculiar odor, and is prepared by distilling solutions of Potassium Ferrocyanide and Sulphuric Acid together, or extemporaneously by adding 6 parts of Cyanide of Silver to a solution of 5 parts of Hydrochloric Acid in 55 of distilled water, shak- ing together and pouring off the supernatant liquid, ttpxl have proved fatal. Dose, rrpj-v. Preparations containing Hydrocyanic Acid. Aqua Laurocerasi, Cherry-laurel Water (Unofficial),—is a water distilled from the fresh leaves of Prunus laurocerasus, the common Laurel or Cherry Laurel, a small tree of the nat. ord. Rosaceae, sub-order Amygdalese. The leaves contain a variable amount of Hydrocyanic Acid and a volatile oil. Dose, tip v-xxx, cautiously. Scheele's Dilute Hydrocyanic Acid (Unofficial),—is a 4 or 5 per cent, solution, and is highly dangerous even by inhalation. Amygdala Amara, Bitter Almond (see its title), and its essential oil; also, various other members of the sub-order Amygdaleae, including the official Prunus Virginiana, perhaps the unofficial Prunus laurocerasus, and the leaves and kernels of the peach and cherry trees, contain a proximate principle Amygdalin, and a ferment Emulsin, which in the presence of water react with each other, forming Hydrocyanic Acid, a volatile oil, and glucose. C20H27NOU (Amygdalin) -}- 2H20 = C7H60 (Oil of Bitter Almond) HCN (Hydrocyanic Acid) -f- 2C6H1206 (Glucose). Other Cyanogen Compounds. Potassii Cyanidum, Cyanide of Potassium, KCN,—a white, opaque salt, of alkaline reaction, bitter-almond taste and a peculiar odor when moist; soluble in 2 of water at 590 F., sparingly soluble in alcohol. Dose, gr. Locally a solution of gr. j-v to the S- Potassii Ferrocyanidum, Ferrocyanide of Potassium, K4Fe(CN6)63H20,— large, lemon-yellow prisms or tablets, efflorescent, odorless, of sweetish taste and neutral reac- tion, soluble in 4 of water, insoluble in alcohol. Employed in pharmacy as a test solu- tion, and in the preparation of Ferrocyanide of Iron, Diluted Hydrocyanic Acid and the Cyanides of Potassium and Silver. Rarely used medicinally. Dose, gr. v-xv. Physiological Action. Prussic Acid is one of the most powerful and rapid poisons known, half a grain having proved fatal. Its action on the organism is one peculiar to itself, the inhalation of a strong preparation producing rapid insensibility and almost immediate exhaustion;—death from a full dose occurring by sudden paralysis of the heart, from a less but still a fatal dose, by paralysis of respiration. The symptoms are those of sudden and complete asphyxia, and some volitional movements may be made before death, unless the dose be very large. In cases in which the dose, though fatal, permitted of the observance of its effects, they were usually divisible into two marked stages, viz. : (1) Dyspnoea, slow and full pulse, giddiness, loss of muscular power. (2) Vomiting, dilated pupils, uncon- 68 acidum hydrocyanicum dilutum. sciousness, spasms, muscular rigidity, and cessation of the heart’s action. In poisonous, but not fatal doses, the following effects have been observed: feeble pulse, dilated pupils, turgid and dusky face, insensibility, convul- sions or rigidity, but no paralysis. Large medicinal doses may produce salivation, irritation of the throat, dizziness, buzzing in the ears, head- ache, numbness, dusky countenance, staggering gait, sense of constriction of the chest, palpitation of the heart, a frequent or an abnormally slow pulse, a sense of great weariness and drowsiness. Post-mortem examina- tion shows usually dilated pupils, the eyes having a marked glassy lustre, the cadaveric rigidity very great. The blood, in cases which have been rapidly fatal, may show the arterial color in both the arterial and the venous systems; but in slower cases it is dark and fluid, engorging both sides of the heart, the venous trunks, and the cerebral sinuses. The par- alyzant action of the drug is chiefly exercised on the nerve-centres in the medulla; next on the peripheral afferent nerves, the spinal cord, the motor nerves, and finally on the muscular tissue. It stops the heart by irritation of the vagus-roots in the medulla, as well as by paralyzing the cardiac motor ganglia. It is said to form with haemoglobin a compound (cyan-haemoglobin), which does not readily give up oxygen. The odor of the acid is fragrant, resembling that of bitter almonds or peaches, and may be detected in the lungs shortly after death. The effects of a medi- cinal dose pass off in an hour at farthest. Locally applied to the skin, Hydrocyanic Acid penetrates the epider- mis and paralyzes the end-organs of the sensory nerves in the derma. It is rapidly absorbed from mucous surfaces. Cyanide of Potassium has similar action, but in addition has some few peculiar to itself. Locally used it produces dermatitis, with an ecze- matous eruption, and if applied to an abraded surface freely may cause fatal effects. Internally it has proved fatal in doses of 3 to 5 grains, with all the symptoms of Prussic Acid poisoning, but its action is less rapid. It is much used in photography, and many cases of poisoning by it have occurred in persons employed in that art. Antagonists and Antidotes. Atropine has antagonistic action, but is too slowly diffused to be of any value. Ammonia by inhalation, by the stomach, and by intra-venous injection, with cold affusion to the spine, and artificial respiration, are the measures most likely to avail in cases of poisoning where there is time to do anything. In poisoning by Potassium Cyanide give the Sulphate of Iron, producing Ferrocyanide of Iron (Prussian Blue). Then evacuation of the stomach, artificial respiration, and Ammonia by intra-venous injection. Hydrocyanic Acid is used for its antispasmodic and sedative effects. In vomiting, whooping-cough, and coughs of spasmodic character, in asthma and other neuroses of the respiratory organs, in affections involving Therapeutics. ACIDUM LACTICUM. 69 the pneumogastric nerve, vertigo and headache from stomachal derange- ments, gastralgia, painful dyspepsia, vomiting, etc., it is very efficient as a palliative. In acute mania and melancholia it has been used with advantage ; and in various skin diseases, accompanied by itching, tingling, etc., its use as a lotion (npxxx-5j ad 3j Aquae Rosae) to the unbroken surface is prompt in relieving the pruritus and other distressing sensations. Cyanide of Potassium in ointment (gr. v ad 5j) is used to allay pruritus, and in solution (gr. iij-v ad 5j) is applied locally with benefit in reflex headaches, and is used as a wash to remove nitrate of silver stains’. It has been used.internally in doses of gr. j for acute articular rheumatism, but such employment of it is highly dangerous. Ferrocyanide of Potassium has been used in doses of 8 to 15 grains as an astringent and anodyne, but it is seldom employed in medicine. Cherry-laurel Water has been extensively used as a flavoring agent, having a very agreeable taste. It is official in the British Pharmacopoeia, and is supposed to be a rather elegant mode of administering Prussic Acid ; but the uncertainty of its strength is such that it should never be used internally, except in very small quantities. It has been employed as an anaesthetic injection into the urethra prior to catheterization, and was formerly employed by ophthalmologists as an eye-wash in painful affections of that organ. ACIDUM LACTICUM, Lactic Acid,—is a liquid composed of 75 per cent, of absolute Lactic Acid (HC3H503) and 25 per cent, of water; nearly colorless, syrupy, odorless, of acid taste and reaction, freely mis- cible with water, alcohol and ether, but nearly insoluble in chloroform. It is produced by the fermentation of sugar of milk, has asp. gr. of 1.212, and is difficult to obtain pure. It enters into Syrupus Calcii Lactophos- phatis. Dose, 5ss-§ss, well diluted. Physiological Action and Therapeutics. Lactic Acid is found in the stomach as a product of the food, and com- bines with bases in the blood, forming lactates, which, being oxidized, are converted into carbonates. It aids digestion and promotes the appe- tite, but, in large doses, causes flatulence and much epigastric pain. Injected into the peritoneal cavity of animals, it excites endocarditis, and given in diabetes, it has produced acute rheumatism and rheumatic endo- carditis. Hence its supposed causation of acute rheumatism when in excess and free in the blood. It dissolves false membranes and the phosphate of calcium. It is used with benefit in diabetes, atonic dyspepsia, oxaluria, and in the lithic and phosphatic diatheses when due to imperfect digestion and 70 ACIDUM NITRICUM. assimilation. As a solvent of false membrane in croup and diphtheria it is unquestionably of great service. In chronic cystitis it arrests the ammoniacal decomposition of the urine. As the acid found in the shops is generally of poor quality, disappointment in its use may be expected. ACIDUM NITRICUM, Nitric Acid,—is a liquid composed of 69.4 per cent, of absolute Nitric Acid, HN03, and 30.6 per cent, of water. It is colorless, fuming, very caustic and corrosive, of sp. gr. 1.420, strongly acid in reaction, and is obtained by the action of Sulphuric Acid on Nitrate of Potassium. Is only used externally as a caustic. I Preparations. Acidum Nitricum Dilution, Diluted Nitric Acid,—has of the above 1 part in 6 of Distilled Water, and contains 10 per cent, of absolute Nitric Acid. Dose Ttp iij—xv, well diluted. Acidum Nitrohydrochloricum, Nitrohydrochloric Acid, Nitromuriatic Acid, Aqua Regia,— a golden yellow, fuming, corrosive liquid, composed of Nitric Acid 4 parts, Hydrochloric Acid 15 parts. Is wholly volatilized by heat, readily dissolves gold-leaf, and a drop added to test-solution of Potassium Iodide liberates Iodine in abundance. Dose, rrpj-viij, well diluted. Acidum Nitrohydrochloricum Dilutum, Diluted Nitrohydrochloric Acid,—consists of Nitric Acid 4, Hydrochloric Acid 15, Water 76 parts. Dose, Tty v-xx, well diluted. Physiological Action and Therapeutics. The action and uses of these agents are herein described with those of the other mineral acids, under the title Acidum Hydrochloricum (see ante, page 65). Some special properties are as follows :— Nitric Acid is an exceedingly powerful escharotic, but, as it coagulates and does not redissolve the albumen of the tissues, it forms a barrier to its own excessive action. The vapor may cause oedema of the glottis, intense bronchitis, etc., and death from suffocation. It is used for the destruction of chancres, warts, hemorrhoids, phagedenic ulcers, etc. ; and internally in dilute form for bilious affections, as it is supposed to have a selective action on the liver. It also lessens phosphatic deposits in the urine, and acts as an astringent in the system, diminishing profuse secre- tion in bronchorrhoea and phthisis. Nitrohydrochloric Acid is also supposed to specially affect the liver. It is usefully employed in jaundice, dyspepsia, and the so-called bilious condition; also in frontal headache, situated just above the eyebrows, when unaccompanied by constipation, and in acidity of the stomach. In hepatic disorders it may be used in dilute form as baths, or applied to the hepatic region on compresses. The official dilute acid is of little use therapeutically, as it rapidly deteriorates, and the same may be said of the strong acid when standing long enough for the color to change to a lemon- yellow. The most efficient preparation is the strong acid freshly pre- pared, when it is of an orange-red color. This should be properly diluted when required for use, and should be constantly protected from light. ACIDUM OLEICUM—ACIDUM PHOSPHORICUM. 71 ACIDUM OLEICUM, Oleic Acid, HC18H3302, is one of the constituent acids of oils and fats, obtained commercially as a secondary product in the manufacture of stearin candles. It is a yellowish oily liquid, semi-solid at 570 F., odorless, tasteless, and of neutral reaction, insoluble in water but soluble in alcohol, chloroform, benzol, benzin, turpentine, and the fixed oils. It dissolves most of the metallic oxides and the un- combined alkaloids, forming the so-called Oleates, which, however, are not pure chemical compounds, but merely compounds of the oxides or alkaloids, as the case may be, with oleic acid, dissolved in great excess of the latter. Two of these are official, viz.— Preparations. Oleatum Hydrargyri, Oleate of Mercury—has 10 per cent, of the Yellow Oxide of Mercury, with 90 of Oleic Acid. Oleatum Veratrince, Oleate of Yeratrine—has 2 per cent, of Veratrine in 90 of Oleic Acid. Unofficial Preparations. Oleates (Oleata) of Aconitine (2 per cent.), Atropine (2 per cent.), Morphine (10 per cent.), Morphine and Mercury (2 per cent, morphine and 20 per cent, mercuric oxide), Quinine (25 per cent.), Strychnine (2 per cent.), Arsenic (gr. xx of oleate of arsenic to the fy), Aluminium, Bismuth, Copper, Iron, Lead, Silver, Zinc, etc., are prepared by the manufacturing pharmacists, and are to be obtained in the shops. Most of them answer to the description given above, but several are Oleo-palmitates, or double salts of Oleic and Palmitic Acids, being prepared from oils which yield the latter acid in considerable quantity. Drs. Shoemaker and Wolff, of Philadelphia, have introduced, under the above names, several solid or semi solid preparations, which they claim to be chemically true oleates, salts having no excess of either their acid or basic radicals. They are produced by the double decomposition of sodium oleate with solutions of neutral salts, the precipi- tates, washed and dried, being the oleates required. These oleates are claimed to be more stable than the official oleic solutions, and using less oleic acid are much less costly. Many of them may be used as dusting powders, or mixed with oil or lard to form ointments. Physiological Action and Therapeutics. Oleic Acid is only used in making the Oleates, which were introduced by Marshall, in 1872, as substitutes for ointments, being cleaner, more elegant, and more penetrating, but decidedly more irritating if applied with friction. Their medicinal properties depend upon the bases employed, hence their actions and uses will be described under the corresponding basic heads. They should usually be diluted with an equal bulk of vase- line or olive oil before being rubbed into the skin, or they may produce a cutaneous eruption or even pustulation. As a rule they should be lightly spread over the surface with the finger or a brush. As parasiticides, the Oleates of Copper and Mercury are most efficient, and in skin diseases generally these preparations are rapidly coming into favor. ACIDUM PHOSPHORICUM, Phosphoric Acid,—is a liquid composed of 50 per cent, of Orthophosphoric Acid, H3P04, and 50 per cent, of water, and is obtained by oxidizing Phosphorus by Nitric Acid. It is strongly acid, odorless, colorless, and of sp. gr. 1.347. 72 ACIDUM PICRICUM ACIDUM SULPHURICUM. Preparations. Acidum Phosphoricum Dilutum, Diluted Phosphoric Acid, has of Phosphoric Acid 20 parts in 80 of Distilled Water, sp. gr. 1.057, and contains 10 per cent, of Orthophos- phoric Acid. Dose, v-xxx, in sufficient water. Phosphates of Ammonium, Ferrum, and Sodium, and the Syrupus Ferri, Quininse et Strychninse Phosphatum, are described under Phosphorus. Physiological Action and Therapeutics. The action and uses of Phosphoric Acid are described with those of the other Mineral Acids under Acidum Hydrochloricum (see ante, page 65). It may be given in larger doses than the other acids without derang- ing digestion, and is therefore preferred in cases requiring acid treatment for a long period, as in diabetes, etc. It is considered of especial value in strumous affections, and it is thought to diminish the growth of osseous tumors, and to dissolve phosphatic deposits. As it contains no free phos- phorus, it cannot be used to obtain the effects of that drug. ACIDUM PICRICUM, Picric Acid, Carbazotic Acid, Trini- trophenol, C6H3(N02)30 (Unofficial),—is obtained by the action of Nitric Acid on Carbolic Acid, or many other substances. It has recently been introduced as a test for albumen and sugar in the urine. A saturated aqueous solution has been used locally in erysipelas with some advantage. Some of its salts (Picrates of Ammonium, Iron, etc.) have been tried therapeutically, without any particular results. Powers as an antiperiodic and anthelmintic and against trichinse have been urged for it, but expe- rience has not supported these claims. Dose, gr. v-xv per diem. Ammonium Picrate, in doses of gr. to gr. jss, in pill, four times daily, has been used in the malarial fevers of India, in over 10,000 cases with most effective results. ACIDUM SULPHURICUM, Sulphuric Acid,—is a strongly caustic and corrosive liquid, oily, inodorous, of strong acid reaction, composed of not less than 96 per cent, of absolute Sulphuric Acid (H2S04) and 4 per cent, of water. It is obtained by the combustion of Sulphur and its oxidation by nitrous fumes. Its specific gravity should not be below 1.840, and it is miscible in all proportions with water and alcohol, with evolution of heat. Occasionally used as a caustic. Preparations. Acidwn Sulphuricu?7i Dilutum, Diluted Sulphuric Acid,—has of the strong acid 1 part to 9 of distilled water. Dose, v-xv, well diluted. Acidum Sulphuricum Aromaticum, Aromatic Sulphuric Acid, Elixir of Vitriol,—is Sulphuric Acid 20 per cent., diluted with Alcohol and flavored with Cinnamon and Ginger. It is not an acid, but rather an ether formed by reaction between the acid and the alcohol. Dose, rfl, v-xv, well diluted. Physiological Action and Therapeutics. The action and uses of Sulphuric Acid generally are described with those of the other Mineral Acids under Acidum Hydrochloricum (see ACIDUM SULPHUROSUM. 7 3 ante, page 65). Its chief use internally is in lead-poisoning, to form the insoluble sulphate, and as a remote astringent in diarrhoea, hemorrhoids, hemorrhages, night-sweats, and mucous discharges. In choleraic diar- rhoea and lead poisoning it is generally administered in combination with Opium. The hemorrhages in which it is efficient are only those from mucous surfaces. It is exerted chiefly by the kidneys, part escaping by the bowels as sulphates, part also by the skin. Like the other mineral acids, it does not increase the acidity of the urine to any considerable extent. Its principal actions are those of an astringent, an anhydrotic and a hemostatic. ACIDUM SULPHUROSUM, Sulphurous Acid,—is .a color- less liquid, of sulphurous taste and very acid reaction, composed of about per cent, of Sulphurous Acid Gas (S02) and 96*4 per cent, of water. It is prepared by heating Sulphuric Acid with charcoal and dissolving the gas produced in distilled water. Dose, upv-oj, largely diluted with water. Preparations. Potassii Sulphis, Sulphite of Potassium, K2S03.2H20.—white, opaque, octahedral crystals, or a crystalline powder, somewhat deliquescent, of bitter, saline, and sulphurous taste, and a neutral or feebly alkaline reaction; soluble in 4 of water at 590 F., and in 5 of boiling water; sparingly soluble in alcohol. Dose, gr. iij-x. Sodii Sulphis, Sulphite of Sodium, Na2S03.7H20, colorless, transparent, monoclinic prisms, efflorescent in dry air, of cooling, saline, and sulphurous taste, and neutral or feebly alkaline reaction; soluble in 4 of water at 590 F., and in 0.9 of boiling water, very slightly soluble in alcohol. Dose, gr. v—xx. Sodii Bisulphis, Bisulphite of Sodium, NaHS03,—opaque prismatic crystals, or a crystalline or granular powder, slowly oxidized in the air; of faint, sulphurous odor, a disagreeable taste, and an acid reaction ; soluble in 4 of water and in 72 of alcohol at 590 F., in 2 of boiling water, and in 49 of boiling alcohol. By strong heat it is con- verted into sulphur and sulphate of sodium. Dose, gr. iij—x. Sodii Hyposulphis, Hyposulphite of Sodium, Na2S203-5H20,—large, colorless, mono- clinic prisms or plates, efflorescent in dry air, of cooling and bitter taste, and neutral or faintly alkaline reaction; soluble in 1.5 of water at 590 F., and in 0.5 of boiling water, which partly decomposes it; insoluble in alcohol. Dose, gr. v-xx. Magnesii Sulphis, Sulphite of Magnesium, Mg,S03.6H20,—a white, crystalline pow- der, gradually oxidized in the air, of bitter and sulphurous taste, and neutral or slightly alkaline reaction; soluble in 20 of water at 590 F., and in 19 of boiling water; insoluble in alcohol. Dose, gr. v-xxx. Antagonists and Incompatibles. All oxidizing substances change the Sulphites into Sulphates, and the mineral acids decompose them. Physiological Action. Sulphurous Acid has great affinity for oxygen, and is a powerful dis- infectant and deodorizer, and very destructive to all plant life. The gas inhaled is irritant to the glottis, and may produce dangerous inflammation of the respiratory passages. The Sulphites and Hyposulphites are partly decomposed by the acid of the stomach, sulphurous acid being given off, and the balance being converted into sulphates act as purgatives, and are absorbed, undergoing 74 ACIDUM TANNICUM. elimination as sulphates by the kidneys and bowels. They were formerly supposed to enter the blood and tissues as sulphites, and to arrest morbid processes of the zymotic character, but both these assumptions have proven erroneous. Therapeutics. Sulphurous Acid Gas (Sulphurous Anhydride) is extensively used as a disinfectant, being the most powerful and convenient agent for this pur- pose. Sulphur is burned on a shovel or plate in the room to be fumigated, all outlets having been carefully closed. It is injurious to many fabrics. Sulphurous Acid is used locally in many throat affections as a spray or by a mop. In diphtheria, stomatitis, aphthae, ulcers of the tonsils, syphilitic and tuberculous laryngitis, chronic bronchitis, etc., it may be thus applied with great benefit. Morbid fermentation in the stomach with growth of penicillium and sarcinae is quickly stopped by 5 to 60-minim doses in water, or by the sulphites in 20-grain doses. In parasitic skin diseases and foul wounds these agents are extremely useful as local appli- cations. The Sulphites were used in zymotic and septic fevers as internal anti- septics on theoretical grounds, but their supposed value has not been realized. ACIDUM TANNICUM, Tannic Acid, Tannin, CuH10O9,—is a solid body in light-yellowish scales, of strongly astringent taste and acid reaction, obtained from powdered galls (see Galla), by exposure for three days in a damp atmosphere, then macerating with ether, pressing, and drying the liquid portion. It is soluble in 6 parts of water, in 0.6 of alcohol, and in 6 of glycerin at 590 F. Dose, gr. j-xx in water, pill or capsule. Preparations. Unguentum Acidi Tannici,—is a 10 per cent, ointment made with Benzoinated Lard. Trochisci Acidi Tannici,—each troche contains one grain of Tannic Acid. Collodium Stypticum.—Styptic Collodion,—has of Tannin 20, Alcohol 5, Ether 20, Collodion 55 parts. Suppositoria Acidi Tannici (Unofficial),—have Tannin I part to 5 of Cacao Butter. Glyceritum Acidi Tannici (Unofficial),—has Tannin 1 part in 4 of Glycerin. Vegetable Astringents contain some form of tannic acid, as Quercitanic Acid from Oak-bark, Rhatania-tannic Acid in Rkatany, etc. (For list, see page 64.) The official acid is Gallo-tannic Acid, being that produced from Galls. Antagonists and Incompatibles. Mineral acids, alkalies, persalts of iron, and salts of antimony, lead and silver, are chemically incompatible. Vegetable alkaloids and gelatin form insoluble precipitates with Tannic Acid. Physiological Action. Tannic Acid is a powerful astringent. It precipitates pepsin and coagulates albumen, impairs digestion, stops peristalsis, and causes con- stipation. A part of that taken into the stomach unites with the pepsin ACIDUM TARTARICUM ACONITUM. 75 and albumen, while a part is converted into Gallic and Pyro-gallic Acids, and in this form is both absorbed and excreted. It is a crystalloidal body, but combines with colloids, and is a valuable antidote in poisoning by the alkaloids and tartar emetic, with which it forms tannates which are nearly insoluble. Its continued use disorders digestion, irritates the mucous membranes, and produces emaciation. Injected into the veins it forms emboli and thus may cause death, but by the stomach it is non-toxic. Some authorities hold that Tannic Acid is merely Gallic Acid Anhydride ; others believe that the difference between them is one of oxidation. Gallic Acid does not coagulate albumen or gelatin, while Tannic Acid does. Therapeutics. Tannic Acid is a more powerful astringent than Gallic Acid, and hence is preferred for local use and for astringent effect on the intestinal canal. It is well employed in hemorrhoids and hemorrhages from the lower bowel, in hematemesis, epistaxis, rectal ulcers or fissures, catarrhs and chronic affections of the mucous membranes, endocervicitis, conjunctivitis, dysen- tery and diarrhoeas, eczema, impetigo and other forms of skin-disease, otorrhoea, bed-sores, prolapsus ani, and many other affections. Styptic Collodion is used to stanch the bleeding from an open wound, to unite and protect incised or lacerated wounds, and to cover and change the character of foul ulcers. ACIDUM TARTARICUM, Tartaric Acid, H2C4H406,—is a crystalline acid, prepared from Acid Tartrate of Potassium (Cream of Tartar), by neutralizing a solution thereof with Chalk and Calcium Chlor- ide, then decomposing the Tartrate of Lime thus formed by Sulphuric Acid, evaporating and purifying. It occurs in colorless, transparent prisms, which are odorless, of acid taste and reaction, and soluble in 0.7 of water and in of alcohol at 590 F. Twenty grains exactly neutral- ize 27 of Potassium Bicarbonate, 22 of Sodium Bicarbonate, or 15y2 of Ammonium Carbonate. Dose, gr. x-xxx. Tartaric Acid is an ingredient of the Effervescing Powders (see under Potassium), and is used in making all the preparations of Aconite. Five Tartrates are official (see Index). Preparations. The actions and uses of Tartaric Acid are similar to those of the other Vegetable Acids, as described under Acidum Aceticum {ante, page 58). It is chiefly employed in preparing refrigerant drinks. ACONITUM, Aconite ,—is the tuberous root of Aconitum Napel- lus, a perennial plant of the nat. ord. Ranunculacese, found in mountain- 76 ACONITUM. ous regions of Europe, Asia and N. America. This plant has deep-blue, helmet-shaped flowers, and leaves which have deeply-cut, wedge-shaped segments, exciting slowly when chewed a sensation of tingling in the tongue and lips. The root is conical and tapering, from 2 to 3 inches long, dark-brown externally, whitish internally, having a thick bark enclos- ing a seven-rayed, star-shaped pith, odorless, taste sweetish at first, soon becoming acrid. A minute portion, cautiously chewed, causes prolonged tingling and numbness. Its active principle is the alkaloid Aconitine (see below), which it contains in the proportion of .03 per cent. It also con- tains gum, sugar, Aconitic Acid, and several other principles, viz.—Aco- nine, Napelline, Pseudaconitine, Lyctonine, etc., concerning which there is much diversity of opinion. Dose, gr. J^-ij. Other aconite-roots are those of A. Cammarum, A. ferox, and the Chinese or Japanese Aconite, A. Chinense vel Japonicum. From the latter an alkaloid is obtained, named Japaconitine, which is even more poisonous than pseud-aconitine. The Indian variety (A. ferox) contains pseud- aconitine but does not yield aconitine. The former is considered to be more active than the latter, and Japaconitine more so than either the other twro. Abstractum Aconiti,—is twice the strength of the powdered drug or its fluid extract. Dose, gr. %-y Extractum Aconiti,—is at least four times as strong as the extract official in the U. S. P., 1870, which was prepared from the leaves, and is yet to be found in the shops. Dose, gr- Extractum Aconiti E'luidum,—each drop represents nearly one grain of the powdered drug: an alcoholic preparation. Dose, Tryy£-ij. Tinctura Aconiti,—Aconite 40, Tartaric Acid 0.4, Alcohol to 100 parts. Is about twenty-eight times as strong as the former tincture of the leaf. Dose, n^j^-iv. Tinctures of Aconite root vary greatly in strength. In Fleming’s Tincture 79 parts of aconite are used in preparing 100 of the tincture, in that of the Br. P. 16, the French 20, the German 10, while the Linimentum Aconiti (B. P.) is really a very strong tincture, of the strength of 1 to iff. Probably the best and safest preparation for ordinary use is a 10 per cent, tincture, of which the maximum single dose for an adult is stated in the P. Ger. at Tty ix, and the maximum daily dose at xxxv. The best rule for the administration of aconite preparations is to give the minimum dose at intervals of 15 to 20 minutes, until the desired effect is produced. Preparations. Unofficial Preparations. Aconitina, Aconitine, C33H43N012,—a white, and usually amorphous solid, of alka- ine reaction, soluble in 150 of cold and in 50 of hot water; much more soluble in alco- hol and ether. Is difficult to obtain of constant strength, some samples being all but inert, others extremely active. As obtained in the shops it is usually a mixture of several alka- loids. The Aconitine Crystalisee of Duquesnel, which, according to Squibb, is a nitrate of aconitine, is considered to be the most active of those in the market. Dose, gr. i _ 1 2tro otr Oleatum Aconitines, Oleate of Aconitine,—is a 2 per cent, solution in Oleic Acid, for external use. Duquesnel’s crystals will not dissolve in Oleic Acid (Squibb). Napellina, Napelline,—is weaker than Aconitine, and has been used in doses of gr. . It has lately been studied by Laborde, who claims for it most valuable hypnotic properties, and proposes to use it as a substitute for opium and chloral. St. Jacob's Oil (a patent medicine),—is a weak Aconite Liniment, which also contains Ether, Alcohol, Turpentine, red coloring matter and water (Squibb). See Appendix. ACONITUM. 77 Physiological Action. Aconite is a powerful depressant of the sensory nerve ends, the heart, the respiration and the spinal system. It is also antipyretic, diaphoretic and diuretic. It acts chiefly on the peripheral ends of the sensory nerves, but paralyzes both the motor and sensory nerves—the sensory being affected first and from the periphery inwards, while the motor nerves are affected from the centres outwards. It relaxes the inhibitory apparatus of the heart, and paralyzes the cardiac muscle and its contained ganglia, the respiratory centres, and the spinal cord in all its functions—sensory, reflex and motor ; but does not affect the cerebrum. Its taste is bitter, acrid and pungent. Soon after the ingestion of even a small quantity, a sensation of numbness and a persistent tingling are felt in the tongue and lips. Full medicinal doses cause a sense of con- striction in the fauces, irritation of the gastro-intestinal 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, cardiac rate and force ; lowered arterial tension and temperature. A lethal dose produces great muscular weakness, dim sight, dilated (sometimes contracted) pupils; shallow, irregular, and labored respiration, slow and weak pulse, cold surface, clammy sweat, great anxiety, numbness and tingling in the extremities, lowered body-temperature (2° to 30), abolished sensation, impaired reflexes and motility, and finally death from paralysis of the heart and respiration, with or without convulsions, con- sciousness being preserved until near the end, when C02 narcosis sets in. 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. Antagonists. Caffeine, Atropine, Morphine, Ether, Ammonia and Amyl Nitrite antagonize its effects on the heart and respiration. Digitalis counteracts its heart action and the relaxa- tion of cardiac inhibition. 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. Caffeine maybe administered hypo- dermically and per orem. Therapeutics. Aconite antagonizes the fever process, and rightly used is therefore one of the most valuable drugs we possess. It has well been called the “ therapeutic lancet,” and is certainly responsible to a great extent for the disuse of venesection. Its power over the circulation, respiration and transpiration renders it of the greatest value in all affections characterized by high resisting pulse, dry hot skin, and elevated body-temperature. It is especially useful in acute throat affections, the early stage of acute ADEPS yETHER. inflammations of the respiratory organs, catarrhal croup, acute pleuritis and peritonitis before the stage of effusion, simple and eruptive fevers, puerperal and surgical fevers, facial erysipelas, acute rheumatism, cardiac affections with overaction or hypertrophy and without valvular lesion, diarrhoea and dysentery from cold or exposure, menstrual suppression from chill, and neuralgia of the 5th (externally and internally), it having a very positive and selective influence on that nerve. It is also highly recommended in otitis, nervous palpitations, restlessness, and sick head- ache, as also in the acute stage of gonorrhoea. Aconite is best administered in small doses frequently repeated; from half a drop to a drop of the tincture every fifteen minutes in a teaspoon- ful of water as a rule give better results than do proportionately larger doses at longer intervals. Aconitine has been remarkably efficient in trigeminal neuralgia;—so also has Napelline been in the same affection, and as an hypnotic it is well mentioned by several observers of authority. ADEPS, Lard ,—is the prepared internal fat of the abdomen of Sus scrofa (Pig), purified by washing, melting and straining. A soft, white, unctuous solid, of bland taste and neutral reaction, entirely soluble in ether, benzin, and bisulphide of carbon; composed of 38 per cent of stearin and margarin, and 62 per cent, of olein. Lard forms 70 per cent, of Ceratum, and 80 per cent, of Unguentum, and enters into the composition of several of the official cerates. Preparations. Adeps Benzoinatus, Benzoinated Lard,—has 2 per cent, of Benzoin in powder incor- porated by stirring. Oleum Adipis, Lard Oil,—is a fixed oil expressed from lard at a low temperature. The actions of the Oils and Fats will be described under Oleum (which see). Lard is only used as an ingredient of ointments and cerates. Lard Oil is used in making the Unguentum Hydrargyri Nitratis, but has been proposed as an inferior substitute for Cod-liver oil in cases where the taste of the latter is particularly offensive. ./ETHER, Ether, Ethyl Oxide (C2H5)20,—in its absolute form is not official, the strongest preparation containing 6 per cent, of alcohol and some water. Considered as a generic term, an ether is analogous to a salt, as an alcohol is to a metallic hydrate. The particular ether officially so named is Ethyl Oxide, prepared from Ethyl Hydrate (Ethylic Alcohol) by a dehydrating agent with the aid of heat, and then purified by various processes. The agent used is Sulphuric Acid, hence this ether is improperly called “Sulphuric Ether,” but the acid simply dehydrates yETHER, 79 the alcohol and remains in the retort, becoming constantly more diluted by the abstraction of water from the alcohol. Consequently H20 is the difference between Alcohol and Ether. (C2HG0)2—H20 = (C2H5)20. The official ethers are the three following, viz.— Ether, Ether,—is a liquid composed of about 74 per cent, of Ethyl Oxide, and about 26 per cent, of Alcohol containing a little water; an inflammable, thin, very diffuse, clear and colorless liquid, having a burning, sweetish taste, and a neutral reaction, of sp. gr. about 0.750 at 590 F. Its vapor is heavier than air and forms therewith a highly explo- sive mixture. Ether is freely soluble in alcohol, chloroform, benzol, oils, and in 8 volumes of water at 590 F. It boils at the temperature of the body (98.6°), and is a solvent of oils, fats, resins, caoutchouc, gutta- percha, and many other substances. It has chiefly a pharmaceutical value. Ether Fortior, Stronger Ether,—is a liquid composed of about 94 per cent, of Ethyl Oxide, and about 6 per cent, of Alcohol containing a little water. Sp. gr. not above 0.725 at 590 F. It is the preparation employed for anaesthetic use, and is generally though improperly called “ Sulphuric Ether,” a term which belongs to Ethyl Sulphate (C4H10SO4). The dose of Ether Fortior for internal administration is npx-5j, in syrup. .Ether Aceticus, Acetic Ether, Acetate of Ethyl, C2H5C2H30,—is an inflammable liquid, transparent and colorless, of ethereal and acetous odor, soluble in alcohol, ether, chloroform, and 17 of water. Sp. gr. 0.889 to 0.897. Is a constituent of Sp. Odoratus and Tr. Ferri Acetatis. Dose, np x-5j. Hydrobromic Ether, Ethyl Bromide, C2H5Br (Unofficial),—is not inflammable. Dose, internally and hypodermically, Trp x-5j. Hydriodic Ether, Ethyl Iodide, C2H5I (Unofficial),—is a colorless liquid, non-inflammable, and insoluble in water. Dose, inhaled, np xv. [For the Chlorinated Ethers see under Chloroform.] Preparations. Oleum VEthereum, Ethereal Oil,—is a volatile liquid, consisting of equal volumes of heavy Oil of Wine and Stronger Ether. Used to prepare the Spt. /Etheris Comp., and as it occurs in commerce is usually a worthless preparation. Spiritus AEtheris, Spirit of Ether,—has of Stronger Ether 30 parts, Alcohol 70. Dose, rrp x-.^j. Spiritus AEtheris Compositus, Hoffman’s Anodyne,—contains Stronger Ether 30, Alco- hol, 67, Ethereal Oil 3 parts. Dose, npv-gj. Spiritus ALtheris Nitrosi, Spirit of Nitrous Ether, Sweet Spirit of Nitre,—is an alco- holic solution of Ethyl Nitrite, C2H5N02, containing 5 per cent, of the crude ether. It turns acid with age, and should not be kept long. It is a constituent of Mist. Glycyrrhizse Co. (3 per cent.), Dose, Its incompatibles are Potassic Iodide, Ferric Sul- phate, Tr. Guaiaci, Tannic and Gallic Acids, and Antipyrine. Ancesthetic Mixtures. Nussbaum's has—Ether 3 parts, Chloroform 1, Alcohol 1. Vienna General Hospital uses—Ether 9, Chloroform 30, Alcohol 9. The “ Vienna Mixture,”—Ether 3, Chloroform 1. Medico-Chirurgical Society of London (1864) proposed—Ether 3, Chloroform 2, Alco- hol 1. 80 iETHER Physiological Action of Ether. Ether is anodyne, antispasmodic, diaphoretic and anthelmintic; a cardiac and cerebral stimulant, an anaesthetic, and a narcotic poison. Given internally, it is one of the most powerful stimulants of the secre- tions, 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 rapidly, chiefly by the lungs. Externally it is a powerful refrigerant and local anaesthetic; also rubefacient when rubbed into the skin. Inhaled Ether produces at first faucial irritation, a sense of strangula- tion and cough; then a stage of excitement (cerebral intoxication), in which the face is flushed and the respiration and pulse are accelerated. A tetanic convulsive stage generally follows, the face being cyanosed, the muscles rigid, and the respiration stertorous. This soon subsides, and complete insensibility is established, the muscles being then relaxed, the reflexes abolished, and the cerebral functions suspended, the lower centres in the medulla carrying on the processes of respiration and circulation. If the inhalation be continued, these also become paralyzed, death usually resulting from slow paralysis of respiration, the heart pulsating long after breathing has ceased. [Chloroform usually paralyzes the heart.] If the inhalation be discontinued before the lower centres are affected, the patient gradually emerges from the condition of insensibility, and, as the narcosis subsides, vomiting is usually experienced. Ether Compared with Chloroform. Ether is less irritant than Chloroform to the mucous membranes when swallowed, but its vapor is more irritant to the air-passages. It is more of a general stimulant, and less depressant to the heart and circulation. It does not clot the blood. Its vapor is very inflammable, less pleasant to inhale, slower in action, has a longer stage of excitement, and a less pro- found narcosis, and causes a greater degree of vomiting. It is much less dangerous than Chloroform, death from the inhalation of Ether occurring slowly and usually by paralysis of respiration—from Chloroform, it is almost always sudden, and by paralysis of the heart. Ether has undoubt- edly caused a number of deaths, besides several which occurred some hours after the anaesthesia. The reported cases of fatal Chloroform nar- cosis number about 500, those from Ether about 20. Modes of Dying from Anaesthetics. (I.) From sudden paralysis of the cardiac ganglia, early in the inhalation, by reflex action proceeding from some peripheral injury before complete anaesthesia is produced. Thus, in the extraction of teeth, a small quantity of Chloroform having been administered, the heart is enfeebled, and the action of the cerebral hemispheres suspended, but not those aETHER. of the basal or medullary ganglia. If at this stage the 5th nerve be irritated, by the inti- mate relation of its nucleus with that of the pneumogastric reflex inhibition may be trans- mitted over the latter, arresting the cardiac ganglia. The stage of incomplete anaesthesia is always a dangerous one in which to perform any operation around the distribution of the 5th nerve. (2.) In the stage of rigidity, from tetanic fixation of the respiratory muscles, the blood backing up on the venous side, and the arresting of the heart’s action, respiration ceasing before the cardiac action is stopped. (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 motor ganglia of the heart. (5.) From depression of the functions by chloroform narcosis, and from shock,—and may occur in the anaesthetic state, or afterwards. Contraindications for Anaesthesia are—fatty degeneration or dilata- tion of the heart, renal and pulmonary disease, enlarged tonsils, cerebral tumor, and chronic alcoholism—particularly the first and last named. Dangerous Symptoms should be met by withdrawing the vapor and inverting the patient head downwards, drawing the tongue forwards, and applying a cold douche to the face and chest. Atropine hypodermically is an agent of great value in combating the cardiac failure,—artificial res- piration and faradization of the respiratory muscles if breathing ceases. Amyl Nitrite by inhalation, or Ammonia hypodermically. Heat to the body and limbs. Notes on Other Ancesthetics. A comparison of these agents in respect to their safety has been lately made by Dr. Richardson, who considers Methylic Ether to be the safest of all, and the others as follows: Safe are—Ethyl Bromide, Ethyl Chloride, Ether, Ethene (olefiant gas), Ethene Chlo- ride, Methyl Bromide, Methyl Chloride, Methyl Ether, Methene Chloride, Methane (marsh gas), Nitrous Oxide. Of doubtful value are—Amylene, Amyl Chloride, Butyl Chloride, Benzene (benzol), Carbon Disulphide, Carbon Dioxide, Carbon Tetrachloride, Methyl Alcohol, Methylal, Spirits of Turpentine. Dangerous are—Amyl Hydride, Butyl Hydride, Carbon Monoxide, Ethyl Hydride. Chloroform and Ethene Dichloride are considered useful, but requiring care. Physiological Action of Other Ethers. Hydriodic Ether is an antispasmodic and a general stimulant; also an anaesthetic if inhaled for a sufficiently long time. Its use as a medicinal agent is chiefly to bring the system rapidly under the influence of iodine. It increases appetite, stimulates the action of the heart, gives vivacity to the general feelings and activity to the intellect. Hydrobromic Ether has a not unpleasant odor, produces but little irritation of the air-passages, has very brief stages of excitement and "rigidity, and but a short stage of insensibility, with prompt awakening and but little of the mental confusion and excitement consequent on the use of the other anaesthetics. It is not inflammable, acts quickly, and is a good local anaesthetic. Its actions in other respects correspond with those of Ether. 82 ether, Nitrous Ether is a mild diaphoretic, a diffusible stimulant, a carmin- ative, and an efficient diuretic. On the blood it acts similarly to Amyl Nitrite, diminishing oxygenation, relaxing the peripheral vessels, accel- erating the heart’s action, and thus lowering arterial tension. Relaxing the renal and cutaneous vessels, it is diuretic and diaphoretic. Acetic Ether has a pleasant odor and taste, forming agreeable combi- nations with other carminatives as a stimulant and antispasmodic. Therapeutics. When diluted with alcohol Ether mixes readily with water, and may be administered internally with advantage in indigestion of fats, and to aid the digestion of Cod-liver Oil. It is also given in hysteria to relieve the paroxysm and flatulence, and in hepatic colic from calculi, Ether with Turpentine (Durande’s solvent remedy), which acts only as an anodyne and antispasmodic, is considered by some as of great value. Subcutaneously Ether is used in the algid stage of cholera, sudden car- diac depression, neuralgia, and in the adynamia of hemorrhage, pneu- monia and the eruptive fevers. Local anaesthesia by the Ether-spray affords great relief in neuralgia of superficial nerves, lumbago, chorea, and spinal irritation. In minor sur- gical operations it is a valuable method. As an Anaesthetic the vapor of Ether is less prompt than that of Chloroform, but is equally efficient and much safer. It should be inhaled in as concentrated a form as possible, and will then produce insensibility in from 5 to 10 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 dan- gerous. [Compare Chloroform.] Besides its surgical uses ether-anaesthesia is employed in neuralgia, cancer, tetanus, chorea, colic, delirium, puer- peral mania and convulsions, infantile convulsions, hystero-epilepsy, epi- leptic seizures, laryngismus stridulus, whooping-cough, and asthma. The unpleasant after-effects may be greatly modified if not entirely prevented by the previous administration of Morphine (gr. yV-i) and Atropine (gr. yy-jj-) subcutaneously. Hydrobromic Ether had a short period of popularity as an anaesthetic, but fell into disrepute after a few cases of death under its influence, which were probably not due to the agent used (Levis’ and Sims’ cases). Its action is less prolonged than that of Ether, but it has many advantages, requiring only 3j to 3ij rapidly given, and being uninflammable. Its inhalation has been of especial value in hysteria, epilepsy, chorea and other spasmodic disorders ; and it has been employed subcutaneously in place of Ether in the treatment of such spasmodic affections as whooping- cough, chorea, etc. AGARICUS ALBUS AGARICUS CHIRURGORUM. The Compound Spirit of Ether (Hoffman’s Anodyne) is an admi- rable agent in gastralgia, colic, flatulence, syncope, etc., also in the various manifestations of the hysterical paroxysm. In combination with the camphorated tincture of Opium it is often remarkably efficient in checking the diarrhoea of hot weather. Spirit of Nitrous Ether is used as a diaphoretic, a diuretic and a carminative; also in expectorant mixtures, as an antipyretic in febrile affections, and to relieve pain in angina pectoris, dysmenorrhoea and asthma. Hydriodic Ether may be obtained in glass capsules containing five minims each, and is used by inhalation in chronic pulmonary disorders, cardiac dyspnoea, spasmodic affections of the bronchi and larynx, asthma, and in catarrhal laryngitis with dyspnoea. It is not employed as an anaes- thetic. AGARICUS ALBUS, Purging Agaric (Unofficial),—is a fungus, occurring in large white spongy pieces, obtained from the European larch. It contains Agaricin, a crystalline substance, and Agaric Acid; also from 40 to 70 per cent, of resins. The taste of Purging Agaric is first sweetish, then becoming very acrid and bitter. The powder inhaled causes violent sneezing, and taken inter- nally in full doses it produces watery stools. Small doses check diarrhoea and dysentery, and diminish the secretions of the bronchi and mammae. Agaricus Albus was formerly employed as a drastic purgative, in doses of gr. xxx to 5j. It has lately been used, with much success, in 15-grain doses of the powder, or 3 grains of the alcoholic extract, to check the night-sweats of phthisis. AGARICUS CHIRURGORUM, Surgeon’s Agaric (Unoffi- cial),—is the interior portion of the fungus Polyporus fomentarius, which grows on the trunks of beeches, birches, and oaks in Europe. It is pre- pared for use by boiling in weak lye and beating with mallets, and then occurs in light, thin, yellowish-brown pieces, soft and pliable, without odor or taste. It is almost pure cellulose. It was formerly used as a mechanical hemostatic, and for the purpose of moxa. When soaked in a strong solution of Potassium Nitrate or Potassium Chlorate and dried, it is very inflammable, and is then called Spunk. 84 AGARICUS MUSCARIUS. AGARICUS MUSCARIUS, Amanita Muscaria, Fly-Agaric (Unofficial),—is a poisonous mushroom, of a disagreeable odor and a burning, acrid taste, used in infusion with milk for poisoning flies, and used by the Tartars as an intoxicant. It contains an actively toxic alkaloid, Muscarine C5H13N02, of syrupy consistence, odorless and tasteless, soluble in water and alcohol, and readily dissolved out by water and dilute acetic acid, so that a doubtful mushroom may be easily rendered innocuous. It may also be produced synthetically, but it is doubtful whether the article so prepared is as active as the natural product. It has been made from Choline by Schmiedeberg. Preparations. Muscarina, Muscarine (Unofficial),—Dose, gr. }-gr. ij. It may be used hypodermic- ally in watery solution. Muscarina Nitras, Nitrate of Muscarine (Unofficial),—may be used hypodermically, in doses of from gr. T\> to gr. f. Physiological Action. Muscarine is a powerful respiratory and cardiac depressant, paralyzing the respiratory centre and arresting the heart in diastole by paralyzing its motor ganglia while stimulating its inhibitory apparatus. It lowers the arterial tension, produces profound salivation, lachrymation 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 tetanic intesti- nal contractions, severe colic, vomiting and purging. It produces spasm of the accommodation, marked myosis and contraction of the pupil when given internally, but dilates the pupil widely when locally applied. [Gel- semium does so also.] Under its action the body temperature is decid- edly reduced, and the excretion of waste-products is lessened. It is eliminated unchanged by the kidneys. Agaricus acts as an intoxicant to the cerebrum, producing more vertigo and delirium than Alcohol, followed by profound sopor with lowered re- flexes, perhaps coma and death. A ntagonists. 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 paralyze the inhibition and restore the pulsations. An equally prompt antagonism runs through their entire spheres of action. Digitaline is to some extent an- tagonistic ; so also is Eserine. Therapeutics. Muscarine has been as yet little used in medicine, but it will probably prove to be a valuable drug. It has been long used, with marked benefit, in the night-sweats of phthisis. A tincture of Agaricus has been found beneficial in ataxic typhus, chorea, and chilblains. Muscarine promises AILANTHUS ALCOHOL. 85 to be of great value in inflammations characterized by copious exudation, especially eye-inflammations, catarrhal jaundice, recent hemorrhoids, acute bronchitis, pulmonary hemorrhage, incipient pulmonary congestion, diabetes of both forms, and in constipation due to intestinal torpor and deficient secretion, accompanied by a torpid liver and difficult digestion of fats. In the latter affection it should be given in small doses, gr. thrice daily. AILANTHUS, Tree of Heaven (Unofficial),—is the bark of Ailanthus glandulosa, a well-known shade tree, of the nat. ord. Simaru- bacese, indigenous to China, but cultivated elsewhere. It contains an oleo-resin and a volatile oil, on which its properties probably depend. Dose, gr. x~5j. Preparations. Extractum Ailanthus Fluidum (Unofficial),—Dose, rtpx-^j. Tinctura Ailanthus (Unofficial),—Dose, ny x- 3 ij. Physiological Action and Therapeutics. Ailanthus is a decided nauseant, and a drastic purgative, causing also vertigo, weakness, cold sweats, dull headache, pains in the back, numb- ness and tingling in the limbs. It paralyzes the cerebrum and spinal cord of animals, impairment of motility beginning in their hind extremities. The cardiac action, at first increased, soon slows, the pulse becoming small and weak, and the respiration depressed, death occurring from paralysis of respiration. It is a good taeniafuge. Ailanthus is used against tapeworm, a decoction of the fresh bark (5j ad §iv), or the oleo-resin in drachm doses, being very efficient. It has also been well employed in malignant scarlatina, with dark and partial eruption, insensibility, delirium and other cerebral symptoms. ALCOHOL ,—is a liquid composed of 91 per cent, by weight (94 per cent, by volume) of Ethyl Alcohol, C2H5HO, and 9 per cent, by weight (6 per cent, by volume) of water. Sp. gr. 0.820 at 6o° F., and 0.812 at 770 F. An inflammable, transparent, colorless, mobile and volatile liquid, of agreeable odor and burning taste. Obtained by the distilla- tion of fermented saccharine fluids. Used in making all the Tinctures and Spirits; also in some of the Liniments, Liquors and Mixtures. Preparations. Alcohol Dilutwn, Diluted Alcohol,—consists of Alcohol and Distilled Water, equal parts of each. Sp. gr. 0.928 at 6o° F. Spirihis Frumenti, Whiskey,—obtained from the distillation of fermented grain, rye or corn (U. S.), barley (Scotch), and at least two years old. Sp. gr. 0.917 to 0.930. Has an alcoholic strength of 44 to 50 per cent, by weight; also Ethers developed by the action 86 ALCOHOL. of acetic and butyric acids on the alcohol, and traces of Amylic Alcohol (fusel-oil) even in the best. Spirilus Vini Gallici, Brandy,—obtained from the distillation of fermented grapes, and at least four years old. Sp. gr. 0.925 to 0.941. Has an alcoholic strength of 39 to 47 per cent, by weight, and (Enanthic and other Ethers developed by age. Pale Brandy is colored by the cask, the dark has caramel to color it. Is often prepared artificially by adding to high wines Acetic or Nitric Ether, Caramel, and Logwood or Catechu for astringency. Spiritus Odoralus. Perfumed Spirit, Cologne-water,—prepared by adding to 800 parts of Alcohol, Water 158, Acetic Ether 2, Oil of Bergamot 16, Oil of Lemon 8, Oil of Rose- mary 8, Oil of Lavender Flowers 4, and Oil of Orange Flowers 4 parts. A perfume or ingredient of lotions. Vinum Album, White Wine,—should contain from 10 to 12 per cent, by weight ot absolute alcohol, and is made by fermenting the unmodified juice of the grape, freed from seeds, stems and skins. Vinum Album Fortius, Stronger White Wine,—should contain 20 to 25 per cent, by weight of absolute alcohol, and is made by adding 1 part of Alcohol to 7 of Vinum Album. Is simply a formal recognition of the fact that the stronger sherries are artificially made. Used to prepare the official Vina (Wines). Vinum Rub rum, Red Wine,—should contain from 10 to 12 per cent, by weight of absolute alcohol, and is made by fermenting the juice of colored grapes in presence ot their skins. Vinum Aromaticum, Aromatic Wine,—consists of Stronger White Wine 94 per cent., with Lavender, Origanum, Peppermint, Rosemary, Sage and Wormwood, of each 1 per cent. Unofficial Alcoholic Preparations. Rectified Spirit, sp. gr. 0.835,—has 85 per cent, by weight of absolute alcohol, and no fusel oil. 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. Proof Spirit, sp. gr. 0.920,—contains 49 per cent, by weight of absolute alcohol, with a peculiar oil and other foreign matters. Rum,—is obtained from the distillation of fermented molasses, and has about 42 per cent, by weight of alcohol. Gin,—has about the same alcoholic strength as rum, and approaches very nearly to the official Spiritus Juniperi Compositus. It is usually distilled from rye or barley, and flavored, in Holland, with juniper berries and hops, in England, often with oil of turpentine, various cheap aromatics, acetate of lead, sulphate of zinc, cayenne pepper, etc. Pure gin is slightly diuretic, from the oil of juniper contained in it. Vinum Portense, Port Wine,—is not a natural wine, spirit being added during the pro- cess of manufacture, and the alcoholic strength raised to 30 or 40 per cent. Vinum Xericum, Sherry Wine,—a dry, spirituous white wine, generally made to order by the dealers, and having from 20 to 35 per cent, of alcohol. Sparkling Wines, as Champagne, Hock, Catawba,—are more or less sweet, and charged with carbonic acid, being bottled before fermentation is completed and the grape sugar all converted into alcohol. They contain 8 to 10 per cent, of absolute alcohol. Sweet Wines, as Burgundy, Tokay, Muscatel, Malaga, Angelica, Madeira, etc.,—are of low alcoholic strength, 6 to 7 per cent., unless fortified. Light Red Wines, as Claret, Red Rhine, Concord,—have 5 to 7 per cent, alcohol, tan- nic acid, grape coloring matter, etc. Dry Acid Wines, as Rhine and Moselle wines, California Hock, Ohio, and Kelley- Island Catawba,—in these fermentation is complete, and the alcoholic strength from 5 to 7 per cent. Beer, Ale and Porter,—are fermented liquors, made from malted grain, with hops and other bitters added. Beer is made by slow fermentation, the yeast sinking; Ale by rapid fermentation, the yeast floating. Their alcoholic strength is from 2 to 3 per cent, in beer, to 4 to 6 per cent, in ale and porter,—and they also contain malt extract, carbonic acid, lactic acid, various aromatics, potassium and sodium salts, etc. Koumiss,—is obtained by the fermentation of milk, that of the mare being used in Tartary, where it is largely employed as a food. It contains from 1 to 3 per cent, of alco- hol, sugar, lactic acid, casein, fat, salts, carbonic acid and ethers. (See page 262.) ALCOHOL. 87 Principal Alcohols. Ethylic Alcohol, Ethyl Hydrate, C2HbO,—Grain-spirit. Methylic Alcohol, Methyl Hydrate, CH40,—Wood-spirit. Amylic Alcohol, Amyl Hydrate, C5H120,—Potato-spirit, Fusel Oil. Occurs also in the excessive distillation of fermented grain, after the ethylic alcohol has distilled over. Phenylic Alcohol, Phenol, Carbolic Acid, C6H60,—from coal-tar (see page 60). Composition, etc., of Alcohols, An Alcohol is a volatile organic compound, which contains no N, has a great affinity for water, and reacts with acids, forming H,20 and ethers. Alcohols are therefore analo- gous to the metallic hydrates, and Ethers to salts. They are obtained by distillation from the fermented product of grape-sugar, or some substance (as starch) easily converted into grape-sugar, which, in the presence of certain low vegetable organisms (as the yeast- plant), splits up into Alcohol and C02; and may be made synthetically by shaking Ole- fiant gas (C2H4) with strong Sulphuric Acid), then diluting and distilling. C2H4 -f- H20 = C2H60,' Ethylic Alcohol. Absolute Ethylic Alcohol, which is only used for chemical testing, is made by shaking Rectified Spirit with Potassium Carbonate, decant- ing, and distilling with slaked lime. Alcohol very slowly oxidized forms Aldehyde (C2H40), if less slowly, Acetic acid (C2H402), if quickly as in burning, C02 and H20, which are in all cases the ultimate products of its continued oxidation. Physiological Action. Alcohol is a cerebral excitant and depressant and a narcotic poison. It is anaesthetic, antiseptic, and antiparasitic, a mild counter-irritant, and it coagulates albumen by abstracting its water. It is very diffusible, and is partly oxidized by the organism, part being excreted unchanged. In small doses, Alcohol 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 sys- tole and reducing the length of the diastole, and increases the functional activity of all the organs. A portion is oxidized by the organism (about Sjss in twenty-four hours), yielding force which is utilized as nervous, muscular and glandular power. The continued use of small or moderate doses congests the stomach and liver, over-stimulating the gastric glands and the hepatic cells to the production of pathological secretions, causing gastric catarrh and morn- ing-vomiting of mucus, and impairing digestion. By irritation it sets up hyperplasia of the submucous connective tissue (sclerosis), especially in the stomach, brain, kidneys and liver (cirrhosis) ; produces fatty degen- eration (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-continued 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 88 ALCOHOL. brain, but are even more 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, hallucina- tions, 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 insensi- bility, stertorous breathing, dilated or contracted pupils, complete mus- cular resolution, and death by paralysis of the heart and respiration. Acute Alcoholism may be confounded with apoplexy, opium narcosis, concussion of the brain, and even acute pneumonia,—the differential diagnosis being impossible to make in the stage of deep coma. The pupils are not a trustworthy indication, as in alcoholism they may be either dilated or contracted. Alcohol is a food within narrow limits, Sjss per diem being the prob- able quantity which the adult organism can oxidize, more than this being probably poisonous, as it sets up structural changes in the various organs, and lowers the power of resistance to morbific influences. It has frequently caused an intractable form of phthisis. The very young and the very old stand more alcohol relatively than the adult. It has been proven to exist normally in the human organism. Treatment of Acute Alcoholism. The stomach should be evacuated, Ammonia by inhalation cautiously, warmth applied to the extremities, cold affusion to the head, faradism of the muscles of respiration. Milk, mucilaginous drinks, black coffee, are useful afterwards. Lupuline as a substitute stimu- lant, Chloral (cautiously) to secure sleep, but is dangerous in old topers. Capsicum is excellent for the same purpose in 20 to 30-grain doses. Nutritious, digestible diet in fluid form and small quantity frequently repeated. The Chloride of Ammonium, about 5 ss in half a pint of water at one draught, has a marvellous effect in generally straightening up the victim, antagonizing stupor, and restoring faculties. Therapeutics. Though Alcohol is decidedly injurious in health, in disease it is a most useful agent. It is invaluable in diphtheria, poisoning by cardiac depres- sants and snake-venom, adynamic fevers and cardiac failure from any cause. It is an excellent dressing to wounds and bed-sores, may prevent colds from exposure by relaxing the peripheral vessels and restoring the balance of the circulation, and in phthisis it does good if it promotes digestion and assimilation. In atonic indigestion of nervous and depressed subjects, cholera infantum, diarrhoea, etc., brandy is universally found to be beneficial. In the vomiting of yellow fever or of sea-sickness iced champagne is very efficient. In anaemia and chlorosis good red wines are almost indispensable, as also in convalescence from acute diseases, sudden and profuse hemorrhage, and in many other morbid conditions. Koumiss is an excellent food and stimulant in feeble digestion, phthisis, chronic bronchitis, and in all adynamic states in which the effects of ALLIUM—ALNUS ALOE. 89 alcohol and nutrients are indicated. The stomach is very tolerant of kou- miss even when it will bear nothing else, and as it increases the body nutrition remarkably it is of great value in the treatment of all the cachexiae. Each quart is estimated to contain 4 ounces of solid food, be- sides 1 to 3 per cent, of alcohol. (See also under Kumyss, page 262.) ALLIUM, Garlic ,—is the bulb of Allium sativum, a plant of the nat. ord. Liliaceae, indigenous to Asia, but cultivated in Europe and America. It is sub-globular and compound, consisting of eight bulblets, covered by dry, membranous scales. Its odor is pungent and disagreeable and its taste is warm and acrid. It contains a Volatile Oil, which consists mainly of the Sulphide of Allyl (C3H5)2S, on which its qualities depend. Allied species are Allium Cepa, the Onion, and Allium Porrum, the Leek. Syrupus Allii, Syrup of Garlic,—contains 15 per cent, of Garlic, Sugar 60, Dilute Acetic Acid 40 parts. Dose, 5[j-iv, according to age. Physiological Action and Therapeutics. Garlic, Leeks and Onions are stimulant to the digestion and to the nervous system, and are supposed to have a special influence upon the bronchial secretion. Garlic is also thought to be emmenagogue and an- thelmintic. It promotes diaphoresis and diuresis, and acts as a tonic and carminative. Many persons use it as a condiment. Large doses will often produce gastric irritation, flatulence, hemorrhoids, headache and fever. In domestic practice it is frequently employed as an external application in the cutaneous eruptions of children, and as a poultice or liniment in infantile disorders of many kinds. Internally it is of real benefit in feeble digestion and flatulence, chronic catarrhal affections of children, in ner- vous and spasmodic coughs and in nervous vomiting. ALNUS, Alder-Bark (Unofficial), is the bark of Alnus serrulata, the common American Alder, a small tree of the nat. ord. Betulaceas. It has similar properties to those of A. glutinosa, the European Alder, and A. urcana, the Tag Alder, and contains a tannic acid, an oil and a resin. The bark and leaves are astringent and bitter, and are chiefly used as gargles for the throat, as local applications to wounds and ulcers, and to restrain the secretion of milk. Dose of the powdered bark gr. x, in decoction or infusion, several times a day. The Tag Alder is highly recommended as a hemostatic. ALOE, Aloes,—is the inspissated juice of the leaves of Aloe soco- trina, a plant of the nat. ord. Liliaceae, inhabitating the island of Socotra and the eastern coast of Africa near the southern shore of the Red Sea. It has orange-colored flowers and resembles in appearance the American 90 ALOE, aloe or century-plant (Agave americana'). It occurs in soft masses, hard exteriorly, of a yellowish-brown color, fragrant odor and bitter taste, solu- ble in alcohol and in boiling water, and containing a peculiar volatile oil, a resin and Soaloin, CJ5H1607, a variety of the principle Aloin, which is common to all varieties of aloes,—also Aloetic and Chrysammic Acids. Dose, gr. j-v. Other varieties are Aloe Barbadensis, Barbadoes Aloes, from Aloe vulgaris; and Aloe Capensis, Cape Aloes, from Aloeferox, the first of which is official in the Br. Phar. Preparations. Aloe Purificata, Purified Aloes,—prepared by heating with alcohol, straining and evaporating. Is almost entirely soluble in alcohol. Dose, gr. j-v. Extractum Aloes Aquosum, Watery Extract of Aloes,—prepared by mixing I with io parts of Boiling Distilled Water, standing 12 hours, decanting, straining and evaporating. Dose, gr. ss-v. Tinctura Aloes, Tincture of Aloes,—has of Aloes 10, extract of Glycyrrhiza 10, Di- luted Alcohol to 100 parts. Dose, 3 ss-ij. Tinctura Aloes et Myrrhce, Tincture ot Aloes and Myrrh,—Aloes 10, Myrrh 10, Alcohol to 100 parts. Dose, g ss-ij. Vinum Aloes, Wine of Aloes,—has of Aloes 6, Cardamom 1, Ginger 1, Stronger White Wine to 100 parts. Dose, gj-iv. Pilules Aloes, Pills of Aloes,—each has of Aloes gr. ij with the same quantity of Soap. Pilules Aloes et Asafetides, Pills of Aloes and Asafetida,—each contains gr. 1A of each ingredient. Pilules Aloes et Ferri, Pills of Aloes and Iron,—each pill contains gr. j each of Aloes, Sulphate of Iron and Aromatic Powder, with Confection of Rose. Pilules Aloes et Mastiches, Pills of Aloes and Mastic, Lady Webster’s Pill,—each has of Aloes gr. ij, Mastic gr. ss, Red Rose gr. ss. Pilules Aloes et Myrrhce, Pills of Aloes and Myrrh,—each contains of Aloes gr. ij, Myrrh gr. j, Aromatic Powder gr. ss, mixed with Syrup. Pulvis Aloes et Canellce, Powder of Aloes and Canella (Unofficial),—contains the pow- dered bark of Canella alba. Dose, gr. v-xx. Aloes is also a constituent of Pilulse Rhei Compositae and Tinctura Benzoini Composita— (which see, pages 336 and 129 respectively). Physiological Action. Aloes is a tonic-astringent and resin-bearing purgative, an emmena- gogue and an anthelmintic against the thread-worm. As a cathartic it acts chiefly on the lower half of the large intestine, in doses of gr. j-iv producing in about 10 hours copious soft evacuations with some griping pain. This effect is produced whether the drug be taken internally or absorbed from an exposed surface, so that it probably diffuses into the blood and is eliminated by the mucous membrane of the colon. It is a stomachic tonic in small doses, a stimulant of the hepatic functions, and an excitant of the pelvic circulation. It may cause abortion in the female and priapism in the male, and is said to have frequently produced hemorrhoids, which if existing it will certainly aggravate. Given to nursing mothers it im- parts a purgative quality to their milk. Therapeutics. Aloes is chiefly used in combination with Iron, Myrrh, Nux-vomica, etc., for amenorrhoea and chronic constipation with atonic dyspepsia and ALTHAEA ALUMEN. 91 hypochondriasis. It is curative in certain forms of hemorrhoids, especially those occurring after delivery and where the condition is not one of active pelvic congestion. It is also used internally and as an injection in gonorrhoea, and for simple atonic jaundice. It must be avoided in irritable rectum, hemorrhoids of active form, menorrhagia and pregnancy, unless given in small doses and with care. The Pil. Aloes et Ferri is perhaps the most generally useful agent in anaemia, amenorrhoea and con- stipation of girls at the period of puberty. ALTHEA, Marsh-Mallow, —is the peeled root of Althcza offici- nalis, a European plant of the nat. ord. Malvaceae, occurring in dry cylindrical pieces, of white color, without pith, of faintly aromatic odor and sweetish mucilaginous taste. It contains about 35 per cent, each ot vegetable mucus and starch, with 2 per cent, of Asparagin, also pectous matter, sugar, fixed oil, but no tannin. It is a constituent of Massa Hydrargyri and Pilulae Phosphori, and is much used as an excipient in extemporaneous pharmacy. Dose, indefinite. Syrupus Atihcece, Syrup of Althaea,—has of Althaea 4 per cent., and should be freshly made. Dose, indefinite. Althea is one of the best mucilaginous drugs, but has no active medi- cinal properties. It is used in Europe to make pectoral teas and syrups, and is extensively employed as a mucilaginous demulcent. The powdered root makes a good emollient poultice. In the German Pharmacopoeia a Compound Althaea Tea is official, which under the common name, “ Ger- man Breast Tea,” is a popular demulcent drink in bronchial affections, coughs, colds, etc. Asparagin is an organic principle, occurring in large rhombic crystals, and found in many other plants, as in the shoots of asparagus, vetches, potatoes, liquorice, the sweet almond, the root of the locust, etc. It is considered a derivative of Succinic Acid, and has diuretic properties, besides being sedative to the circulation. It may be used in ascites, espe- cially in children, in the anasarca of Bright’s disease, and in gout. Dose, gr. ij-iij, in water. Physiological Action and Therapeutics. ALUMEN, ALUM, Potassa-alum,—is the Sulphate of Potassium and Aluminium, K2A12(S04)4. 24H20, which, when the 24 molecules of water are driven off, becomes A lumen Exsiccatum, Dried Alum, K2A12(S04)4. Alum occurs in large, octahedral crystals, or cubebs, of sweetish astringent taste and acid reaction. It is soluble in 10parts of water at 590 F., and in 0.3 part of boiling water, but is insoluble in alcohol. The Ammonia-alum (Aluminii et Ammonii Sulphas) was formerly official, and is still sold and dispensed as “Alum.” Dose, gr. x-xx,—as an metic 3j for a child. 92 ALUMINIUM. Preparation. Alumen Exsiccalum, Dried Alum,—is a white, granular powder, slowly soluble in 20 parts of water at 590 F., and quickly soluble in 0.7 of boiling water. Dose, gr. x-xx. Alum is an astringent, coagulating albumen and stimulating muscular contraction. At first it excites the flow of saliva and then markedly diminishes it. It coagulates pepsin and arrests digestion, stops peristalsis, and usually causes constipation, though sometimes inducing diarrhoea. Although coagulating albumen, even in weak solution, it enters the blood, constricts the capillaries, arrests secretions, especially those of mucous surfaces,, and stops capillary hemorrhage. In teaspoonful doses Alum is an efficient and non-depressant emetic. In large doses it is a gastro-intestinal irritant, of dried Alum having caused the death of an adult in 8 hours. Physiological Action. Therapeutics. Alum is used locally as an astringent in chronic catarrhs, leucorrhoea, gonorrhoea, hemorrhoids, bed-sores, ulcers, relaxed throat, colliquative sweats, catarrhal ophthalmia and granular lids. The dried powder is escharotic, destroying granulations and warty growths, and is used by insufflation in chronic nasal catarrh. Internally it is beneficial in gastric catarrh, gastralgia, enteralgia, pas- sive hemorrhages, lead colic and constipation. As an emetic it is em- ployed in croup, and it is a good antidote in lead-poisoning. Alum is best administered alone, as it forms precipitates with a large number of drugs. ALUMINIUM.—This metal is not official, though of its salts two are, besides Alum. They are— Aluminii Hydras, Hydrate of Aluminium, Hydrated Alumina, AL2H06,—is a white, light, amorphous, tasteless powder, insoluble in water or alcohol, but soluble in strong alkaline or acid solutions. Dose, gr. iij-xx in powder or mixture. Aluminii Sulphas, Sulphate of Aluminium, A12(S04)3.i8H20,— is a white crystalline powder, soluble in 1.2 of water at 590 F., almost insoluble in alcohol. Used locally. Physiological Action and Therapeutics. The Hydrate is a feebly astringent and desiccant powder, occasionally used in inflammatory skin affections as a local application, and internally in diarrhoea. The Sulphate is antiseptic and astringent. It has been used internally in diarrhoeas, but is chiefly employed in a 5 per cent, solution locally to ulcers, or in stronger solution (5'ij ad gvj) in foul discharges from mucous surfaces. A saturated solution is a mild caustic, and may be used daily as a local application to the enlarged tonsils, nasal polypi, ulceration of AMMONIACUM AMMONIUM. 93 os uteri, and various chronic enlargements. The Benzoinated Solution of Alumina is an unofficial preparation used for the same purposes. AMMONIACUM, Ammoniac ,—is a gum-resin, obtained from Dorema Ammoniacum, a Persian plant of the nat. ord. Umbelliferge, occurring in yellowish-brown tears of peculiar odor, and bitter, acrid and nauseous taste. When triturated with water it readily yields a milk-white emulsion, and contains a Volatile Oil, which differs from that of Asafoetida in that it is neither sulphuretted nor phosphoretted. It also contains resin, gum, gluten, etc. Dose, gr. x-xxx. Mistura Ammoniaci, Ammoniac Mixture,—is an emulsion with water of 4 per cent, strength, the resin being suspended by the contained gum. Dose, £ss-j. Emplastrum Ammoniaci, Ammoniac Plaster.—Ammoniac 100 parts, digested with 140 of Dilute Acetic Acid until emulsionized, then strained and evaporated. Emplastrum Ammoniaci cum Hydrargyro, Ammoniac Plaster with Mercury.—Am- moniac 72, Mercury 18 per cent., and contains also Lead-plaster, Sulphur, Olive Oil, and Dilute Acetic Acid. Ammoniac is a stimulating expectorant and a laxative, and has a mildly irritant action on the skin. Its actions are similar to those of Asafoetida, but much less powerful. It is not much used, but may be employed with benefit in chronic bronchial affections, especially of the aged, the mix- ture with the Chloride or Carbonate of Ammonium facilitating expectora- tion and lessening wheezing. It is also recommended in asthma, and in glandular enlargements and indolent swellings the plasters are employed as stimulating alteratives and resolvents. AMMONIUM, NH4, —is a hypothetical compound radical, which does not exist in the free state, but which in combination with acids forms salts which closely resemble those of the elements Potassium and Sodium. Many of its salts are official, as well as the aqueous solutions of the gas Ammonia, NH3, which is produced during the putrefaction of all organisms and of many organic nitrogenous compounds existing in the air and in the soil in the free state. The chief commercial source of Ammonium salts is the ammoniacal liquor from gas-works and bones. Preparations of Ammonia. Aqua Ammonice, Water of Ammonia,—is an aqueous solution of Ammonia, contain- ing -jlgth by weight of the gas. It is a colorless liquid of pungent odor, acrid taste and strongly alkaline reaction. Sp. gr. 0.959 at 590 F. Dose, well-diluted. Aqua Ammonice Fortior, Stronger Water of Ammonia,—contains 28 per cent, by weight of the gas. Sp. gr. 0.900 at 59° F. Spiritus Ammonice, Spirit of Ammonia —is a 10 per cent, solution of the gas in alco- hol. Sp. gr. about 0.810. Dose, Ttp diluted. Spiritus Ammonice Aromaticus, Aromatic Spirit of Ammonia,—contains Ammonium Carbonate, Aqua Ammonise, Oils of Lemon, Lavender, and Pimenta, Alcohol and Water. Used in the Tinct. Guaiaci Ammoniata and the Tinct. Valerianae Ammoniata. Dose, Linimentum Ammonice, Ammonia Liniment,—has of Aqua Ammonia; 30 parts, Cotton- seed Oil 70. 94 AMMONIUM. Ammonium Salts and their Preparations. Liquor Ammonii Acetatis, Solution of the Acetate of Ammonium, Spirit of Mindere- rus,—is prepared by neutralizing Dilute Acetic Acid with Carbonate of Ammonium, and contains about Per cent, of the Acetate. It should be freshly made. Used in Mis- tura Ferri et Ammonii Acetatis. Dose, j. Ammonii Benzoas, Benzoate of Ammonium, NH4C,II502,—in minute four-sided laminar crystals, soluble in 5 of water and 28 of alcohol at 590 F. Dose, gr. v-xv. Ammonii Bromidum, Bromide of Ammonium, NH4Br,—in prismatic crystals or as a granular salt, soluble in 1]/z of water and 150 of alcohol at 590 F. Dose, gr. x-gss, well diluted. Ammonii Carbonas, Carbonate of Ammonium, NH4HCOs.NH4NH2C02,—occurs in white masses consisting of both the bicarbonate and carbonate, which on exposure to air becomes a white powder (acid carbonate). Soluble in 4 parts of water at 590 F. Dose, gr. v-x. Ammonii Chloridum, Chloride of Ammonium, Sal-ammoniac, HN4C1,—a white, crystalline powder, of saline taste, and slightly acid reaction ; soluble in 3 of water and very sparingly in alcohol. Dose, gr. j-xx. Trochisci Ammonii Chloridi, Troches of Chloride of Ammonium,—each contains 2 grains of the chloride. Ammonii Lodidum, Iodide of Ammonium, NH4I,—a deliquescent, granular, white salt, soluble in 1 of water and 9 of alcohol at 590 F. Dose, gr. ij—x. Ammonii Nitras, Nitrate of Ammonium, NH4N03,—in colorless crystals or fused masses, soluble in 0.5 of water and 20 of alcohol at 590 F. Only used to prepare Nitrous Oxide Gas by heating to 365° F., for anaesthesia. Ammonii Phosphas, Phosphate of Ammonium (NH4)2HP04,—in colorless prisms, soluble in 4 of water, insoluble in alcohol. Dose, gr. v-xx. Ammonii Sulphas, Sulphate of Ammonium (NH4)2S04,—is only used for the prepara- tion of other ammonium salts. Ammonii Valerianas, Valerianate of Ammonium NH4C5H902,—in white, quadrangu- lar plates, deliquescent; very soluble in water and alcohol. Dose, gr. j-v. RaspaiPs“ Eau Sedative" (Unofficial),—consists of Aqua Ammoniae g ij, Sodii Chlori- dum ij, Spiritus Vini Camphorat. g iij, Aqua g xxxij. For local use. Physiological Action. The gas Ammonia is intensely alkaline and irritant to raucous mem- branes ; inhaled producing spasmodic cough and a sense of suffocation. Its prolonged inhalation will induce violent inflammation of the air- passages and oedema of the glottis. It stimulates the nasal branch of the fifth nerve, exciting the vaso-motor centre by reflex action, and thus rais- ing the arterial tension. Applied to the skin and allowed to evaporate, it has a slight rubefacient effect, but if evaporation be prevented it pene- trates the epidermis and has a powerfully vesicant action. The Aqua, swallowed undiluted, may cause death quickly by suffocation from the action of its vapor upon the air passages; if not, it may excite gastro- enteritis accompanied by coma, differing in the latter respect from potassium or sodium poisoning. After absorption it stimulates both the respiration and the circulation by direct action on their respective nerve- centres. Ammonia exists normally in the circulation, where it keeps the fibrin in solution and thus maintains the fluidity of the blood. It in- creases the glycogenic function of the liver, and is converted finally into urea. It is a powerful irritant to muscular tissue, causing tetanic contrac- tion and subsequent rigor mortis when directly applied. Ammonium Salts all stimulate and finally paralyze the spinal cord, ammonium. 95 motor nerves and muscles, in animals, but the order and readiness of the action vary with the salts employed, some having a predominating influence on the cord, others on the motor nerves. In general they may be said to form a series, of which the members at one end stimulate the cord, and those at the other paralyze both the cord and the motor nerves. At the stimulant end are Ammonia and the Chloride ; at the paralyzant end the Iodide; the Bromide, Phosphate and Sulphate lying between (Brunton). In medicinal doses they act on man as stimulating expectorants, in large quantity they injure the structure of the red blood-corpuscles, and if long- continued they produce rapid emaciation by impairing digestion and increasing-tissue-waste. The Chloride has decided cholagogue powers, increases the excretion of urea, in 20-grain doses is purgative, and is considered to have a select- ive action upon the gastric mucous membrane. The Carbonate is a powerful and very diffusible stimulant; when administered internally in moderate doses, it is probably decomposed by the HC1 of the gastric juice, nascent ammonia being set free and absorbed. It stimulates the respiratory centre, acts as a stimulating expectorant, and in very small doses stimulates the secretion of the gastric juice. It is also emetic, and has been supposed to prevent iodism when administered conjointly with Iodide of Potassium. The Solution of the Acetate is an active dia- phoretic if the body be warm, or a diuretic if it be cool. In wineglassful doses it will counteract many of the immediate effects of alcohol. The Phosphate is diuretic, and is believed to decompose the insoluble Urate of Sodium in the blood, converting it into the soluble salts Urate of Am- monium and Phosphate of Sodium, and thus promoting its elimination. The Benzoate is also diuretic, and like Benzoic Acid passes out of the system in the urine as Hippuric Acid. It acidifies the urine where there is phosphatic tendency of the same. The Nitrate and Sulphate are only used for the preparation of other salts, while the Iodide, Bromide and Valerianate correspond in action to that of their titular bases, and are described under their respective titles, Iodum,Bromium and Valeriana. Antagonists to Ammonia. When inhaled, give HC1 vapors by inhalation to form the chloride; if taken in solu- tion, give Vegetable Acids, and demulcents to protect the mucous surfaces. Its physio- logical antagonists are the cardiac sedatives, Aconite, Digitalis, Veratrum, etc. Therapeutics. The strong solution of Ammonia may be used as a rubefacient and vesicant, and its vapor, by cautious inhalation, in syncope and the results of shock. Locally, it is a good application to bites of the less venom- ous reptiles and to the stings of insects. The Carbonate is used inter- nally in the eruptive fevers, delirium tremens, continued fevers, pneu- monia, etc., where much depression exists; as a stimulating expectorant 96 AMMONIUM. in chronic bronchitis, in the broncho-pneumonia of children, and in cardiac asthma. It is highly recommended in scarlet fever in doses of 3 to 5 grains every one, two or three hours, all acid drinks or fruits being prohibited while it is being administered. With ten-minim doses of tinc- ture of capsicum in an ounce of some bitter infusion it is exceedingly efficient, in 5-10-grain doses, for the sinking sensations and craving for stimulants experienced by subjects of alcoholism. It may be used as an emetic in bronchitis, when the tubes are choked with mucus and the cir- culation of the patient is weak. It may also be employed by inhalation, and administered internally, for similar purposes as Liquor Ammonise. The Chloride has a high repute in catarrh of the stomach, with anorexia, bad taste in the mouth, flatulence, coated tongue, etc., in short, the symptoms of so-called “ biliousness 3” also, in chronic congestion of the liver, jaundice from catarrh of the bile-ducts, nervous and sick headaches, myalgia, amenorrhoea, muscular rheumatism and neuralgia. In the latter affection it should be given in 30-grain doses several times a day. It is also efficient in bronchial catarrh without fever, and in chronic bron- chitis when the secretion is scanty and tough. It is remarkably efficient in straightening up a victim of acute alcoholism3 to one almost on the verge of delirium tremens, a drachm in half a pint of water, swallowed at one draught, will restore the patient’s faculties so quickly as to astonish one who has never seen it so employed. Locally, in solution, it has been well employed in inflammatory swellings, as sprains, inflamed joints, orchitis, etc., as a lotion 3 also, to allay itching in prurigo, to remove ecchymoses and glandular enlargements. Eau Sedative is often a good local application in headaches. The Solution of the Acetate is especially beneficial in the exanthe- mata, influenza, coryza, anomalous febrile conditions of children, acidity and vomiting3 also, in erysipelas when there is feeble circulation, cyan- osis and delirium. It is frequently combined with Spirit of Nitrous Ether, as a diuretic and diaphoretic in febrile affections. The Phosphate is particularly applicable to gout and lithaemia, and is a very efficient chola- gogue. The Benzoate is useful in cystitis with alkaline urine and phos- phatic deposits, as it acidulates the urine, at the same time stimulating and disinfecting the mucous coat of the bladder. Aqua Ammonize has been administered by intra-venous injection, with efficacy and safety, in sudden or threatened thrombosis, cardiac paralysis from Chloroform, and in poisoning by Hydrocyanic Acid and other car- diac depressants. In the same manner, it has been employed, but unsuc- cessfully, in poisoning by the bite of venomous reptiles. Ten drops of the strong Liquor are diluted with three parts of water, and carefully injected into a vein, all air being rigorously excluded from entrance thereinto. The therapeutics of the Iodide, Bromide and Valerianate are enume- rated under the titles Iodum, Bromum and Valeriana respectively. AMYGDALA. 97 AMYGDALA, Almond,—the seeds of two varieties of Amygdalus communis (nat. ord. Rosaceae), namely Amygdala amara and Amygdala dulcis, are official, together with several preparations, some prepared from one variety, some from another, while one is from either and one from both. An important point is the reaction between Amygdalin and Emulsin in the presence of water producing Hydrocyanic Acid (see atite, page 67). Amygdalin, C20H27NOU, is a crystalline glucoside, existing in Amygdala amara but not in Amygdala dulcis ; while the ferment Emulsin is common to both varieties. Amygdala Amara, Bitter Almond,—is the seed of Amygdalus commu- nis, var. amara, a tree of the nat. ord. Rosaceae, indigenous to Western Asia, but cultivated in many other parts of the world. The seed is lanceo- late in shape, brownish in color, about an inch long, having a white, oily embryo of bitter taste, which, when triturated with water, emits an odor of Hydrocyanic Acid. Cultivated chiefly in Spain and the Balearic Islands. Amygdala Dulcis, Sweet Almond,—is the seed of Amygdalus commu- nis, var. dulcis, a tree of the nat. ord. Rosaceae. The bitter and sweet almond trees are identical botanically, and the fruits and seeds of the two varieties resemble each other closely, only differing in taste and the pres- ence of Amygdalin (see above). The sweet almond is largely cultivated about Malaga and in California. Preparations. Aqua Amygdalce Amarce, Bitter Almond Water,—is a weak solution of the Oil of Bitter Almond in Distilled Water (1 to 1000). Is only a flavored water. Dose, indefinite. Oleum Amygdala Amarce, Oil of Bitter Amond,—is a volatile oil, of peculiar and aromatic odor, bitter, burning taste, and neutral reaction; soluble in 300 of water, but freely in alcohol and ether. Dose in mixture. This essential oil, one of the products of the reaction between Amygdalin and Emulsin (see ante, p. 67), contains a varying quantity of Hydrocyanic Acid (3 to 14 per cent.), which may be removed by distillation with caustic potash. Nitrobenzol, or “ Oil of Mir- bane,” closely resembles the oil of bitter almond, and like it is used for flavoring. It con- tains no Hydrocyanic Acid, but is a dangerous poison, producing toxic effects when inhaled, even in small doses. Syrupus Amygdalce, Syrup of Almond,—has of Bitter Almond 3 per cent., of Sweet Almond 10. Dose indefinite. Mistura Amygdalce, Mixture of Amygdala, — made of Sweet Almond 6 per cent., with Acacia, Sugar and Water. A demulcent drink, used as a vehicle for cough mix- tures. Dose, 3 ij- 3 ss. Oleum Amygdalce Expressum, Expressed Oil of Almond,—is the fixed oil which is expressed from either Bitter or Sweet Almond. Used in Unguentum Aquae Rosae, and as a bland local application in skin affections. Physiological Action and Therapeutics. The bitter and sweet varieties of the species Amygdalus communis differ in action only through the agency of the principle Amygdalin contained in the former. The Sweet Almond is demulcent and nutritive, while the fixed oil expressed from either variety is a bland application, having the same action as Olive Oil. The action of the Bitter Almond and its oil is due to the Hydrocyanic Acid contained in them (see ante, p. 67). 98 amyl nitris. The Expressed Oil of Almond is demulcent, and in doses of 3 j-ij a mild laxative. It is used externally for excoriations, chapped hands, and inflammatory skin affections, and is applied to the ear in earache. The cake remaining after the expression of the fixed oil from the sweet almond is ground into flour, and used in the form of biscuits for diabetics as a substitute for bread, as it contains no starch. The Oil of Bitter Almond is used as a flavoring agent, and may be employed locally or internally in lieu of Hydrocyanic Acid. The Syrup is somewhat sedative, but is generally used as a demulcent or for flavoring purposes. The Mixture is used in catarrhal affections and as a vehicle for cough-mixtures. The poisonous character of the Bitter Almond and its essential oil (Oleum Amygdalae Amarae) should be kept in mind. AMYL NITRIS, Nitrite of Amyl, C5HnN02,—is a clear, yellow- ish liquid, of ethereal and fruity odor, aromatic taste, and neutral or slightly acid reaction, extremely volatile, insoluble in water but freely soluble in alcohol, ether, chloroform and benzin. It is produced by the action of Nitric or Nitrous Acid upon Amylic Alcohol, and when impure may have Nitric or Hydrocyanic Acid in it. Dose internally dissolved in alcohol,—by inhalation ttlij—v j but larger doses are probably safe. . Unofficial Analogue. Nitroglycerinum,—Nitroglycerin, Glonoin, Trinitrin, Trinitrate of Glyceryl, C3H5- (N08)„—is a clear, oily liquid, insoluble in water, but soluble in alcohol, ether, oils, etc., produced by the action of nitric and sulphuric acids upon glycerin. Is a dangerous explosive, and should not be kept in stronger solution than 1 per cent. Dose, rtp2Ar to Ay or more, according to susceptibility. Unofficial Preparations of Nitroglycerin. Tindura Nitroglycerini, Tincture of Nitroglycerin,—a 1 per cent, solution in alcohol. Dose, The strong tincture sold by the homoeopathic pharmaceutists and official in their American Pharmacopoeia is a 10 per cent, solution, or ten times the strength of the above. It is an extremely dangerous preparation, both as an explosive and as a medicine. (See American Homoeopathic Pharmacopoeia, 2d ed., Boericke & Tafel, 1883, page 235.) Tabellce Nitroglycerini, B. P.,—Tabellae Trinitrini,—are tablets of chocolate, each con- taining gr. of pure Nitroglycerin. Dose, j-ij. Other Nitrites. Sodii Nitris, Nitrite of Sodium, and Potassii Nitris, Nitrite of Potassium (both unoffi- cial), are used as substitutes for Amyl Nitrite and Nitroglycerin. The former is a white, granular powder, deliquescent, with a cool, saline taste, very soluble in water, is made by heating Sodium Nitrate, and has the formula NaN02. Dose, gr. according to indi- vidual susceptibility. Ethyl Nitrite, C2H5N02,—constitutes 5 per cent, of Spiritus Athens Nitrosi. (See ante, page 79.) Physiological Action. Nitrite of Amyl and the other Nitrites agree closely in their general action, producing great vascular dilatation by paralyzing either the sym- pathetic system, the vaso-motor centre or the muscular coat of the arteri- AMYL NITRIS. V 99 oles,—which, is yet undecided. They cause tumultuous action of the heart by relaxing its inhibition;—lowered respiration, from paralysis of the re- spiratory muscles and impairment of the ozonizing function of the blood; —diminution of sensation, motility and reflexes ;—a sense of heat, but lowered body-temperature; also throbbing pain in the head, beating carotids, quickened pulse, flushed face and vertigo. The effect of an ordinary inhalation of Amyl Nitrite on man is very transitory, excepting the headache, which may last several hours. Of the nitrites it is the most prompt but least enduring in action, and is best administered by inhalation. It causes sugar to appear in the urine and increases the quantity voided. Mixed with blood it forms methsemoglobin, which is not so readily deoxidized as haemoglobin, and under its influence the blood in the body becomes of a dark chocolate color both in the arteries and in the veins. Nitroglycerin acts similarly, but less promptly, and its action is more enduring. Its headache is of intensely frontal character, and persists for hours after the other effects have passed off. It is more suitable for internal administration. Nitrite of Sodium is also slower in action than Amyl Nitrite, and does not cause so much throbbing headache as Nitroglycerin. It may be given in solution with water. The action of all these agents is probably due to the Nitrous Acid con- tained in them. A ntagonists. Ergot, Belladonna, Strychnine, Brucine, Digitalis, Picrotoxin, and all other agents which increase the functional activity of the spinal cord and sympathetic are antagonistic, though by reason of their slower rate of diffusion the antagonism may not be always avail- able. Stimulants, artificial respiration, the alternate cold and hot douche, with cold to the head, and Ergotin or Atropine subcutaneously, are the best means to be used in cases of poisoning by the Nitrites. Therapeutics. The inhalation of Amyl Nitrite is a useful palliative in angina pectoris, epilepsy, tetanus, and many of the respiratory neuroses, as spasmodic asthma, whooping-cough, laryngismus stridulus, etc. It is also indicated in migraine of the pale-face form, and in the cold stage of intermittents and pernicious remittents, to prevent internal congestion,—also in convul- sions of various kinds, including the puerperal. It has been sometimes used in threatened death from chloroform ansesthesia, and in poisoning by strychnine. Nitroglycerin has been used with benefit in neuralgic dysmenorrhcea, sea-sickness, and in chronic interstitial nephritis, by redistributing to the kidneys their blood-supply cut off by degeneration of the renal ganglionic centres. It promptly relieves hiccough, migraine of spasmodic character, and has afforded immediate relief in neuralgia of the fifth. Its administra- tion in angina pectoris, though not producing such prompt results as that AMYLUM—ANISUM. of Amyl Nitrite, gives excellent and much more lasting effects. It is useful in the weak heart of the aged, or that from fatty degeneration, or when, as in Bright’s disease, the arterial tension is above normal; also in irritable and overacting heart, which it relieves by lowering arterial tension. Nitrite of Sodium has been successfully employed in angina pectoris, hemicrania, and in asthma of purely bronchial and neurotic origin. It has also proved decidedly beneficial in the abnormally high arterial ten- sion of chronic desquamative nephritis, especially when complicated with a weakened and dilated heart. AMYLUM, Starch, C6H10O3,—is the fecula of the seed of Triticuvi vulgare, common wheat, a plant of the nat. ord. Graminaceae. Though wheat-starch is the official kind, any other might be properly used, as the starch occurring in barley, oats, arrow-root, sago and tapioca, all of which foods were official in the U. S. P. of 1870. The last three are entirely com- posed of starch ; wheat contains about 70 per cent., and rice 90 per cent. Starch is a carbo-hydrate, and occurs in distinct grains, forming irregular, angular masses, white, inodorous and tasteless, easily pulverized, of neutral reaction, and insoluble in alcohol, ether or cold water. Under the microscope the granules are seen to be lenticular in form and concentrically striated. When boiled with water it yields a whitish jelly of bluish tinge, which when cool gives a deep blue color with test-solution of iodme, the color disappearing on warming and returning on cooling. By boiling with dilute mineral acids starch is converted into glucose, dextrin being formed as an intermediate product. Hot concentrated nitric acid converts it into oxalic acid, but cold fuming nitric acid dissolves it, forming an explosive compound. Diastase, ptyalin and pancreatin con- vert it into glucose. [For Glycogen, Dextrin, Cellulose and other allied substances see the article Saccharum in the following pages.] Amylum lodatum, Iodized Starch,—has of Starch 95 parts, Iodine 5, triturated with distilled water and dried. Used as a method of giving Iodine {see Iodum). Dose, 31“ Ass- Glyceritum Aniyli, Glycerite of Starch,—has of Starch 10 parts, Glycerin 90, tritu- rated and heated to a transparent jelly. Used as a vehicle for external applications. Starch, though a nutritive of the first order, may be regarded as inert medicinally. It serves as a protective and absorbent if dusted over the skin, as a vehicle for enemata, and as an antidote in iodine-poisoning. Mixed with glue it makes an excellent stiff bandage for surgical purposes. ANISUM, Anise ,—is the fruit of Pimpinella Anisum, a European plant of the nat. ord. Umbelliferae. It occurs in ovate bodies, yi inch long, hairy, of grayish color, aromatic odor, and sweet, spicy taste, resembling conium fruit in appearance. Dose, gr. x-xx. ANTHEMIS. Preparations. Oleum Anisi, Oil of Anise,—is a volatile oil distilled from Anise or from Illicium anisalum (the star-anise), and represents the medicinal qualities of the plant. That from Anise congeals at 50° to 590 F., and is soluble in an equal part of alcohol. That from Illicium congeals at about F. The oil is an ingredient of Tinctura Opii Cam- phorata, Trochisci Glycyrrhizse et Opii, and of the two following preparations. Dose, nJ-v- Aqua Amsi,—has in 500 parts 1 of Oil of Anise mixed with distilled water by the aid of cotton. Dose, indefinite. Spiritus Anisi,—is a 10 per cent, solution of the oil in alcohol. Dose, rj j-ij. The Volatile Oil is the active constituent of Anise. It has a slightly stimulant action on the heart and the digestive organs, and liquefies the bronchial secretion, being probably in part excreted by the bronchial mucous membrane. It is a favorite flavoring ingredient of cough-mix- tures, and relieves slight intestinal colic and flatulence in children. In full doses it has a weak narcotic power. ANTHEMIS, Chamomile,—the flower-heads of Anthemis nobilis, a European perennial of the nat. ord. Compositse, collected from culti- vated plants. Chamomile-flowers are sub-globular, about inch broad, having numerous white, three-toothed florets on a conical, solid receptacle, a strong but agreeable odor, and an aromatic, bitter taste; and contain a volatile oil, a camphor and a bitter principle but no alkaloid. There are no official preparations. An infusion (giv to Oj) may be given in doses of gj-ij. Oleum Anthemidis, Chamomile Oil (Unofficial),—the volatile oil is of a dark blue or green color, and is composed of various ethers, the Angelates and Valerianates of Butyl predominating. Dose, npij-x, on sugar. Physiological Action and Therapeutics. Chamomile is a stomachic tonic. It improves the appetite and aids digestion by increasing the vascularity of the gastric mucous membrane. In large doses the warm infusion is emetic, and perhaps diaphoretic, though the latter action is chiefly due to the hot water. The oil is re- markably efficient in reducing reflex excitability in frogs, even after its excitation by Strychnine or Brucine. Chamomile is popular in domestic practice. An infusion is used by nurses for many infantile complaints, and externally as a fomentation to relieve pain, as in colic, etc. The oil is very efficient in reflex cough, pulmonary catarrh, acute dyspepsia, diarrhoea of children, spasmodic asthma, whooping-cough, colic, and the spasmodic and pseudo-neuralgic affections of hysterical women. It should prove extremely useful in poi- soning by Strychnine, from its power over reflex excitability. The Chamomile of the homoeopaths is the Matricaria Chamomilla, or German Chamomile, official in the U. S. Pharmacopoeia as “Matri- caria,” which see. 102 ANTIMONIUM. ANTIMONIUM, Antimony, Sb.—Metallic Antimony is not official, nor is it used in medicine. It is represented, however, by the following official salts and preparations, viz. : Compounds of Antimony and their Preparations. Antimonii et Potassii Tartras, Tartrate of Antimony and Potasssium, Tartar Emetic, 2KSb0C4H406.H20,—small white crystals or a granular powder of sweet, disagreeable metallic taste, soluble in 17 of water at 590 F., and in 3 of boiling water, insoluble in alcohol. Dose, gr. but after tolerance is established as high as gr. ij may be given. Is an ingredient of the two following, viz.: Vinum Antimonii, Wine of Antimony,—has of Tartar Emetic 4, Boiling Distilled Water 60, Stronger White Wine to 1000 parts. Contains about 2 grains of Tartar Emetic to the % , and is an ingredient of Mistura Glycyrrhizae Composita. Dose, as a febrifuge and expectorant, Ttyv-xv. Syrupus Scillce Compositus, Cox’s Hive Mixture, Hive Syrup (see under Scilla),—con- tains about grain of Tartar Emetic to the 3 , or more accurately 3 parts in 2000, with Squill, Senega, etc. Dose, rt\, ]— 3 j, cautiously in children. Antimonii Oxidum, Oxide of Antimony, Sb2Os,—a heavy, gray powder, insoluble in water of alcohol, but readily and wholly soluble in Hydrochloric or Tartaric Acids. Dose, gr. j-iij. It constitutes yd of— Pulvis Antimonialis, Antimonial or James’ Powder,—consists of the Oxide of Anti- mony 33 parts, with 67 of Calcium Phosphate. Dose, gr. iij-viij, every 3 hours as a dia- phoretic, larger doses for emetic and cathartic effects. Antimonii Sulphidum, Sulphide of Antimony, Sb2S3,—is the native sulphide, purified by fusion, and as nearly free from Arsenic as possible,—steel gray masses, or a black, lustreless powder, insoluble in water or alcohol. Dose, gr. J^-j. Antimonii Sulphidum Purificatmn, Sb2S3,—is purified by maceration in Aq. Ammo- nias, washing and drying. Dose, gr. %-]■ Antimonium Sulphuratum, Sulphurated Antimony,—is chiefly Sb2S3, with a very small amount of Sb203. A reddish-brown, odorless and tasteless powder, insoluble in water or alcohol. Is a constituent of Pil. Antimonii Compositae. Dose, gr. j-v. Pilules Antimonii Composites, Plummer’s Pills,—each pill containing gr. y2 each of Calomel and Sulphurated Antimony. Physiological Action. Tartar Emetic in its action represents the other official antimonial preparations, being a cardiac, arterial and general depressant, a proto- plasmic poison, a systemic and local emetic, a specific gastro-intestinal irritant, an expectorant and a diaphoretic. Like Aconite, Arsenic, Hy- drocyanic Acid and Potassium, it is destructive to protoplasm, destroying function in all nitrogenous tissue, and paralyzing the spinal cord, the motor nerves, the muscles and the sensory nerve terminations. It is especially depressant to the heart-muscle and the cardiac motor ganglia; it combines with the red blood-corpuscles, lessening their oxidizing power, lowering the blood-pressure and reducing the body-temperature. Its taste is styp- tic and one of its earliest effects is the production of constriction of the fauces. It promotes waste and rapid excretion of waste-products, carbonic acid and urea being especially increased. Being eliminated by all the excretory organs, including the skin, it excites follicular inflammation at the points of elimination ; resulting in an eruption which is papular at first, then becomes vesicular, and finally pustular, the pustules being um- bilicated, like those of variola. This same eruption is also produced by the application of the drug to the skin with friction. Aphthous ulcerations, antimonium. 103 extending from the mouth to the stomach, with salivation and painful deglutition, may also result from its continued use. In small doses Tartar Emetic stimulates secretion in the bronchial and salivary glands, the stomach, intestinal canal, liver and pancreas. In larger doses it excites nausea, vomiting and purging, with evacuations like the “ rice-water discharges” of cholera, and great prostration of the vital powers. Toxic doses produce similar symptoms, besides epigastric pain, cyanosis, delirium, cramps, motor and sensory paralysis, suppression of urine and collapse,—much the same phenomena as observed in Asiatic cholera. The Sulphide occurs native, and is the source from which the other compounds are prepared. It seems to be inert medicinally. Sulphurated Antimony owes its efficacy to the small quantity of the Oxide contained in it, and as this is variable, the action of the preparation is uncertain. The Oxide has a similar action to that of Tartar Emetic, but being in- soluble in water, it is of much less certain activity. Antidotes ana Antagonists. Tannic Acid, or any substance containing it, is the antidote, forming the insoluble tan- nate. Opium, Alcohol, Ether, and other antispasmodics are physiological antagonists. Demulcent drinks should be freely administered to protect the mucous membranes. Al- kalies and Salts of Lead decompose Tartar Emetic. Therapeutics. Tartar Emetic was formerly much employed as an antiphlogistic on account of its power to cut short acute inflammations of sthenic type, and its use was very much abused, so that it has now gone out of fashion as a remedy. The contra-stimulant treatment of pneumonia and other inflam- matory diseases by large doses of this salt after tolerance was established, is only worthy of reference as an historical fact. The same may be said of its external use as a counter-irritant as well as of its employment as an emetic, in both of which capacities it is too severe, while its emesis is too tardy in action to be of any value in poisoning. It is, however, a very efficient agent in many grave affections, if used in small doses (gr. being highly recommended in acute inflammatory affections of the respi- ratory tract, especially pneumonia, broncho-pneumonia, acute oedema of the lungs, feverish and catarrhal colds, bronchitis, laryngitis and tonsil- litis. In many respects it acts like Aconite in these and kindred affections, producing copious diaphoresis, slowing the pulse and allaying restlessness. It is considered a good remedy in puerperal peritonitis, mammitis and orchitis, in lumbago and other muscular rheumatisms, also in photophobia and in gastric indigestion after beer-drinking. In still smaller doses (gr. hourly) it is particularly efficient in catarrhal inflammations of the respiratory mucous membrane in children, accompanied by rattling breathing and much mucus, which is expelled with difficulty. Such cases 104 ANTIPYRINA. often simulate asthma, the attacks being marked by cough, wheezing, and difficult respiration, also sibilant rales in the chest, and usually follow on severe colds or on measles. The Compound Syrup of Squill is commonly used as an expectorant and nauseant in the treatment of bronchitis and croup. The quantity of Tartar Emetic in it (gr. t0 ie 3) should be remembered in administering it to children. (See Scilla.) The Oxide is chiefly employed in the form of James’ Powder (Pulvis Antimonialis) for its mild diaphoretic qualities. The Sulphide is not used in medicine. Sulphurated Antimony is very uncertain in action and is but little used. The Compound Pill of Antimony (Plummer’s Pill) was devised to obtain mercurial results without writing Hydrargyrum on a prescription. ANTIPYRINA, Antipyrine, Dimethyl - oxy - chinicine,— C20H18N4O2 (Unofficial),—is an alkaloidal product of the destructive dis- tillation of Coal-tar (compare Chinolina), and prepared by a patented and complicated process. It may also be obtained synthetically by heat- ing Methyl-oxy-chinicine with Phenyl-hydracine, and collecting the powder. It is a grayish or reddish-white 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-hydrochloric 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. The full antipyretic dose for an adult was at first stated at 30 grains hourly for three hours, or 90 grains for the antipyretic effect. For children, gr. j for each year of age as a dose, to be repeated twice, or thrice, with the same intervals between each dose. That such dosage was far too great, soon became evident from the many reports of alarming symptoms of collapse resulting in numerous instances; and the tendency has lately been towards a decreased size of dose at shorter intervals, which should be lengthened as soon as the drug-effects begin to be manifested. An average adult dose is now placed at 10 grains, for children % grain per year of age between 2 and 5, grain per year from 5 to 10; not exceeding 5 grains at a dose for any child under 15 years of age. Antipyrine has but little flavor, is not unpleasant, and is therefore readily taken by chil- dren, in which respect it is greatly superior to Quinine. It may be administered in com- pressed tablets, each having from I to 5 grains;—or in Elixir Aurantii,— say gr. lxxx in g iv, of which solution each 3 contains gr. ijss. If vomiting result, the same dose may be dissolved in half its weight of hot water, and injected hypodermically while warm. Antipyrine may be decomposed when brought into contact with Nitrous compounds, a new and poisonous substance being supposed to be formed, of uncertain composition, but resembling the Anilin greens. The mixture of this drug with Spiritus Etheris Nitrosi is, therefore, highly dangerous, if this supposed reaction is at all likely to occur. Physiological Action. Antipyrine is a powerful antipyretic, a local anaesthetic, and a general analgesic,—and also possesses diaphoretic, mydriatic, antiseptic, disinfec- ANTIPYR1NA. 105 tant, hemostatic and slightly hypnotic powers. After the ingestion of a full medicinal dose, (gr. xxx), there is a stimulant stage of short duration, in which the heart’s action is increased, and a subjective sense of heat is experienced, with flushing of the face. This is soon followed by profuse sweating, 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 Kairine, 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 has 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 Kairine, Chino- line, 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 eliminated by the kidneys, appear- ing in the urine some three hours after its ingestion. The profuse sweat- ing which it causes may be prevented by giving in advance a small d.ose 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. As an Antipyretic, Antipyrine, like Alcohol, acts by a double mode of operation,—(1), by diminishing oxidation, and (2) by promoting heat- loss. The latter is attained by dilating the cutaneous vessels, allowing free radiation from the surface, and by the refrigerant action of the evapo- ration of the sweat. As an Analgesic, Antipyrine has a very considerable degree of power, in common with all the Chinoline 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 Ergotine. 106 apiol. Therapeutics. By far the most popular of the modern antipyretics, Antipyrine deserves its rank in professional esteem, being the most certain, the most powerful and the least dangerous;—but 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. In acute rheumatism, it has held the first place as a remedy, for some time ; a claim which is now disputed in favor of Salol. In typhoid fever and other febrile con- ditions, wherein hyperpyrexia occurs, as phthisis, erysipelas, pleuritis, pneumonia, surgical fever, etc. In neuralgise, neuritis, and other painful affections, especially when of rheumatic origin,—as lumbago, sciatica, hemicrania, supra-orbital neuralgia, etc., in which io-grain doses are gen- erally sufficient, and may be given hypodermically. In painful affections of hysterical persons;—pain from cerebral tumors and from cardiac dis- eases,—also painful menstruation ;—all of which are often relieved by it. In acute paroxysms of gout, a dose of io grains every two hours, preceded by a commencing dose of 25 grains, promptly relieved the pain and short- ened the duration of the attack in one very thoroughly observed and carefully reported case. In chronic gout, very remarkable results are reported from the use of this agent, indicating a specific action thereon of curative character. It has seemed to render efficient service in dysmenorrhoea, carbuncle, and cerebro-spinal meningitis; and affords valuable aid in the pyrexia of intermittents, in which stage the slow action of Quinine prevents its availability for immediate relief. APIOL (Unofficial),—is a non-volatile, oily liquid, of acid reaction and. pungent taste, soluble in alcohol, ether, chloroform, and in glacial acetic acid. It is extracted from the fruit of Petroselinum sativum (Pars- ley), a biennial plant of the nat ord. Umbelliferae, which also contains a gelatinous substance named Apiin, and a Volatile Oil which is by some considered to be the true emmenagogue principle of the plant. Apiol is probably a mixture of several substances, and as found in commerce is often an impure oleoresin. Dose, npiij-x in capsule two or three times a day ; as an emmenagogue, rtpxv in one daily dose. Physiological Action and Therapeutics. In small doses (iTpiij—v) Apiol is carminative, diuretic, diaphoretic, ex- pectorant and stimulant to the circulation. In full doses (npxv) it is decidedly emmenagogue and feebly antiperiodic, producing headache, tinnitus aurium, intoxication, giddiness, etc., its action generally resem- bling that of Quinine. Large doses (ffLxxx-oj) are decidedly narcotic. It has had some reputation in intermittents and in malarial neuralgiae, but is most frequently employed in amenorrhoea and dysmenorrhoea, APOCYNUM APOMORPHINA. 107 being of especial advantage in the amenorrhoea of anaemia, also when the menstrual discharge is fetid. It is becoming fashionable as a supposed abortifacient, but is useless for this purpose, and if freely used may produce decided narcotism, especially if the preparation employed should happen to be an active one. The capsules of Apiol put up in France and sold in this country over the counters of drug-stores to any applicant are gen- erally inert; hence cases of poisoning by this drug are seldom observed. They are, however, an important source of revenue to the retailers, as, being “imported” preparations, they command a high price, which is readily paid by gullible women who wish to “bring around their courses.” APOCYNUM, Canadian Hemp, —is the root of Apocynutn can- nabinum, an indigenous perennial plant of the nat. ord. Apocynacese, and inodorous but of bitter, disagreeable taste. It contains a peculiar active principle, Apocynin, also tannic and gallic acids, resin, wax, ca- outchouc, etc. Dose of the powdered root, gr. v-xxx. A decoction (Sss to the pint) may be given in doses of Sj-ij thrice daily. Physiological Action and Therapeutics. Apocynum is powerfully emetic and cathartic in full doses, also diapho- retic, expectorant and sometimes actively diuretic. It lowers the pulse- rate, produces much nausea, and induces drowsiness. It should not be confounded with Indian or American Hemp (Cannabis sativa), which have entirely different qualities. The only condition in which Apocynum has proven of much value is dropsy, especially the anasarca of Bright’s disease and ascites, in which 15-grain doses are indicated. The active principle, Apocynin, is a good expectorant, in doses of gr. y to gr. y2. APOMORPHINA, Apomorphine, —is an artificial alkaloid, pre- pared from Morphine or Codeine by the action of strong acids or zinc chloride. The Hydrochlorate (C17H17N02HC1) is official, and occurs in minute, colorless crystals, odorless, of bitter taste, and neutral or faintly acid reaction ; soluble in 7 of water and 50 of alcohol at 590, F., almost insoluble in ether or chloroform; decomposed by boiling water or boil- ing alcohol. Dose,gr. Ar to hypodermically, gr. TC to by the mouth. For young children, gr. Aj to A" should not be exceeded. Solutions should be fresh when used, and as they alter rapidly by keeping, should have a few drops of hydrochloric acid added to them, to pre- vent decomposition. Physiological Action and Therapeutics. Apomorphine is a systemic emetic, acting directly on the vomiting centre, and is the quickest, most certain and least irritating of all emetics, acting in from five to twenty minutes with but moderate nausea. In large dose it is very depressant to the heart (gr. y having caused death in a 108 AQUA. weak adult by cardiac failure), and produces paralysis of the motor and sensory nerves, delirium, convulsions, and depression of respiratory power. Small doses (gr. fa) are expectorant. The Hydrochlorate is the preparation usually employed, and the only official one. It is the best emetic to use in many cases of poisoning, par- ticularly when swallowing is difficult, but is useless in narcotic poisoning after narcosis has blunted the vagus centre. It is a very desirable agent in any case where time is of great importance. As an expectorant it is highly recommended but has not yet been much used. In catarrhs the fa of a grain every 3 hours will prove of great advantage, but it must be used with caution especially in young children, who bear this remedy very badly. In hacking coughs without expectoration it has proven a very efficient agent, given in minute doses, gr. to fa in the 24 hours. AQUA, Water, H20,—is natural water, in its purest attainable state, a colorless, limpid liquid, devoid of odor or taste, of neutral reaction, and containing not more than 1 part of fixed impurities in 10,000 parts. Besides entering into the composition of most of the official extracts, fluid extracts, and many other pharmaceutical preparations, from it are pre- pared the 13 official Waters (Aquae), and also the official— Aqua Destillata, Distilled Water, H20,—1000 parts of water are distilled, the first 50 parts obtained being thrown away, 800 parts are preserved. It is as near chemically pure water as can be obtained. Aqua Carbonata, Carbonated Water, Soda-water, is water highly charged with car- bonic acid gas, C02, the excess of gas being dissolved in the water by pressure, and escaping in bubbles when the pressure is taken off. It was official in the U. S. P., 1870, under the title Aqua Acidi Carbonici, the formula requiring that the water be charged with five times its volume of gas, for which a pressure of five atmospheres is required. The materials usually employed by soda-water manufacturers for producing the gas, are either Sodium Bicarbonate or Marble-dust, and Sulphuric Acid. Aqua Fluvialis, River-water. Aqua Pluvialis, Rain-water. Aqua Fontana, Spring or Well-water. Aqua Marina, Sea-water. Aqua Carbonata, Carbonated Water, Soda Water. Nomenclature of Water. Aqua Destili.ata, Distilled Water. Aqua Bulliens, Boiling Water. Aqua Fervens, Hot Water. Aqua Communis, Common Water. Balneum Maris, Warm-water Bath. Balneum Vaporis, Vapor Bath. Mineral Waters. Natural Water differs from Distilled in containing saline and other con- stituents in varying proportions,—from common water (Aq. Communis), in which they are so small in quantity as not to alter the taste, color, etc., up to the Sea-water, having per cent., and that of the Dead Sea with per cent. Spring waters, impregnated with foreign substances so as to have a decided taste and a marked action on the human system, are called Mineral Waters, which may be subdivided into various groups, according to their prevailing constituents, as Carbonated, Alkaline, Saline, Sulphuretted, Silicious, etc. Full analyses of all the principal mineral AQUA, 109 waters of Europe and America are given in the United States Dispensa- tory, 16th edition, but a few of the most prominent will be mentioned here. Carbonated Mineral Waters. Selters, Nassau, Germany, 30 cubic inches ) Apollinaris, Nuenahr, Prussia, 47 “ I Old Sweet Spring, West Virginia, ..... 11 “ [ Sweet Chalybeate Spring, Virginia, 13 “ of C02 to the pint. These waters are cold, contain generally Carbonates of Calcium, Magnesium and Sodium (in some, Iron), which are held in solution by the excess of Carbonic Acid, also Chlorides of Sodium and Potassium, Sulphates, Phosphates, etc. Alkaline Mineral Waters. Ems, Germany. Salzbrunn, Germany. Gleickenberg, Austria. Vichy, France. Vais, France. Bladon Spring, Ala. Congress Spring, Cal. Seltzer Spring, Cal. Perry Spring, Ills. St. Louis Spring, Mich. Buffalo Lithia Spring, Va. Hot Spring, Va. Warm Spring, Va. Berkeley Spring, Va. Bethesda Spring, Wis. Gettysburg Spring, Pa. These waters are generally cold, those of Vichy and Ems being warm. They contain a considerable amount of Sodium Carbonate, also Sodium Chloride and Sulphate, and various other Chlorides, Carbonates and Sulphates, with Carbonic Acid gas in varying quantity. Vichy and Vais waters depend for their efficacy almost wholly on the quantity of Sodium Carbonate contained in them, which is for Vichy from 26 to 50 grains and for Vais about 60 grains to the pint. Saline Mineral Waters. Friedrichshall, Germany. Hunyadi Janos, Hungary. Baden-Baden, Germany. Wiesbaden, Germany. Carlsbad, Bohemia. Pullna, Bohemia. Seidlitz, Bohemia. Marienbad, Bohemia. Cheltenham, England. Kissengen, Bavaria. Reichenhall, Bavaria. Adelheidsquelle, Bavaria. Kreutznach, Prussia. Saratoga Springs, N. Y. Ballston, N. Y. Hot Springs, Arkansas. St. Catherine’s, Ontario, Canada. These waters are of more complex composition, the various waters of Saratoga contain- ing more than thirty constituent salts. Those usually present are the Sulphates and Car- bonates of Sodium, Calcium, Magnesium, etc. (Magnesian waters); Chlorides of Sodium, Potassium and Lithium (Chlorinated waters); Ferrous salts (Chalybeate waters), with Iodine, Bromine, Manganese salts, and Phosphates in some few. Carbonic Acid gas is present in all. Most of them are purgative, some are considered alterative, and many are warm (ioo°-i6o°). The most powerful member of the saline group is Hunyadi Janos, which contains about 150 grains each of Magnesium and Sodium Sulphates to the pint, and is, therefore, effec- tively purgative. Nearly as strong is Pullna water, with 124 grains of Sodium Sulphate and 93 grains of Magnesium Sulphate to the pint. Friedrichshall is less powerful, but perhaps a better aperient water in doses of 6 to 10 fluid ounces. Marienbad contains no Magnesium Sulphate, but has 36 grains of Sodium Sulphate, 9 of Sodium Carbonate, 11 of Sodium Chloride, and a small quantity of Ferrous Carbonate to the pint; in trans- portation, however, it loses its Carbonic Acid and deposits the Iron. It is not aperient in ordinary doses. Carlsbad water contains 20 grains of Sodium Sulphate and 9 each of Sodium Carbonate and Chloride to the pint. The so-called “ Carlsbad Salt ” is simply Sodium Sulphate with a trace of the Carbonate. Hartnack gives the following formula for its artificial preparation : Sodium Sulphate 100 parts, Sodiutn Bicarb. 80, Sodium Chlo- ride 40; a dessertspoonful in water as a mild saline purgative. These waters are imported into the United States in large quantities, and may be ordered through any druggist. AQUA, Sulphurous Mineral Waters. Aix-la-Chapelle, Prussia. Bareges, S. France. Eux-Bonnes, S. France. Llandrindod, Wales. Harrowgate, England. Blue Lick Spring, Ky. Sharon Spring, N. Y. Yellow Sulphur Spring, Va. White Sulphur Spring, W. Va. Salt Lake Warm Springs, Utah. These waters all contain Sulphuretted Hydrogen gas, also Carbonic Acid gas and Car- bonates, Chlorides and Sulphates of Sodium, Potassium, Magnesium and Calcium; some- times Carbonate and Oxide of Iron, Iodide and Bromide of Sodium. Silicious Mineral Waters. Hot Springs, Iceland. Geysers of Yellowstone Park. The constituents of these waters are chiefly alkaline Silicates. Physiological Action of Water. Water is an essential constituent of all the tissues of the body, form- ing from 0.2 per cent, of the enamel of the teeth to 77 per cent, of the ligaments. In the liquids of the organism it is contained in the propor- tions of 78 per cent, of the blood to 93 per cent, of the urine, and 99 per cent, of the tears. In moderate quantity it is necessary to digestion, but in large amount it weakens digestion by diluting the gastric juice. Ice-cold water, if freely used, suspends the action of the pepsin, depresses the nerves of the stomach, and lowers its blood supply. The free use of water internally produces increased cutaneous and renal excretion, and promotes the elimination of some of the products of tissue-change, as urea, phosphoric acid, etc. In some subjects it favors the deposition of fat. Cold Water applied externally, as by a bath (4o°-6o° F.), abstracts a portion of the body-heat, lowering the surface temperature and depress- ing the cutaneous nerves, producing spasmodic breathing and a quick- ened pulse. If the temperature of the water is not too low and the bodily vigor is good, reaction soon occurs, and the general effect is tonic to the muscular power, circulation and respiration. If this does not take place a secondary chill occurs, and serious depression may result. Warm Water (95°-ioo° F.) applied to the surface of the body, as by baths of water or steam, packing, etc., acts in the opposite manner at first, increasing the circulation in the skin, the rapidity of the pulse and respiration and the body temperature. Rapid tissue-change occurs, the waste products being eliminated chiefly by the skin and the pulmonary mucous membrane. If long-continued, precordial oppression, giddiness and muscular debility are experienced. Hot Water (iio°-ti2° F.) at first dilates the vessels of the part to which it is applied, and soon afterwards contracts them. It is a valuable means of relieving congestion and inflammation, and is a most effective hemostatic when the bleeding is from small vessels or of capillary charac- AQUA, 111 ter. Whether generally or locally applied it is one of the most reliable means of relieving spasm. Hot Vapor applied to the surface accelerates the circulation and pro- duces profuse sweating. Its general action is similar to that of warm water. Mineral Waters taken internally act chiefly by virtue of the water, partly in accordance with the effects of their various constituents. As baths, their action is doubtless entirely due to their temperature. Cold Water or Ice has many external applications of value in the treatment of disease. As a wet pack it is used in tonsillitis, diphtheria and croup. Cold baths are the most effective antipyretic in the high tem- perature of fevers, and the cold wet pack is used for the same purpose. Ice or cold water is applied to the head in acute cerebral congestion, and to the spine in chorea, etc.; also locally in hemorrhoids, bubo, orchitis, and to the uterus in post-partum hemorrhage. Cold affusion to the body is employed as a preventive of spasmodic croup, as well as to lessen the tendency to taking cold. Hot Water externally as fomentations, hot wet pack, baths, etc., is most effective in reducing local congestion and setting up resolution of local inflammation. Hot fomentations to the renal region are useful in functional inactivity of the kidneys. The hot spinal douche is used in affections of the spinal cord and meninges, and in the backache of women. The hot wet pack is highly esteemed in inflammations of the chest organs, and hot injections for chronic inflammation of the uterus. Hot water dressings for wounds are strongly recommended by many high surgical authorities. Vapor and Turkish baths are used as diaphoretics in advanced kidney disease, in acute and chronic rheumatism, mineral poisoning, and syphilis. Warm baths, with cold applications to the head, are esteemed as of value in infantile convulsions and chorea. Internally, water is chiefly of value as a diuretic, and if hot as a dia- phoretic. A glass of cold water before breakfast daily is often an effective means of overcoming constipation, while the drinking of hot water an hour before each meal has been of great value to many dyspeptics. The value of the popular teas in chronic diseases is almost entirely due to the diluent, diuretic and diaphoretic actions of the hot water used. Carbonated Water, or “Soda-water,” as it is popularly called, is employed as a grateful beverage in hot weather, being flavored with various syrups. It is also an agent of great value for febrile cases, as it allays thirst, lessens nausea, and promotes the secretion of urine. It forms an excellent vehicle for the administration of the saline cathartics, especially Magne- sium Sulphate, and of the various carbonates. It is one of the numerous agents which have been found efficacious in the vomiting of pregnancy. Therapeutics of Water. ARGENTUM. Therapeutics of the Mineral Waters. An undue value is placed by the laity and interested proprietors on the medicinal value of mineral waters, causing the various localities of the best advertised springs to become resorts for invalids and idlers from every civilized country. The benefit derived is in most instances due to the change of climate and scene, freedom from home cares and business worry, regularity of life and diet, drinking of water in quantity, and in many cases the substitution of water for alcoholic beverages. In order to get the worth of their money, people will gladly submit to rigid hygienic and dietetic restrictions at a watering-place which they would totally ignore at home. The same may be said of the treatment at the so-called “ hydropathic ” or “ water-cure ” establishments. As a rule, those springs will prove of most value which are furthest removed from the patient’s residence, for “ distance lends enchantment ” in these matters as well as in many others. Invalids whose homes are in the vicinity of some wonder-working spring will not usually derive much benefit from its water, but will by that of another spring, similar in constituents, but located several hundred miles away. The principal affections in which mineral waters are esteemed most highly are the following: dyspepsia, cirrhosis of the liver, gout, rheu- matism, lithiasis, diabetes of hepatic origin, constipation, strumous disorders, obesity, plethora of the pelvic organs, hypochondriasis, skin diseases, especially those dependent on gastric derangement, phthisis, constitutional syphilis, metallic poisoning, etc., in all of which the influ- ences above mentioned are especially efficacious, and are no doubt the chief factors in producing any benefit which may be attainable. Aperient and purgative waters are useful in many cases where a prejudice exists against purgative medicine, but none against the same agents in a natural water. The strong saline-aperient waters, as Carlsbad, Hunyadi, Fried- richshall, etc., have considerable repute in the treatment of the uric-acid diathesis and calculous affections, and the waters of St. Catherine’s Wells are credited with decided influence upon local and chronic rheumatism. The special therapeutics of mineral waters are to be found in this volume under the heads of their principal constituents, as Sodium Chloride, Sodium Sulphate, Magnesium Sulphate, etc., also in the therapeutical part of the work. ARGENTUM, Silver, Ag,—is represented by the following four official salts, viz.: — Compounds of Silver and their Preparations. Argenti Nitras, Nitrate of Silver, AgN03,—occurs in colorless rhombic crystals, of bitter caustic taste and neutral reaction, soluble in 0.8 of water and 25 of alcohol at 590 F. Is best given in pill or distilled water; never with tannin or a vegetable extract, lest an explosive compound result. Dose, gr. —if watched, up to gr. j may be given. When melted with 4 per cent, of Hydrochloric Acid, it makes— Argenti Nitras Pusus, Moulded Nitrate of Silver, Lunar Caustic,—for local use as a ARGENTUM. 113 mild caustic and an astringent. Argenti Nitras Dilutus, Diluted Nitrate of Silver, Miti- gated Stick,—is the same melted with an equal weight of Potassium Nitrate. Is used locally by ophthalmologists. Argenti Cyanidum, Cyanide of Silver, AgCN,—has no medicinal use except for the extemporaneous preparation of Hydrocyanic Acid. (See ante, page 67.) Argenti Iodidum, Iodide of Silver, Agl,—a greenish yellow powder insoluble in water or alcohol. Is used instead of the nitrate internally, as it is supposed not to discolor the skin. Dose, gr. %.—} in pill. Argenti Oxidum, Oxide of Silver, AgaO,—a brownish black powder, nearly insoluble in water and insoluble in alcohol. It should not be triturated with readily oxidizable or combustible substances, and should not be brought into contact with ammonia. Dose, gr. in pill. Is not dangerous. All the silver salts should be protected from light in dark amber-colored vials. Nitrate of Silver is a powerful astringent and a limited escharotic. Applied to the skin or mucous membrane it combines with the albumen of the tissue, excites superficial inflammation, which is soon followed by an altered condition of the part, and stains the same black under the influence of light. The stains may be removed by washing with a strong solution of Potassium Cyanide. Given internally in small doses it increases secretion, stimulates the heart, promotes nutrition, and acts as a nerve tonic. Its continued use produces symptoms which are collec- tively termed Argyria, and are as follows: gastro-intestinal catarrh, tissue waste, uraemia, albuminuria, fatty degeneration of the heart, liver and kidneys, hemorrhages, fluidity of the blood, a slate-colored line along the margin of the gums, and a similar discoloration of the skin and mucous membranes, with centric impairment of the nervous system producing paralysis on a large scale, loss of coordination power, convul- sions, and finally death by paralysis of respiration. Large doses produce violent gastro-enteritis, also ulcer of the stomach from thrombosis of its veins, and destruction of the gastro-intestinal mucous membrane. The Iodide and Oxide are sometimes used to produce the same con- stitutional effects, they being supposed not to discolor the skin, but this has been found to be fallacious. The oxide is much the least irritant of the silver salts. Antagonists and Incompatibles. Common Salt freely used is the antidote, precipitating the insoluble chloride of silver and acting as an emetic. The nitrate is exceedingly sensitive to organic material and light, which decompose it readily. Incompatibles are all the soluble chlorides (hence it should be used in distilled water), most of the mineral acids and their salts, alkalies and their carbonates, lime water and astringeut infusions. A course of silver medication should be regulated by suspending the remedy after 5 or 6 weeks’ use, and then promoting elimination by purgatives, diuretics and baths. To prevent the general discoloration Potassium Iodide should be given conjointly with the silver, and baths of Sodium Hyposulphite used frequently. Physiological Action. Locally the Nitrate is much used as a stimulant application, an astrin- gent, a caustic, an alterative and an antiphlogistic. To ulcers and in throat affections the solid stick may be used, but solutions of various Therapeutics. 114 ARNICA. strengths from gr. j to gr. xl to the 3 are much better. The mildest solutions are employed in conjunctivitis (never over the cornea), the stronger in throat and mouth affections, and the strongest in lupus, ery- sipelas and other skin diseases. A solution in Nitrous Ether (gr. xl to the 5) is said to abort superficial inflammations if applied early to the neighboring integument, and in erysipelas a solution of gr. xx to the 5 is often used over the inflamed surface and beyond, after careful washing and drying, in the hope of preventing the extension of the disease, which it will not do. The mucous membranes of the conjunctiva, fauces, larnyx, urethra, bladder, uterus, vagina and rectum, have all been sub- jected to the local action of this salt. Internally the silver salts are used in dyspepsia with vomiting of yeasty fluid, chronic gastritis and gastric ulcer, dysentery of chronic type, espe- cially if rectal ulcer (the Nitrate internally and by enema), the diarrhoea of phthisis and typhoid fever (Nitrate with Opium), chronic spinal in- flammations causing locomotor ataxia or paraplegia, and epilepsy, in the latter affection the Nitrate having occasionally given good results. The Oxide has been used internally for gastric neuralgia, irritative dyspepsia, pyrosis, gastric and pulmonary hemorrhages, and menorrhagia. The Iodide is used to obtain the constitutional effects of silver, but has no advantage over the other preparations. ARNICA ,—is the plant Arnica Montana or Leopard’s Bane, a peren- nial of the nat. ord. Compositse, indigenous to the mountains of Northern Europe and Siberia, and said to have been also found in the mountains about the headwaters of the Missouri and Columbia rivers. It has large orange-yellow flowers, and a small, curved rhizome with several rootlets. Both the flowers and the root are official. Its most important constituent is Trimethylamine, C3H9N, an ammoniacal alkaloidal principle which is probably the active ingredient. It also contains Arnicin, Inulin, Capro- nic and Caprylic Acids, tannin, mucilage, resins, and two essential oils, one of which exists in the flowers, the other in the root. Flores, Arnica Flowers,—the flower-heads of Arnica Montana, large, yellow, having 14 to 16 strap-shaped florets in the ray, twice as long as the disk, which consists of numerous tubular florets. The odor is feebly aromatic, the taste bitter and acrid. Used in Tincture and Infusion. Arnkle Radix, Arnica Root,—the rhizome and rootlets of Arnica Montana, is about 2 inches long and to inch thick, externally brown and rough from leaf-scars, internally whitish, with a thick bark contain- ing a circle of resin-cells and a large, spongy pith. Odor somewhat aro- matic, taste pungent, aromatic and bitter. Resembles Valerian, which is distinguished by its smell; Serpeniaria, which has many contorted root- lets ; and Veratrum Viride, which has thicker rootlets. Dose, gr. v-xx. ARNICA. 115 Preparations of the Flowers. Tinctura Arnicce Florum,—20 per cent. Dose, uyv-xxx. Infusum Arnicce (Unofficial),—Arnica flowers 20 in 100 parts of water, is thought by many observers to be the best form for local use, as it does not excite dermatitis, probably from containing none of the Volatile Oil, or the insoluble principle Arnicin. Preparations of the Root. Extractum Arnicce Radicis,—Dose, gr. j-iij. Extractum Arnicce Radicis Fluidum,—Dose, Ityv-xx. Tinctura Arnicce Radicis,—10 per cent. Dose, rtyv-xxx. Emplaslrum Arnicce, — contains Extract of Arnica Root 50 parts to 100 of Lead Plaster. Derivative. Trimethylamina, Trimethylamine, C3H9N (Unofficial),—is a thin, colorless, strongly alkaline liquid, boiling at 50° F., and at ordinary temperatures is a colorless, inflammable gas. The Hydrochlorate is the most stable salt, crystallizing in white or colorless prisms, nearly odorless, of pungent taste, very deliquescent, and freely soluble in water and in alcohol. Dose, gr. ij-iij in syrup every 2 hours. Trimethylamine has been obtained from Arnica flowers and those of several other plants, from Ergot, Hops, Codeine, Cod-liver Oil, and decomposing albuminous sub- stances, such as human urine, herring-pickle, and the residue left in making sugar from beets. It is sometimes incorrectly named Propylamine, a term also applied to an impure trimethylamine, but in reality an allied and isomeric compound. Arnica is irritant, stimulant, depressant, antipyretic, diuretic and vul- nerary. It irritates the gastro-intestinal tract, and in some persons the local use of an alcoholic preparation of the flowers will excite erysipela- tous inflammation of the skin, though those of the root have not been observed to do so. In small doses internally it increases the action of the heart, raises the arterial tension and stimulates the action of the skin and the kidneys. Large doses produce a transient excitement, followed by depression of the circulation, respiration, and nerve-centres; headache, unconsciousness, and even convulsions being induced, the body-tempera- ture lowered, the pupils dilated, and muscular paresis produced. A toxic dose paralyzes the nervous systems of animal and organic life, causing collapse and death. Trimethylamine is an active escharotic and a gastro-intestinal irritant. It lowers the rate and force of the heart, decreases the body-temperature, and diminishes (though sometimes increases) the excretion of urea. The Hydrochlorate is a powerful antipyretic in doses of gr. ij every 3 hours. Physiological Action. Therapeutics. Arnica is a popular remedy with those who patronize the so-called homoeopathic school of practice, but like many other agents which the homoeopathists claim to have given to medicine, it is a remedy much older than homoeopathy, and was investigated originally by regular physi- cians, notably by Van der Kolk in the sphere of mental affections. Externally, the tincture in water has a popular reputation in sprains, bruises, etc., though an infusion is better for local use. Ecchymoses are 116 ARSENIUM. rapidly dispersed by its administration internally as well as externally; and, in internal bruises from shocks or concussions, its internal use has proven very efficacious. The aqueous preparation locally promotes the rapid union of cut surfaces. Internally, besides its value as noted above, Arnica is undoubtedly effectively employed in typhus and typhoid fevers as a stimulant and antipyretic, also in delirium tremens, rheumatism and rheumatic gout, hemorrhages, epistaxis, haemoptysis, amaurosis, concussion of the brain, chronic dysentery, and paralysis of the bladder. In idiopathic mania, after the first excitement has diminished, Arnica, in aqueous preparation internally, has given great satisfaction. It has often checked an exhausting diarrhoea after many other remedies have failed. Trimethylamine has been found useful in acute rheumatism and gout, relieving pain, reducing temperature, and diminishing the frequency of the pulse. In chronic rheumatism, as a limiment (i to 3 of Glycerin), it is said to give relief equal to that produced by any anodyne. It has also been used with benefit in chorea, moderating the spasmodic move- ments when not suspending them entirely. ARSENIUM, Arsenic, As.—The metal Arsenic is not used in medicine, but is represented by one of its Oxides, a salt of another Oxide, and the Iodide, which are official; together with four preparations of these compounds, or of their salts, viz. :— Arsenic Compounds and their Preparations. Acidum Arseniosum, Arsenious Acid, Arsenious Oxide, White Arsenic, As203,—is a heavy, white solid, occurring as an opaque powder, or in semi transparent masses having usually a striated appearance, soluble in 30 to 80 of water at 590 F., the solubility varying with its physical condition, also soluble in 15 of boiling water, in alkalies and their carbo- nates, hydrochloric acid and in glycerin. It is volatilized at 424.50 F., without melting, and when thrown on ignited charcoal it emits an alliaceous odor. Arsenious Acid is obtained by roasting native arsenides, and condensing the fumes in a long horizontal chimney. Dose, gr. to T\p Liquor Acidi Arseniosi, Solution of Arsenious Acid (Liquor Arsenici Hydrochloricus, B. P.), is a 1 per cent, solution of Arsenious Acid in Hydrochloric Acid and Distilled Water. Dose, n\ij-x. Liquor Potassii Arsenilis, Solution of Arsenite of Potassium, Fowler’s Solution,—is prepared by boiling together Arsenious Acid 1, Bicarbonate of Potassium 1, and Distilled Water 10; then adding Compound Tincture of Lavender 3, and Distilled Water up to 100 parts. Dose, rtDj-x. Sodii Arsenias, Arseniate of Sodium, Na2HAs04.7H20,.—is a salt of the second oxide, Arsenic Acid, As205. It is in colorless, prismatic crystals, of feebly alkaline taste and a faintly alkaline reaction, soluble in 4 of water at 590 F., very soluble in boiling water, hardly soluble in alcohol. Dose, gr. ; of the dried salt, gr. Liquor Sodii Arseniatis, Solution of Arseniate of Sodium, Pearson’s Solution,—has of the Arseniate dried 1 part in 100 of Distilled Water. Dose, ULij-xv. Arsenii Lodidum, Iodide of Arsenic, Asl3,—in glossy, orange-red, crystalline masses or scales, gradually losing iodine by exposure to the air, soluble in of water and in 10 of alcohol at 50° F., is gradually decomposed by boiling water and by boiling alcohol, and is completely volatilized by heat. Dose, gr. X— ARSENIUM. 117 Liquor Arsenii et Hydrargyri Iodidi, Solution of Iodide of Arsenic and Mercury, Donovan’s Solution,—has of Iodide of Arsenic I, Red Iodide of Mercury i, in ioo parts of Distilled Water. Dose, ny ij-x. Unofficial Salts of Arsenious Acid. Cupri Arsenis, Arsenite of Copper,—occurs in the various cupro-arsenical pigments, Scheele’s green, Mineral green, Paris green, etc., used for wall-paper coloring, and as insect poison. It is highly poisonous. Arsenii Bromidutn, Bromide of Arsenic. Liquor Bromi Arsenitis, Solution of the Arsenite of Bromine, Clemen’s Solution. Dose, rqj-v, in water, twice daily after meals. Physiological Action. Arsenious Acid, when applied to the skin denuded of its epidermis, acts as a painful escharotic, producing violent inflammation and resulting in a slough which forms a barrier to its absorption. If applied in dilute solution over a large surface, it will be absorbed, and may produce the systemic effects to be described. In small doses it is a stomachic and general tonic, promoting the appetite and digestion, increasing the cardiac action, the respiratory power, and the intestinal secretions,—stimulating peristalsis, exalting mental activity and the sexual appetite, and producing a fair skin and a rotund form. When tolerance of the drug is established, large doses are used with impunity, as by the arsenic-eaters of Styria, who can swallow at once as much as 5 grains with safety. They are careful, however, not to take any water into the stomach at the same time, so that the dose is slowly absorbed, and probably eliminated rapidly. Not all those who begin its use can acquire tolerance of it, but those who do so seem to continue it without injury, and live to an old age, undergoing great exertion without exhaustion, and being enabled to ascend steep moun- tains without difficulty of respiration. In full medicinal doses, continued for some time, it causes itching and oedema of the eyelids, ptyalism, nausea and vomiting, diarrhoea or dysen- tery, epigastric pain and soreness, feeble and irritable heart, dyspnoea, disordered sensibility, herpes zoster, urticaria, eczema and other skin eruptions, jaundice and albuminuria. In large doses, it is a powerful irritant to the gastro-intestinal and bronchial mucous membranes. Toxic doses may produce either symptoms of gastro-enteritis, or those of profoundly narcotic character. In the first and most usual form of acute arsenical poisoning, there is burning pain in the throat and stomach extending over the abdomen, vomiting, thirst, bloody stools, strangury, suppressed, albuminous or bloody urine, rapid and feeble heart, great anxiety, cold breath, finally exhaustion and collapse,—a group of symptoms much resembling cholera. Autopsy shows erosions, ecchymoses, and softening of the gastro-intestinal mucous mem- brane, congestion of the lungs and bronchi, and fatty degeneration of the liver, kidneys and cardiac muscle. The poison is found in the urine, 118 ARSENIUM. saliva, tears, sweat, etc., and maybe detected even in the parenchymatous tissues. In the nervous form of poisoning by Arsenic, profound coma and insensibility come on suddenly without any gastro-intestinal symptoms. Arsenical preparations are generally classed as alteratives, but they are valuable tonics and antiseptics, and possess antiperiodic powers second only to those of Quinine. Chronic Arsenical Poisoning may occur from the inhalation of arsenical vapors or dust arising from wall-papers or other substances containing the poison. The quantity necessary to produce symptoms of poisoning when inhaled seems to be very small. The most prominent symptoms are, at first increased appetite, next colicky pains, mucous or dysenteric stools, irritation of the eyes, coryza, a short, dry cough, and a white and silvery tongue, all accompanied by great bodily prostration. To avoid arse?iical poisoning during a course of the drug, full doses (np x of Fowler’s Solution) should be used at the commencement, and always taken on a full stomach. The dose should then be steadily re- duced. Susceptible persons often tolerate it better if a few drops of Tinctura Opii are administered with each dose. Antidotes and Incompatibles. Poisoning by Arsenic is treated by prompt evacuation of the stomach, and washing it by means of the stomach pump, then Magnesia, Chalk and Lime-water freely, or better still, the chemical antidote to Arsenic in solution, viz., the Hydrated Oxide of Iron, freshly precipitated and in a soft magma, in the proportion of gr. viij for each grain of the poison ingested. (See Ferri Oxidum Hydratum for the preparation of this antidote.) Oil or mucilaginous drinks should be given to protect the mucous membranes, and di- luents, alkaline mineral waters or Iodide of Potassium to promote elimination. Dialyzed Iron has been shown to be quite efficient as an antidote, and is more easily obtained than the hydrated oxide. It has rendered good service in many cases of poisoning from inhalation of arsenical fumes. Incompatibles are salts of iron, magnesia and lime, and astringents. Therapeutics. Externally, Arsenic has been employed in the form of paste as a depila- tory, and as an escharotic in cancers, but is excessively painful. Most of the secret “cancer-cures ” have arsenious acid for their basis. Internally, it is used as a tonic and astringent to the intestinal canal, as a tonic and antispasmodic in nervous diseases, and for its action on tissue change. It is of especial value in irritative dyspepsia, gastralgia, pyrosis, gastric ulcer or cancer, regurgitation of food without nausea, diarrhoea coming on immediately after taking food, vomiting of drunkards and chronic alcoholism. It has proven of signal service in the commencement of phthisis, and in catarrhal pneumonia, probably by causing fatty degen- eration of the exudation in the alveolar cavities, thus breaking it up and quickening its absorption. It is often very serviceable in chronic bron- chitis with copious expectoration, in acute catarrh, hay-fever, whooping- cough, asthma, chorea, epilepsy, angina pectoris and other spasmodic ASAFCETIDA. nervous disorders. In many forms of neuralgia, it often gives prompt and permanent relief, especially in cases due to malarial poisoning. As an antiperiodic, it has high rank, being, however, of particular value in chronic malarial poisoning, and as an adjunct to Quinine in the intervals between the paroxysms of intermittents. Ansemia and chlorosis are re- markably benefited by it, and in rheumatic arthritis and chronic rheuma- tism it is sometimes of great service. In chronic scaly and papular skin diseases its value is very great, but it is not serviceable in acute forms, and the more chronic the cutaneous affection the more likely is it to be amenable to Arsenic. Epithelioma may be retarded by small doses long continued, and it has certainly been useful in delaying the progress of other cancers, particularly scirrhus of the stomach and uterine carcinoma. Hypodermically its solutions have been extremely efficient in histrionic spasm, local chorea of the head and neck, obstinate cases of general chorea, and in lymphadenoma. The Bromide of Arsenic is much in favor, in the form of Clemen’s Solution, as a remedy for diabetes of hepatic origin. ASAFCETIDA, Asafetida, — a gum-resin obtained by incision from the living root of Ferula Narlhex and Ferula Scorodosma, peren- nial herbs of the nat. ord. Umbelliferae, and natives of Persia and Afghanistan. It occurs in whitish tears embedded in a grayish sticky mass, of alliaceous odor and taste, soluble in alcohol to at least 60 per cent., and triturated with water it yields a milk-white emulsion. Its principal constituent is a Sulphuretted Volatile Oil, consisting chiefly of Sulphide of Allyl, C6H10S; it also contains a gum and a resin, with ferulaic, malic, acetic, formic and valerianic acids. Dose, gr. v-xx. Preparations. Tinctura Asafcetidce,—strength 20 per cent. Dose, g ss-ij. Mistura Asafcetidce,— a watery emulsion of strength 4 per cent. Dose, £ ss- 3 ij. Emplastrum Asafcetidce,—Asafetida 35, Lead Plaster 35, Galbanum 15, Yellow Wax 15, and Alcohol 120 parts. Pilulce Asafcetidce,—each has gr. iij with gr. j of Soap. Dose. j-iv. Pilulce Aloes et Asafcetidce,—each has gr. I V of each ingredient. Pilulce Galbani Compositce,—each has gr. of Asafetida, and gr. jss each of Gal- banum and Myrrh, with syrup. Dose, j-iv pills. Mistura Magnesite et Asafcetidce, Dewees’ Carminative,—Magnesium Carbonate 5, Tinct. Asaf. 7, Tinct. Opii 1, Sugar 10, Aqua Dest. q. s. ad 100 parts. Dose, gss-^ss. Spiritus Ammonite Fcetidus (Unofficial),—Asafetida Liquor Ammoniae Fortior 2, Spirit 20 parts. Dose, gss-j. Physiological Action. Asafetida is a powerful antispasmodic, a stimulant to the brain and nervous system, a stimulating expectorant, also tonic, laxative, diuretic, diaphoretic, emmenagogue, aphrodisiac and anthelmintic in action. Its odor and taste are extremely nauseous and persistent. 120 ASCLEPIAS. In small doses continued it is said to cause impaired digestion, alliace- ous eructations, acrid sensation in the fauces, gastralgia, flatulent disten- tion, fetid flatulence, burning urination, diarrhoea and tenesmus. Full doses produce various nervous or hysterical phenomena, with nausea, vomiting and purging. The Volatile Oil diffuses into the blood and tissues, and is excreted in the urine, sweat, breath, etc. By its action the circulation is stimulated, the arterial tension raised, the power of the cardiac motor ganglia is increased and the inhibition relaxed. Asafetida also stimulates the brain even to a very pleasant intoxication, and produces a subjective sensation of warmth without any rise of body temperature. It stimulates the nervous system, the secretions and excretions, the menstrual flow and the sexual appetite. In Asia it is used as a condiment with food, and though at first it is extremely nauseous to most people, a taste for it may be readily acquired. Therapeutics. The disgust which is generally felt for this remedy makes its use very restricted, though a valuable medicine. The Mixture is extremely service- able in the flatulent colic of infants, and as an enema in infantile con- vulsions. There is no better remedy in hysteria and hypochondriasis with indigestion and flatulence,—in constipation with amenorrhoea of ansemic subjects, due to ovarian and intestinal torpor,—in bronchial affections, cough of habit, chronic catarrhs, and flatulent indigestion. ASCLEPIAS, Pleurisy Root ,—is the root of Asclepias tuberosa, a plant of the nat. ord, Asclepiadaceae and a native of the Eastern and Southern States. Two other species of Asclepias are used in medicine and were formerly official. There are no official preparations, but a fluid extract is in the market, the dose of which is about 3j every four hours. An infusion or decoction may be made in the proportion of %) of the powdered root to a quart of water, and given in teacupful doses eYery 2 or 3 hours. Asclepias contains two resins, a peculiar principle, tannic and gallic acids, albumen, pectin, gum, various salts and a volatile, odorous, fatty matter. It is emetic and cathartic in full doses, also diaphoretic and expectorant, as well as depressant to the action of the heart, and prob- ably slightly sedative and astringent. It is a popular remedy in the Southern States for pleurisy (hence its common name), and has been used in medicine for catarrh, pneumonia, phthisis, diarrhoea, dysentery, rheu- matism, gastralgia, and to promote the eruption in exanthematous fevers. It is undoubtedly a powerful diaphoretic. Physiological Action and Therapeutics. ASPIDIUM AURANTIUM. 121 ASPIDIUM, —is the rhizome of Aspidium Filix-mas (Male Fern) and of Aspidium marginale (Marginal Shield Fern), plants of the nat. ord. Filices, the former found in most parts of the world, the latter indi- genous to N. America. It is 3 to 6 inches long, thick, scaly, having fibro-vascular bundles within, arranged in an interrupted circle; odor slight but disagreeable, taste sweetish and bitter, astringent and nauseous. The above principle is Filicic Acid, CUH1805, which is extracted in the oleo-resin. It also contains a green, fatty oil, a volatile oil, resin, tannin, etc. Dose, 3ss-5jss in a single dose fasting, or in divided doses at short intervals, followed by a purgative. Preparation. Oleoresina Aspidii,—is an ethereal extract and deposits Filicic Acid on standing. It should be well shaken before being used. Dose, in capsules, repeated every 3 hours for 2 or 3 doses. Physiological Action and Therapeutics. Aspidium is an efficient vermicide against tape-worm, particularly the unarmed variety (Bothriocephalus latus). The oleoresin is the best form in which to use it, the patient having fasted for the previous day, or only used a milk diet, 3j may then be given in 4 doses % hour apart. This may be repeated the next morning and followed by three drops of croton oil in emulsion. This is one of many methods. Brayera (Kousso) may be combined with it advantageously. A formula for a mixed treatment by Aspidium, Pomegranate and Pumpkin-seed is given under the title Granatum. AURANTIUM, Orange ,—occurs in two official varieties of fruit and flowers, viz., those of Citrus vulgaris, the Bitter Orange, and Citrus Aurantium, the Sweet or Portugal Orange, both trees of the nat. ord. Aurantiaceae, cultivated in almost all warm climates. Other varieties are described under Limon. The official titles are— Aurantii Amari Cortex, Bitter Orange Peel,—the rind of the fruit of Citrus vulgaris, characteristics well known. Contains a Volatile Oil isomeric with Oil of Turpentine, C10H16, and a bitter, crystalline principle, Hesperidin or Aurantiin. Aurantii Dulcis Cortex, Sweet Orange Peel,—is the rind of the fruit of Citrus Aurantium. It contains a Volatile Oil differing from that of the bitter orange, and less of the bitter principle. Aurantii Flores, Orange Flowers,—the partly expanded fresh flowers of Citrus vulgaris and Citrus Aurantium. They contain an aromatic Volatile Oil (the official Oleum Aurantii Florum), and a trace of bitter principle. 122 AURUM Preparations. Extractum Aurantii Amari Fluidum,—Bitter Orange Peel ioo, Alcohol and Water. Used as flavoring. Dose, gss-j. Tinctura Aurantii Amari,—Bitter Orange Peel 20, Diluted Alcohol q. s. ad 100. A flavoring preparation. Dose, gj-ij. Tinctura Aurantii Dulcis,—Sweet Orange Peel 20, Diluted Alcohol q. s. ad 100. For flavoring. Dose, gj-ij. Syrupus Aurantii,—Sweet Orange Peel 5, Alcohol 5, Calcii Phosphas Prsecip. 1, Sugar 60, Water q. s. ad 100. Flavoring. Oleum Aurantii Corticis,—a volatile oil, extracted by mechanical means from fresh orange peel. Is soluble in 2 of alcohol, and is an ingredient of Bay Rum (Sp. Myrciae). Dose, gtt. j-v. Elixir Aurantii, Simple Elixir,—Oil of Orange Peel I, Sugar 100, Alcohol and Water q. s. ad 300. An excipient for extracts and tinctures, designated to replace the unofficial elixirs. Spiritus Aurantii, —Oil of Orange Peel 6, Alcohol 94 parts. Dose, to be regulated by the quantity of alcohol desired. Aqua Aurantii Florum, Recent Orange Flowers 40, Water 200 parts distilled to 100 parts. Dose, indefinite. Oleum Aurantii Florum, Oil of Neroli,—a volatile oil, distilled from fresh orange flowers. Is the most important constituent of Cologne Water (Spt. Odoratus). Dose, gtt. j-v. Syrupus Aurantii Florum, Orange-flower Water 35, Sugar 65. A delicate flavoring agent, but having to some persons an extremely sickish taste. Orange is aromatic and tonic, also more or less bitter, but has little action except a mild influence on the nervous system due to its volatile oil. Persons much exposed to its fumes a,re liable to cutaneous eruptions and various nervous disorders. The oil may produce violent colic and convulsions in children, one case being reported in which death resulted from eating the rind. Its use in medicine is confined to flavoring pur- poses, though the preparations of the Bitter Orange may be used as mild tonics and stimulants to the digestion, but they are usually combined with more energetic agents for these purposes. Physiological Action and Therapeutics. AURUM, Gold, Au,—is represented by but one official preparation. The Chloride is found in the shops, being much used by photographers ; and triturations of the metal itself may be prepared according to the general formula therefor. Auri et Sodii Chloridum,—is a mixture composed of equal parts of dry Chloride of Gold and Chloride of Sodium, AuC13 NaCl. An orange-colored powder, soluble in water. _ Dose, gr Auri Chloridum (Unofficial),—occurs in needle-shaped prisms, of an orange-yellow color, deliquescent, freely soluble in water. Dose, gr. 55—fV Is best given in solution. Preparations. Physiological Action. Locally used the Chloride of Gold is escharotic ; administered inter- nally its action closely resembles that of the Bichloride of Mercury. In small doses, it promotes appetite and digestion, and stimulates the func- tions of the brain, producing marked mental exhilaration and a general AZEDARACH. 123 sense of well-being. Continued, it induces aphrodisiac effects in both sexes, and in women increases the menstrual discharge. Full doses cause nausea and vomiting, glandular irritation, salivation without loosening of the teeth or sore gums, increased urinary discharge, sweat and fever (the auric fever) ; nutrition is impaired and rapid waste set up. A toxic dose produces effects similar to those from corrosive sublimate, namely, violent gastro-enteritis, mental disturbance, priapism, tremor, convulsions and paralysis. ■Antagonists. Poisoning is treated by albumen (eggs) or flour, and evacuation of the stomach—just as in the case of Corrosive Sublimate. Therapeutics. Chloride of Gold is a useful remedy in irritative dyspepsia, gastro- duodenal catarrh, hypochondriasis, amenorrhcea, functional impotence, chronic metritis, habitual abortion, ovarian dropsy, vertigo and vertigin- ous sensations from disordered stomach. It is especially recommended in chronic albuminuria, hepatic sclerosis, granular and fibroid kidney, as it prevents hyperplasia of connective tissue. In syphilis its utility is proven beyond doubt, particularly in the tertiary manifestations and syphi- loma of the bones, in which it is fully as efficacious as the Bichloride of Mercury, with incomparably less inconvenience to the patient. AVENA SATIVA,—the common Oat, a plant of the nat. ord. Graminaceae,—was official in the U. S. P. 1870, as Avence Farina, or Oat-meal. A concentrated tincture or fluid extract has recently been extensively advertised by drug manufacturers as a nerve stimulant and tonic, especially efficacious in the treatment of chorea, epilepsy, insomnia, nervous exhaustion, alcoholism and the Opium-habit. The seeds contain starch, gluten, gum, etc.,and form a nutritious food, the meal being made into a porridge, or gruel. In the latter form it is a good demulcent for coughs. The pericarp contains an amorphous alkaloid, which has doubt- less some stimulant and narcotic power; but the claims advanced for it, as a specific remedy for the cure of the opium-habit, have been strenu- ously denied by many competent observers, Dose of the concentrated tincture or fluid extract, may be stated at Tipx—5ij. AZEDARACH, —is the bark of the root of Melia Azedarach, or Pride of China, a handsome tree of the nat. ord. Meliaceae, indigenous to China and India, but naturalized in the Gulf States. It occurs in curved pieces or quills, which are almost inodorous and have a sweetish taste, afterwards becoming bitter and nauseous. There are no official preparations, but a decoction of the fresh bark (gij to Oj boiled to 0)4) may be used in tablespoonful doses. 124 BALSAMUM PERUVIANUM BALSAMUM TOLUTANUM. Physiological Action and Therapeutics. This drug is known to produce symptoms of narcotic poisoning, as giddiness, dimness of sight, mental confusion, stertorous breathing, dilated pupils and stupor. Large doses are necessary to cause these effects, and some authorities question their occurrence. It is, however, a gastro- intestinal irritant, producing vomiting and purging, and an anthelmintic against the round-worm. Its active principle has not been isolated. It is only employed as an althelmintic against lumbricoid worms, and as the fresh bark is difficult to obtain in any region where it does not grow, other agents will be more generally used. It is given to horses affected with “ bots.” BALSAMUM PERUVIANUM, Balsam of Peru,—is a bal- sam obtained from Myroxylon Pereira, a Central American tree, of the nat. ord. Leguminosse. Occurs as a thick, brown-black liquid, its odor reminding of benzoin and vanilla, soluble in 5 of alcohol, almost insoluble in water, which only extracts from it some Cinnamic Acid and Cinnamein. It is not a true balsam, as it contains no volatile oil. Com- position is,—Cinnamein (Benzyl Cinnamate, C16Hu02) 60 per cent., Cinnamic Acid 6 per cent., Resins 30 per cent ; also Benzoic Acid, and other bodies. Dose, npx-xxv, in emulsion. There are no official pre- parations. Physiological Action and Therapeutics. The actions of Balsam of Peru are those of its several constituents, namely, antiseptic, disinfectant, stimulant to the circulation, and sedative to the nervous system; acting chiefly on the mucous membrane, it is tonic and expectorant, diuretic and diaphoretic. In large doses, it causes gas- tralgia, nausea and vomiting, colic and diarrhoea. It closely resembles in physiological action its congeners, Styrax and Benzoin. Balsam of Peru is used locally in chronic skin diseases of inflammatory ■type and sore-nipples, to relieve itching, cleanse bed-sores, promote the healing of wounds and sores, and to kill the acarus scabiei, being consid- ered by some authorities the best of all applications in itch. Internally, it is used as a stimulant and disinfectant expectorant in chronic bronchitis, asthma, etc., as well as in gonorrhoea, gleet, leucorrhoea, and other dis- charges from mucous membranes. Incorporated with Iodoform it par- tially covers the odor of that drug. BALSAMUM TOLUTANUM, Balsam of Tolu—is a balsam obtained from Myroxylon toluifera, a tree of the nat. ord. Leguminosae, native in Venezuela and New Granada. Its composition and properties are similar to those of Balsamum Peruvianum, except that it is of lighter BAPTISIA BELLADONNA. 125 color, more agreeable odor, and contains a volatile oil, Tolene, in the pro- portion of about i per cent. Preparations. Tinctura Tolulana, Tincture of Tolu,—contains io per cent, of the balsam dissolved in 90 of alcohol. Dose, rt\x-xxx. Syrupus Tolutanus, Syrup of Tolu,—has of the balsam 4 parts in 100 of sugar and water. Dose, 3 j—ij. Much used in cough mixtures. Covers the taste of Chloral well. Physiological Action and Therapeutics. Balsam of Tolu has similar actions to those of Balsam of Peru, but being more agreeable in flavor it is used internally more than the latter. It is chiefly employed as a pleasant excipient in cough-mixtures, and is a constituent of the compound Tincture of Benzoin. BAPTISIA, Wild Indigo (Unofficial),—is the root bark of Baptisia tinctoria, a plant of the nat. ord. Leguminosse, native in North America, and contains an alkaloid and a resin, neither of which have been examined critically. The so-called Baptisin is an impure resinoid, obtained by precipitation from the alcoholic extract with water. Preparations. Extractum Baptisice, Extract of Baptisia (Unofficial). Dose, gr. j-x. Extractum Baptisia Fluidum, (Unofficial). Dose, npij-xx. Tinchira Baptisice, (Unofficial). Dose, tt(v-xxx. Baptisin (Unofficial),—the resinoid. Dose, gr. j-v. Physiological Action and Therapeutics. Baptisia has a bitter and acrid taste; in small doses it is laxative, in large violently emeto-cathartic, and may excite severe gastro-intestinal inflammation. It is a decided stimulant of the liver, and increases the secretions of all the glandular appendages of the gastro-intestinal mucous membrane. It has considerable power as an antiseptic. Baptisia has been used locally in decoction or cataplasm to obstinate and painful ulcers, in threatened or exciting gangrene, and gangrenous sores. Internally, it is a useful remedy in amenorrhoea, typhoid and typhus fevers, variola, scarlatina, and epidemic dysentery. In the common continued-fever, or in the first stage of typhoid, it will be found of great service in drop-doses of a fresh tincture, repeated every hour. BELLADONNA, Deadly Nightshade ,—is an herbaceous, peren- nial plant, of the nat. ord. Solanacese, having dark-purple, bell-shaped flowers, and glossy, purplish-black berries about the size of cherries. It is indigenous in the mountainous districts of Central and Southern Europe and Asia, and is cultivated in Europe and in the United States. It con- tains two alkaloids,—the official Atropine (see below), and Belladonnine, the latter being considered by many authorities as identical with Hyoscy- 126 BELLADONNA. amine, Daturine, and Duboisine. These exist in the plant in combination with Malic Acid. The plant also contains the usual vegetable constituents, as albumen, gums, etc., and a coloring principle named Atrosin. The official titles are as follows : Belladonna Folia, Belladonna Leaves,—ovate and tapering, brownish- green above, grayish-green below, of slight odor and bitter, disagreeable taste. Stramonium leaves are more wrinkled, Hyoscyamus leaves are more hairy. Dose, gr. j, gradually increased. Belladonna Radix, Belladonna Root,—cylindrical, tapering, wrinkled pieces, y2 to i inch thick, nearly odorless, taste bitter and acrid. Dose, gr. j, cautiously increased. Preparations of the Leaves. Extractum Belladonna Alcoholicum,—Dose, gr. Tindura Belladonna,—15 per cent. Dose, trpj-xxx. Unguentuni Belladonna,—has of the Alcoholic Extract 10, Diluted Alcohol 6, Ben- zoinated Lard 84. Preparations of the Root. Abstradum Belladonna,—Dose, gr. A-j. Extradum Belladonna Fluidum,—Dose, TT\j-v. Emplastrum Belladonna,—made with Resin Plaster. Linimentum Belladonna,—Fluid Extract 95, Camphor 5. Atropine and its Derivatives. Atropina, Atropine, C17H23N03,—in white, acicular crystals, odorless, of bitter taste and alkaline reaction; very soluble in alcohol and in chloroform, also in 600 of water at 50° F. Is decomposed by prolonged contact with caustic alkalies and is resolvable into Tropin and Tropic Acid. Atropina Sulphas, Sulphate of Atropine (C17H23N03)2H2S04,—a white powder of bitter taste and neutral reaction, soluble in 0.4 of water and in 6.5 of alcohol at 50° F. Dose, gr. jzrnV Homatropina, Homatropine, C16H21N03 (Unofficial),—is a derivative alkaloid obtained by the action of dilute HC1 on Amygdalate of Tropin. The Hydrobromate of Homatropine is used by ophthalmologists as a mydriatic, its effects passing off much sooner than those of Atropine. Homatropine slows the heart, Atropine quickening it. Tropeius (Unofficial),—is a result of the action of a mineral acid on Tropin. Physiological Action. Belladonna is an irritant narcotic, a mydriatic, an antispasmodic and an anodyne ; in small doses a cardiac, respiratory and spinal stimulant— in large doses a paralyzer of the cardiac and respiratory centres, the spinal cord, the motor nerves and involuntary muscles. It produces con- gestion and dryness of the mucous membrane of the throat, mouth, nose and larynx, and at first lessens the gastric and intestinal secretions, but soon reproduces these in large quantity. The heart rate is at first slowed, but soon becomes very rapid and vigorous, the pulse being doubled in rapidity; the arterial tension being at the same time raised, the circula- tion is greatly increased. This is accomplished by stimulation of the cardiac sympathetic, and paralysis of the pneutnogastric, thus stimulating the accelerator apparatus while lessening the inhibitory. [Digitalis increases both.] The vasomotor ganglia are stimulated all over the body, belladonna. 127 but are afterwards paralyzed by over-stimulation, the heart weakens, the vessels relax, and the blood-pressure becomes greatly reduced. Complete motor paralysis follows, delirium, stupor, and finally death, which usually occurs by asphyxia. The pupils are dilated by the local or systemic use of the drug, it stimu- lating the end-organs of the sympathetic and paralyzing those of the motor oculi, thus increasing the power of the radiating iris fibres and lessening the action of its circular ones. Atropine locally also paralyzes accommodation and increases the intraocular pressure. The least quantity of Atropine which will affect the pupil is stated at gr. (Wood) gr. (Roosa), gr. 40007 (Ely)> gr> innnnr (I rousseau), gr. yg oxo on (Coring), gr. 70oW (Bonders). The brain is congested by Belladonna, headache, vertigo, busy delirium, hallucinations, etc., being produced, the latter from a selective action on the cells of the gray matter. The spinal cord is stimulated from the 3d cervical to the 10th dorsal vertebra, resulting in complete motor paralysis, central and peripheral, power being lost first in the lower extremities. Sensation is also impaired somewhat, but the muscular irritability is not. Respiration is increased and the body temperature elevated. Metamor- phosis is greatly promoted by the increased activity of the circulation. A diffused eruption of scarlet color, greatly resembling the eruption of scarlet fever, is often produced on the skin and fauces by Belladonna, with dysphagia and sore throat, and is sometimes followed by desquama- tion of the epidermis. It is due to capillary congestion caused by the greatly increased circulation. Belladonna is rapidly diffused and quickly eliminated, particularly by the kidneys. The urine of an animal under the action of the drug will dilate the pupil of another animal. Herbivorous animals and birds are scarcely susceptible to it, and pigeons are not affected by it at all. Atropine has the same actions as above described, being the active principle of the plant. Belladonnine was long supposed to be inert, but has recently been shown to be identical with Hyoscyamine. It is a mydriatic when given internally, but not when used locally. Antagonists and Incompatibles. Opium is the physiological antagonist to the effects of Belladonna on the cerebrum, pupil, heart, respiration, arterial tension and kidneys. Physostigmine, Aconite, Pilocar- pine and Quinine are each antagonistic to some of its effects, Muscarine to most of them. In poisoning by this drug, Tannic Acid and emetics should be used, then Morphine, Physostigmine or Pilocarpine for the nervous disturbances. Caustic alkalies decompose Atropine and are therefore incompatible with the preparations of Belladonna. Therapeutics. Belladonna is one of the most valuable drugs in the Materia Medica, ranking with Aconite, Arsenic and Opium in efficacy and wide range of 128 BENZINUM. use. It is especially useful in the pain of inflammation, particularly that of rheumatism, gout, neuralgia due to peripheral disturbance, sciatica, cancer and pelvic affections. In cerebral and spinal hyperaemia, conges- tive headaches, encephalitis, meningitis and myelitis it proves one of the very best remedies. In erysipelas of superficial and non-vesicular charac- ter and when cerebral, it is really curative locally and internally adminis- tered. Inflammations of the lungs, iris, bladder, kidneys and breasts, are all amenable to it. In constipation from atony of the bowels it is remarkably efficient, and in the enuresis of children it is equally so if used freely, 10 to 20 drops of the tincture thrice daily. In recent cystitis from chill, spasm of the urethra, bladder and sphincter ani, typhus and typhoid fevers, acute nasal catarrh, sore throat with fever, inflammation, and swollen tonsils, many skin diseases, asthma and whooping-cough, epileptic and puerperal convulsions, spermatorrhoea and seminal losses, Belladonna is often a highly useful agent. Its local application is effi- ciently used in ulcers of the rectum, anal fissure, abscesses, boils carbun- cles, and other superficial inflammations. In scarlet fever it relieves many of the symptoms, and is especially indicated in this disease when the rash is imperfect, the pulse feeble and the condition one of adynamia. Its prophylactic power against scarlet fever is believed in by many of our best practitioners, though questioned by many others. Atropine is used in poisoning by Opium, Physostigma, and Prussic Acid ; in ptyalism from mercury, pregnancy, etc.; in the sweats of phthisis, sudden cardiac failure, and by eye-surgeons to paralyze accommodation, dilate the pupil, contract the vessels, lessen pain, and diminish (?) intra- ocular tension. In opium-poisoning, it should be given in very small doses, and repeated for effect, as most of the unsuccessful cases of its use in this connection were due to overdosing with the antagonist, superinducing belladonna-narcosis upon the opium-narcosis. In cases of heart-failure from Chloroform or Ether inhalation, the hypodermic injection of Atro- pine has, in the writer’s hands, saved several lives when all other methods of resuscitation had failed. BENZINUM, Benzin, Petroleum Ether, —is a purified distil- late from American petroleum, consisting of hydro-carbons, chiefly of the marsh-gas series, having a specific gravity from 0.670 to 0.675, and boil- ing at 1220 to 140° F. It is a transparent, colorless liquid, highly inflam- mable, very diffusive, insoluble in water, but soluble in alcohol, ether, etc. It should be distinguished from Benzol, which is called Benzene by Eng- lish chemists. In pharmacy it has many uses, on account of its powers as a solvent for oils, fats, resins, caoutchouc and some alkaloids. Dose, gtt. v-x, on sugar or in mucilage. BENZOINUM. 129 Physiological Action and Therapeutics. Benzin is reported to have caused death in one case from gastro-enteritis, but ordinarily it does not produce vomiting or diarrhoea. It has been used with some success externally as a remedy for rheumatic pain, neural- gia, itch and prurigo ; and internally as a vermicide against tapeworm. Its chief value is that of a solvent in cleaning old clothing and in phar- maceutical operations. BENZOINUM, Benzoin, —is a balsamic resin obtained from Styrax Benzoin, a tree of the nat. ord. Styracese, native in Sumatra and Siam, by incision of its bark. It occurs in agglutinated tears or a brown, mottled mass, is soluble in alcohol and solution of potassa, and is composed of Resins 80 per cent., Benzoic Acid io to 20 per cent., and a trace of Volatile Oil. Some varieties of benzoin yield also Cinnamic Acid. Preparations of Benzoin. Adeps Benzoinatus, Benzoinated Lard,—has of Benzoin 2 parts in 100 parts of Lard. Tinctura Benzoini, Tincture of Benzoin,—has of Benzoin 20 parts, Alcohol q. s. ad 100. Dose, gss-j. Tinctura Benzoini Composita, Friar’s Balsam,—has of Benzoin 12, Aloes 2, Styrax 8, Balsam of Tolu 4, Alcohol q. s. ad 100 parts. Dose, 3 ss-ij. Preparations of Benzoic Acid. Acidum Benzoicum, Benzoic Acid, HC7H502,—occurs in light, feathery plates and needles, and is obtained from Benzoin by sublimation. It is soluble in 500 of water, and in 3 of alcohol at 950 F., but its solubility in water is aided by Borax, one part of each being soluble in 100 parts. It is a constituent of Tinctura Opii Camphorata. Dose, gr. x-xxv, in wafers. Ammonii Benzoas, Benzoate of Ammonium,—is soluble in 5 parts of water and in 28 of alcohol. Dose, gr. v-xxx. Lithii Benzoas, Benzoate of Lithium,—soluble in 4 parts of water and in 12 of alcohol. Dose, gr. v-xxx. Sodii Benzoas, Benzoate of Sodium,—is efflorescent on exposure to air, soluble in 2, parts of water and in 45 of alcohol. Dose, gr. v-gj. Physiological Action. Benzoin is decidedly antiseptic and disinfectant, and when used exter- nally is somewhat stimulant to the vessels. Its actions are due to its Benzoic Acid, which taken internally produces slight epigastric heat, increases the pulse-rate, and stimulates the action of the skin, the salivary glands, and of the bronchial mucous membrane. It is chiefly excreted by the kidneys, in part as hippuric acid by combination with glycocoll, and in part unchanged. It renders the urine acid and increases its quan- tity. Benzoin is irritant to the fauces, and the powder inhaled excites sneezing and coughing. Therapeutics. • Benzoin is principally used as a stimulant expectorant, especially in the chronic bronchitis of the aged, and by atomization in laryngeal affections. The compound tincture, 3j to gj in a pint of boiling water, is a useful 130 BERBERIS. sedative inhalation for the irritation and cough of subacute laryngitis and tracheitis. It has also been used beneficially in chlorosis and some uterine disorders. The compound tincture is a good local application (i to 4 of glycerin and water) for sore nipples and chaps of the hands and lips. For use as a cosmetic, either tincture is mixed with 20 parts of water, and employed to remove freckles and other skin affections, especially urticaria. They are excellent applications to foul-smelling wounds, and form the basis of all the proprietary preparations sold for that purpose. Benzoic Acid and its salts are the only certain means we possess, by which to neutralize morbid alkalinity of the urine. In cystitis, with phosphatic deposits and alkaline urine, they are extremely valuable, acid- ulating the secretion, and stimulating and disinfecting the mucous sur- faces involved. Phosphatic calculi are said to be dissolved by the long- continued use of Ammonium Benzoate. Benzoate of Sodium has been largely used as a substitute for the salicylates in the septic diseases, being equally antiseptic and antipyretic. Though slower in action, its effects are more permanent, and it is capable of being used in larger doses (5ij-iij daily). In diphtheria and scarlet fever it has been highly efficient, and in acute rheumatism, typhoid and the malarial fevers, it has rendered good service. In phthisis, its use by inhalation to the extent of of the body-weight daily has seemed to be of value in some cases. It has also proven very efficient in whooping- cough. Benzoate of Lithium is intended for use in gout and the uric acid diatheses, with the object of forming the very soluble urate of lithium in the system, as also on the theory that, as benzoic acid is converted into hippuric acid at the expense of nitrogenous material which would otherwise become uric acid, the latter product will be lessened. BERBERIS, Barberry (Unofficial), is the root of several species of the nat. ord. Berberidaceae, the one generally used being the Berberis aquifolium, or Oregon grape, which grows on the Pacific slope of the United States. Its value is probably due to its alkaloid, Berberine, C2oHnN04, a yellow, crystalline body, soluble in hot water and alcohol, but not in ether, which is found also in several other plants, as Hy- drastis, Coptis, Podophyllum, Menispermum, Calumba, Xanthoxylum, etc. Preparations. Extractum Berberidis Fluidum (Unofficial),—Dose, rtpv-xxx. Tinctura Berberidis (Unofficial),—1 to 5. Dose, Berberina, Berberine (Unofficial),—Dose, gr. j-x. Usually occurs in commerce as “ Hydrastin,” which is a Muriate of Berberine, prepared from Hydrastis. BERGAMII OLEUM BISMUTHUM. 131 Physiological Action and Therapeutics. Berberis is an astringent bitter, a tonic and stomachic in small doses, but in large doses it is cathartic, producing watery diarrhoea with abdom- inal pain. It is also believed to possess considerable alterative powers. Berberine has some antiseptic and antiperiodic value, and in large doses is a gastro-intestinal irritant. Berberis has been successfully used as a local application in conjunc- tivitis, and internally as a remedy for intermittent remittent and typhoid fevers, diarrhoea and dyspepsia. As an alterative and tonic it has been found useful in syphilitic and strumous affections, and in pain, soreness and burning sensations along the biliary or urinary tracts with a tendency to gravel or gall-stones it will be found a useful remedy. The Muriate of Berberine is a useful injection in gonorrhoea, in which it acts by virtue of its antiseptic and astringent powers. BERGAMII OLEUM, Oil of Bergamot,—is a volatile oil, extracted from the rind of the fresh fruit of Citrus Bergamia, an orange- tree of the nat. ord. Aurantiaceae, native in Southern Europe. It is of greenish color, faintly acid, sp. gr. 0.87, and is soluble in alcohol, glacial acetic acid and liquor potassse. It contains several hydrocarbons of the formula C10H16, together with Bergaptene or Bergamot Camphor. It is an ingredient of Spiritus Odoratus, and is exclusively used as a perfume in the manufacture of toilet articles. BISMUTHUM, Bismuth, Bi,—is represented by three of its salts, and one combination of the Citrate with Aqua Ammonise. Preparations. Bismuthi Citras, Citrate of Bismuth, BiC6H507,—is a white, amorphous powder, odorless and tasteless, insoluble in water or alcohol, but soluble in water of ammonia. Used only for pharmaceutical purposes. Bismuthi et Ammonii Citras, Citrate of Bismuth and Ammonium,—is not proven to have any definite composition. Small, pearly scales, very soluble in water. Dose, gr. j-v. Bismuthi Subcarbonas, Subcarbonate of Bismuth (Bi0)2C03.H20, is a white or yellowish-white powder, tasteless, insoluble in water or alcohol. Dose, gr. x- 3 j, in pow- der or emulsion. Bismuthi Subnitras, Subnitrate of Bismuth, Bi0N03.H20,—a heavy, white powder, odorless and almost tasteless, slightly acid, insoluble in water or alcohol. Dose, gr. x- 3 j. Physiological Action. The action of the last two Bismuth salts is chiefly a local one, being sedative to the end-organs of the nerves, though a minute quantity passes into the blood and acts as a tonic, promoting constructive metamorphosis by increasing the appetite and digestion. They are also feebly astringent, and produce constipation after a time, coloring the stools and tongue a dark clay color, from their conversion in part into the sulphide. Toxic 132 BOLDUS BRAYERA. effects when occurring are due to Arsenic, with which the commercial preparations are usually contaminated. The Citrate of Bismuth and Ammonium, being soluble, is more rapid in action, more astringent and probably more irritant, though it is prob- ably precipitated in the stomach by the hydrochloric acid of the gastric juice. Therapeutics. The insoluble Bismuth salts are used internally in many forms of dis- ordered digestion, gastralgia, vomiting and diarrhoea, especially in chil- dren, but large doses are necessary for efficiency. The best vehicle for them is milk. Locally they are used with advantage in acne rosacea, stomatitis, nursing sore mouth, eczema, intertrigo, ulcers, conjunctivitis, coryza, gonorrhoea, gleet and leucorrhoea. The Citrate is not used except for pharmaceutical purposes, and the Citrate of Bismuth and Ammonium is only serviceable in diarrhoea without irritation of the intestinal mucous membrane, but rather with relaxation thereof. The Subiodide of Bismuth makes an excellent antiseptic dressing for ulcers and wounds. BOLDUS, Boldo (Unofficial),—the leaves and stems of Peunius Boldus, an evergreen shrub of the nat. ord. Monimiacese, found in Chili. It contains a volatile oil and a bitter alkaloid, Boldine. A tincture is made (i to 5), of which the dose is rrLv-viij, gradually increased, but large doses have a somewhat narcotic effect, besides causing vomiting and purging. Boldo is used in anaemia, rheumatism, dyspepsia and general debility, also in catarrhal affections of the urinary passages, and as a substitute for QuininA In France it is employed as a tonic, especially for cases with chronic torpor of the liver; and in South America it is much used in gonorrhoea and in chronic cystitis. BRAYERA, Kousso,—is the female inflorescence of Brayera anthelmintic a, an Abyssinian tree of the nat. ord. Rosaceae. It occurs in bundles or rolls, of fragrant, tea-like odor, and bitter, nauseous taste, and contains tannic acid, a volatile oil, and a crystalline principle named Koussin, which by itself is apparently inert. Dose of Brayera oij_oj- Preparations. Extractum Brayera Fluidum,—Dose, 3 ij- 3j. Infusum Brayera,—6 per cent. Dose, 3 iv-viij or more. Physiological Action and Therapeutics. Kousso has little or no effect except the nausea, vomiting, colic and slight diarrhoea produced by large doses. Its chief action is anthelmintic BROMUM. against both varieties of tape-worm, but it rarely expels' the head of the parasite, and is very nauseous to the taste and difficult of retention by the stomach in the large doses necessary to efficiency. 3ij to %) of the flowers infused in giv of boiling water is the usual dose, and should be taken on an empty stomach and followed by a castor-oil or saline purge after 3 or 4 hours. An emulsion of the official infusion with castor-oil, yolk of egg, a few drops of ether and oil of anise with 10 to 20 drops of Oleoresin of Male-fern, is more agreeable and efficient than the infusion alone. BROMUM, Bromine, Br.,—is a dark, brownish-red, volatile liquid, evolving an irritant vapor of peculiar and suffocating odor. It is soluble in 33 of water at 590 F., very soluble in alcohol, ether, chloro- form and carbon disulphide ; is a non-metallic element found in sea- water, and in the mother-liquor of certain salt-works, usually in combi- nation. It is only used by inhalation and as an escharotic. Bromides and their Preparations. Potassii Bromidum, Bromide of Potassium, KBr,—colorless, cubical crystals, soluble in 1.6 of water, and 200 of alcohol. Dose, gr. v-gj. Sodii Bromidum, Bromide of Sodium, NaBr,—colorless, monoclinic crystals, soluble in 1.2 of water, and 13 of alcohol. Dose, gr. v-gj. Lithii Bromidum, Bromide of Lithium, LiBr,—a white, granular, deliquescent salt, very soluble in water and alcohol. Dose, gr. v-xx. Ammonii Bromidum, Bromide of Ammonium, NH4Br,—colorless, prismatic crystals, soluble in 1.5 of water, and 150 of alcohol. Dose, gr. v-xx. Calcii Bromidum, Bromide of Calcium, CaBr2,—a white, granular, deliquescent salt, very soluble in water and alcohol. Dose, gr. v-gj. Zinci Bromidum, Bromide of Zinc, ZnBr2,—a white, granular, deliquescent powder, very soluble in water and alcohol. Dose, gr. Arsenii Bromidum, Bromide of Arsenic,—see under Arsenium, ante, page 117. Syrupus Ferri Bromidi, Syrup of Bromide of Iron,—is a syrupy liquid containing 10 percent, of Ferrous Bromide, FeBr2, prepared by acting on Iron Wire 35 parts with Bromide 75, adding Sugar 600 and Water up to 1000 parts. A translucent, pale-green, odorless liquid of sweet, ferruginous taste and neutral reaction. Dose, gss-j. [Hydrobromic Acid is described on page 64, Ethyl Bromide on page 79, and Cam- phora Monobromata under Camphora.~\ Physiological Action. Bromide is an active and very painful escharotic, a deodorant and an antiseptic, setting free ozone. Its vapor is highly irritant to the respira- tory mucous membrane and the eyes, producing cough, hoarseness and dyspnoea. Internally, it is an active, corrosive poison, causing violent gastritis, depression and collapse. The Bromides are preeminently depressants of the cerebral and spinal functions, also alterative, antispasmodic and hypnotic. The Potassium salt is especially a cardiac and muscular paralyzant. They have a saline taste, and are very diffusible, but slowly eliminated. They are decomposed in the blood, and reformed at the points of elimi- nation (fauces, bronchi, intestines, skin and kidneys), where they irritate 133 134 bromum,—bromides. 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 arte- rioles, they lower arterial tension. They lessen the activity of the brain cells, producing somnolence; diminish the sensibility of the peripheral nerves, causing anaesthesia of the skin and mucous membranes. They impair motility and the sexual function, cause great pallor and emacia- tion, lowered body-temperature, acne on the face and upper extremities, fetid breath, dysphagia, sluggish reflexes and defective coordination ; and if long continued may even impair the mental faculties, producing hallu- cinations in some cases, in others melancholia with suicidal tendency ; also incompetence of the sphincters and paralysis, beginning at the pe- riphery and extending to the centres. They sometimes cause maniacal excitement, as in the case of a physician who committed suicide in a frenzy caused by bromidizing himself for sea-sickness. The general result of their action is termed “ Bromism,” and is her- alded by the acne and 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. Difference in Action between the 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 energetically 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 resem- bles the sodium salt in action. It has proved better than the others in some cases of epilepsy, and is by several authorities considered to be the best hypnotic of the series. Calcium Bromide is an efficient hypnotic, but otherwise much less active than the other salts. Zinc Bromide, in large doses, is violently irritant. It is supposed to combine the tonic effects of zinc with the sedative actions of the bromides. Ferrous Bromide is official only in the Syrup. It is supposed to combine the actions of iron and the bromides, and to produce the effects of a sedative chalybeate tonic. It is not an eligible chalybeate. Antagonists and Incompatibles. Vaso-motor stimulants, as Digitalis, Ergot, Belladonna, antagonize many of the effects of the Bromides, but Morphine is the most efficient antagonist, especially for the mental symptoms. Nitrous Ether is incompatible with the Bromide of Ammonium, and Acids and metallic salts are so with all the Bromides. BRYONIA. 135 Therapeutics. The Bromides are used as sedatives to the nervous system, to lower reflex activity, to produce sleep, to subdue excitement of the genital appa- ratus, 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 the last chapter of his book on Nervous Diseases. They should not be used in anaemic conditions, and never for any length of time without the daily supervision 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 con- vulsive and spasmodic affections the bromides are very efficient, and in epilepsy, especially when the seizures are diurnal, the sodium salt is used with great advantage over a long period, in sufficient quantity to maintain anaesthesia of the fauces. It requires occasional purgation to prevent its accumulation, and arsenic to combat the acne. In diabetes of nervous origin, the ammonium salt, long used, has proved curative by its sedative influence on the medulla; and in acute rheumatism it is an excellent alkali. In muscular rheumatism, rheumatic arthritis and myalgia, also in the uric acid diathesis, and the various affections due to undeveloped gout, the lithium salt gives good results. In tetanus and strychnine-poisoning the potassium salt, in large doses, is antagonistic. The agents are gen- erally efficient in nervous erethism, insomnia with congestion, infantile colic, cholera infantum, vomiting of cerebral origin, cardiac irritability when not due to anaemia, delirium tremens, melancholia, whooping-cough and other reflex coughs, seminal losses when plethora exists, and nympho- mania. The potassium salt is, by some writers, considered almost spe- cific in subinvolution of the womb, and uterine hemorrhage not due to a mechanical cause. Bromine is not much used. Its vapor may be inhaled from hot water in acute coryza, hay-asthma, etc., and in chancre and hospital gangrene it is the best escharotic. In diphtheria and membranous croup, a solution of ttlviij to the used internally, and inhalation of the vapor have been used successfully in the most severe cases. The Syrup of the Bromide of Iron has been reported by some observers as very efficient in chorea, and its usefulness as strenuously denied by others. [The therapeutics of Hydrobromic Acid are detailed on page 65, ante.~\ BRYONIA, Bryony ,—is the root of Bryonia alba and of Bryonia dioica, European perennial plants of the nat. ord. Cucurbitaceae. It occurs in transverse sections about 2 inches in diameter, having numerous small wood-bundles arranged in circles and projecting lines in the central por- tion, which is white or grayish. Its taste is acrid and bitter, but it is 136 BRYONIA. inodorous. The active principle is the glucoside Bryonin, C48H80O19, which is intensely bitter, and soluble in water and in alcohol, but insoluble in ether. Dose, of the powdered root, gr. x-xxx. Tinctura Bryonia;, Tincture of Bryonia,—a io per cent, solution of the root in alcohol. Dose, n\v-if ss. Bryonin (Unofficial),—is a violent poison in doses of from 3 to 4 grains. Dose, as a drastic purgative, gr. Ye~Y- Preparations. Physiological Action. Bryonia is a pure irritant, setting up local inflammation wherever applied, with febrile phenomena. It has a vesicant action on the skin, and is violently irritant to the serous and mucous membranes. Taken internally, it has caused fatal gastritis; introduced into the pleura, fatal pleuritis has resulted with fibrinous effusion. It has a specific determina- tion to serous and synovial membranes, especially the pleurse, and is also irritant to muscular fibre, and to the bronchial mucous membrane, causing dry, continuous, shaking cough, with soreness behind the sternum. It produces cerebral congestion, with frontal headache, vertigo, and epis- taxis ; also, hepatic and renal congestion, burning pain and tenderness in the hepatic region with bilious disturbance amounting sometimes to severe jaundice, vesical tenesmus, and depression of the action of the heart. It is a drastic purgative and a powerful diuretic. Therapeutics. Bryonia is a very old medicine, its most ancient reputation having been in epilepsy, hysteria and mania, conditions in which it is now superseded by other agents. It is a most valuable drug in the second stage of serous inflammations, especially in pleurisy, pleuro-pneumonia, and pericarditis, after Aconite has reduced pyrexia, to limit the extent of the effusion and to promote its absorption. For this, small doses frequently repeated are required. Also, in rheumatic fever, after the swelling of the joints has been reduced by other means, Bryonia is extremely efficient for the pain and stiffness. It is one of the best remedies for a “ cold-on-the-chest,” with dry, shaking cough, soreness, or shooting pains. It has been used with success in common, continued, or “ gastric ” fever, relapsing fever, congestive headaches increased by stooping, bilious headache with vomit- ing, gastralgia with pyrosis and soreness of the epigastrium, constipation, cholera infantum during dry, hot weather, congestion of the liver, croup, and threatened mammitis. Pains of shooting or tearing character, which are increased by movement, are often quickly relieved by this drug. In dropsies of various forms it is used as a drastic purgative and diuretic to remove the accumulated fluid. BUCHU—cadmium. 137 BUCHU ,—is the leaf of Barosma betulina, B. crenulata, and B serra- tifolia, S. African shrubs, of the nat. ord. Rutacese, each species having differently-shaped leaves, but all the leaves having crenated or serrated margins, and conspicuous oil-glands at the edges and on their under sur- face. They contain a Volatile Oil, which is probably the active principle, and gives them a peculiar and penetrating odor, resembling that of pepper- mint; also,. Barosmin, a bitter extractive, and resin, gum, lignin, etc. Dose, of the leaves, gr. xv-xxx. Preparations. Extractum Buchu Fluidum,—Dose, rtyx-^j. Infusum Buchu (Unofficial),— 3j to the pint. Dose, 3 ss—ij. Physiological Action. Buchu in small doses causes a sense of heat in the stomach, which is gradually diffused over the body. It increases the pulse-rate, stimulates the appetite, and produces slight moisture of the skin. It increases the flow of urine, which becomes of darker color and strongly aromatic odor, and deposits a brownish sediment. In large doses, it produces vomiting, purging, and strangury, with a burning sensation at the stomach. Therapeutics. Buchu is of especial value in chronic affections of the genito-urinary mucous membrane, on which the volatile oil acts topically, being elimi- nated by the kidneys. It is a very useful remedy in pyelitis, cystitis, and urethritis; also, in lithiasis, chronic bronchitis, and affections of the prostate gland. It is recommended in atonic dyspepsia, chronic rheuma- tism, affections of the skin, and for dropsy, but it is not so actively diuretic as to be very efficient in the latter condition. The infusion makes an excellent vehicle for saline diuretics. CADMIUM, Cd (Unofficial).—This metal was official in the Phar- macopoeia of 1870, but is no longer so. In its physiological action it resembles both Antimony and Zinc, being escharotic, astringent, and a very depressant emetic. In over-doses, its salts act as irritant poisons, with cerebro-spinal symptoms, such as coma and convulsions. It is never used internally. Its salts in general use are—• Cadmii Sulphas (Unofficial),—transparent oblique prisms, efflorescent, and very soluble in water. Used externally in a solution of gr. ss-iv ad aq. destil., or as an ointment (1 to 40 of fresh lard). Cadtnii Iodidum (Unofficial),—large, white, pearly crystals, soluble in water and alco- hol. Used as an ointment, 1 to 8 of lard. Therapeutics. The Sulphate has been used almost exclusively as a stimulating astringent in gonorrhoea and diseases of the eye. Corneal opacities are 138 CAFFEA. absorbed under the use of a solution of gr. ij to the %, and in gonorrhoea a mild injection (gr. ad 5j) is very beneficial. The ointment of the Iodide has been usefully employed for enlarged glands, chronic joint affections, cutaneous diseases, nodes and chilblains. CAFFEA, Coffee, the seed of Coffea Arabica, is officially repre- sented only by its active principle, Caffeine. The coffee-plant is a small tree, of the nat. ord. Rubiaceae, 15 to 30 feet high, native of South Arabia and Abyssinia, but cultivated in various parts of the world. Its seeds contain Caffeine (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. Caffeina, Caffeine, C8Hj 0N4O2.H2O. The U. S. Phar. of 1880 defines Caffeine as “ a proximate principle of feebly alkaloidal power, generally prepared from the dry leaves of Camellia Thea, * * or from the dried seeds of Coffea arabica, * * or from Guarana, and occurring also in other plants.” According to this, the principles severally named Caffeine, Theine and Guaranine, were officially declared identical, and such was the general opinion until very recently; their composition being expressed by the formula C8Hj 0N4O2, and the physiological action of one being accepted for the others. Recent investigations, however, leave no doubt as to the non identity of the first two, and some observers maintain that Guaranine also is a separate body, distinct from either of the others. For the present, however, we must look upon it as identical with Caffeine. The Caffeine of commerce is usually obtained from old tea-leaves, and is in reality Theine. It contains mt>re nitrogen than almost any other proximate vegetable principle. It occurs in colorless, flexible crystals, which are soluble in 75 of water and 35 of alcohol at 590 F. Dose, gr. j-v. Extractum Caffea Viridis Fluidum (Squibb), Fluid Extract of Green Coffee (Un- official),—is intended as a substitute for the Fluid Extract of Guarana. Dose, 3 ss-ij. [Compare the title Guarana.~\ Caffeince Citras, Cirate of Caffeine (B. P.). A very uncertain mixture, not considered a definite compound. Dose, gr. ij-x. Theina, Theine,—that from Merck the most reliable. Its solubility in water is much increased by adding an equal part of Sodium Benzoate, say 3 j of each to the fluid 3, with gr. x of Sodium Chloride. Of this, rr\,vj equals gr. y of Theine. Dose, gr. yfa-), hypodermically, several times a day, for relief of pain. Theine is contained in the leaves of Camellia Thea, the tea-plant, a native of China and Japan, and a member of the nat. ord. Ternstromiaceae. The tea-plant also contains tannic acid, and a volatile oil, the latter being most abundant in green teas. Preparations. Physiological Action. Coffee is a cerebro-spinal stimulant, a stomachic tonic, and a laxative. It is decidedly diuretic, and is somewhat antiperiodic and highly anti- septic. The green bean produces very different effects from those of the roasted one, exhibiting the action of Caffeine alone, unmodified by that of the empyreumatic 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. CAFFEA. 139 As a beverage, if used with moderation Coffee assists digestion, promotes intestinal peristalsis, allays the senses of fatigue and hunger, lessens tissue-waste and consequently decreases the formation and excretion of urea (?). Used to excess it disorders digestion, and causes functional dis- turbances of the nervous system, shown by headache, vertigo, mental con- fusion, and palpitation of the heart. It increases secretion, blunts sensation, exalts reflex excitability, in- creases mental activity, and may produce insomnia and great nervous restlessness. 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 abun- dant in those infusions which are kept a long time on the stove before being served. The Common Stimulant Beverages Compared. 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 stimu- lating to the mental processes, and (3) sedative to the nervous system. 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 con- sidered 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 is more stimulating than Coca, and less sustaining. It is apt to cause severe palpitations of the heart; and may disorder digestion, if long stewed. The Coffee-bean contains only 0.2 to 0.8 per cent, of Caffeine. Tea (Camellia Thea) 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 flatulent dyspepsia, tremulousness of the limbs, 140 caffea. pallor of the surface, irregular cardiac action, and feeble impulse, hallu- cinations, night-mare, anorexia, headache, nausea and vomiting, obstinate neuralgise—especially of the supra-orbital and occipital nerves; also con- stipation, 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. Mate (Ilex Paraguayensis, Paraguay tea), is supposed to be inter- mediate in its effects between tea and coffee. It also contains Caffeine, in the proportion of 1.2 per cent. Guarana (.Paullinia sorbilis of Brazil), contains an alkaloid — Guara- nine, 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 npxx, three or four times daily, when the basis of that preparation happens to be of good quality. Coca, or Cuca (.Erythroxylon Coca), 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 nutri- tious than any of the group, containing a large quantity of fat, Oleum Theobroiruz (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. Caffeine in general terms is a stimulant at first, 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 threby 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-pres- sure ;—in the smaller animals exalting the reflex excitability of the cord CAFFEA. 141 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 resem- bling rigor mortis. If administered in sufficient quantity it would doubt- less 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.) Theine, upon the smaller animals, agrees in most respects with Caffeine, except that it requires much larger doses to produce the same effects. It differs, however, in some important particulars. Theine chiefly affects the sensory, Caffeine the motor system. Theine causes spasms and con- vulsions, and impairs the nasal reflex, early in the course of the poisoning process;—while Caffeine does so late, if at all. Theine decreases the body-temperature,—Caffeine increases it. Theine causes convulsions in frogs, a power now denied to Caffeine, though hitherto ascribed to it. Both alkaloids tend to produce muscular contraction, but Theine causes a peculiar rhythmical contraction in voluntary muscles, which lasts for several hours, and seems to act transversely across the fibre, as the muscle is elongated at each contraction. In man, the principal action of the hypodermic injection of Theine is the production of a profound local ansesthesia at and below the point of injection,—acting therefore outwards along the nerve-trunk, and not towards the centre. It does not affect the motor apparatus, nor does it seem to produce narcosis. Guaranine is generally considered as identical with Caffeine, though some few observers find in its action a closer analogy to Theine. It affects both sensory and motor nerves, the sensory first, paralyzing them from the centres outwards. [ Cocaine and Brucine act from the periphery inwards.] It causes general hyperaesthesia, and subsequently convulsions of spinal origin,—at first increases and afterwards depresses respiration and the action of the heart. It seems to have a stronger affinity for the sensory than for the motor nerves, and hence resembles Theine more than Caffeine. Theobromine has the formula C7H8N402, and is closely allied to Caf- feine, physiologically and chemically. In fact, Caffeine may be considered a Methyl-theobromine, C7H9(CH3)N402. During roasting the cocoa-bean develops an aromatic principle which gives to chocolate its peculiar flavor. In large doses Theobromine is fatal to small animals. Therapeutics. Although without a very extensive range of usefulness, Caffeine is a valuable stimulant in many forms of nervous and cardiac depression, and has proved especially efficacious in headaches of neuralgic or nervous 142 cajuputi oleum. 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. In choleraic diarrhoea, and that of phthisis, it checks outward osmosis by stimulating the depressed nervous apparatus. In dropsy, car- diac and renal, Caffeine is a diuretic and cardiac stimulant. In cervico- brachial neuralgia, Caffeine hypoder., gr. j, increased to gr. v. In lithaemia and gout, a tincture of the green bean has marked diuretic and antispasmodic powers, and is very useful in these conditions. In insomnia of chronic alcoholism, gr. of Caffeine hypodermically. For adynamic fevers, it may well be used in place of alcoholic stimulants. In intermittents, Coffee has a curative reputation among the inhabitants of the Philippines, which is corroborated by the Dutch physicians. In asthma, if not used habitually, Coffee is valuable in the paroxysm. In opium narcosis, Caffeine hypodermically, or better still strong black coffee, to antagonize the increasing torpor of the nervous centres. Therapeutics of Theine. This alkaloid is a valuable analgesic, especially so by reason of its pro- longed influence over sensation. Its great field of employment is in neu- ralgia of any kind, cervico-brachial, sciatic, etc., doses of gr. y to gr. y2 hypodermically, are efficient, and may be kept up as long as required. To make a cure, however, the nutrition of the nerves must be attended to. In locomotor ataxia, lumbago, etc., it has been used with prompt benefit, in the same manner, promptly relieving pain, without producing any narcotic effect. (Mays.) CAJUPUTI OLEUM, Oil of Cajuput, —is a volatile oil distilled from the leaves of Melaleuca Cajuputi, a tree of the nat. ord. Myrtaceae, native of the Molucca Islands. It is a bluish-green or colorless liquid, of camphoraceous odor, and neutral reaction. Specific gravity about 0.920, freely soluble in alcohol. It contains Cajuputol or Bihydrate of Cajuputene, which forms y, of it, the other y, being another oil. Dose, Physiological Action and Therapeutics. Cajuput Oil resembles Oil of Turpentine, and has similar actions to those of the other volatile oils, being a stimulant carminative, somewhat diuretic and diaphoretic, antiseptic, parasiticide and anthelmintic. Exter- nally used, it is irritant to the skin. Swallowed, it produces a sense of warmth in the stomach and accelerates the pulse. It is not much used internally, though it has been given with benefit in flatulent colic, dropsy, hysteria, chronic rheumatism, scrofula, syphilis, elephantiasis and other cutaneous disorders. Externally, as a strong, CALAMUS CALCIUM. 143 stimulating rubefacient, it is efficient in chilblains, muscular rheumatism and nervous headaches. CALAMUS, Sweet Flag,—is the rhizome of Acorus Calamus, a plant of the nat. ord. Aracese, native in Europe and North America, having an aromatic odor and pungent taste. The unpeeled root should only be used, peeled or bleached calamus being almost inert. It contains a volatile oil and Acorin, which is a nitrogenous, bitter principle, also benzoic acid, starch, etc. Dose, indefinite. Preparation, Extractum Calami Fluidum,—is made with Alcohol as a menstruum. Dose, ff\xv-3j. Calamus is an aromatic bitter, and stomachic tonic, increasing the appetite and stimulating digestion. It is one of the constituents of the preparations termed “bitters,” and is chewed as an appetizer. CALCIUM, Ca,—is the metal characteristic of Lime, Chalk, and all calcareous substances, and though itself unofficial is represented by several official salts and preparations. Official Salts of Calcium. Calcii Carbonas Prcecipitatus, Precipitated Carbonate of Calcium, CaC03,—a fine im- palpable, white powder, odorless and tasteless, insoluble in water or alcohol, but soluble in mineral acids or acetic acid with effervescence. Creta (chalk) is the native carbonate of calcium (see below). Dose, gr. v-xx. Calx, Lime, Oxide of Calcium, CaO,—hard, white masses, gradually resolving to a white powder in the air, odorless, of sharp, caustic taste and alkaline reaction, soluble in 750 of water and 1300 of boiling water, insoluble in alcohol. Not used internally except in solution. Is a constituent of Potassa cum Calce. (See-under Potassium.) Calcii Chloridum, Chloride of Calcium, CaCI2,—hard, colorless masses, deliquescent, of sharp, saline taste, soluble in of water and 8 of alcohol at 590 F. Dose, gr. x-xx in solution. Calcii Bromidutn,—described under Bromides, ante page 133. Calcii Hypophosphis,—described under Phosphorus. Calcii Phosphas Prcecipitatus,—described under Phosphorus. Calcii Sulphidum,—described under Sulphur. Preparations of the Carbonate. Creta Preparata, Prepared Chalk,—is native carbonate of Calcium freed from most of its impurities by elutriation; a white, amorphous powder, odorless and tastless, insol- uble in water or alcohol. Dose, gr. v-xx. Is a constituent of Hydrargyrum cum Creta, and also of the following : Pulvis Cretce Compositus, Compound Chalk Powder,—has of Prepared Chalk 30, Acacia 20, Sugar 50 parts. Dose, gr. v-^j. Mistura Cretce, Chalk Mixture,—has of the preceding 20 parts, Cinnamon Water 40, Water 40, rubbed together and made fresh as required. Dose, ss. Trochisci Cretce, Troches of Chalk,—each contains of Prepared Chalk 4 grains, Acacia I, Sugar 6, with a little Nutmeg. Dose, indefinite. Testa Preparata, Prepared Oyster-shell (Unofficial),—contains animal matter intimately mixed with the carbonate of calcium. Dose, gr. x-xx or more. 144 CALCIUM. Preparations of the Oxide. Liquor Calcis, Solution of Lime, Lime-water,—contains about 0.15 per cent, ot Cal- cium Hydrate, Ca(HO)2. A clear, colorless liquid, of saline taste and alkaline reaction. Dose, Syrupus Calcis, Syrup of Lime, Saccharated Solution of Lime,—contains 5 per cent, of Lime, 30 of Sugar, the latter aiding the solvent powder. Dose, gss-ij. Is the antidote to poisoning by carbolic or oxalic acid. Linimentum Calcis, Lime Liniment,—contains equal parts of Liquor Calcis and Cotton- seed Oil. Is nearly the same as the application known as “ Carron Oil.” Calx Chlorala,—described under Chlorine. Calx Sulphurata,—described under Sulphur. Potassa cum Calce,—described under Potassa. Preparations of the Phosphate and Hypophosphite. Syrupus Calcii Ladophosphatis, ] Syrupus Hypophosphitum, V Syrupus Hypophosphitum cum Ferro, ) are described under Phosphorus. Physiological Action. Lime before it assumes the condition of Hydrate is irritant and caustic, and if inhaled or swallowed may produce dangerous inflammation. The preparations of Lime and Chalk are feebly alkaline and astringent; they neutralize the acid of the gastric juice and are sedative to the mucous mem- brane of the stomach. A small quantity of the oxide passes into the blood and promotes constructive metamorphosis,—but if used in large quantity or for a long time it will act in the opposite manner, producing waste. Calcium Chloride is a gastro-intestinal irritant, very diffusible and remarkably alterative, being apparently a powerful antagonist to the strumous diathesis. [The actions of the other salts of Calcium are described under the titles of their respective bases.] Antagonists and Incompatibles. The preparations of Lime and Chalk are incompatible with acids and metallic salts. In poisoning by Lime the antidote is a dilute vegetable acid, followed by demulcents or the fixed oils to protect the mucous membrane. Therapeutics. Lime may be used as a caustic and depilatory, but is better known as an agent for hastening decomposition which it does by its affinity for water, the resulting Hydrate absorbing many of the products. Chlorinated Lime is an excellent antiseptic and disinfectant, but as it owes its energy entirely to its chlorine it will be noted under that title. Lime- water is a favorite remedy for vomiting, especially in children, and is added to milk to increase its digestibility. It is also efficient for acid dyspepsia and mucous enteritis, as an antacid and astringent. Locally it is usefully employed as an enema against thread-worms, as a lotion in many mucous and purulent discharges, and in aphthae. The vapor of slaking CALENDULA CALUMBA. 145 lime or lime-water as spray are often very serviceable inhalations in diph- theria. Syrup of Lime contains more lime in solution than lime-water, and may be used instead of the latter where a diluent is not advisable. It is the antidote for poisoning by Carbolic or Oxalic Acid, while lime in any form (as wall-plaster) is a valuable antidote for poisoning by any mineral acid. Chalk-mixture is used in the diarrhoeas of children with sour-smelling, watery stools; and may be conveniently prescribed in combination with other astringents. Lime Liniment is used on cotton or lint as a dressing for burns. Calcium Chloride has been advantageously employed in the various manifestations of the strumous diathesis. It sometimes resolves glandular enlargements, calcifies tubercular deposits, aids the cicatrization of ulcer- ating cavities, and has been curative in eczema and lupus. It is strongly recommended in chorea, phthisis and in the colliquative diarrhoea of strumous children. In solution externally as a fomentation it will hasten the maturation of boils. [The therapeutics of the other salts of Calcium are included under those of their respective bases.] CALENDULA, Marigold ,—is the fresh, flowering herb of Calen- dula officinalis, the common Garden Marigold, a plant of the nat. ord. Compositse, frequently cultivated for ornament. The tincture (20 per cent.) is also official, and is exclusively used as a local application to pro- mote the healing process in wounds, ulcers, burns and other breaches of tissue. Extravagant views of its powers as a vulnerary are promulgated by the so-called “ homoeopathic surgeons,” and serve as one of their excuses for professing an exclusive position in the art of surgery. CALUMBA, Columbo,—is the root of Jateorrhiza Calumba, a plant of the nat. ord. Menispermacese, native in southeastern Africa, but culti- vated in the East Indian Islands. It occurs in nearly circular disks, having two or three interrupted circles of projecting wood-bundles, odor slight, taste mucilaginous, aromatic and bitter. It contains the alkaloid Berberine (see under Berberis, ante, page 130), a bitter principle named Calumbin, also Calumbic Acid and Starch, but no Tannin. Dose, gr. v-xxx. Preparations. Extractum Calumba Fluidum.—Dose, tr^v-xxx. Tindura Calumba,—1 in 10. Dose, 3 ss-ij. Calumba is the first in alphabetical order of the simple bitters, having no astringency or aroma, and its action, as herein described, will apply 146 CAMBOGIA. to the other members of that class (Quassia, Gentian, Cornus). It stimu- lates the nerves of taste, increases the flow of saliva, excites the flow of the gastric juice and the gastric circulation, thus increasing the appetite and promoting digestion, and so promoting the constructive metamorphosis. As it also increases the gastric mucus, its continued use will set up catarrh of the stomach, and interfere with digestion, though it is one of the least irritant of stomachic tonics. Therapeutics. As Calumba contains no Tannin, it may be administered with the salts of Iron, and is often prescribed with the sub-carbonate. It is useful in atonic dyspepsia with pain after eating, in the convalescent stage of dis- ease to promote appetite and digestion, in diarrhoea and dysentery, vomiting, sea-sickness, cholera morbus and cholera infantum. An Infu- sion of Calumba with Ginger and Senna is effective in flatulence, and the same preparation is a good vehicle for the administration of acids and alkalies, tonics, aromatics and mild cathartics. Having little or no irritant quality, it is an excellent tonic in the hectic of phthisis. CAMBOGIA, Gamboge,—is a gum-resin, obtained from Garcinia Hanburii, a Siamese tree of the nat. ord. Guttiferae. It occurs in cylin- drical pieces, of orange-red color, but yellow when powdered. Its taste is very acrid. It contains 73 per cent, of Gambogic Acid, a resinous substance, also 25 per cent, of gum and 2 of water. It is partly soluble in alcohol and ether. The only official preparation is the Pil. Catharticae Co. (described under Colocynthis), each pill containing gr. % of Gam- boge. Its dose, as a cathartic, is gr. ij-v,—as a diuretic, gr. j at short intervals. Physiological Action and Therapeutics. Gamboge is an irritant purgative, decidedly diuretic, and its powder is sternutatory. Its catharsis is accompanied by vomiting and colic, and the stools produced are watery, but not so much so as generally believed. It has no cholagogue action. Full doses are liable to produce violent gastro-enteritis, and incautiously used (as in Morrison’s pills) it has fre- quently caused death. On the other hand, large doses have been given continuously in some cases, without producing any dangerous symptoms. Gamboge was formerly much used as a hydragogue cathartic and diuretic in dropsies, but its irritant qualities have caused it to be superseded by other agents (elaterium, digitalis, etc.). However, for dysentery, espe- cially when in young subjects, very small doses (gr. y at short intervals, up to gr. Yi' in 24 hours, have proven to be remarkably efficacious. CAMPHORA. 147 CAMPHORA, Camphor, C10H 160,—is a stearopten (solid volatile oil), derived from Cinnamomum Camphora, a tree of the nat. ord. Laura- cese, and purified by sublimation. Occurs in white, translucent, waxy masses, of penetrating odor and pungent taste, lighter than water, in which it is sparingly soluble (x to 1300), but dissolves readily in alcohol, ether, chloroform, benzin, oils, etc. The camphor-tree is indigenous in China, Japan, Formosa and other parts of eastern Asia. Borneo Camphor has the formula C10H18O bears the same relation to Japanese Camphor as alcohol bears to aldehyde, and is heavier than water. Dose, gr. j-xx. Derivatives of Camphor are—Camphor-cymol which is obtained by its distillation with zinc chloride,—Camphoric and Camphretic Acids, which result respectively from its lesser or greater oxidation. Preparations. Aqua Camphorce, Camphor-water,—Camphor 8, Alcohol 16, Distilled Water q. s. ad 1000 parts. Used externally or as a vehicle.' Dose, Spiritus Camphorce, Spirit of Camphor,—Camphor 10, Alcohol 70, Water 20 parts. Dose, rtyv-xx. Linimentum Camphorce, Camphor Liniment,—Camphor 20, Cotton-seed Oil 80 parts. For external use. Ceratum Camphorce, Camphor Cerate,—has of the Liniment 3, Olive Oil 12, Cerate 85 parts. Used for itching skin-affections. Camphora Monobromata, Monobromated Camphor, C10H15BrO,—colorless, prismatic needles or scales, of mild camphoraceous odor and taste, and neutral reaction, almost insoluble in water, slightly in glycerin, freely in alcohol, ether, oils, etc. Dose, gr. j-x, in emulsion. Rubini's Tincture of Camphor (Unofficial),—is a saturated solution in alcohol, gj in °f which the dose is from 4 to 10 drops, rtyvij have caused toxic symptoms in an adult. Rasp ail's “Rau Sedative" (Unofficial),—contains Aq. Ammonite £ ij, Sodii Chlori- dum ij, Camphorated Spirits of Wine g iij, Water Oij. Used externally. Camphor is also an ingredient of Linimentum Saponis, Linimentum Sinapis Composi- tum, and Tinctura Opii Camphorata. Physiological Action. Camphor is antispasmodic, anodyne, antiseptic, diaphoretic, a stimu- lant expectorant, a cerebral excitant, a gastro-intestinal irritant, and a rubefacient. It has an acrid, hot taste, and 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 arterial tension. It also stimulates respiration and mental activity, even produc- ing intoxication; promotes diaphoresis, 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 cause gastro-intestinal inflammation, depress the heart and lower arterial tension, diminish the reflex function of the spinal cord, produce coldness of the surface, insensibility, coma, convulsions and perhaps death. 148 CAMPHORA. As many as 200 grains have been taken without fatal result, yet 6 or 7 grains have produced extreme drowsiness and weakness of the pulse, and 20 grains laid an Alpine guide up for a day. It is eliminated by the bronchial mucous membrane, skin and kidneys, and has often caused dysuria. Monobromated Camphor resembles the bromides in action, but is not identical therewith. In mammals it produces muscular weakness passing into paralysis, lowered temperature and respiration, stupor and death. In some cases its use by man has been followed by epileptiform convulsions. It is a nervous sedative and hypnotic, and a gastric irritant. Antagonists and Incompatibles. Arterial sedatives coffee, cold, etc., antagonize its action. Water precipitates it from the alcoholic solution, alkalies and earthy salts precipitate even the small quantity which is soluble in water. Emetics to remove as much as possible. Opium and Bromides for the convulsions. Therapeutics. Camphor was much used by the older physicians as an antispasmodic, and is yet greatly valued in China and Japan. It has a reputation for uncertainty of therapeutic action, but is usefully administered in cholera and choleraic diarrhoea, summer diarrhoea and that of infants, vomit- ing, gastralgia, cardiac depression, nervousness and nervous headache, nymphomania, capillary bronchitis, typhoid and eruptive fevers, dysmen- orrhoea, afterpains, chordee, strangury, and catarrhal colds. Locally it is effective in myalgia, lumbago, toothache, gangrene, and other conditions where counter-irritation or a local anodyne are required. A solution in ether has been found to be a beneficial application in erysipelas. Monobromated Camphor is used as a nerve sedative and hypnotic, but is not particularly efficient in this regard. It has been used with advantage in whooping-cough, neuralgia, chorea, hysteria, delirium tre- mens and epilepsy. Camphora Carbolata is a name given to a mixture of parts of camphor with one each of carbolic acid and alcohol. This preparation, mixed with olive-oil, is a good non-irritating and antiseptic dressing for wounds and breaches of surface. Camphor-Chloral is a fluid obtained by triturating together equal parts of camphor and chloral hydrate. It has decided solvent powers, dissolving sulphate of'morphine readily (gr. xx in 5ij)> and many other salts of alkaloids. It is often a serviceable application in superficial neuralgia, and is said to allay spasmodic cough if painted over the larynx. Camphora Salicylata is obtained by heating together 11 parts of salicylic acid and 14 of camphor. An ointment prepared from this sub- stance has been used with very satisfactory results in the treatment of phagedena, spreading syphilitic sores, epithelioma, lupus, etc. cannabis. 149 CANNABIS, Hemp ,—is Cannabis sativa, the hemp-plant, a coarse, pubescent, somewhat viscid annual of the nat. ord. Urticaceae, having an erect, branching stem 3 to 6 feet high, with alternate or oppo- site digitate leaves on long, weak petioles; and dioecious flowers, the staminate clusters being lax, drooping, leafless at the base ; the pistillate clusters erect and leafy at the base. It is indigenous to Asia, but is culti- vated in most civilized countries for its textile bast-fibres and its oily fruit. The two official varieties are specifically identical with each other, differing only in the degree of their 'action, that grown in India being the most powerful. They contain a resin named Cannabin, and a Vola- tile Oil, from the latter of which are obtained Cannabene, a light hydro- carbon, and Hydride of Cannabene, a crystalline body. Cannabis should not be confounded with the so-called “Indian or Canadian Hemp,” Apocynum cannabinum (see ante, page 107). The official varieties of Cannabis are as follows:— Cannabis Americana, American Cannabis,—is Cannabis sativa, grown in the Southern United States and collected while flowering, having a stem about six feet long and rough, leaves petiolate and digitate, opposite below, alternate above, flowers dioecious, odor heavy, taste bitter and slightly acrid. No official preparations. Cannabis Indica, Indian Cannabis, Indian Hemp,—the flowering tops of the female plant of Cannabis sativa, grown in the East Indies. Is about two inches long, branching, compressed and brittle, having a few digitate leaves with linear-lanceolate leaflets, and numerous bracts, each containing two small pistillate flowers, sometimes with the nearly ripe fruit, the whole agglutinated with a resinous exudation. Color brownish, odor peculiar and narcotic, taste slightly acrid. Preparations. Extraction Cannabis Indices,—Dose, gr. £-j, if active. Extraction Cannabis Indices Eluidum,—an alcoholic preparation which in mixtures must be emulsified with Gum Acacia, otherwise the resin will separate and float to the top or adhere to the sides of the bottle. Dose, rtp j-v, but the author has frequently taken gj of a good fluid extract without experiencing untoward effects. Whatever may be the reason, it is a fact which he has often verified, that if the precipitate, formed when the alcoholic preparation is added to water, be of a brownish hue, a dirty, yellow-brown, the sample will prove to be almost inert;—but if of a decided olive-green color, the prepara- tion will be active. The activity will be found to increase almost in direct proportion to the decided green of the precipitate. Samples from the same manufacturer show this difference, often seen between two bottles in the same shipment. The active principle seems to be intimately connected with the chlorophyll or other coloring matter present, and to be destroyed therewith by whatever injures the latter. Tinctura Cannabis Indices,—strength 20 per cent. Dose, Ttpxx— 3 j- The above re- mark on mixtures containing the fluid extract applies also to the tincture. Similar preparations of Cannabis Americana are prepared by the manufacturers and may be used in larger quantities. The dosage of all preparations of hemp is uncertain, as specimens of the plant vary very much in activity. The best rule is to begin with a small dose, gradually testing the activity of the drug and the susceptibility of the patient by carefully increased doses. Cannabin Tannate (Unofficial),—is a yellowish-brown permanent powder, insoluble in water and ether, slightly soluble in alcohol, having a not unpleasant odor and a bitterish, astringent taste. No formula has been published for it, but it is claimed to be the tannate 150 CANNABIS. of a glucoside by Merck of Darmstadt, who placed it on the market. Dose, as a hyp- notic, gr. v-x. Preparations used in the East. Churrus is an impure resin, prepared by rubbing the leaves of the plant together and scraping off the adhering resin. Gunjah is the dried leaf and tops as sold in the bazaars for smoking purposes. Hashish, Bhang or Siddhi is a confection consisting of the leaves and small stalks coarsely broken and mixed with fruits and aromatics. It is employed in the preparation of various electuaries and beverages, and is also smoked with or without tobacco. Physiological Action. Cannabis is an antispasmodic,' analgesic, anaesthetic and narcotic, a cerebro-spinal stimulant and a powerful aphrodisiac. It increases intel- lectual and motor activity, stimulates the vaso-motor nerves raising arterial tension, depresses sensation, and strengthens the energy of the uterine muscular fibre, but has no power to initiate uterine contractions. In large doses it causes a pleasurable intoxication during which the peculiar traits of the individual are exalted, and the ideas follow each other so rapidly as to produce a sense of great prolongation of time, minutes seem- ing as if hours or even days. With this occurs increased sexual desire, great uterine activity, and sensations of double consciousness and enor- mous dimensions. The sight and hearing are exalted, pupils dilated, anaesthesia sets in, the reflexes are lowered by stimulation of inhibition (Setchenow’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 produced by this drug. After-effects are dullness, heaviness, vertigo, headache, and confused thought, anaesthesia of the skin, and marked diuresis,—but no nausea, no vital depression, no constipation. Repeated use of the drug causes mental weakness and impotence, the result of over-stimulation. A raven- ous appetite is usually one of its effects. Antagonists and Incompatibles. Strychnine and faradism are antagonistic. Caustic alkalies are incompatible. In poisoning by it the stomach should be evacuated, stimulants given cautiously, and respira- tion maintained. The effects of a large dose last over 24 hours. Lemon-juice is said to antagonize its effects. Therapeutics. Cannabis was formerly much employed as an anodyne and hypnotic, also as an anaesthetic during surgical operations. It is now somewhat out of fashion. In migraine it is useful to prevent recurrence of the attack, and in neuralgia it is often very efficient. Uterine affections, as—chronic metritis, subinvolution, menorrhagia, dysmenorrhoea, etc., are greatly benefited by its anodyne quality and its power over the uterine muscular fibre. It is the best hypnotic in delirium tremens, and in traumatic tetanus and paralysis agitans large doses will lower the reflex activity. Dysuria and retention of urine are often relieved by it, while in spasm of the bladder and other painful affections of that organ it will be found a most efficient remedy. It is useful in functional impotence, especially if CANTHARIS. combined with Ergot and Nux-vomica. In gonorrhoea it lessens the discharge, relieves the inflammation, burning pain and restlessness, and allays chordee. The tincture of C. Americana is the most useful in this affection, being fully as efficient as Copaiba or Sandal Oil, and much more agreeable. It should, however, be prepared from the fresh plant, and be given in 3 to 5 drops doses 3 or 4 times daily after the subsidence of the acute symptoms. Full doses of the tincture of the Indian plant are extremely efficient in many cases of headache at the menopause, but should be used cautiously until the activity of the sample and the suscep- tibility of the patient are tested. Tannate of Cannabin is recommended as a powerful hypnotic, not in any degree dangerous and neither disturbing the secretions nor leaving unpleasant after-effects. It has been used with benefit in acute mania. CANTHARIS, Cantharides, Spanish Flies,—is the dried beetle Cantharis vesicatoria, an insect of the nat. ord. Coleoptera, about an inch long, of a shining green color, the powder being grayish-brown, with green particles, odor very disagreeable. Contains Cantharidin, C10H12O4, the active principle,—also a greenish volatile oil and peculiar fatty bodies. Preparations. Tinctura Cantharidis,—strength 5 per cent. Dose, try-xx. Ceratum Cantharidis, Cantharides Cerate, Blistering Cerate,—Cantharides 35, Yellow Wax 20, Resin 20, Lard 25 parts. Ceratum Extracti Cantharidis,—Cantharides 30, Resin 15, Yellow Wax 35 parts, Lard 35 parts, Alcohol q. s. Charta Cantharidis,—Cantharides X, Canada Turpentine I, Olive Oil 4, Spermaceti 3, White Wax 8, Water 10 parts—spread bn paper. Linitnentnm Cantharidis,—Cantharides 15, Oil of Turpentine q. s. ad 100. Emplastrum Picis cum Cantharide, Pitch Plaster with Cantharides, Warming Plaster, —Burgundy Pitch 92 parts, Ceratum Cantharidis 8 parts. Collodium cum Cantharide, Cantharidal Collodion,—Cantharides 60, Flexible Collo- dion 85, Commercial Chloroform q. s. Physiological Action. Cantharis applied to the skin is a rubefacient and vesicant, acting more slowly than mustard but much more severely. Internally it is also irri- tant, causing heat of stomach, gastralgia, nausea, and vomiting, the circu- lation is stimulated, temperature elevated, urine becomes scanty and irritating, is voided with difficulty and pain, and often contains blood and albumen. Afterwards the pulse falls, temperature and arterial tension are lowered, and depression ensues. A toxic dose produces severe gastro- enteritis, abdominal tenderness, tenesmus, mucous or bloody stools, pain in the stomach and loins, dysphagia, ptyalism, strangury, priapism, hema- turia, swollen genitals, abortion, muscular tremor, convulsions, coma and insensibility. Post-mortem shows evidences of violent metritis, gastro- enteritis and general peritonitis. Cantharis is aphrodisiac by causing vascular turgescence of the genital apparatus, but only in doses which 152 CANTHARIS. produce dangerous symptoms. It is only abortive in toxic dose. In small doses it is diuretic and emmenagogue. Counter-irritation by rubefacients or blisters acts on disease probably through the nervous system. Its influence is explained by the theory that the peripheral extremities of the nerves supplying the skin of the part to which the agent is applied undergo some molecular change, which extends to the nerve centre and is thence radiated to centrifugal or trophic nerves, effecting various changes in nutrition and secretion over the areas to which they are distributed. In addition to this method of action, neighboring parts are affected by direct extension of the inflammation produced, and distant parts are also affected by absorption through the vesicated surface of agents having special affinities for certain organs. Blisters act primarily as a stimulant to the body generally as well as to the organs in its vicinity, but if permitted to remain long enough to pro- duce large blebs, the result is a depression proportionate to the amount of serum abstracted, the serum containing nearly as much albumen as the blood itself. Antagonists. There is no chemical or physiological antagonist to Cantharis. Evacuation of the stomach, mucilaginous drinks freely, Opium for the gastro-enteritis, are the best measnres in poisoning by this agent. Therapeutics. As a counter-irritant and vesicant Cantharis is of great value in neu- ralgia if applied close to the emergence of the nerve from the spinal column, also in sciatica and neuritis, and in acute rheumatism around the affected joints. A blister at the nape of the neck controls many head- aches, and one behind the ear will modify inflammatory affections of the eye. In pleuritic effusions a succession of small blisters (flying-blisters) will promote absorption of the pleural contents, and a blister applied to the perineum will often cure a rebellious gleet. Though valuable as a therapeutic measure in very many conditions, blistering is going out of fashion except in hospitals and among people who believe in heroic treatment. As an internal remedy Cantharis must be employed in very small doses (rrij-iij of the tincture) in order to be efficient. When so used it is an admirable agent in acute desquamative nephritis after the active inflamma- tion and fever have subsided, to reduce the albumen and blood in the urine. Drop-doses are particularly useful in irritable bladder with frequent desire to micturate, so often observed in women, also in the incontinence of the aged and of children, and in cystitis, gonorrhoea and gleet. The same dose thrice daily will generally abate chordee. In spermatorrhoea, prostatorrhoea, scanty menstruation and menorrhagia in subjects of lax fibre and general want of tone it is often very serviceable. Cutaneous squamse and vesiculae are greatly improved by small doses frequently ad- ministered and gradually increased, and it is one of the best remedies for CAPSICUM. 153 psoriasis. For alopecia areata it is of the utmost value as an external application, and the tincture, greatly diluted, is an ingredient of all the hair-renewers in common use. In pleurisy, after effusion has taken place, it will be found admirable in i to 2 drop doses every 2 or 3 hours, and in the after prostration of diphtheria it proves a serviceable stimulant. One of the best applications to burns or scalds is a cloth dipped in a lotion of the tincture one part to thirty or forty of water. The same lotion is an efficient application to vesicular erysipelas and herpes zoster. CAPSICUM, Cayenne Pepper, —is the fruit of Capsicum fasti- giatum, a plant of the nat. ord. Solanaceae, native in tropical Africa and America. Occurs in small red pods, enclosing two cells containing flat,' yellowish seeds, and has a peculiar odor and an intensely hot taste. It contains Capsicin, which is a thick, red liquid, and is the active principle, —also a volatile alkaloid having the odor of Conine. Dose of the pow- dered drug, gr. v-x. Preparations. Extractum Capsici Fluidum,—alcoholic. Dose, rtyv-^j. Tinctura Capsici,—5 per cent, strength. Dose, rtyx- 3 j. Oleoresina Capsici, prepared by ether. Dose, rt\J-v. Emplastrum Capsici, Capsicum Plaster,—prepared from the oleoresin of capiscum and resin plaster. Physiological Action. Capsicum is irritant to the skin and mucous membranes. Externally used for sufficient length of time it will produce vesication, internally in quantity it will excite gastritis. In medicinal doses it increases the saliva, excites a sensation of warmth in the stomach, promotes appetite and digestion, and produces more easy and copious alvine evacuations. It stimulates the action of the heart, is diaphoretic and diuretic, also decidedly aphrodisiac. It is a general stimulant to the nervous system, but in repeated doses produces a slight narcotic effect upon the brain. On the vascular system it acts like ergot, powerfully constringing the vessels by influencing the unstriped muscular fibre in their walls, either directly or through the vaso-motor nerves. Therapeutics. Capsicum is an excellent stomachic tonic in atonic dyspepsia and in that of chronic alcoholism with tremor and insomnia. In acute dipso- mania and delirium tremens large doses are efficient in producing sleep and promoting appetite. It is the best substitute for alcohol and opium in attempts to cure those habits. It is well used in intermittents, chiefly as an adjuvant to more active drugs,—in flatulent colic especially when occurring in hysterical women and hypochondriacs,—also in low fevers and cholera as a stimulant. It gives good results in functional impotence, in spermatorrhoea from loss of tone, in chronic parenchymatous nephritis 154 carbo to check the waste of albumen, and is beneficial in chronic cystitis and in prostatorrhoea. The tincture internally and a plaster externally over the loins are efficient in cases of renal congestion with habitual pain in the back and a trace of albumen in the urine. Locally the tincture diluted (3j to Sviij) or the powder with honey, form excellent gargles for relaxed throat and its accompanying cough, relaxed uvula, inflammatory sore throat, and the cynanche of scarlet fever, but they must be used with caution as such applications are sometimes very irritating. The Capsicum-plaster is a mild counter-irritant, of great value in lum- bago and other muscular rheumatisms as a palliative application. CARBO, Carbon,—exists in nature in many forms, of which two are official, namely, the charcoals specified below. Carbo Animalis, Animal Charcoal,—prepared from bone, occurring in dull black fragments or powder, odorless and nearly tasteless, insoluble in water or alcohol. Carbo Ligni, Charcoal,—prepared from soft wood, is black, shining, brittle, inodorous, tasteless and insoluble. Preparations. Carbo Animalis Purificatus, Purified Animal Charcoal,—the bone-phosphate and cal- cium carbonate being removed by digesting with Hydrochloric acid and washing. Dose, gr. xx-gj. ... Carbonei-Bi-sulphidum, Bisulphide of Carbon, CS2,—is a clear, colorless, diffusive liquid, of strong, offensive odor, aromatic taste and neutral reaction; soluble in alcohol, ether, chloroform and oils, insoluble in water; vaporizes at ordinary temperatures, and is highly inflammable. Dose, rr\,ss-j. Physiological Action. Charcoal is an efficient deodorant and disinfectant, as it absorbs and condenses many gaseous bodies and vapors. It is evacuated unchanged by the bowel and exerts no specific action on the body. Carbon Bisulphide is largely used in the arts, hence its effects are fre- quently observed. Persons exposed to its fumes are affected by headache, vertigo, over-excitement of the nervous system, emaciation, incoordination of movement, depression of all the special senses with impairment of sen- sation and motility and perhaps insanity. Inhaled directly, it excites vio- lent coughing and produces anaesthesia characterized by great muscular rigidity. Being a powerful cardiac paralyzant, it is extremely dangerous as an anaesthetic. In 3-drop doses, it produces severe nausea and vomit- ing, with a sense of heat in the stomach and a weak and rapid action of the heart. It is a good solvent for Caoutchouc and many other substances. Therapeutics. Charcoal is used in pharmacy for decolorizing vegetable principles, CARDAMOMUM—CARDUUS. 155 removing alkaloids from infusions of plants, and making several prepara- tions, as acidum sulphurosum, potassii iodidum, etc. Externally, it makes an efficient disinfectant, absorbent and deodorant application to cancerous discharges, foul ulcers and gangrenous wounds. Having no odor it is not open to the charge of substitution of one smell for another. A small quantity added to water will keep it sweet for a long time. It is an excellent dentifrice if finely powdered. Internally, it is used for the same purposes, namely, to absorb gases and offending products of indigestion. In flatulent dyspepsia, gastralgia, pyrosis, diarrhoeas, nausea of pregnancy, epidemic cholera, and consti- pation, it has warm advocates. When used internally for any time, an occasional purgative should be given to prevent its accumulation in the intestines. It has been proposed as an antidote for several alkaloidal poi- sons on theoretical grounds, but its efficacy in this respect is doubtful. Carbon Bisulphide has such a horribly offensive odor that it will never be used for any purpose for which another agent can be found. It relieves the pain of gastric cancer, and in doses will alleviate nausea and vomiting, also gastralgia. Locally it has been used as a counter-irritant and a local anaesthetic, for deafness due to want of nervous energy, in facial neuralgia and various local pains. CARDAMOMUM, Cardamon,—is the fruit of Elettaria Carda- momurn, a plant of the nat. ord. Zingiberaceae, cultivated in Malabar. Occurs as dried capsules, containing small, reddish-brown seeds, of warm? aromatic taste and agreeable odor. Contains about per cent, of a Volatile Oil, C10H16, isomeric with Oil of Turpentine, which oil is the active principle, also a fixed oil, coloring matter, etc. It is an ingredient of Pulvis Aromaticus and of Extractum Aromaticum Fluidum (see under Cinnamomum), as well as of several compound preparations. Preparations. Tinctura Cardamomi,—15 per cent, strength. Dose, 3 j - ij. Tinctura Cardamomi Composita,—Cardamon 20, Cinnamon 20, Caraway 10, Cochi- neal 5, Glycerin 60, Diluted Alcohol q. s. ad 1000. Dose, Infusum Cardamomi (Unofficial),—may be made in the strength of gj to 0}£, and used in wineglassful doses. Physiological Action and Therapeutics. Cardamon is aromatic, carminative and stomachic, and is used as an agreeable flavoring for bitter mixtures in dyspepsia and other stomach affections. It is especially useful when combined with purgatives to check flatulence and griping, and it makes the best flavoring for saline solutions or mineral waters. CARDUUS (Unofficial),—the seeds of Carduus marianus, or St. Mary’s thistle, an annual European plant of the nat. ord. Compositse. A decoction (§ij ad Oj) is the preparation usually employed. It is an old 156 CARUM CARYOPHYLLUS. remedy recently revived as a hemostatic, and reported as very efficient in hemoptysis, uterine hemorrhage, melsena and amenorrhoea connected with derangement of the portal circulation. It has proved curative in conges- tion of the liver and simple jaundice, and in Germany it has long been popularly deemed efficacious in gall-stones, and liver affections generally. Dose of the decoction, 5j-3ss,—of a tincture, npx-xx. Carduus Benedictus, the “ blessed thistle,” also called Cnicus bene- dictus and Centaurea benedicta, is another plant of the same order, formerly held in high esteem as a popular “cure-all.” It contains Cnicin, an amorphous bitter principle, which has been used as an antiperiodic in doses of gr. v-x, but generally produces burning sensations and pharyn- geal constriction, with nausea, vomiting, colic and diarrhoea. It acts chiefly as a bitter tonic, resembling Calumbaand Taraxacum most closely. CARUM, Caraway,—is the fruit of Carurn Carvi, a European plant, of the nat. ord. Umbelliferae, and is of oblong shape, of an inch in length, separating into two parts, each having 5 ribs and 6 oil-tubes. Its odor and taste are aromatic and agreeable. The active principle is the Volatile Oil, which is also official. Caraway is an ingredient of Tinct. Cardamomi Composita. Preparations. Oleum Cari,—is the volatile oil distilled from Caraway, and is resolvable into Caruen, CjoHjg, isomeric with Turpentine, and Caruol, C10HnO, isomeric with Thymol. It is an ingredient of Spiritus Juniperi Compositus. Dose, ft\j-v. Infusum Cari (Unofficial),— 3j-ij ad Oss. Dose, ss-ij. The Oil of Caraway is fatal to small animals, and in one case 5j pro- duced cerebral congestion, delirium and rigors in man. The chief use of Caraway is as a flavoring agent, but it is efficient in the flatulent colic of children, and to prevent griping from the use of purgatives. CARYOPHYLLUS Cloves,—are the unexpanded flowers ©f Eugenia caryophyllata, a handsome evergreen tree of the nat. ord. Myr- i taceae, cultivated in the East and West Indian Islands. They are about long, of a dark-brown color, consist of a calyx-tube terminated by four teeth and surmounted by a globular head formed by four petals, which cover numerous curved stamens and one style. They emit oil when scratched, have an aromatic odor, and a pungent, spicy taste, and are contained in Tinctura Lavandulae Composita, TincturaRhei Aromatica and Vinum Opii. They contain a heavy Volatile Oil, which is official,— also Eugenin, C10H12O2, a crystalline body; Caryophyllin, C10H16O, a camphor; Caryophyllic Acid, and tannin, gum, etc. Preparations. Oleum Caryophylli, Oil of Cloves—a volatile oil distilled from Cloves, soluble in alcohol, and of sp. gr. 1.050. It consists of a light and a heavy oil, the latter containing Eugenol, Ci„Hi20, a phenol-like compound, and Caryophyllin, C10H16O, which yields as a product of its oxidation Caryophyllintc Acid, C20H32O6. Dose of the oil, ffij-iv. Infusum Caryophylli (Unofficial), may be made of strength I to 40, and used in doses of one to two fluid ounces. CASCA BARK—CASCARA AMARGA. 157 Physiological Action and Therapeutics. Cloves may be considered as a type of several agents yielding aromatic oils, which as a rule consist of terpenes with camphors, resins, fatty and other acids, etc., closely allied to phenol and benzoic acid, the balsams ind gum-resins. Such are Orange, Lemon, Allspice, Cajuput, Caraway, Peppermint, etc. Their oils are antiseptic, locally angesthetic, stimulant and irritant, antispasmodic, stomachic and carminative. Internally they inarease circulation and temperature, promote digestion and nutrition (in quantity may cause inflammation), relieve pain and spasm, and are excreted by the kidneys, skin, liver and the bronchial mucous membrane, stimulating and disinfecting their routes through the organism. These agents are used to flavor pharmaceutical preparations, to correct the griping tendency of many purgatives, to correct flatulence, to relieve pain in the stomach and bowels, and to promote the flow of saliva and gastric juice. As external applications they are efficiently employed for anaesthetic and counter-irritant purposes, to relieve pain in chronic rheu- matism, myalgia, lumbago, superficial neuralgia, toothache, etc. The Oil of Cloves is an effective deodorizer for sponge-tents, a good applica- tion to a painful tooth, and is occasionally applied over the course of an aching nerve with relief to the pain. CASCA BARK, Sassy Bark, Ordeal Bark, (Unofficial)—is the bark of Erythrophlceum Guinense, an African tree used by the negroes as an ordeal in trials for witchcraft. It contains a poisonous glucoside, Erythrophlein, and when used in quantity produces nausea and vomiting, stricture across the brow, severe cephalalgia, narcosis and death. It is used as a remedy in Africa for intermittent fever, dysentery, diarrhoea and colic, and in England is considered to resemble Digitalis in action and uses. A tincture is made (gij ad Oj) of which the dose is npx, or a watery Extract may be used in doses of gr. j. Erythrophlcein, the active principle, is a glucoside, and is said to be a local anaesthetic of extraordinary power, even surpassing Cocaine. It is found in Africa in a red mass, called “ Hayah,” which is proven to be identical with an extract of the original plant described by CErtel early in this century, and deposited by him in the Berlin museum. It closely resembles Digitalis in action, being a cardiac tonic and a hydragogue diuretic. CASCARA AMARGA, Honduras Bark (Unofficial,)—is the bark of a Mexican tree of the nat. Ord. Simarubacese, which has been used with apparent success as an alterative tonic and diuretic in syphilis and various chronic skin affections. The use of tobacco and alcohol seems to counteract its usefulness. It is certainly a very powerful tonic and has been employed by competent observers with uniformly good results in syphilis and syphilodermata, chronic liver complaints, chronic eczema, chronic nasal catarrh and psoriasis. A Fluid Extract is on the market of which the dose is 5ss-j thrice daily. 15 8 CASCARA SAGRADA CASCARILLA—CASSIA FISTULA. CASCARA SAGRADA, Chittem Bark, Sacred Bark (Un- official),—is the bark of Rhamnus Purshiana, or California Buckthorn, a small tree of the nat. ord. Rhamnaceae growing on the Pacific coast of the United States. It contains a Volatile Oil, a neutral crystalline sub- stance, several Resins, with tannic, malic and oxalic acids. A Fluid Extract is on the market, of which the dose is 3ss-j, two or three times a day. It has been found very serviceable in the treatment of chronic constipation, given in gradually diminished doses. It produces large, soft and painless evacuations, and the bowels are said to act naturally and regularly after its disuse. Cascara Cordial is a trade preparation, intended as a remedy for constipation, dyspepsia and hemorrhoids, and as a pleasant excipient for nauseous and bitter drugs. A similar preparation may be made by com- bining the fluid extract with the official Elixir Aurantii in the proportion of 3j to §ij, of which teaspoonful doses or more may be administered. Another species of the same genus, Rhamnus Frangula, is official under the title Frangula, which see. CASCARILLA, —is the bark of Croton Eluteria, a shrub or small tree of the nat. ord. Euphorbiacese, growing in the Bahamas. It occurs in grayish-brown quills, having a warm, bitter taste, and a fragrant odor when burned. Contains Cascarillin a crystalline principle, two resinoid extracts, aromatic volatile oils, with tannic acid, etc. There are no official preparations, but an Infusion (i to io) or a Tincture (i to io) may be prepared and given in doses of 3j_oj- Physiological Action and Therapeutics. Cascarilla is an aromatic bitter. It increases appetite and digestion, the mucous secretion, the flow of saliva and gastric juice, stimulates the intestinal secretions, and acts as a mild astringent by the influence of its tannin. Large doses produce nausea, vomiting and diarrhoea, and in medicinal doses continued it will set up gastric catarrh and consequently indigestion. It has slight antiperiodic powers. It has been used with success in epidemic dysentery, flatulent dyspepsia, debility, chronic bronchitis, intermittents, and low nervous fevers. It is difficult to dispense, as the infusion decomposes quickly, and acids pre- cipitate the resin from the tincture. CASSIA FISTULA, Purging Cassia,—is the fruit of Cassia Fistula, a tree of the nat. ord. Leguminosse, growing in tropical regions of Asia, Africa and America. It occurs in long, brown pods which are divided into numerous transverse cells, each containing a dark pulp in which is a glossy seed. No active principle has been isolated as yet. The pulp is the only valuable part of the drug. There are no official preparations, but it is one of the ingredients of Confectio Sennas. CASTANEA CATECHU CAULOPHYLLUM. 159 Cassia-pulp is laxative in doses of oj-ijj and purgative in large quan- tities, producing nausea, flatulence and griping. It is rarely prescribed alone, owing to its tendency to cause colic and flatulence. CASTANEA, Chestnut,—the leaves of Castanea vesca, a stately tree of the nat. ord. Cupuliferse, and should be collected while green. Chestnut leaves are 5 to 10 inches long and about 2 broad, have a slight odor and somewhat of an astringent taste. They contain tannic and gallic acids, salts, gum, etc. Preparation. Extractum Castanece Fluidum,—Dose, 3 ss- g ij. This drug has not been studied as to its physiological actions, if it has any. It is classed among the vegetable astringents by reason of its con- taining tannin. Its only reputation therapeutically is as a remedy for whooping-cough, in which it is said to be very efficacious. An infusion or decoction of the leaves has been used in indefinite doses. CATECHU ,—is an extract prepared from the wood of Acacia Cate- chu, a tree of the nat. ord. Leguminosse, native of the East Indies. Occurs in irregular masses, dark brown and brittle, nearly inodorous, but of astringent and sweetish taste, soluble in alcohol, and partly so in water. It contains Catechutannic Acid 50 per cent., and Catechuic Acid which is converted into the former by heat. Dose, gr. j-3ss. Preparations. Tindura Catechu Composita,—contains Catechu 12, Cinnamon 8, Diluted Alcohol q. s. ad 100 parts. Dose, ir^x-gy Trochisci Catechu,—each troche contains of Catechu 1 grain, mixed with Sugar, Tragacanth and Orange-flower water. Physiological Action and Therapeutics. Catechu is a powerful astringent, acting by virtue of its tannic acid, (See ante, page 74, for actions and incompatibles). Its uses depend en- tirely on its astringency. In the diarrhoea of children the Tincture with Chalk-mixture is very serviceable, and with Opium it is efficient in dysen- tery. It is also used as a gargle and mouth-wash in relaxed conditions of the pharyngeal mucous membrane, as an injection in leucorrhoea, and to control passive hemorrhages, spongy gums, etc. CAULOPHYLLUM, Blue Cohosh,—is the rhizome and rootlets of Caulophyllum thalictroides, a plant of the nat. ord. Berberidacese growing in Canada and the northern United States. Rhizome about 4 inches long, thick and bent, rootlets numerous and matted, taste sweetish, bitter and acrid. Contains Saponin a glucoside, and two resins. Dose, gr, v-xx. There are no official preparations. The eclectic preparation Caulophyllin is a resinous precipitate obtained by pouring an alcoholic extract into water. 160 CERA CERII OXALAS. Physiological Action and Therapeutics. Caulophyllum is a new addition to the pharmacopoeia, and has not yet been made the subject of experimental work by reliable observers. It was much used by the aborigines of this country in all affections to which their women were peculiarly subject, and was known among them by the name “squaw-root.” It is said to produce intermittent contractions of the gravid uterus, to have diuretic, emmenagogue and antispasmodic powers ; and is used as a remedy for deficient labor-pains, spasmodic after- pains, spasmodic pains in the uterus at any time, spasmodic dysmenorrhoea, and pains in other organs seemingly in sympathy with uterine affections. It has somewhat of a reputation in acute rheumatism of the hands and fingers, and as a preparative medicine for labor. CERA, Wax ,—is a mixture of Myricin, Cerotic Acid and Cerolein, is formed by the honey-bee, and exists in the pollen and leaves of many plants, particularly in Myrica cerifera, the wax myrtle. That produced by the bee is alone official. Cera Alba, White Wax,—is yellow wax bleached. Cera Flava, Yellow Wax,—is a peculiar concrete substance prepared by Apis nullified, the honey-bee. It is a yellowish solid, of agreeable odor and faint, balsamic taste, melting at 145.40 to 1470 F., of sp. gr. 0.955-0.967, insoluble in water and almost so in cold alcohol, but soluble in 35 of ether, xi of chloroform, boiling alcohol, fixed and volatile oils. Preparations. Ceratum, Cerate,—consists of White Wax 30, Lard 70. Unguentum, Ointment, consists of Yellow Wax 20, Lard 80. Wax is also a constituent of the 7 compound Cerates, 5 of the 25 compound Ointments, and 8 of the 17 Plasters. Physiological Action and Therapeutics. Wax owes its value to its power of resistance to decomposition and to many chemical agents. Its fusibility at a moderate degree of heat, and its solidity at the temperature of the body, together with its unirritating quality, make it a valuable ingredient of the cerates and ointments to give them consistence. Ceratum and Unguentum may be used as simple protective applica- tions. They form the bases of most of the compound preparations so named. CERII OXALAS, Oxalate of Cerium, Ce2(C204)3.9H20,— is a white, slightly granular powder, odorless and tasteless, insoluble in water or alcohol, but soluble in hydrochloric acid. Dose, gr. j-x, in pill. Physiological Action and Therapeutics. Oxalate of Cerium is a gastric sedative (like Bismuth), and is thought CETACEUM CETRARIA CHAULMOOGRA OIL. 161 to have selective action as a sedative to the motor distribution of the pneumogastric nerve. It is considered to be particularly useful in vomit- ing of reflex origin, especially in the vomiting of pregnancy, but it often fails, probably because not given in sufficient doses. To be effective at least 4 or 5 grains should be given 3 times a day to adults, and no results promised until after it has been used several days. It is also recom- mended in the vomiting of phthisis and bronchitis, cough with vomiting, gastralgia, chorea and diarrhoea. CETACEUM, Spermaceti ,—is a peculiar, concrete, fatty sub- stance obtained from Physeter macrocephcilus, the sperm whale. Occurs in white, pearly masses, odorless, of bland taste, and neutral reaction, becoming rancid in the air, soluble in ether, chloroform, carbon bisul- phide and boiling alcohol. Is a constituent of Unguentum Aquae Rosae, and Charta Cantharidis. Ceratum Cetacei, Spermaceti Cerate,—consists of Spermaceti 10, White Wax 35, Olive Oil 55 parts. Spermaceti consists of Cetin or Palmitate of Cetyl with several other fats in small quantities. Its action is solely that of an emollient, and it is rarely used internally. The Cerate is used as a bland ointment in blisters, abrasions, and ulcers. CETRARIA, Iceland Moss, —is the lichen Cetraria islandica, found in northern latitudes. Occurs about 2 to 4 inches long, brown above, whitish beneath, taste mucilaginous and bitter. Contains Lichenin or lichen starch, which forms as a jelly when the plant is boiled in water; —also Cetraric Acid. Decoctum Cetraria,—5 per cent, strength. Dose, £ ij-iv. Cetraria is nutrient, demulcent and feebly tonic. It has a popular reputation in pulmonary affections, and is of value in chronic catarrhs, chronic bronchitis, purulent discharges from mucous surfaces generally, also in chronic diarrhoea and dysentery. CHAULMOOGRA OIL (Unofficial),—is a fixed oil expressed from the seeds of Gynocardia odorata, an East Indian tree of the nat. ord. Eixacese. It is nauseous and bulky, solid at 62.6° F., and soluble in alcohol, ether, choloform, etc. Its active principle, Gynocardic Acid, is the best preparation for use, and may be given internally in doses of gr. ss-iij, or applied as an ointment, gr. xx ad 5j of Petrolatum. Dose of the oil, gtt. v-x, in capsules. Chaulmoogra Oil is credited with a few cures of leprosy, and several cases improved by its use both internally and externally. It is recom- mended as an external application in scaly eczema, psoriasis, syphilitic CHELIDONIUM CHENOPODIUM CHIMAPHILA. skin-diseases, chronic rheumatism, rheumatic arthritis and tabes mesen- terica. CHELIDONIUM, Celandine ,—is the plant Chelidonium majus, nat. ord. Papaveracese, which grows in Europe, and N. America about rocky places. It has a peculiar, unpleasant odor, and a pungent, acrid taste. Contains 2 alkaloids, Chelidonine, Ci9H17N303, and Chelerythrine, the latter being identical with Sanguinarine : also Chelidoxanthin, a yellow, crystalline substance, and Chelidonic Acid, supposed to be identical with Succinic Acid. Dose of the plant, gr. x-xxx,—of the fresh juice npv-xx. There are no official preparations. Chelidonium used externally is irritant, internally it is a drastic purga- tive but an unreliable one. It is also perhaps diuretic, diaphoretic and expectorant. In overdoses it is considered poisonous. It is an old remedy for jaundice and liver affections, but has been obsolete for some time. The fresh juice is a popular application for warts and corns, and a tincture in whiskey is used in Indiana as a remedy for phthisis, the menstruum being probably the most useful agent. It seems to be of real service in simple jaundice, whooping-cough, right-sided pneumonia with hepatic involvement, and the catarrhal pneumonia of children. CHENOPODIUM, American Wormseed,—is the fruit of Chenopodium ambrosioides, var. anthelminticum, a plant of the nat. ord. Chenopodiacese, indigenous in the United States. It is about -pj inch in diameter, and contains a glossy, black seed, has a peculiar, terebinthinate odor, and a pungent, bitter taste. Its active principle is a Volatile Oil which is official. Oleum Chenopodii,—a thin, colorless or yellowish liquid, of aromaticodor and pungent, bitter taste. Dose, Trpv-xv. The Oil is the only preparation used and that rarely, its odor and taste being very disagreeable. It increases the cardiac rate, and promotes the secretions of the skin, bronchi and kidneys. It is an efficient anthel- mintic against the round worm in doses of gtt. x three times a day for two days and followed by a cathartic. It seems to possess some tonic properties, and certainly is a diffusible stimulant. As such it has been used with benefit in chorea, hysteria, flatulent dyspepsia, and chronic malaria. CHIMAPHILA, Pipsissewa ,—the leaves of Chimaphila umbellata, or Prince’s Pine, an evergreen plant of the nat. ord. Ericaceae, indigenous in all parts of the United States. The leaves are about 2 inches long, serrate above, wedge-shaped towards the base, having an astringent and bitter taste. Contains Chimaphilin, a yellowish crystalline principle, Arbutin, also crystalline but colorless, with tannic acid, etc. CHINOLINA. 163 Extractum Chimaphilce Fluidumt—Dose, gss-ij. Decoctum Chimaphilce (Unofficial),—i to 17. Dose, 3 j-iij. Chimaphila is a tonic, astringent diuretic, belonging to the same group as Buchu, Uva Ursi, Pareira and Scoparius. It is probably the most active diuretic among them, stimulating all the excretory organs but especially the kidneys. It is an agreeable tonic, excites the appetite and promotes digestion. The fresh leaves, bruised and applied to the skin, are rubefacient and vesicant, showing the presence of some irritant prin- ciple. Chimaphila is a good diuretic in dropsy, and is efficient in several forms of chronic kidney disease with albuminuria, and in chronic catarrhal affections of the urinary passages, as hematuria, ischuria, dysuria and gonorrhoea. It is believed to check the secretion of uric acid, and should prove useful in gout and rheumatism. Externally, it has been applied to ulcers and tumors with benefit. CHINOLINA, Chinoline, Leucoline, C9H7N (Unofficial), a constituent of coal-tar oil—but may be obtained from Quinine or Cin- chonine by their destructive distillation with potassium hydrate,—and may be artificially prepared by heating Anilin or Nitro-benzol with gly- cerin in the presence of a dehydrating agent. Chemically, it is consid- ered to be formed by a union of Benzene and Pyridine atoms. (Compare the article Cinchona.) It is a colorless, oily liquid, strongly refractive, boiling at 460° F. without decomposition, turns dark on exposure to the air; soluble in alcohol, ether and carbon disulphide, sparingly so in water. It combines, like an alkaloid, with acids to form crystalline salts ; all of which, except the tartrate, are very deliquescent. Chinolince Tartras,—a white, micaceous, crystalline powder, of pungent odor and sharp taste, stable in the air and soluble in water. Dose, gr. v-xx. Physiological Action and Therapeutics. Chinoline is a valuable antiseptic, and antipyretic, being nearly as effective in this respect as Quinine, which it closely resembles in chemical character and physiological action. It is one of the most powerful anti- pyretics of all the substances which have been discovered in the search for an artificial quinine (Hydroquinoine, Antipyrin, Pyrocatechin, Resor- cin, Thallin, Kairine, etc). Chinoline has a very disagreeable taste and smell, and is irritant in action, hence the tartrate is preferred for medi- cinal use. It has been extensively used as an antipyretic in pneumonia, typhus, diphtheria, typhoid and other fevers, with varying success. In diphtheria, a 5 per cent, solution in weak alcohol is painted on the affected surface with great benefit. The tartrate has been used bene- ficially in neuralgia and whooping-cough, and as an antiperiodic in inter- mittents. 164 CHIRATA CHLORAL. CHIRATA, Chiretta ,—is the Indian plant Ophelia Chirata, nat. ord. Gentianacese, occurring in bundles composed of all but the coarser woody stems. It is inodorous but intensely bitter, and contains Chiratin and Ophelic Acid, two amorphous, bitter principles, but no tannin. Dose of the powdered plant, gr. xv-xxx. Extractum Chirata Fluidurn,—made with glycerin and diluted alcohol. Dose, tipxv-xxx. Tinctura Chirata,—io per cent. Dose, 3 ss-ij. The action of this plant is that of a simple bitter, like its congener Gentian. It is an excellent tonic, in this respect rivalling Cinchona, and is used in India as a substitute for the latter. It is laxative and stomachic, diminishes flatulency and acidity, and is particularly serviceable in the dyspepsia of gouty subjects. As it contains no tannin, it may be admin- istered with preparations of Iron. CHLORAL, Hydrate of Chloral, C2HC130,H20,—is inaccurately named, the hydrate being the official preparation. Chlo?-al, properly so-called, is Tri-chlor-aldehyde, C2HC130, an unstable, oily, colorless fluid, formed by the action of Chlorine upon Alcohol, whence its name Chlor-al. Its hydrate, the official Chloral, is a colorless, crystalline solid, which slowly evaporates on exposure to the air, of aromatic and acrid odor, bitter and caustic taste, and neutral reaction. It is freely soluble in water, alcohol, ether, glycerin, oils, etc., liquefies when mixed with camphor or carbolic acids, melts at 136° F. and is decomposed by alkalies into chloroform and a formiate of the alkaline base. Its aqueous solu- tion becomes acid, but the alcoholic solution remains neutral. Dose varies much with individual susceptibility and with the presence or absence of cardiac and pulmonary disease. Death has been caused in several instances by gr. xxx, in one case by gr. x, and in another gr. vijss produced alarming symptoms, all being adults. On the other hand several hundred grains have been ingested at one time with- out lethal effects, and where tolerance has been established by habital use, 3 ij- 3 iij are frequently taken without poisonous symptoms. An average dose for a healthy adult is gr. xv, for a child gr. j for each year of age up to gr. vj. It is best given in Syrup off Tolu. Caution is necessary when prescribed in combination with alcoholic preparations, as Chloral Hydrate is then very apt to separate as an alcoholate, especially if the Bromides of Potassium or Sodium are used in the same mixture and if the solutions are at all concentrated. In this way great danger is incurred of giving a heavy overdose, as the alcoholate floats on the surface of the mixture, and the entire Chloral contained therein may be taken at a single dose. Unofficial Analogues of Chloral. Amylene Hydrate, C5H120, Di-methyl-ethyl-carbinol,—a tertiary alcohol, 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 exerted chiefly on the cerebrum in doses sufficient to produce profound narcosis; and in medicinal doses it leaves behind no unpleasant effects, and has no perceptible influence on the heart or respiration. By very large dosage the medullary centres are paralyzed, including those governing respiration and cardiac action. Dose, 3i-3iss- CHLORAL. 165 Cannabini Tannas, Tannate of Cannabin,—(see ante, page 149),—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. Fron- miiller considers it a very useful hypnotic, powerful and not dangerous, not disturbing the secretions, nor leaving unpleasant after-effects, if used in proper doses. Chloralamid, Chloral Formulate,—is chemically a union of Chloral anhydride (C2H C130) with Formamide (CHO.NH.J. It is a proprietary drug, having been both patented and trade-marked, wherever possible, by its proprietor and exclusive manufacturer, Schering, of Berlin. It occurs as colorless, faintly bitter, odorless crystals, which are de- composed in hot water or warm solutions. Soluble in 20 parts of cold water, or in of alcohol;—rapidly decomposed by caustic alkalies and slowly by alkaline carbonates. The Dose is put at from 10 to 60 grains. The average adult hypnotic quantity about 30 grains, given in a teaspoonful of whiskey or brandy, or in any alcoholic compound;— for example, 30 grains in 2 drachms each of Tinct. Cardamom. Co. and Elixir Simplex, as one dose. By some observers a 45-grain dose is considered the limit of safety and equal to 30 grains of Chloral hydrate; by others this amount is considered necessary for its certain hypnotic action. Sixty grains have frequently been administered without pro • ducing unpleasant symptoms;—but, as Dr. Steele has pointed out, the slow solubility of the drug in the watery contents of the stomach must be taken into account, and when considering its action, the menstruum and the condition of the gastric mucous mem- brane should be known. The Action of Chloralamid is essentially a hypnotic one, and it is extensively advertised as the least depressant and most efficient sleep-producer at our command,—without un- pleasant after-effects from ordinary doses, except in 2 per cent, of the cases in which used, 1 per cent, having gastric and the other I per cent, having cerebral symptoms; while these were always slight unless the dose of 30 grains had been exceeded. The more severe and unusual effects (from doses above 30 grains) are vertigo, thirst, nausea, dry mouth, vomiting, anorexia, slight delirium, cardiac weakness, rapid and feeble pulse, and restlessness. The drug does not seem to have any cumulative action, nor any tend- ency to provoke a habit of using it. It is also credited with considerable analgesic power in certain conditions (see below), as well as with anti-dyspnceic and anti-hydrotic action. Therapeutically the main field of Chloralamid has been in the treatment of insomnia, particularly the simple or idiopathic form, and when not due to excitement or severe pain, but from nervousness, hysteria, chronic alcoholism, and similar states; also in that ac- companying typhoid fever, asthma (both cardiac and bronchial), organic heart disease, the opium habit, and diabetes mellitus (Steele). It is less effective in organic nervous affec- tions and mental disorders, and is useless in these conditions when the insomnia is due to excitement, hallucinations, or severe pain. As an analgesic, it has lessened and checked the pains of aneurism, carcinoma of the stomach and liver, sarcoma of a rib, erysipelas, rheumatic fever, gall-stone, etc.;—and in dysmenorrhcea has given entire relief, used just as the painful period approached, in a single dose of 30 grains. It has been reported curative of chorea, in doses of gr. 15 thrice daily for five days, in a boy of eleven years ; and in a girl who had resisted all other treat- ment for the same affection, it was successful in 8 days. Compared with Sulphonal, Chloralamid is preferred for all cases in which collapse is feared, by reason of its apparent freedom from depressant action on the cardiac centres or the respiratory mechanism. In phthisis it has proven efficient against the most obstinate night-sweats, while at the same time securing rest in cases in which the cough was not very violent. To secure the best results as a hypnotic, the drug should be given about an hour and a half before sleeping-time, in a dilute alcoholic menstruum, and on a stomach containing little or no watery fluids to interfere with its solution and absorption. Croton - chloral, C4H5C130,H20, Butyl-chloral Hydrate (B. P.),—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 distribution long before producing general anaesthesia (Liebreich). Dose, as hypnotic, gr. v-xx. Hyoscinae Hydrobromas, Hydrobromate of Hyoscine,—is an efficient hypnotic, with the advantage of being tasteless, and having a very small dose, (gr • sY)> so that it may be given in tea, coffee, etc. It is apt to affect the head afterwards, and soon loses its power by repetition. In large it is a dangerous respiratory depressant. Hypnone, C6H.(CO)(CH3), Phenyl-methyl-acetone,—a member of the Ketones, occurring above 70° F. as a colorless, mobile liquid, having a strong almond and orange CHLORAL. 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 disagree- able 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 respira- tion. Dose, nyv-x, in capsule, rtyvij to rtyviij being usually required. Methylal, CH2(OCH3)2, Methylene-di-methyl Ether,—one of the products of the oxidation of Methylic Alcohol, occurring as a volatile, mobile liquid of pleasant, aro- matic 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 medicinal doses does not leave any bad after-affects. Dost,per orem, rtyiv-v, repeated thrice at short intervals. Paraldehyde, C6H1203,—a polymeric form of Aldehyde, if represented thus (C2H40)3. Occurs as a strong-smelling, bad-tasting fluid, soluble in 8 parts of water. It is a reliable hypnotic of about one-half the power of chloral, leaving behind no unpleasant effects except a very disagreeable odor to the breath. In medicinal doses it slows and strengthens the heart, but 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, rt\,xxx- in water, syrup, etc,—n\xl being about the average hypnotic dose. Sulphonal, (CH3)2C(C2H2S02)2, belongs to the group of Disulphones, and has the chemical name Di-ethyl-sulphon-di methyl-methan. It is a whitish, 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 milk, 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 decfeases with use. Urethanej NH2C02C2H5, Ethyl Carbamate,—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 paralde- hyde or chloral; neither does it affect the circulation 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. an average hypnotic dose being gr. xxx ; but it is best, given in 5-grain doses repeated fre- quently, as a large dose may cause vomiting. Physiological Action. Chloral is a powerful hypnotic, also an antispasmodic, an antiferment, a preventive of the coagulation of fibrin, indirectly an anaesthetic, and especially a depressant of the cerebral, medullary and spinal centres and of the cardiac muscle. It is more hypnotic than chloroform but less of an anaesthetic. Applied to the skin or mucous membranes a i per cent, solu- tion (gr. v ad 3j) is antiseptic, but strong solutions are irritant and vesi- cant, may produce sloughing ulcers, and if taken internally may excite gastritis with nausea and vomiting. After a brief period of stimulation a medicinal dose depresses the heart and lowers arterial tension, diminishes oxidation and decreases the body temperature. On the brain cells it has a selective action, producing a deep sopor very like normal sleep, from which the patient may be awak- ened, but immediately falls asleep again, and which is not followed by headache or depression. This effect is considered by some authorities to be the result of cerebral anaemia produced by the drug. In some persons, chloral. 167 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 over- whelming the centres it drowns the consciousness of pain, and is therefore only indirectly anaesthetic. A toxic dose produces profound narcotism, abolishment of reflexes and sensibility, complete muscular relaxation and a great fall of body temperature. Death may result in the chloral sleep from paralysis of the respiratory centre or the cardiac motor ganglia, or by sudden failure of the heart-muscle in cases of fatty degeneration or in old drunkards. The Chloral-habit produces a state of marked anaemia and muscular weakness, especially of the legs (DaCosta) ; its subject presenting a weak, irritable, often irregular heart, deranged hepatic functions, jaundice, bileless stools, perhaps purpura and sloughing of a finger from decreased blood-supply. Its votaries are on the border of insanity, excitable, un- controllable in speech and action, talking in a silly manner and very volubly, and showing a marked loss of power of the limbs, so much so as to simulate paralysis thereof. Many cases of insanity have their origin in chloralism. On the blood its action is to increase the fluidity, crenate the red corpus- cles, and to destroy the leucocytes if used in large quantity. It is rapidly diffused, and is excreted by the kidneys partly unchanged, but chiefly as urochloralic acid, producing some diuresis,—also by the skin, causing various eruptions if used for any lengthened period. It has been held that the blood, being an alkaline fluid, decomposes it, setting free chloroform, but there are many facts against this theory. Chloral and Atropine, though antagonistic in their action on the spinal cord, both produce motor paralysis, the former by paralyzing the cord, the latter by direct paralysis of the motor nerves. Antagonists and Incompatibles. Atropine antagonizes its cardiac, respiratory and spinal depression, and should be injected in small doses frequently repeated, until its effects are apparent. Morphine administered with Chloral antagonizes the tendency to cardiac failure, while synergistic to the hypnotism. While Chloral is the antagonist to Strychnine, opposing the spinal action of that drug, the reverse is only true to a very limited extent. Heat is a necessary application, to maintain the body-temperature, and artificial respiration should be practiced if required. All alkalies are incompatible. Therapeutics. Chloral Hydrate is of great value as a hypnotic and antispasmodic, but must be cautiously used if at all in old alcoholics or persons with weak or fatty hearts, atheromatous vessels or advanced pulmonary disease. In combination with Potassic Bromide it is much used in asylum and general practice, and equally abused, both drugs being active cardiac poisons. It is highly serviceable in fevers, when high temperature exists with excite- ment, restlessness and a sthenic condition, as it lowers temperature and 168 CHLORAL BUTYLICUM CHLOROFORMUM. prevents the coagulation of fibrin. In the algid stage of cholera and in violent cases of cholera morbus it may be injected hypodermically in 15-grain doses with extraordinary efficacy. In sea-sickness small doses (gr. v) two or three times a day are generally very efficient. In obstetrics it is used to relieve suffering, relax the os uteri, palliate convulsions and to relieve after-pains. For nocturnal epilepsy a full dose at bedtime is a useful palliative. In neuralgia it may be triturated with camphor and applied over the course of the affected nerve. Tetanus is best treated by chloral and potassic bromide. It is an excellent remedy for infantile convulsions and colic, chorea, spasmodic asthma, whooping-cough, laryn- gismus stridulus, and the first stage of diphtheria, but not when the heart is weak. In acute mania and delirium tremens it is the best hypnotic, but has been too incautiously employed. In cancers and ulcers a 25 per cent, solution is a good antiseptic and anodyne application. In strych- nine-poisoning Chloral is the antagonist. It is generally given by the mouth in dilute solution with some simple elixir or cinnamon-water, but is well absorbed by the rectum. Its hypodermic administration is liable to result in great local irritation and even sloughing ulcers. The mixture of Chloral and Camphor is a good local application in superficial neuralgia, and may be painted over the larynx for spasmodic cough. It makes a good remedy for internal use in colic, cholera and cholera morbus, especially if combined with Morphine. CHLORAL BUTYLICUM, Butyl-chloral Hydrate, Croton- chloral, C4H5C130,H20 (Unofficial),—is formed by the action of Chlo- rine upon Aldehyde, then adding to the Butyl-Chloral thus produced the necessary water. It occurs in crystalline scales, insoluble in chloroform, sparingly soluble in water, but freely soluble in alcohol, hot water and glycerin. Dose gr. v-xx, in syrup or pill. But the best method is to give 5 grains every half-hour until 20 grains have been taken or relief afforded. Physiological Action and Therapeutics. Croton-chloral so far as is ascertained has an action parallel to that of Chloral Hydrate, but feebler and less certain. It is said to have a specific paralyzant power over the 5th nerve, and to have no paralyzant effect on the heart. It has been used with benefit in various neuralgias, especially tic-douloureux, also in sciatica and dysmenorrhoea. All statements of the action and therapeutics of this drug are to be received with hesitation, as wide differences are reported by the best authorities. CHLOROFORMUM, Chloroform, CHC13 or CHC1SC1,—the Terchloride of Methyl, or the Chloride of Bichlorinated Methyl (Di-chlor- methyl Chloride),—is formed by the substitution of 3 atoms of Chlorine CHLOROFORMUM. 169 for 3 of Hydrogen in Methyl Hydride (marsh-gas, CH4). In practice it is obtained from Ethylic Alcohol or Methylated Spirit by the action of Chlorinated Lime, or from Chloral by an alkaline hydrate, and is known chemically as Normal Chloroform. If prepared from Methylic Alcohol (wood-spirit) it is called Methylic Chloroform, and is purified with great difficulty. The object of purification is to remove the chlorinated pyro- genous oil. Absolute Chloroform has a sp. gr. of 1.500, and decomposes easily in sunlight or diffused daylight, but when reduced to a sp. gr. of 1.485 to 1.490 by alcohol it will keep well. It is official in two forms, viz.— Chloroformum Venale, Commercial Chloroform,—is a liquid con- taining at least 98 per cent, of Chloroform, and having a sp. gr. not lower than 1.470. It contains sundry Hydrocarbons, free Chlorine, Aldehyde and Hydrochloric Acid, and is used only for external applications, or to make the purified article. It is a constituent of Linimentum Chloroformi. Chloroformum Purificatum, Purified Chloroform,—is a heavy, clear, colorless, diffusive liquid, of characteristic odor, sweet, burning taste and neutral reaction, soluble in 200 of water, freely so in alcohol or ether, also in oils, benzol or benzin. Sp. gr. 1.485 to 1.490 at 590 F., and contains to 1 per cent, of alcohol. Dose, internally, npij-xx, for in- halation about 3j, repeated until the desired effect is produced. Preparations. Mistura Chloroformi,—contains of Purified Chloroform 8, Camphor 2, fresh Yolk of Egg 10, Water 80 parts. Dose, j. Spiritus Chloroformi,—contains of Purified Chloroform 10, Alcohol 90 parts. Dose, trpx-gj, well diluted. Linimentum Chloroformi,—Commercial Chloroform 40, Soap Liniment 60 parts. Linimentum Chloroformi Compositum (Unofficial),—Chloroform 3 j, Oil of Turpentine gj, Tincture of Opium giv, Tincture of Aconite Chlorodyne (Unofficial),—a celebrated secret mixture, put forth by Dr. J. Collis Browne, of London, and since imitated by many others. It is supposed to contain Chloroform, Ether, Morphine, Cannabis Indica, Hydrocyanic Acid, Capsicum, etc., and is powerfully anodyne, antispasmodic and narcotic, and therefore highly dangerous in non- professional hands. Dose, nyx-xxx, according to the quantities of Morphine and Chloro- form present, these being the active agents in the preparation. A comparison of the principal formulae which have been used in imitation of Browne’s Chlorodyne is given in the appendix, and will show the wide differences between them. A list of 25 formulae for Chlorodyne was published in the Therapeutic Gazette for October, 1883. Tinctura Chloroformi et Morphince (B. P.),—has been recently made official as a sub- stitute for Chlorodyne. Each dose of 10 minims contains of Chloroform Ether Alcohol Ttpil, Morphine Hydrochlorate gr. Dilute Hydrocyanic Acid TlLf, Oil of Peppermint Fluid Extract of Liquorice Treacle and Syrup q. s. Tinctura Chloroformi Composites (B. P.),—has of Chloroform 2, Alcohol 8, and Com- pound Tincture of Cardamoms 10. Dose, rqxx-gj. Ancesthetic Mixtures containing Chloroform,—see under /Ether, ante, page 79. Some Chlorinated Ancesthetic Compounds. Ethylene Bichloride, Dutch Liquid, Chloric Ether, C2H4C12,—is a rapid and powerful anaesthetic, probably safer than Chloroform and less so than Ether. It always paralyzes the respiratory centre before the heart, so that its effects may be easily watched and con- trolled. This is the substance which Guthrie supposed he had obtained when he dis- covered Chloroform. 170 CHLOROFORMUM. Ethylidene Chloride, Chlorinated Muriatic Ether, CH3,CHC12,—is a mixture of varying sp. gr., and is not inflammable. It closely resembles Chloroform both physically and physiologically, but is less depressant to the heart, consequently safer, and recovery from its effects is very prompt. Methyl Chloride, CH3C1,—a colorless gas, slightly soluble in water, of sweetish odor and taste, inflammable, burning with a greenish flame. Cold liquefies it, and the liquid boils at—7.6°F. It is used locally in neuralgise to produce intense cold, and with re- markable success. Methylene Bichloride, Dichloro-methane, CH2C12,—is an effective anaesthetic which it was supposed would displace Chloroform as being much safer. Dr. Richardson intro- duced it and Mr. Spencer Wells advocates its use, but though little used as compared with other anaesthetics several deaths have occurred from its employment. It kills by paralyzing the heart. Carbon Tetrachloride, CC14,—is less irritant than Chloroform, but far more dangerous to the heart. Physiological Action. The action of Chloroform is similar to that of Ether (see ante, page 80) with several important differences, as follows : It is more irritant to the mucous membranes, and if swallowed undiluted it produces violent gastro- enteritis, which becomes apparent after the subsidence of the profound narcotism which at first follows its ingestion in quantity. A dose of 5j internally will cause death. It is less of a stimulant than Ether, and more depressant to the heart and circulation. It clots blood outside the body, making a mass like sealing wax. Inhaled for anaesthetic purposes it is considered much more dangerous than Ether from its direct paralyzant effect on the heart. Its vapor requires admixture with per cent, of air to produce anaesthesia with safety according to the authorities on the subject. As compared with Ether its vapor is less irritant to the air-passages, uninflammable, more pleasant, more prompt in action, has a shorter stage of excitement and a more pro- found narcosis, and produces much less vomiting. Its mortality is greater, being 1 in 3000, against 1 in 16,000 for Ether, about 500 fatal cases being reported, none of which, however, were in obstetrical practice. Death from Chloroform-inhalation is almost always sudden and by cardiac paraly- sis,—from Ether it is slow and usually by paralysis of respiration. [For modes of death from anaesthetic vapors and the treatment of dan- gerous symptoms, see ante, page 81.] Antagonists. There is no chemical antidote. If swallowed, the stomach should be evacuated and the case treated as one of poisoning by an irritant. Amly Nitrite by inhalation, and Atropine hypodermically, to sustain the heart. Therapeutics. Chloroform is used for the same condition as is Ether, and is much employed in liniments as a rubefacient and anodyne application, as in pruritus, rheumatic and neuralgic pains, etc. Internally it is advanta- geously administered in true cholera, in which it has been more efficacious than any other single remedy, in cholera morbus, vomiting, colic, dys- CHLOROFORMUM. 171 menorrhcea, hepatic colic, and other pains of internal and spasmodic character. In sciatica, tic-douloureux and other neuralgiae of important nerves the deep injection of npv-xv of pure Chloroform in the vicinity of the nerve is highly recommended, though it may cause dangerous local disturbance. The writer has, in several cases of severe supra-orbital neu- ralgia, injected two or three minims of Chloroform into the vicinity of the supra-orbital nerve just above its foramen of exit, with the most grati- fying results, though severe local pain and considerable swelling were experienced for several days. The vapor in small quantities inhaled from warm water is useful in many neuroses, as hay-fever, spasmodic- asthma, reflex cough. As an Ancesthetic the use of Chloroform is decreasing every year in favor of Ether, except for young children and in obstetrical practice. Its vapor being four times denser than air, and the rule for its effective use requiring fully 96*4 per cent, of air with it, its administration according to the orthodox fashion requires most careful management, and should never be attempted in any but the recumbent posture. An ounce of Brandy and a hypodermic injection of Morphine, gr. with Atropine, gr. given 20 minutes before commencing the inhalation, are means of great utility in sustaining the heart and respiration, as well as in ren- dering the anaesthesia more profound. No operation, especially on parts supplied by the fifth nerve, should be undertaken during partial chloro- form anaesthesia, for the reasons given on page 81. Dr. Sayre administers Chloroform in a manner which is calculated to strike terror to the heart of an emotional observer who is impressed by the orthodox rule of per cent, air with per cent, of the anaesthetic as the only safe proportion. Having been made familiar with the prac- tice of Dr. Sayre through observance of the method employed by some of his pupils, the writer sought for more direct instructions from that distin- guished surgeon, and received from him a letter from which the following paragraphs are extracted. “ I have employed no other method for more than twenty years, have used it in this manner in some thousands of cases without the least appearance of danger, and can there- fore speak with confidence as to its safety. “ My plan is simply to ansesthetize the patient with the smallest amount of Chloroform possible; and as Oxygen is the Antidote to the anaesthetic I exclude all air that is not impregnated with the ancesthetic. “ In this manner a very few inspirations will produce immediate anaesthesia without the muscular struggling which always follows when pure air is admitted with the chloro- form. I always measure my dose with the same care as if I were administering Arsenic, Strychnine, Corrosive Sublimate, or any other potent agent; and then I know what I am doing. If by accident there should be some peculiarity about the patient, making him unduly susceptible, a few artificial respirations would soon remove the influence of the few drops which had been inhaled, and thus all danger can be avoided. Five, ten or twenty drops of Chloroform administered in this manner is all that is requisite to produce imme- diate and profound anaesthesia. I have explained my method hundreds of times at my clinical lectures in Bellevue Hospital, many of which have been published at different times in different medical journals by various persons who have made stenographic re- 172 CHLORUM. ports of my lectures. In the ‘ Transactions of the International Medical Congress,’ held in Philadelphia in 1876, is a verbatim report of my remarks on this subject made while I was performing an exsection of the hip-joint in the hospital before the Congress.” I remain yours truly, Lewis A. Sayre. The writer can add his testimony to that of the above letter respecting the thorough anaesthetic effect and freedom from unpleasant symptoms observed in a large number of cases in which Chloroform was administered in the manner described under his observation during the past six years. As to the safety of this method over the ordinary way no conclusion can be reached without the results of many thousands of examples in the hands of many different observers. CHLORUM, Chlorine, Cl,—is a greenish-yellow gas having a suffo- cating odor and belonging to the group of Halogen elements, so named (from akq, the sea) because its most important members Chlorine, Bro- mine and Iodine are derived from the ocean, Chlorine being obtained from sea-salt, Bromine from sea-water, and Iodine from sea-weed. Chlo- rine itself is not official, but is represented in medicine by 2 Chlorates and 8 Chlorides (of Potassium, Sodium, Ammonium, Calcium, Iron, Gold, Zinc and Mercury), which are described under the titles of their respective bases; also by Hydrochloric Acid, Chloral, Chloroform, etc., and by the following preparations which furnish it. Preparations. Aqua Chlori, Chlorine Water,—is an aqueous solution of Chlorine, containing at least 0.4 per cent, of the gas; and is prepared by heating together Black Oxide of Manganese 10 parts and Hydrochloric Acid 40 parts, then saturating 400 of distilled Water with the gas so obtained. It is a clear, greenish-yellow liquid, of suffocating odor and disagreeable taste. Dose, well diluted, as a lotion or spray; internally, rtyx-xx in water. Chlorine Water may be extemporaneously prepared by mixing in a mortar Chlorate of Potassium 40 grains and Hydiochloric Acid ]/% ounce, and adding a pint of distilled water by agitation during the evolution of the vapors. If done in a closed vessel danger may arise from the explosive gas, C1204 which is liberated at the same time. It should be quickly bottled. Calx Chlorata, Chlorinated Lime, Chloride of Lime,—is a compound resulting from the action of Chlorine upon Calcium Hydrate, and containing at least 25 per cent, of available Chlorine. It is obtained by exposing slaked Lime to the action of Chlorine gas as long as the latter is absorbed, and should not be confounded with Chloride of Calcium (see ante, page 143). It occurs as a whitish, dry powder or friable lumps, gradually decomposing in the air, of saline, disagreeable taste and a feeble Chlorine odor, partially soluble in water and in alcohol, and when dissolved in dilute Hydrochloric acid gives off Chlorine gas. Dose, gr. iij-vj in water; for external use a 1 to 3 per cent, solution. Liquor Calcis Chlorata, B. P., is a solution of 1 pound in 1 gallon of water. Liquor Soda Chlorata, Solution of Chlorinated Soda, Labarraque’s Solution,—a pale- greenish liquid, of faint Chlorine odor, and alkaline taste and reaction ; prepared by add- ing together watery solutions of Sodium Carbonate 100 parts and Calx Chlorata 80, each in 400 parts of water, then adding Water up to 1000. Contains Sodium Hypochlorite and Chloride. Dose, rryx-gj in 20 parts of water. Physiological Action. Chlorine is actively irritant to the skin and mucous membranes. Locally applied it produces heat, burning and even vesication. Inhaled in any CHLORUM. 173 quantity it causes cough, sneezing and spasm of the glottis, also inflam- mation of the air-passages and of the lungs. It is the most powerful of all disinfectants and deodorants, also an antiseptic and antifermentative agent of the highest activity. Its power in ail these respects is due to its affinity for hydrogen, decomposing all bodies in which hydrogen enters as a molecular constituent, forming chlorhydric acid and setting oxygen free in its nascent form (ozone). Used internally it has the same local action on the parts with which it comes in contact, and on reaching the stomach in dilute solution it is converted into hydrochloric acid and chlorides, losing all further action on the body in its own character. Antidotes. Ammoniacal vapors inhaled after Chlorine from Ammonium Chloride. Ammonium Sulphide has a similar reaction, but should be inhaled in great moderation. Albumen is the antidote if Chlorine preparations have been taken into the stomach, and a little Aqua Ammoniae, sufficiently diluted, may also be administered with advantage. The chlorinated preparations are used as disinfectants and deodorizers of rooms, drains and discharges from the body. They are rarely used about the person or clothing of patients by reason of the irritation pro- duced by them when inhaled, and their power to destroy the color of fabrics. In dilute solution they are well employed as local applications in aphthae, gangrene, scarlet fever and diphtheria, in which their principal action is to destroy fetor. The same may be said of their use in sloughing ulcers and gangrenous wounds, foul discharges, etc., as they are rarely employed about the person in sufficient strength to have any destructive effect on disease-germs. A strong solution of Chlorinated Soda is a good application to bites of serpents and insects, to prevent infection by the syphilitic poison, and to wash the hands after contact with infectious material. A combination of Potassium Chlorate and Tinctura Ferri Chloridi, makes a solution of Chlorine, Euchlorine, Potassum Chloride and Ferric Chloride, when diluted with water, and gives one of the best and most innocuous solutions of antiseptics. It makes an excellent gargle for sore throats, simple or diphtheritic. Glycerin should never be added to it, as the resulting mixture will be liable to explode violently. These preparations have been administered internally in septic diseases, low fevers, etc., but without producing any marked bene- ficial results. To disinfect unoccupied rooms all means of exit should be stopped up, then a pound of Chlorinated Lime sewed loosely in a strong canvas bag is immersed in a mixture of a pint and a half of common muriatic acid with 4y2 pints of water, and left 24 hours. Therapeutics. 174 CHONDRUS—CHRYSAROBINUM CIMICIFUGA. CHONDRUS, Irish Moss, —consists of two sea-algse, Chondrus crispus and Chondrus mammi/osus, dried and bleached. Is horny, trans- lucent, pale yellowish-white, swelling in water, of sea-weed odor and mucilaginous, saline taste. On boiling with 30 parts of water for ten minutes it yields a solution which gelatinizes on cooling. It contains 90 per cent, of mucilage with traces of Iodine and Bromine, also 1 per cent, of Nitrogen. There are no official preparations. A jelly or blanc mange may be prepared by boiling Sij in Sxxxiv of water for an hour, straining and adding §iij of sugar while hot. Dose, indefinite. Physiological Action and Therapeutics. Irish Moss is a demulcent and nutrient substance of some slight value in bronchial and catarrhal affections. Having no starch in its composi- tion it is not so valuable as Iceland moss (Cetraria) as an article of food for the sick. CHRYSAROBINUM, Chrysarobin, —is a mixture of proximate principles extracted from Goa-powder, a substance found in cavities formed by decay in the wood of the trunk of Andira Araroba, a Brazil- ian tree of the nat. ord. Leguminosae. It is commonly misnamed “ Chrysophanic Acid” (which is one of the constituents of Rheum)— though easily converted into that substance. Occurs as an orange-yellow powder, odorless and tasteless, nearly insoluble in water and alcohol, but readily soluble in ether, solutions of alkalies and sulphuric acid. Dose, gr. xx. • Preparation. Unguentum Chrysarobini,—Chrysarobin 10, Benzoinated Lard 90 parts. Should be diluted for average use from 3 to 5 times. Physiological Action and Therapeutics. In 20-grain doses Chrysarobin is a gastro-intestinal irritant, producing large, watery, bilious stools, with repeated vomiting but not much nausea. Locally it produces diffuse dermatitis often followed by follicular and fu- runcular inflammation. It stains the skin a dark yellowish-brown color, which may be removed by a weak solution of chlorinated lime. The use of this remedy is confined to superficial parasitic skin diseases of vegeta- ble origin, and for psoriasis, in the latter affection it being the best remedy known. It may be used in weak ointment locally, and internally in yi -grain doses. CIMICIFUGA, Black Snake-root, Black Cohosh,—is the rhizome and rootlets of Cimicifuga racemosa, a plant of the nat. ord. Ranunculacese, native in the United States. Rhizome horizontal, 2 cimicifuga. inches long or more, about 1 inch thick, with numerous upright or curved branches. Rootlets numerous, containing a ligneous cord which branches into four or five rays. Contains a Volatile Oil when fresh, resin, tannic and gallic acids, also an acrid, crystallizable, neutral principle. Cimi- cifugin or Macrotin is an impure resin obtained by precipitation from a concentrated tincture by the addition of water. The active principle has not been isolated. Preparations of the Fresh Root. Extraction Cimicifugce Fluidum,—alcoholic. Dose, rrpv-xxx. Tinctura Cimicifuga,—20 per cent. Dose, Macrotin (Unofficial),—Dose, gr. Physiological Action. Cimicifuga is stomachic, antispasmodic, aphrodisiac, diaphoretic, diu- retic and expectorant. Its taste is bitter and nauseous, resembling that of Opium. It acts on the heart and circulation similarly to Digitalis, and on unstriped muscular fibre like Ergot, but is much feebler in activity than either of these agents. Small doses stimulate digestion and secre- tion, the generative function and the menstrual flow, and especially the secretions of the bronchial mucous membrane and the kidneys. Full doses slow the heart while increasing its force, raise arterial tension and stimulate uterine contraction. Large doses dilate the pupils and produce dimness of vision, vertigo, intense headache, nausea, vomiting, and in some persons soporific and anodyne effects. Cimicifuga closely resembles Digitalis in action, but it is safer, and should be more frequently used when the latter drug is indicated. In cardiac diseases it is very efficient, especially in weak or fatty heart where Digitalis would be dangerous. It is a good stomachic tonic particularly in the irritable dyspepsia of alcoholism. As an expectorant it is used in acute and chronic bronchitis. It is a good nerve-tonic in delirium tre- mens, and in functional impotence it is remarkably efficient. In rheuma- tism of the localized muscular variety, as lumbago, torticollis, pleuro- dynia, intercostal rheumatism, etc., it is one of the most efficacious remedies, having a strong affinity for the muscular system. Neuralgias of various kinds are benefited by it, particularly ovarian neuralgia. Chorea about the age of puberty is one of the affections in which it is most effi- cient, and the same may be said of the hysterical form of this disease. Many uterine disorders are remarkably benefited by Cimicifuga, such as amenorrhcea, neuralgic and congestive dysmenorrhcea, subinvolution, spinal irritation due to some obscure sympathetic or neuralgic affection of the womb, sympathetic pains and neuralgise arising from the so-called irritable womb, passive menorrhagia, etc. In obstetrics it gives excel- Therapeutics. 176 CINCHONA. lent results when used to initiate uterine contractions, check hemorrhage, allay afterpains and nervousness after delivery. In puerperal mania and peritonitis its good effects are frequently remarkable, and in puerperal hypochondriasis it is strongly recommended by very high authority. CINCHONA, Peruvian Bark.—The Cinchona tree belongs to the nat. ord. Rubiacese and is a native of the eastern slope of the Andes, but has been largely planted in India, Ceylon, Java and Burmah, with the result of improving the quinine-yielding value of many species by cultivation. In late years the test of appearance has given way to that of assay in judging of the various barks of commerce, and only those are official which yield 3 per cent, of total alkaloids of which at least 2 per cent, must be Quinine. Yellow bark contains most Quinine (as high as 9 per cent, having been obtained from one specimen), pale bark contains most Cinchonine and least Quinine, while red bark contains these alka- loids in about equal proportions. The Columbian varieties afford the largest percentage of Cinchonidine. The principal varieties of the sub-order Cinchoneae, the barks of which are found in commerce and used by manufacturers of the alka- loids, are— Cinchona Calisaya, Yellow Bark,—from Peru, Bolivia and India. Cinchona Succiruba, Red Bark,—from Ecuador, Java and Ceylon. Cinchona Condaminea, Pale Bark,—from Ecuador and Peru. Cinchona Pitayensis, Pitaya Bark,—from New Granada. Cinchona Micrantha, Gray Bark,—from Peru and Bolivia. Altogether there are some 31 species acknowledged by botanists, and the list is constantly increasing from the tendency of the different trees to hybridize. Several trees formerly acknowledged as Cinchonas are now placed in the genus Cascarilla, but their barks are to be found on the market. Cuprea bark is from trees of the genus Remijia, growing in Columbia; it contains Quinine and a peculiar alkaloid, Cinchonamine, but no Cinchonidine. Official Species. Cinchona,—is the bark of any species of Cinchona which contains at least 3 per cent, of its peculiar alkaloids, as determined by assay accord- ing to a prescribed rule. Cinchona Flava, Yellow Cinchona, Calisaya Bark,—is the bark of Cinchona Calisaya, containing at least 2 per cent, of quinine. Occurs in tawny-yellow flat pieces or quills, ridged exteriorly, finely striated on inner surface, breaking with a transverse fracture showing numerous rigid fibres in bundles or radial rows. Cinchona Rubra, Red Cinchona,—the bark of C. succiruba, containing at least 2 per cent, of Quinine. Occurs in brown-red quills and flat pieces of various sizes, with ridges and warts on outer surface, coarsely striated on inner surface. Bark may be administered in doses of gr. but it is never used now in substance, being too bulky and disagreeable. CINCHONA. 177 Composition of Cinchona. The bark contains 21 natural alkaloids (of which 4 are official), 8 arti- ficial alkaloids, 2 simple acids, 2 tannic acids, a resinoid and coloring- matter, as follows:— Quinine, C20H24N2O2,—a strong base, fluorescent, the most valuable of all the alka- loids; heated with glycerin to 3740 F., it is converted into the isomeric base Quinicine. Quinidine, C20H24N2O2,—isomeric with Quinine, fluorescent, probably the most powerful as an antiperiodic, but existing in very small quantity. Cinchonine, C20H24N2O,—the least active of the official four, having about half the therapeutic power of Quinine. Not fluorescent. Cinchonidine, C20H24N2O,—isomeric with Cinchonine, not fluorescent, one of the most powerful of the alkaloids. Kinic and Kinovic Acids,—are combined in the bark with the alkaloids. The former is used to make a Kinate of Quinine, and the latter occurs in non-official pharmacy as Kinovate of Lime, an ingredient in Deloudre’s Extract, which is used in Europe and India for dysentery. Kino-tannic and Kinovo-tannic Acids,—give to bark its peculiar and powerful astrin- gent qualities. They have not been fully studied. Kinovin,—is a bitter, amorphous resinoid, which is resolvable into Kinovic Acid and sugar. It is soluble in alcohol, but not in water. Cinchona Red,—a reddish-brown, insipid, inodorous substance. [The other alkaloids are of no interest medicinally.] Preparations of the Bark. Extradum Cinchonce,—made from Yellow Cinchona. Dose, gr. j-v. Extradum Cinchonce Fluidum,—from Yellow Cinchona, Dose, tqpc-gj. Tindura Cinchonce,—Yellow Cinchona, strength 20 per cent. Dose, 5J ss-ij. Tindura Cinchonce Composita,—made from Red Cinchona, strength 10 per cent. Contains Bitter Orange-peel 8, and Serpentaria 2 per cent. Dose, Infusum Cinchona,—made from any official bark. Cinchona 6, Aromatic Sulphuric Acid 1, Water 93 parts. Is the only official infusion containing this acid. Dose, j or more. Huxham's Tincture of Bark, 1788 (Unofficial),—is still used. Red Cinchona iv, Orange peel iij, Serpentaria gr. lxxx, Spanish Saffron gr. clx, Cochineal gr. lxxx, Brandy gxl, digested for 4 days, expressed and filtered. Dose, 5ss-ij. Quinine and its Salts. Quinina, Quinine, C20H24N2O2.3H2O,—a white, amorphous or minutely crystalline powder, of alkaline reaction and very bitter taste, soluble in 1600 of water and 6 of alcohol at 590 F., in 25 of ether, 5 of chloroform, and readily in dilute acids. Dose, gr. j-xx, or xl in special cases. Is insoluble in saliva. Quinince Sulphas, Sulphate of Quinine (C20H24N2O2)2.H2SO4.7H2O,—very light, snow-white, fragile crystals, of very bitter, persistent taste, soluble in 700 of water and 65 of alcohol at 590 F., in 30 of boiling water, 3 of boiling alcohol, also in acidulated water. Dose, gr. j-xx, or even gr. xl in special cases. Quinince Bisulphas, Bisulphate of Quinine, C20H24N2O2.H2SO4.7H2O,—clear, color- less, efflorescent crystals or small needles, of very bitter taste and strongly acid reaction, soluble in 10 of water with blue efflorescence, and in 32 of alcohol, at 590 F. Dose, gr. j-xxx, or even gr. lx in special cases. Quinince Hydrobromas, Hydrobromate of Quinine, C20H24N2O2HBr.2H2O,—color- less needles, of very bitter taste, soluble in 16 of water and in 3 of alcohol at 590 F., and in 1 of boiling water or alcohol. Is the best salt for hypodermic use, gj of water dissolving gr. iv, which may be injected every 4 hours without causing irritation. Dose, gr. j-xx. Quinince Hydrochloras, Muriate of Quinine, C2dH24N204HC1.2lI20,—white needles in tufts, of very bitter taste, soluble in 34 of water and 3 of alcohol at 590 F., in 1 of boil- ing water or alcohol. Is used hypodermically. Dose, gr. j-xx. An excellent salt which should be more generally used; 5 to 10 gr. doses are antipyretic. Quinince Valerianas, Valerianate of Quinine, C20H24N2O2C5H10O2.H2O,—white, pearly crystals, of valerianic odor and bitter taste, soluble in 100 of water and in 5 of 178 CINCHONA. alcohol at 590 F. Dose, gr. j-iij. It is the only salt of Quinine supposed to be affected by the constituent acid. Quinince Hydrochloras Carbamidata, Carbamide Hydrochlorate of Quinine (Unofficial), —is a new compound salt of Quinine and Urea, soluble in equal parts of water and there- fore admirably adapted for hypodermic administration in a 50 per cent, solution. It is almost unirritating to the tissues, and is given subcutaneously in doses of gr. j-iij. Chininum Amorphum Boricum, Amorphous Borate of Quinine (Unofficial),—is a new preparation, soluble in an equal quantity of water, and claimed by its introducers to be equally as satisfactory as any other Quinine salt, and much better borne by the stomach than any other one. It is also said to cause little or no congestion of the membrana tym- pani. Tinctura Pyrexialis, Warburg’s Tincture (Unofficial),—is a celebrated preparation, formerly secret, but published in 1875 by the originator, whose formula is as follows:— }£. Aloes soc. lb j; Rad. rhei (chinens), Sem. angelicas, Confec. Damocratis,* aa jfiv; Rad. helenii (s. enulae), Croci sativi, Sem. foeniculi, Cretae, prep., aa £ ij; Rad. gentianae, Rad zedoariae, Pip. cubebae, Myrrhae elect., Camphorae, Bolet. laricis, aa Digest the whole with 500 oz. of proof spirit in a water-bath for 12 hours, express, add x Bisul- phate of Quinine, dissolve by aid of a water-bath, cool and filter. Dose, j|j, in two doses 3 hours apart. Hager’s modification of the original formula is—R. Quininae sulph. part, j, Spt. camphorae part, ij, Elix. proprietatis (Tinct. aloes et myrrhae) part, xxij, Alco- holis part. xvj. The evidence published in favor of this preparation goes to show that its power does not wholly lie in the quinine, camphor, aloes or rhubarb, but in some of the aromatic plants contained in it. Other Official Alkaloids and their Preparations. Cinchonina, Cinchonine, C20H24N2O,—white, lustrous prisms or needles, of bitter after-taste, almost insoluble in water, readily so in dilute acids and no of alcohol at 590 F. Dose, gr. j-xxx or more. Cinchonince Sulphas, Suphate of Cinchonine (C20H24N2O)2H2SO4.2H2O,—white, shining prisms, of very bitter taste, soluble in 70 of water and in 6 of alcohol at 590 F., and readily soluble in dilute acids. Dose, gr. v-xxx or more. Cinchonidince Sulphas, Sulphate of Cinchonidine (C20H24N2O)2H2SO4.3H2O,— white, silky crystals, of bitter taste, soluble in 100 of water and in 71 of alcohol at 590F., freely soluble in acidulated water. Dose, gr. j-xx or more. Quinidince Sulphas, Sulphate of Quinidine (C20H24N2O2)2H2SO4.2H2O,—white, silky needles, of bitter taste, soluble in 100 of water and in 8 of alcohol, readily in acidu- lated water, at 59°F. Dose, gr. j-xx or more. It is not so bitter as Quinine, is less expensive, and is a valuable antipyretic and antiperiodic. Chinoidinum, Chinoidin, Quinoidin,—a mixture of alkaloids, mostly amorphous, obtained as a by-product in the manufacture of the crystallizable alkaloids from Cinchona. A black solid when cold, plastic when warmed, of bitter taste, almost insoluble in water, freely soluble in alcohol and in dilute acids. It contains the 4 alkaloids in amorphous condition, and has about y2 the therapeutic power of Quinine. Dose, gr. v-xxx or more. Non- Official Preparations. Quinquinina, or Quinetuni,—is an Indian preparation containing the total alkaloids extracted from bark by acidulated water, then precipitated by soda and dried. In India it is called “ febrifuge.” Cinchonidince Salicylas, Salicylate of Cinchonidine,—has anti-malarial power only inferior to the salts of Quinine. Substitutes 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. Though in this they have as yet been unsuccessful, they have discovered several * For the formula for this ingredient see the article on Confections in the section on Extemporaneous Pharmacy, Part II. CINCHONA. 179 organic bodies, which closely resemble each other and also quinine, both in chemical constitution and physiological action. These substances belong to the aromatic series of carbon compounds, all of which are de- rivatives of Benzene or Benzol, C6H6, the Hydride of the organic radical Phenyl, C8H5. 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 distilla- tion, etc.,—and they are all derivatives of Benzene (Benzol), either directly or from some of the products formed therefrom, by substitution ; various radicals replacing the different constituent atoms of H and C. Thus, by the ring-arrangement of atoms peculiar to this series, there are formed from Benzene (C6H6), the following substances, viz.— Phenol, or Carbolic Acid, C6H5OH—by replacing H by OH, (hydroxyl). Pyrocatechin, or Ortho- ) Rescorcin, or Meta- j- Hydroquinone, or Para- J C6H4(OH)2. di-hydroxy-benzene,—by replacing 2H by 2OH. C6H4(OH)2. Pyrogallol, Pyrogtillic Acid, Tri-hydroxy benzene, C6H3(OH)3,—3H by 3OH. Amido-benzene, or Anilin, C6H5.NH2—by replacing H by NH2 (amidogen.) Nitro-benzene, C6H5.N02—by replacing H by N02 (nitroxyl). Benzoic Acid, C6H5CO.OH—by replacing H by CO.OH (carboxyl). Salicylic Acid, HC7H503—by replacing 2H by OH and CO.OH. Naphthaline, C10H8—by uniting two Benzines in an over-lapping ring. Pyridine, C5H5N—by replacing tetrad C by triad N. Chinoline, C9H7N—uniting Benzene (C6H6) and Pyridine (C5H5N). Derived from Chinoline is the hypothetical base. Chinicine or Quinicine, C9H9N2,—represented in Antipyrine. Also Kairine, Thalline, and other compounds. The most important of these are Antipyrine, Acetanilide, Resorcin, Chinoline and Naphthaline, which are respectively described in separate articles. Others of the same class are the following, viz.— Some Unofficial Antipyretics. Kairina, Kairine (Hydrochlorate of Oxy-ethyl-chinoline-hydride), C10H13NO.HC1. H20,—is an artificial alkaloid prepared from Chinoline, belonging to the phenol group of carbon compounds, and a powerful antipyretic in 8-grain doses hourly. It stains the urine a deep green, and has not proven fatal though 220 doses have been administered in one case. In some cases of typhus it has caused cyanosis and collapse. It produces profuse sweating and vomiting, and the subsequent rise of temperature after its antipyretic influence has worn off is generally ushered in by a severe rigor. It is by many authorities considered to be the most certain, most powerful and most rapid antipyretic drug we possess, though this claim is now disputed by the advocates of Antipyrine. It occurs in white crystals, which are freely soluble in water, but is best given in wafer-paper or cap- sules. Dose, gr. iij-xxx. Kairolina, Kairoline (Sulphate of Tetra-hydromethyl-chinoline),—is antipyretic, but much less efficient than Kairine. Thalline (Parachinanisols),—is a synthetically prepared alkaloid, having the chemical name Telra-hydro-paramethyl-oxy-chinoline. It occurs as a colorless powder, which is soluble in water, and enters into combination with acids, forming salts, of which the tartrate and sulphate are the most eligible, especially the latter. The dose of Thalline or its Sulphate ranges from gr. ij to gr. xv, a mean average dose being about 5 grains, given in the form of compressed tablets. Thalline is an antipyretic of very great power, doses of 5 to 12 grains lowering the temperature in typhoid fever 40 to 50, in 2 hours’ time, the effect lasting nearly 3 hours. In tuberculosis similar results were obtained. Large doses, 180 CINCHONA. however, produce very profuse sweating and a dangerous degree of depression ; so that this agent is not a favorite remedy for hyperpyrexia. Hydroquinone (Para-di-hydroxy-benzene) C6H4(OH)2,—is isomeric with Resorcin (see ante, page 179). It crystallizes in rhombic, colorless prisms which are slightly soluble in water, readily so in alcohol and in ether, and is obtained from Arbutin, a glu- coside constituent of Uva Ursi and other Ericaceae. It is an efficient antipyretic, without injurious effects so far as observed, but its influence is only temporary. The action of this drug on animals is summarized in the N. Y Afedical Record for August 15th, 1885, and its influence on pyrexia elucidated in the same journal for May 30th, 1885. Dose, as an antipyretic, gr. xv-xx, best given in alcohol. Or. xl have been given without disagree- able effects. Pyrocatechin, Catechol (Ortho-di hydroxy-benzene), C6H4(OH)2,—is also isomeric with Resorcin, and is one of the acid constituents of coal-tar, also obtained from wood-tar and from kinic acid. It is a good antipyretic, but much inferior to Quinine or Rescorcin. Phenacetine (Para-Acetphenetidine),—a white and glossy, crystalline powder, in chem- ical constituent analogous to Acetanilide. It is tasteless, and but slightly soluble in water, more so in glycerin, and still more so in alcohol and in lactic acid. It is a very efficient antipyretic and antineuralgic, with no disagreeable after effects. The dose is about one-half that of Antipyrine, or gr. x-xx. Pheno-resorcin,—is a mixture of Carbolic Acid 67 with Resorcin 33 and Water 10, forming a liquid which mixes readily with water. It is supposed to combine the virtues of both its ingredients. Physiological Action. The action of Cinchona in sufficient dose is generally that of its alka- loid Quinine, except that bark is decidedly astringent, more of a gastric irritant, and by reason of its bulk its active principles are more slowly absorbed. In large doses (5ij) the powdered bark has produced flatu- lence and eructation, and in many well-authenticated instances has pro- duced a well-marked febrile paroxysm, beginning with chill, then fever and headache, which gradually subsided in slight perspiration. So also, Quinine, while incapable of producing intermittent fever in a healthy person, will, if taken in large doses unnecessarily, throw the nervous system into high commotion, and if untimely used by a malarial subject may reproduce the paroxysm with greater or less severity. Cinchona is an astringent bitter and a stomachic tonic. At first it promotes appetite, digestion, the flow of saliva and of gastric juice; long- continued it sets up a gastric catarrh, impeding digestion and causing constipation. Quinine is a bitter tonic, antiseptic, antiperiodic, antimiasmatic and antipyretic, a diminisher of reflex action, a protoplasmic poison, a cardiac depressant and perhaps an oxytocic. It is rapidly diffused and slowly ex- creted, being found in the urine in 15 minutes after its administration and for two or three days afterwards. Its action on the stomach is similar to that of cinchona. It arrests the movements of the white blood-corpus- cles though increasing their number, and prevents acetification and decay of the blood. It is actively destructive of lowly organized life, a solution of 1 to 500 being fatal to infusoria and fungi, while one of double this strength prevents alcoholic fermentation and checks putrefactive decom- position. The heart and arterial tension are somewhat stimulated by small doses, but depressed by large ones (gr. xl-lxxx), which slow and CINCHONA. 181 enfeeble the pulse by direct action on the cardiac ganglia. The brain is rendered hyperaemic and exhilarated by small or moderate doses, but large ones produce a sense of fulness and constriction in the head, cere- bral anaemia, pallor, tinnitus aurium, vertigo, staggering gait, amaurosis and deafness, great headache, dilated pupils, delirium, coma, and in ani- mals convulsions. The eyes and ears are very rarely injured permanently. These symptoms collectively are termed Cinchonism. It reduces the size of the spleen when enlarged, and lowers the temperature of pyrexia, though it does not depress the body temperature in health. Large doses lower the reflex function of the spinal cord. In some subjects it produces sexual excitement, in others cutaneous eruptions sometimes followed by desquamation. It lessens the excretion of uric acid, but not that of urea, and is a uterine stimulant in labor, but its power to initiate uterine con- tractions is a much debated question. Quinidine and Cinchonidine correspond in action with Quinine both qualitatively and quantitatively, the latter however producing less severe head symptoms. Cinchonine also corresponds in effect, but is much the least active of the four alkaloids. It is said to produce greater headache, and much pre- cordial pain and muscular weakness, but to have little effect on sight or hearing. Antagonists and Incompatibles. Morphine antagonizes its cerebral action. Atropine its nervous, cardiac and antipyretic powers. Free Tannic Acid is incompatible with the Infusion of Cinchona. Iodine preparations, Alkalies, Alkaline Carbonates and Earths, are incompatible with solutions of the alkaloids, the first-named forming insoluble compounds, the latter precipitating them. Therapeutics. Cinchona is used as a tonic and has many applications. The Infusion or Compound Tincture with a mineral acid is extremely serviceable in atonic dyspepsia, gastric catarrh of alcoholics, adynamia, convalescence, asthma, chronic bronchitis, and generally in weak subjects of flabby flesh and perspiring skin. Quinine finds its principal field of action in the malarial diseases, over which its power is that of a specific. In intermittents, a ten-grain dose of the sulphate should be given in the sweating stage and again 5 hours before the expected time of the next paroxysm. In the intervals Arsenic is better used, as Quinine will cause a daily exacerbation of temperature if long continued. In remittents 20- to 30-grain doses should be admin- istered once or twice a day until the temperature is reduced to the normal point. In pernicious remittents large doses (gr. xxx to lx) are necessary to the safety of the patient. In chronic malarial poisoning Quinine has considerable power, but Chinoidin is more effective. Small doses of Quinine (gr. ij-iij per diem) are efficient as a prophylactic against malaria. 182 CINNAMOMUM. As an antipyretic Quinine is used with the best results, especially in typhus, typhoid, variola, pneumonia and acute rheumatism. Inflamma- tions may, at their inception, be aborted by 15- or 20-grain doses, com- bined with Morphine, which in this respect is synergistic to Quinine. Acute tonsillitis and acute catarrh may sometimes be aborted by a full dose. In surgical fevers, pyiemia and exhausting suppurative conditions, also in septicaemia, hectic fever, and before surgical operations, Quinine is much employed. Neuralgias of malarial origin are amenable to it, as also neuralgia of the ophthalmic division of the fifth nerve. In eruptive fevers, especially scarlet fevers, erysipelas and measles, it is advantageously administered throughout their course. In some skin diseases, particularly erythema nodosum, it is quite efficient, also in whooping-cough and hay- fever. In the latter affection a solution of gr. vj to the % of the neutral hydrochlorate is a very useful local application. Antipyresis has of late received considerable attention, particularly in the German hospitals. The most certain and safe of all antipyretics is undoubtedly the cold bath, but it is not always the most practicable, especially in private practice. Internal antipyretics are therefore of great value, and of these the safest and best is Quinine, next in order being Antipyrine. Warburg’s Tincture has obtained a very high reputation in the hands of Indian army-surgeons in the treatment of remittent and other malarial fevers of the most malignant types, in malarial neuralgise, acute nervous exhaustion and sudden collapse without organic disease. The most pronounced testimony to its value is that of Dr. Maclean (.Med. Ti?nes and Gazette, Nov., 1875), whose authority will not be questioned by the most captious. He affirms that the influence of this combination to arrest an exacerbation of remittent fever is far more powerful than that of Qui- nine alone. The remedy has become much less of a favorite since its originator was induced to make public the secret of its composition. A dm inistration. The persistently bitter taste of Quinine and its salts is best obviated by administering them in pill form, made with glycerin as an excipient, or by using Liquorice, Eriodyction or Chocolate to cover the taste if given in solution or powder. The taste is extremely well covered by using as a vehicle a combination of Glycyrrhizin and Fluid Extract of Eriodyction, named “ Veloutine,” but the Quinine must be suspended therein by the aid of mucilage, as when an acid is used to dissolve it the bitter taste cannot be disguised. For hypodermic use the best salt is the Hydrobromate, it being the most soluble,— gr. xij in of distilled water gives gr. j in The Carbamide Hydrochlorate is coming into favor for hypodermic administration by reason of its solubility and freedom from irritating qualities. CINNAMOMUM, Cinnamon, —is the inner bark of the shoots of Cinnamomum Zeylanicum (Ceylon), or the bark of the shoots of sev- eral species of Cinnamomum (nat. ord. Lauracese) grown in China COCCUS. 183 (Cassia Bark). The former occurs in light, yellowish-brown quills, con- sisting of several pieces rolled together, each very thin, while the Chinese variety comes in single quills of irregular form and rougher texture. The taste is warm and aromatic, and the odor very fragrant. The active prin- ciple is a Volatile Oil, and it also contains a resin, tannic and cinnamic acids. Dose, gr. x-xx. Preparations. Oleum Cinnamomi,—is the volatile oil, a yellowish-colored liquid of sp. gr. 1.040 to 1.060, becomes dark by age, of slightly acid reaction. The oil of Chinese Cinnamon is not so agreeable in odor or taste. Dose, gtt. j-v. Aqua Cinnamomi, Cinnamon-Water,—has of the oil 2 parts in 1000, percolated through cotton. Dose, indefinite. Spiritus Cinnamomi,—contains 10 per cent, of the oil. Dose, rrpv—xxx. Tinctura Cinnamomi, contains 10 per cent, of the powdered bark. Dose, gss-ij. Pulvis Aromaticus, Aromatic Powder,—Cinnamon 35, Ginger 35, Cardamom 15, Nutmeg 15, rubbed together in fine powder. Dose, gr. x-xxx. Extractum Aromaticum Fluidum,—has of Aromatic Powder 100 grammes, Alcohol q. s. ad 100 cubic centimeters. Dose, Ubx-xxx. Cinnamon is an agreeable carminative, somewhat astringent and stimu- lant, also highly aromatic and antiseptic. The oil is not astringent but is a pleasant stimulant to the nervous and vascular systems, and is by some believed to exercise a specific action on the uterus, particularly as a hemostatic. The various preparations are in general use as flavoring excipients, and the aqua is a pleasant vehicle for extemporaneous prescriptions. The bark and its preparations are used to check diarrhoea in combination with opium, chalk, or some vegetable infusion. The oil is a good stimulant in flatulence, paralysis of the tongue, cramp of the stomach, enteralgia, etc., and is sometimes used to check nausea and vomiting. Cinnamon was formerly used with success in uterine hemorrhage, generally in com- bination with sulphuric acid, which of itself is an efficient uterine hemo- static. It has lately been employed in France as an internal germicide, with great satisfaction; and has given particularly good results in the treatment of typhoid fever, against the supposed bacillus of which disease it is believed, by its advocates, to have specific and destructive powers. COCCUS, Cochineal,—is the dried female of Coccus cacti, an insect of the order Hemiptera, which feeds on the cactus plants of Mexico and Central America. Occurs in ovate, plano-convex form, of a purple- gray or purple-black color, yielding when crushed a dark-red powder, which contains Carminic Acid, or Carmine, the red coloring-matter, which is soluble in water and alcohol, but not in oils. Cochineal is an ingredient of Tinctura Cardamomi Composita, and is used in pharmacy solely as a coloring material. The only therapeutic use of Cochineal is in whooping-cough and neu- ralgia, in which affections it is supposed to have considerable influence, especially in the former. Its dose to an infant is about gr. yi thrice daily. 184 COLCHICUM. COLCHICUM, Meadow Saffron,—is the corm and seed of the Colchicum autumnale, a European plant of the nat. ord. Melanthacese. It contains an intensely bitter, poisonous alkaloid, Colchicine, CnHi9N05, which by the action of acetic and mineral acids is converted into Col- chice'ine and a resin,—also tannic and gallic acids, resin, starch, sugar, etc. It is official in two forms, namely— Colchici Radix, Colchicum Root,—the corm, about i inch long, white internally, grooved on one side, inodorous, taste sweetish, bitter and acrid. Is less active than the seed. Dose, gr. ij-viij. Contains of Colchicine, 0.45 per 1000. Colchici Semen, Colchicum Seed,—about inch thick, sub-globular, resembling black mustard seed but larger, very hard and tough, inodor- ous, of bitter and acrid taste. Dose, gr. j-v. Contains of Colchicine, 3.35 per 1000. Preparations. Extraction Colchici Radicis,—made with Acetic Acid 35 parts to 100 of the root, and sufficient water. Dose, gr. Extractum Colchici Radicis Fluidum,—Dose, rtyij-x. Extraction Colchici Seminis Fluidum,—Dose, TT\j—v. Vinum Colchici Radicis,—strength 40 per cent. Dose, rtyv-xv. Vinum Colchici Seminis,—strength 15 per cent. Dose, Ityx-xxx. Tinctura Colchici,—from the seed, strength 15 per cent. Dose, Ttpx-xxx. Colchicina, Colchicine, C17H19NOs (Unofficial),—a white or yellowish, amorphous powder, of saffron-like odor and bitter taste, soluble in water and in alcohol. Dose, gr. t&ttV Is suitable for hypodermic injection. Laborde and Houde condemn all preparations made with acetic acid, also those made from the tubers and all wines. The best preparation is Colchicine, in granules or in a wine; or a strong tincture made from fresh seed with the shell on, the latter containing a very volatile but active oil. Of this seed to pint of highest proof alcohol, standing for 2 weeks. Of this 3 v to water q. s. ad 0]/z, of which the dose is every 4 hours night and day, avoiding acids, until nausea, vomiting and purging set in. Physiological Action. Colchicum is emetic, diuretic and diaphoretic, a drastic purgative, a gastro-intestinal irritant and a cardiac depressant. In small doses it in- creases secretion, especially the urine and the sweat. In full doses its action is emeto-cathartic, producing profuse watery discharges, great nausea and extreme muscular feebleness. In large doses it is a powerful irritant of the gastro-intestinal tract, causing severe griping, choleraic dis- charges, lowered arterial tension and depression of the heart by reflex action over the distribution of the pneumogastric,—then great prostration, convulsions and collapse, death occurring from exhaustion, with con- sciousness preserved until carbonic acid narcosis sets in. On the excretion of uric acid and urea its influence is very much disputed, but it probably increases the flow of bile, and certainly unloads the portal circulation. Antagonists and Incompatibles. Tannic Acid to retard absorption. Emetics and cathartics, also warm demulcent drinks freely. Morphine hypodermically to antagonize the cardiac depression, also Alcohol. COLOCYNTH IS. 185 Therapeutics. Colchicum is a specific palliative in gout of acute form, in which it should be given with an alkali, and kept short of emeto-catharsis. It does not prevent relapses, and its power in this disorder is weakened by repe- tition. In ascites from obstructive disease of the liver it is most effective, given in full doses to establish a profuse drain, with opium to sustain the heart. In acute cerebral congestion and in portal congestions it is well given as a drastic purgative. It is often used with marked success in acute rheumatism, but frequently fails, and in no case should it be con- tinued long in this affection. It has been used with good results in the treatment of gonorrhoea and chordee. The alkaloid is probably the best preparation for general use, and is admittedly superior to the other pre- parations in acute gout. COLOCYNTHIS, Colocynth,—is the fruit of Citrullus Colocyn- this, deprived of its rind. The plant is a native of Spain and Asiatic Turkey and belongs to the nat. ord. Cucurbitaceae, the fruit being of the size of a small orange, white, light, spongy, inodorous, very bitter, con- taining many flat, brown seeds which should be rejected before the pulp is used. Its active principle is Colocynthin, C56H81023, an amorphous but crystallizable bitter glucoside, readily soluble in water. It also contains Colocynthein, a resin, and Colocynthitin, which is a tasteless, crystalline powder, soluble in ether but not in water, and devoid of purgative action. Preparations. Extraction Colocynthidis,—alcoholic. Dose, gr. Extractum Colocynthidis Compositum,—contains of the preceding 16 parts, Aloes 50, Cardamom 6, Resin of Scammony 14, Soap 14, Alcohol 10. Dose, gr. v-xx. Pilules Catharticce Composites, Compound Cathartic Pills,—each has of the preceding gr. 1.3, Abstract of Jalap gr. j, Calomel gr. j, Gamboge gr. Dose, j-iij pills. Laville's Anti- Gout Remedy,—is a proprietary medicine prepared in France and pur- porting to be “ a mixture of prepared Kino-colocynthine.” The published formula is as follows: Active principle of Colocynth Quinine and Cinchonine 5, Spanish Wine 800, Alcohol 100, Water to 1000 parts; but there is good reason for believing that it contains Colchicine instead of Colocynthin. Physiological Action. Colocynth is classed among the tonic-astringent and resin-bearing purgatives. In moderate doses it increases peristalsis and the intestinal glandular secretions, producing bilious, watery evacuations with much colicky griping pain. Its purgative action is specific, and may be ob- tained by its application to the skin over the abdomen. In large doses it is a violent irritant of the gastro-intestinal tract, and has frequently pro- duced fatal gastro-enteritis. It is popularly supposed to be abortifacient, but this is only true of quantities sufficient to endanger life. It is an in- direct diuretic. 186 conium, Therapeutics. Colocynth is too severe an agent to be administered alone for constipa- tion, but it makes a useful factor in compound purgatives, as the com- pound cathartic pill. In cerebral congestion it may be used to produce rapid derivation, and in ascites to set up a profuse drain from the intes- tinal canal. In certain cases of chlorotic amenorrhoea it stimulates the pelvic nerves and vessels with excellent results. There seems to be abun- dant evidence that in very small doses a tincture) colocynth is an efficient remedy in colic, sciatica, ovarian and other neuralgiae, as well as in the pain of glaucoma. These actions may be due to its two non-purgative principles, which may prove to possess powers not hereto- fore suspected, an example of which is seen in the recently-discovered cardiac influence of Convallaria, a drug until recently only known as a purgative and a diuretic. CONIUM, Hemlock ,—is the full-grown fruit, gathered while green, of Coniurn maculatum, the spotted hemlock (nat. ord. Umbelliferse). It is smaller than anise-fruit, of a gray-green color, slight odor and taste, and contains 3 alkaloids, namely,—Coniine, C8H15N, liquid and volatile, Methyl-coniine, C8H14NCH3, and Conhydrine, C8H17NO, solid and vola- tilizable ;—also Coniic acid and a volatile oil. Paraconiine, is an artificial substance produced by the reaction between Butyric Aldehyd and an alcoholic solution of Ammonia, and isomeric with Coniine but not iden- tical with it. The leaves of Conium are no longer official. - Preparations. Abstraction Conii,—made from 200 parts of Conium, 6 of Dilute HC1 acid, Sugar of Milk and Alcohol to make 100 parts; each grain representing 2 grains of the powdered drug. Dose, gr. ss-iij. Extraction Conii Alcoholicum,—each grain represents a grain of the crude drug. Dose, gr. ij-v—xl. Extraction Conii Fluidum,—of the same strength as the alcoholic extract. Dose, Ttyj-v-xl. Tinctura Conii,—strength 15 per cent. Dose, rrLx-gj, beginning with the 10-minim dose and gradually increasing until physiological effects are manifest. Coniina Coniine, C8H15N (Unofficial),—an oily, limpid, volatile liquid, of acrid taste, alkaline reaction, and an odor compared to that of the urine of mice. It is quickly decomposed by heat, and if exposed to the air soon becomes inert. Dose, gr. or in minim-doses, ttkyj-ij. Is too irritant for hypodermic use, unless carefully neutralized by acetic acid. The Hydrobromate in watery solution of gr. viij to the 3, of this trbx-|, is a good form for subcutaneous or stomachal administration, and may be given in doses of gr. fa to gr. j, as it is not actively toxic. All the preparations of Conium are uncertain in action, particularly the extract and abstract, as the active principle is very volatile. Any specimen must be carefully tested before deciding on its dosage, and if the powerful mouse-like odor of the drug be absent, it is probably worthless. Physiological Action. The special action of Conium and Coniine is the production of motor paralysis without loss of consciousness or sensation. It paralyzes the CONVALLARIA MAJALIS. 187 motor nerves, the action commencing at the peripheral end-organs and extending upwards, involving the nerve-trunks and finally the centres, but the muscular irritability remains unaffected. Methyl-Coniine acts similarly but reversely, affecting first the motor columns of the cord. The sensory nerves are not affected, but the general sensibility is, a feel- ing of numbness being experienced in the extremities. Gastric irritation is usually the first sensation produced by a full dose of Conium, nausea and vomiting being its symptoms. Then weakness of the legs, numbness and fatigue, drooping eyelids, diplopia, slightly dilated pupils, vertigo, impaired utterance, slow and labored breathing, and if the dose be a lethal one, paralysis of the voluntary muscles, those of the lower limbs being first affected, speech and vision are lost, and finally death occurs from paralysis of the muscles of respiration. The heart is not affected and the mind remains clear, but torpid and indiffer- ent, until carbonic acid narcosis sets in. Muscular movement counteracts the effects of the drug to a very great extent. Conium is believed to have been the state poison of the Athenians, by the juice of which Socrates and Phocion died. Antagonists and Incompatibles. Nux Vomica and its alkaloids, Picrotoxin and other tetanizers are antagonistic. Tannic acid and caustic alkalies are chemically incompatible. Therapeutics. Conium is especially indicated in diseases characterized by excessive motor activity. Large doses are required as some physiological action is necessary. Children bear it well, their constant activity preventing its full action. In chorea it palliates by depressing the motor nervous sys- tem. In acute mania and delirium tremens to quiet motor excitement and prevent exhaustion, it is remarkably efficient, especially when given conjointly with Morphine. When pain and spasm are present, it will prove a useful agent; and in tetanus, blepharospasm, asthma, whooping- cough, and other spasmodic affections it is frequently used with great benefit. The pain of cancer seems to be especially amenable to its influ- ence when locally applied, and Coni'ine-vapor is an admirable palliative of the tickling cough of phthisis and the irritability of the air-passages in acute bronchitis. In pneumonia and pleurisy the hypodermic use of Coniine to afford the organs rest by inducing a paretic state of the respira- tory muscles has been followed by a marked decrease in the temperature and pulse-rate. CONVALLARIA MAJALIS, Lily of the Valley (Unofficial), — is a stemless perennial of the nat. ord. Liliacese, indigenous to Europe, 188 convallaria majalis. Northern Asia and the Southeastern portion of the United States. All parts of the plant are used, but the preparations vary in action according to the quantity of the Resin present, it being emeto-cathartic. Convalla- ria contains two glucosides, namely, Convallamarin, on which the cardiac action depends, and Convallarin, a crystalline, purgative principle, insol- uble in water;—also an acrid Resin which probably contains the latter glucoside. Preparations. Extractum Convallarice (Unofficial), prepared from the flowers and stalks with of the leaves and root; is a black solid, freely soluble in water and alcohol. Dose, gr. ij-x. Extractum Convallarice Fluidum (Unofficial),—as found in the shops is an alcoholic preparation of the whole plant, and is likely to contain Convallarin, which is not present in aqueous preparations, being insoluble in water. Dose, rtyj-x. Infusum Convallarice (Unofficial),—prepared from the flowers, leaves and stems 25, in water 75. Dose, ijss-ij. Convallamarinum, Convallamarin, C23H44012 (Unofficial),—an amorphous, white, bitter powder, freely soluble in water and in alcohol, but insoluble in ether. Dose, gr. X-ffi Physiological Action. Convallaria has long been known as a decided cathartic and a prompt and powerful diuretic, but its cardiac action has only lately excited atten- tion, and it is now considered a close analogue of Digitalis, while free from the cumulative action which makes the latter drug so frequently a dangerous remedy. Preparations of the root have a powerful emeto-cathartic action, prob- ably due to a preponderance of the resin. Those freed from this ingre- dient correspond in action with Convallamarin, stimulate the appetite without impairing digestion, increase peristalsis without producing cathar- sis, slow the heart and raise the arterial tension, also slowing and deepen- ing respiration. Lethal doses at first produce irregularity of the cardiac action and spasm of the respiratory muscles, high arterial tension and a very rapid pulse,—followed by lowered blood-pressure, very slow and deep breathing, and finally arrest of the heart in systole. Its mode of action is by direct stimulation of the pneumogastric, the motor and sensory nerves retain their irritability, the muscles preserve their contrac- tility, and the cerebral functions and the pupil are unaffected. Convallarin is a drastic purgative in 3-grain doses. Convalla- marin is an emetic even in small quantity, and the powdered root is sternutatory. Therapeutics. Convallaria is a heart-tonic like Digitalis, and is indicated in the same class of cases as is that drug, with the advantage that having no cumula- tive action it is not dangerous to the heart in medicinal doses, and does not disturb the stomach or the functions of the cerebro-spinal axis. In doses of gr. xv-xxv of the extract it slows the action of the heart and increases the force of its contractions, raises arterial tension, augments COPAIBA. 189 the force and volume of the respiration, and produces prompt diuresis without altering the composition of the urine. It is a most valuable remedy in mitral stenosis or insufficiency with venous stasis, dilatation of the heart, palpitation, vehement cardiac action or disordered rhythm, and in all valvular affections accompanied by dropsy and a weak heart. It has also been used with benefit in pneumonia, typhoid fever and renal dropsy. Its action is maintained for several days after its use has been suspended. COPAIBA, Balsam of Copaiba,—is the oleoresin, of Copaifera Langsdorffii, and other species of Copaifera, a S. American tree of the nat. ord. Leguminosse, growing chiefly in the valley of the Amazon. It is a translucent, viscid liquid, of yellow color, aromatic odor, acrid and bitter taste, not fluorescent, soluble in alcohol and benzol. Is not a bal- sam as it contains no cinnamic acid. Its constituents are a Volatile Oil and a Resin in about equal proportions, the latter containing nearly 99 per cent, of Copaibic Acid. Dose, npx-oj. Preparations. Oleum Copaibce, C10H16,—the volatile oil, a pale yellow liquid, of sp. gr. 0.890,0! bitter taste and neutral reaction, soluble in an equal weight of alcohol. Dose, TT^x-xv. Resina Copaibce,—is the residue left after distilling off the volatile oil from Copaiba, a yellowish, brittle body, of acid reaction, soluble in alcohol, benzol or amylic alcohol. Consists mainly of Copaibic Acid, which is crystallizable, also if per cent, of a viscid resin. Dose, gr. j-v. Massa Copaibce,—consists of Copaiba 94, fresh Magnesia 6 parts, mixed and set aside to concrete into a pilular mass. Dose, rtyx- Mistura Copaibce Composita, Lafayette’s Mixture (Unofficial),—R. Copaibae 3 vij, 01. Cubebae 3 j, Glyceriti Vitelli 3 vij. Triturate and add gradually while triturating Syrupi Aq. Menth. Piperitse 3 ijss. Then add with constant stirring Liq. Potassae J ss, Tr. Cardamomi Co. 39, Spt. Etheris Nitrosi j|ss, Aq. Menthae Pip. q. s. ad Dose, 3J-3ss- Physiological Action. Copaiba is a stimulant diuretic, diaphoretic, expectorant, and a gastro- intestinal irritant. Its taste is bitter and nauseous. In the stomach it causes heat, unpleasant eructations, heaviness, frequently anorexia and diarrhoea, and if continued for any length of time gastro-intestinal catarrh and desquamative nephritis may result. The oil and resin diffuse into the blood and are excreted by the bronchial mucous membrane, skin and kidneys, producing increased secretion at the points of elimination. The various secretions have the odor of the drug, especially the urine. In medium doses it increases the quantity of urine and its solid con- stituents, but large doses will cause scanty urine, containing albumen, casts and blood, with pain in the loins and other signs of renal con- gestion. On the skin it often produces itching and several forms of eruption. 190 CORIANDRUM—CORNUS. Therapeutics. Copaiba has been largely used in gonorrhoea after the acute symptoms have subsided, also in chronic cystitis, acute and chronic bronchitis, and in dropsies, particularly ascites. In all these affections is a useful rem- edy, but its nauseous taste and irritant effects on the stomach are driving it out of fashion, especially in private practice. One eminent surgeon de- clares that not only is it useless in gonorrhoea but that it does more harm than good, often prolonging the disease beyond its natural limit. In psoriasis and urticaria, and in cutaneous affections characterized by torpid peripheral circulation, this drug has been administered internally with excellent results. In long-standing cystitis in the female Copaiba has been injected into the bladder with great benefit. The resin is the most active ingredient, especially for diuretic purposes. CORIANDRUM, Coriander, —is the fruit of Coriandrum sativum, a European plant of the nat. ord. Umbelliferse. It is a minute, globular, brownish-yellow body finely ribbed, of aromatic odor and taste, and con- tains a volatile and a fixed oil. Dose, gr. x-xx. Preparation. Oleum Coriandri,—the volatile oil. Dose, npij-v. Physiological Action and Therapeutics. Coriander is stimulant, aromatic and carminative. It is used almost wholly as a flavoring to other remedies, or as a corrective against the griping effects of certain purgatives. Its flavor covers the taste of Senna and Rhubarb, and it is an ingredient of the official Confectio Sennae. CORNUS, Dog-wood,—is the bark of the root of Cornus florida, a small tree of the nat. ord. Cornaceae, indigenous in the U. S. Occurs in reddish-brown, curved pieces, of astringent, bitter taste, and contains a bitter principle named Cornin, which is crystallizable and soluble in water and alcohol ; also a resin and tannic acid. Preparation. Extradum Cornus Fluidum,—Dose, rtpx— g j. Physiological Action and Therapeutics. Cornus is a simple bitter, having stomachic and other qualities similar to those of Calumba (which see). In addition it is possessed of con- siderable antiperiodic power, and has a good deal of reputation in the Southern States as a remedy in malarial fever, the physicians of that sec- tion considering it as next to Quinine in efficiency. Heat destroys its active principle, consequently a decoction is a useless preparation. COTO—CREASOTUM. 191 COTO, Coto Bark (Unofficial),—is the bark of some unknown tree growing in Bolivia, from whence it comes in brownish pieces of aromatic odor and acrid, bitter taste. It contains an acrid, bitter principle, of yellow color, crystalline and soluble in hot water and alcohol, named Cotoin, C2,H1806 ; also Piperonylic Acid, C8H604, and a volatile oil, resin, etc., but no tannin. Dose, gr. j-xv. Paracoto Bark, or False Coto,—is thicker than the true bark, has a fainter odor and taste, and is marked by whitish furrows on its surface. Its principle, Paracotoin, C19H1206, has a strong similarity to Cotoin thera- peutically, but is less active. A fluid extract of the official strength is prepared, also a tincture (io per cent.), which may be administered in doses of from Ttpj-xx. Cotoin is used in doses of gr. j-iv, and Paracotoin in somewhat larger quantities. The physiological action of Coto has not been studied, all that is known about it being that it is decidedly irritant to the skin and mucous mem- branes. After its internal administration the urine takes a dark-red color with Nitric Acid. Ferric Chloride blackens a dilute solution of Cotoin, but has no reaction with Paracotoin. The bark and both principles are highly recommended in diarrhoeas of various forms, especially those of phthisis, typhoid fever, and cholera. In Asiatic cholera Paracotoin has been used hypodermically in 3-grain doses with success. Where there is any tendency to acute inflammation of the gastro-intestinal tract this agent must be used with caution. Small doses of the tincture (ny-v) are said to be very effective in the diarrhoea of children. CREASOTUM, Creasote,—is a product of the distillation of wood-tar, chiefly consisting of the four phenols, Guiacol, Creasol, Methyl- creasol and Phlorol, in varying proportions. It is a nearly colorless, inflammable, oily liquid, of smoky odor, caustic taste and neutral reaction, soluble in 80 of water at 590 F., in 12 of boiling water, and in all pro- portions in alcohol, ether, chloroform and acetic acid. It does not coagulate albumen (?) or collodion, Carbolic Acid does. It was named from its remarkably preservative power over meat creas, flesh, and sohzoh, preserve. Much of the commercial Creasote is an impure Carbolic Acid, or a heavy oil distilled from coal-tar and containing Carbolic and Cresylic Acids. Dose, rrpj-iij, well diluted. Aqua Creasoti,—a I per cent, solution, containing rryivy in each fluidounce. Dose, 3HV- . . Morson's Beechwood Creasote,—is best for internal use. Dose, try every 3 hours, in wine or whiskey, well diluted. Creasote is expectorant, astringent, antiseptic, styptic, escharotic, an- aesthetic and narcotic. Its action is practically the same as that of Car- 192 CREOLIN CROCUS. bolic Acid (see ante, page 60), especially upon the heart, respiration and nervous system, but differs from that of the latter in not causing convul- sions, and in increasing the coagulability of the blood. It is eliminated by the kidneys and bronchial mucous membrane, which it stimulates, being quite a good expectorant. In small doses it seems to have a selec- tive sedative influence on the terminal nerve-filaments in the gastric mucous membrane. In large doses it is a powerful poison, resembling Carbolic Acid in its symptoms, except that its nervous effects are even more marked. It explodes when combined with Oxide of Silver in pill, unless previously diluted with an inert powder. Being a very complex substance of varying composition Creasote as a therapeutic agent has been almost entirely supplanted by Carbolic Acid. It is used internally with success in reflex nausea and vomiting, as from sea-sickness, pregnancy, cholera, etc., also as an aseptic and expectorant in chronic basilar cavity, in which it seems to have greater efficacy than any other remedy. As an astringent it has been employed in intestinal hemorrhage, gonorrhoea and gleet, and generally in the same affections as Carbolic Acid. Externally it is a good application in eczema, pruritus, ulcers and scaly skin diseases, and it effectually relieves the pain of an exposed dental nerve if applied thereto. It is a good agent by inhalation in chronic bronchitis and gangrene of the lung, and it has lately been administered internally in phthisis with decided benefit. CREOLIN, (Unofficial)—is a coal-tar product of uncertain compo- sition, occurring as a semi-fluid, black substance, of the consistence of honey. It forms a white cloud when added to water, with which, how- ever, it is miscible, as an emulsion, up to about io or 12 per cent, strength. The Solutions in general use vary from to 2 per cent.; the Ointments to 5 per cent., and Creolin Gauze is prepared of 10 per cent, strength of the drug. Creolin was highly vaunted, by Professor v. Esmarch and other authorities, as the ideal antiseptic for external use, being possessed of great germicidal power, and a most efficient deodorant and disinfectant, while its absorption caused no toxic results whatever. Experience has justified these claims in the main, but the drug has, however, given rise to serious symptoms, when used to excess. As a vaginal wash, in puerperal cases, the 2 per cent, solution is reported as fully equal to sublimate solutions, while better as a deodorant, and free from danger by absorption. The weaker solutions have given satisfaction as local applications in the treatment of otorrhoea, nasal ulcers, rhinitis (1 to 1000), blepharitis, keratitis, etc.; and in female cystitis a 1 per cent, solution as a vesical wash, gradually increased to 2 per cent, is highly praised by Parvin. The Ointments and Gauze are used for wounds and other solutions of continuity, in the same manner as carbolized prepara- tions, and with better satisfaction, Creolin being less volatile than Carbolic Acid, and of a more agreeable, though powerful, odor. CROCUS, Saffron,—the stigmas of Crocus sativus, a plant of the nat. ord. Iridacese, cultivated in Europe, containing a volatile oil and coloring matter. Occurs as separate stigmas or three attached to the style, CUBEBA. 193 of orange-brown color, peculiar, aromatic odor, and bitter taste. So- called American Saffron is not Crocus but the flowers of Carthamus iinc- torius. True Saffron is expensive, as it requires about 60,000 flowers to furnish one pound of the stigmas. Dose, gr. v-xx, in infusion. Tinctura Croci,—10 per cent. Dose, j—ij. Saffron Tea, so much used in domestic practice, is an infusion of Carthamus tinc- orius, or Safflower. Crocus is a stimulant aromatic, having some antispasmodic and anodyne qualities. The hot infusion produces diaphoresis, probably by virtue of the hot water alone. It is said to have caused death with narcotic symp- toms. On the continent of Europe it is employed as a stimulant and emmenagogue, but in this country its only use is as a coloring agent. The miscalled Saffron Tea noted above is used in domestic practice for measles and other exanthemata. CUBEBA, Cubeb ,—is the unripe fruit of Cubeba officinalis, a plant of the nat. ord. Piperaceae, cultivated in Java. Occurs as a blackish-gray, wrinkled, globular body, about the size and shape of black pepper, of strong, spicy odor, and aromatic, pungent taste. Contains a Volatile Oil, which is official, an acrid resin composed in part of Cubebic Acid, also a fatty oil, gum, and Cubebin, which is an insoluble, neutral, odorless and tasteless body. The volatile oil may be separated into Cubebene a cam- phor, and Cubeben a liquid portion. The active principles are the volatile oil and the cubebic acid, both of which are contained in the oleoresin. Cubeb should be kept whole and not pulverized until wanted for use. Dose of the powdered drug, gr. x— 3ij • Extractum Cubeba Fluidum,—alcoholic. Dose, tipv-xxx. Tinctura Cubeba,—10 per cent. Dose, Ttyx- g iij. Oleoresina Cubeba,—extracted by ether. Dose, tiyv-xxx. Trochisci Cubeba,—each contains of the Oleoresin gr. l/2, Oil of Sassafras gr. 0.15, Extract of Glycyrrhiza gr. iv, Acacia gr. ij, and Syrup of Tolu q. s. to form a mass. Dose, j-iij. Oleum Cubeba, C15H21,—is the volatile oil, a colorless or pale greenish-yellow liquid, of sp. gr. 0.920, warm, aromatic taste, odor of cubeb and a neutral reaction. Is soluble in an equal weight of alcohol. Dose, rtpv-xx. Cubeb belongs to the pepper family, and like black pepper is an aromatic stomachic and a stimulant diuretic in small or medium doses, but large doses derange digestion and may act as a gastro-intestinal irri- tant. Its constitutents are eliminated by the bronchial mucous membrane, the skin and the kidneys, stimulating and disinfecting the genito-urinary passages, increasing the bronchial mucus, sweat and urine, and frequently causing an urticarial or vesicular eruption. It increases the action of the heart and of the vascular system, stimulates the venereal appetite, and promotes the menstrual discharge. Cubeb is particularly useful in affections of the bladder and urethra. 194 CUPRUM. It is used in the acute stage of gonorrhoea, chronic cystitis, prostator- rhoea and chronic bronchitis with excellent results. The powder is a good application in hay-fever, chronic nasal catarrh and follicular pharyn- gitis, blown on to the mucous membrane by an insufflator. It may also be smoked in cigarettes with temporary relief in cases of acute nasal catarrh with “ stuffed ” nasal passages. In some subjects the continued use of cubeb produces nausea, hemorrhoids, hematuria and severe head- ache. The troches are a useful preparation in chronic irritability of the fauces, pharynx and air-passages, and are much employed by singers and public speakers for their tonic effect on these parts and for the relief or prevention of hoarseness. CUPRUM, Copper, Cu,—is not official, but two of its salts are, namely the Acetate and the Sulphate. The metal itself is inert, but in combination it is actively poisonous. Copper has been found in the normal human blood in very minute quantity. Sal/s and Preparations of Copper. Cupri Acetas, Acetate of Copper, Cu(C2H;l02)2.H20,—forms green, prismatic crys- tals, efflorescent, of nauseous, metallic taste and acid reaction, soluble in 15 of water and 135 of alcohol at 590 F. Its aqueous solution is of a blue color. Dose, gr. Cupri Sulphas, Sulphate of Copper, CuS04-5H20,—blue, translucent crystals, efflor- escent, of nauseous, metallic taste and acid reaction, very soluble in water, insoluble in alcohol. Its solution is blue by transmitted light, green by reflected light. Dose, as an emetic, gr. ij-v, every 10 or 15 minutes,—as a tonic, gr. Solution of Potassio-Cupric Tartrate, Fehling’s Solution (Unofficial), used as a reagent for glucose, may be made as follows,—Dissolve 70 grains of Sulphate of Copper in 400 minims of Distilled Water. Also Dissolve 488 grains of Rochelle Salt (Pot. et Sodii Tart.) in 1600 minims Solution of Soda (Liq. Sodse), sp. gr. 1.12. When required for use pour the copper solution into the other, and add distilled water to make 2720 minims (^5%)■ Cuprum Ammonia turn, Ammoniated Copper (Unofficial),—is made by triturating 3 parts of Ammonium Carbonate with 4 of Cupric Sulphate until effervescence has ceased, then drying. A deep-azure blue powder, of ammoniacal odor, a styptic, metallic taste, and alkaline reaction, soluble in water. Dose, gr. Cupri Arsenis, Arseniteof Copper, See ante, page 117. Physiological Action. The salts of Copper are gastro-intestinal irritants, producing a metallic taste, nausea with greenish vomited matter, purging of blood and mucus, constricted fauces, depressed heart-action, hurried respiration and fever. Or, as with Arsenic, gastro-enteritis may not occur, but instead profound nervous symptoms, as headache, defective coordination, coma and con- vulsions. The symptoms of chronic poisoning are bronchial irritation and catarrh, gastro-intestinal catarrh, colic with diarrhoea [Lead produces colic with constipation], dysentery, nausea, emaciation, anaemia, saliva- tion, and a green lme (sulphide) along the margin of the gums in those who do not clean their teeth. The nervous symptoms above mentioned are also usually well marked. The liver becomes atrophied from irrita- tion of its connective tissue and fatty degeneration of the hepatic cells. The lungs are congested, even pneumonic consolidation may be set up, CUPRUM. the metal seeming to have a selective affinity for the parenchyma of these organs. These effects are often produced by the inhalation of cuprous fumes, and by eating acid fruits cooked in a copper vessel. Sulphate of Copper is a simple, irritant emetic, producing prompt and continued vomiting with but little nausea or depression. In small doses it is a nerve-tonic and astringent to the gastro-intestinal tract. Externally applied in solution it is a useful stimulant and astringent to diseased mucous surfaces, and is mildly caustic if used in substance. The Acetate is possessed of the same general action as above described. Its local action is stimulant and escharotic. The impure acetate (verdigris) is a violent irritant poison. Ammoniated Copper has no special action other than above noted Antagonists and Antidotes. Ferro-cyanide of Potassium is the antidote to Copper salts, but albumen or magnesia may be used. Any chemical antidote should be followed by prompt evacuation of the stomach, then Opium and demulcents for gastro-enteritis, and Potassium Iodide even to saturation of the system. Alkalies and their carbonates, lime water, iodides, mineral salts except the sulphates, are all incompatible. Therapeutics. The Sulphate is a prompt and efficient emetic, and is so used in croup and narcotic poisoning. In phosphorus poisoning it forms a comparatively insoluble phosphide of copper besides producing emesis. Fifteen or twenty grains may be dissolved in £iv of water, and a teaspoonful or more, according to age, given every ten minutes until vomiting is pro- duced. In acute diarrhoea and chronic dysentery it is the best metallic astringent in doses of gr. to y with Opium, and in gastro-intestinal catarrh it is equally efficient. Locally, it is used with benefit in throat affections, gonorrhoea, granular lids and corneal ulcers, indolent granula- tions and chronic inflammations of mucous membranes. In most of these affections weak solutions (gr. to to the 3) are best, but in granular conjunctivitis the smooth crystal may be rubbed quickly over the surface once daily. In various nervous diseases, as epilepsy, chorea, hysteria, etc., the salts of copper are sometimes beneficial, the Ammoniated Copper being con- sidered the most efficient preparation in these cases. In Germany a tinc- ture of the Acetate was official and has been used successfully in the treatment of pneumonia. Ammoniated Copper has lately been highly recommended for facial neuralgia, but requires pushing to the production of some physiological action. Ointments or lotions of the Acetate are useful applications in eczema, herpes, tinea sycosis, mentagra and herpes circinatus. Villate's Solution has been successfully used as a local injection for the cure of caries. It is composed of Sulphate of Copper, Sulphate of Zinc of each 15 parts, Liquor Plumbi Subacetatis 30, Vinegar 200. The solu- tion is thoroughly injected into the sinuses leading to the carious bone. 196 CURARE. CURARE, Woorara (Unofficial),—is a vegetable extract obtained from various members of the Strychnos family and from Paulinia curare and other plants. It is used in S. America as an arrow-poison under various names, as Caroval, Vao, etc. Its active principle is the crystal- lizable alkaloid Curarine, which contains no oxygen. The dose of Curare is gr. Jo~& hypodermically,—of Curarine, gr. hypoder- mically, or gr. by the stomach, but as the samples vary greatly in activity they should first be tried on some inferior animal before being administered to man. Physiological Action. Curare is a paralyzer of the voluntary muscles, affecting them through the end-organs of the motor nerves. It does not at first act upon the brain or spinal cord, but if life be prolonged by artificial respiration the cord, sensory nerves and even the muscular tissue all become affected. The heart, at first quickened, becomes depressed, and the blood-pressure is lowered, the eyelids droop, the eye-balls protrude, vision is disordered, intestinal peristalsis and sensibility to stimuli are greatly increased, and an artificial glycosuria (curare-diabetes) is set up. The limbs are paralyzed first, death occurring by paralysis of respiration. The absorption of the drug by the stomach is very slow, as its active principle passes with diffi- culty through animal membranes, and its elimination, which takes place by the kidneys, being more rapid and complete than that of any other agent, no marked effect may be produced when administered internally. When hypodermically injected its action is very prompt. The urine of a curarized animal will poison another, and that of the second will paralyze a third. As compared with other motor depressants Curarine and Coniine para- lyze the end-organs of the motor nerves, Gelsemine and Methyl-coniine paralyze the motor centres. Antagonists and Incompatibles. Strychnine, though from a member of the same family, is antagonistic as to the action on the heart and respiration. So also is Atropine. Artificial respiration is the most efficient antagonist, maintaining life until elimination occurs. Evacuation of the bladder repeatedly is important to prevent reabsorption. The caustic alkalies destroy Curarine as they do all other alkaloids. Therapeutics. Cfirare is chiefly used for experimental purposes on the lower animals. It has an historical interest from its having been the means by which Ber- nard demonstrated the existence of muscular contractility as an essential endowment of that tissue. It has been used with some success in spas- modic nervous affections, particularly in tetanus, both idiopathic and traumatic, in hydrophobia, chorea and epilepsy. It does not promise well as a therapeutic agent, but two undoubted cases of hydrophobia are reported by high authority as cured by this drug. CYDONIUM—cypripedium—damiana. 197 CYDONIUM, Quince Seed ,—is the seed of Cydonia vulgaris, a tree of the nat. ord. Rosacese, native in Crete and Austria, and cultivated elsewhere. The seeds are about inch long, triangularly compressed, covered with a whitish epithelium, and in water they swell up forming a mucilaginous mass. The mucilage is the only constituent of importance and is contained in the epithelial cells. It has been named Cydonin, and considered to be a compound of gum and cellulose. Preparation, Mucilago Cydonii,—prepared by macerating 2 parts of Cydonium in ioo of Distilled Water. Dose, indefinite. Physiological Action and Therapeutics. Cydonium is of value for its mucilage, which is used as a bland, de- mulcent application in conjunctivitis, abrasions of the skin, fissures of the mucous membranes, and as a vehicle for injections in gonorrhoea. In- ternally it may be used as a soothing remedy for the throat, stomach, or intestines. The preparation known as Bandoline, used as a hair-dressing, is identical with the mucilage ol Cydonium. CYPRIPEDIUM, Ladies’ Slipper,—is the rhizome and rootlets of Cypripedium pubescens, and of C. parviflorum, the Moccasin-plant, or American Valerian (nat. ord. Orchidacese). Is dark or orange-brown in color, of strong, heavy odor, and bitter, pungent taste. It contains a volatile oil, a volatile acid, resins and tannin. Preparations. Extractum Cypripedii Fluidum,—Dose, irpx-xxx. Cypripedin (Unofficial),—is an impure alcoholic extract. Dose, gr. ss-iij. Physiological Action and Therapeutics. Cypripedium is antispasmodic, tonic, stimulant and diaphoretic, pos- sessing the same general properties as Valerian, whence one of its common names. It is a popular remedy in some parts of the U. S. for nervous hyper- sesthesia unaccompanied by organic lesion, especially morbid sensibility of the eye. It is reported to have even cured epilepsy, and to be highly useful in neuralgia, hysteria, nervous headache and insomnia. DAM I AN A (Unofficial),—the leaves of Turnera aphrodisiaca, a plant of the nat. ord. Turneraceae, growing in Mexico and Lower Cali- fornia. Several varieties of so-called Damiana are in the market, but the true leaf is of a light-green color, small, lanceolate, and dentate along the margin. It contains a volatile oil and a resin. Dose, 3j daily. DATURA TATULA DIGITALIS. Preparations. Extraction Damiance (Unofficial),—Dose, gr. ij-x. Extraction Damiana Fluidum (Unofficial),—Dose, j. Physiological Action and Therapeutics. Damiana is said to be a powerful aphrodisiac in cases of sexual atony, but the published reports of its use since its introduction vary greatly as to its efficacy. It is probably a stimulant diuretic, a bitter tonic, and a purgative in sufficient doses. Besides its use as an aphrodisiac Damiana has been administered with benefit in some forms of cerebral exhaustion and general atony of the nervous system, also in sick headaches and in some few cases of paralysis. It forms the chief stock in trade of the numerous charlatans who fill the daily papers with advertisements of “ manhood-restorers.” DATURA TATULA (Unofficial),—is an indigenous plant of the nat. ord. Solanacese, resembling Stramonium very closely, with which it generally agrees in its physiological action and therapeutics. It is distin- guished by its purple stem, purple flowers and anthers, and the darker green of its leaves. It probably contains the alkaloid Daturine (see Stramonium),—and has been smoked in asthma, in a few cases giving continued relief when Stramonium had failed to render any service. DIGITALIS, Fox-glove,—Digitalis consists of the leaves, col- lected from plants of the second year’s growth, of Digitalis purpurea, the Purple Foxglove, a plant of the nat. ord. Scrophulariaceae, which grows wild in Europe, and is cultivated in this country, often in private gardens for its beautiful spike of purple flowers, and largely by the Shakers for the drug market. The British Phar. directs that the official drug shall consist of “ the dried leaf, collected from the wild, indigenous plant, when about two-thirds of the flowers are expanded.” Much of the leaf found in our shops is of very poor quality, a large proportion being inert; but whether this is due to our Phar. not restricting the official drug to the wild plant, or to careless treatment in gathering and drying, is not definitely known. When, however, the leaves are imperfectly dried, a process of decomposition sets in, which destroys the active principles, and may produce new and poisonous ones. A similar decomposition is said to occur whenever the tincture of Digitalis is mixed with watery or syrupy solutions. Certain it is, at any rate, that Digitalis is one of the most unreliable drugs, in respect of the physiological activity of any particular sample or preparation. The seeds are known to contain the active principle in much greater proportion than the leaves, but they are never used. The active principle of Digitalis has been designated by the term Digi- talin, (Digitalinum), under which name a substance was official in the U. S. and Br. Phar. and a process was given therein for its extraction, until their last revision, when it was struck from both lists. It was an amorphous product, of complex composition, and did not represent Digitalis. DIGITALIS. In 1871 Nativelle received the Orfila prize from the French Academy for the discovery of a crystalline principle in Digitalis, which he named Digitaline. This was supposed to be the active principle of the plant, until Roucher, (1872) and Schmiedeberg, (1875) found it to be a complex body, consisting of a mixture of Digitoxin and Digitalin. Schmiedeberg’s latest analysis is now accepted as the most accurate determination yet obtained of this vexed question. He enumerates five principles at least as contained in Digitalis, viz. :—(1) Digitalin, amorphous, insoluble in water, but readily soluble in alcohol; the active ingredient of Homolle’s French Digitaline and the Digitalin of the U. S. and Br. Pharmacopoeias;—(2) Digitoxin, insoluble in water and sparingly soluble in alcohol; the most active of all, and the principal constituent of Nativelle’s prize Digi- taline(3) Digitalein, soluble in both water and alcohol;—(4) Digitonin, readily soluble in water, sparingly so in alcohol;—active, but acts like Saponin, forming a solution which froths easily and antagonizes the other three;—(5) Digit in, which seems to be entirely inert. The first three are cardiac poisons, the fourth antagonizes them; and all five are non-nitrogenous, and except Digitoxin, are glucosides. Preparations. These vary greatly in results, by reason of the different solubilities and actions of the active principles. Digitalis, Folia Digitalis, Digitalis Leaves. Dose, gr. ss-iij. Abstra'ctum Digitalis, Abstract of Digitalis. Dose, gr. j^-ij. Extractum Digitalis, Extract of Digitalis,—Al. 2, Aq. 1. Dose, ]/(,-%. Extr. Digitalis Fluidum, FT. Ext. of Digitalis,—Al. 3, Aq. 1. Dose, rrpj-iij. Tinctura Digitalis, Tincture of Digitalis,—15 per cent. Dose, ripv-gj. Infusum Digitalis, Infusion of Digitalis,—I]/2 per cent. Dose, 5 ss-j. Is flavored with Cinnamon, and has percent, of Alcohol. Digitalinum, Digitalin,—the complex product of the process in the U. S. and Br. Phar., but no longer official. Dose, gr. Note on the Preparations.—Of the above, the Tincture and Fluid Extract, being alcoholic preparations, contain a large proportion of Digitalin and Digitalein, with a small proportion of Digitonin; the Digitoxin going to the bottom as an insoluble precipitate. The Infusion contains a larger proportion of Digitonin than of the others, some Digitalein, and little or no Digitoxin or Digitalin. It is the best for diuretic action, the Tincture for acting upon the heart; but to obtain the action of the plant itself, the powdered leaves must be used in pill or capsule. Physiological Action. Digitalis is a cardiac tonic and a vascular stimulant, an excito-motor, also emetic, diuretic, hemostatic, anaphrodisiac, and paralyzant. In over- doses it irritates the mucous membranes, causing sneezing, severe gastric disturbances, nausea, vomiting, colic and purging, the discharges being of a grass-green color. It lowers temperature, probably by lessening the blood-supply to the tissues, produces headache, irregularity of the heart’s action, vertigo and an appearance of vibratory fringes of color around objects. The Heart is slowed by Digitalis, but its force is at the same time increased. The drug stimulates the cardiac motor ganglia, the inhibitory apparatus, and the vaso-motor centres, contracting the arterioles; and thereby greatly raising the arterial tension. Full doses continued exhaust the irritability of the motor ganglia and paralyze the cardiac muscle itself. The recumbent posture must be maintained when Digitalis is given for its full cardiac effects. Its general effect on striped muscular tissue is to lessen the contractile power, causing great weakness and languor. Under 200 DIGITALIS. it, the excretion of urea is at first increased, but soon decidedly dimin- ished. It lessens the sexual appetite and impairs the venereal function. The Diuretic Action of Digitalis is due to its peculiar influence upon the general and renal circulation, it increasing the force of the ventricular contractions, while at the same time one of its constituents, Digitalin, contracts the blood vessels of the body, and two others, Digitoxin and Digitalein, dilate the renal arteries. The effect of this combined action is to greatly raise the arterial tension and the blood-pressure in the glomeruli, their afferent vessels being contracted;—while the rapidity of the renal circulation is increased and its volume augmented by the greater force of the heart-beat and the dilatation of the afferent vessels. No other drug known has this double power, and therefore, so far as vascular action is concerned, Digitalis is the ideal diuretic. Still, while its power to pro- duce diuresis in cardiac disease is unquestioned, most observers deny that it has any such power in health. Lethal Doses lessen the reflexes by stimulation of Setschenow’s centre, and paralyze the muscles and the peripheral nerves, motor and sensory. Respiration, at first slowed, becomes rapid and feeble; cyanosis, coma and convulsions follow, and death by sudden paralysis of the heart, which is arrested in systole. Compared with Aconite, both it and Digitalis slow the heart, but other- wise their actions are antagonistic. Aconite relaxes inhibition and depresses the cardiac motor ganglia,—Digitalis increases inhibition and stimulates the motor apparatus. Both drugs finally paralyze the cardiac ganglia, Aconite by direct depression, Digitalis by over-stimulation. Both depress the cardiac muscle. Under Aconite the heart is arrested in diastole, under Digitalis in systole. The arterial tension is lowered by Aconite, raised by Digitalis. Aconite acts quickly, Digitalis very slowly, —a fact which makes the latter drug of little value in poisoning by the former. During the use of this drug for any length of time the motor apparatus of the heart is so nearly over-stimulation that on suddenly assuming the erect position the cardiac energy may fail, more especially if the doses used are administered too cfosely together to admit of the elimination of one before the ingestion of the next. This is the expla- nation of the so-called cumulative action of Digitalis, which is not now recognized in the sense in which the term was formerly applied. Antidotes, Antagonists and Incompatibles. Tannic Acid is the chemical antidote, but as the tannate is not inert the stomach should be evacuated. Aconite is the best antagonist to the effects of large doses, Opium to those of its long-continued use. Saponin and Senegin are considered to be its most complete physiological antagonists. Incompatibles are Cinchona, Sulphate of Iron, Tinc- ture of the Chloride of Iron, and Acetate of Lead, also syrupy and watery solutions which may decompose the active principles of the plant. DIOSCOREA. 201 Therapeutics. The chief use of Digitalis in disease is based on its property as a heart tonic. Its great sphere is in mitral disease, when the heart is rapid and feeble, it moderating pulmonary hypersemia and engorgement by giving the auricle time to empty itself through the obstructed orifice. In aortic disease it gives relief when the compensatory hypertrophy has not set in, otherwise it is contraindicated. It is particularly useful in dilatation of the right side of the heart with incompetence of the tricuspid. The rational symptoms which indicate its use are—rapid and feeble cardiac action, low arterial tension, cough, dyspnoea, pulsating jugulars, a dusky face, scanty and high-colored urine and general dropsy. In the irritable heart of soldiers Digitalis is frequently curative, and palpitation, cardiac failure, and venous engorgement are well treated by it. It should not be used in simple hypertrophy when compensatory, aortic stenosis with com- pensatory hypertrophy, pericarditis or fatty heart, except temporarily for some special indication. It is a useful remedy in dropsy, both cardiac and renal, in the first stage of pneumonia and other inflammations, in the early stage of scarlet fever and when the kidneys strike work in that disease, in exophthalmic goitre, congestive headaches, and hemicrania, in mania, delirium tremens and other congestive conditions of the brain. As a hemostatic it may be used in hemorrhage from a large surface, in the hemorrhagic diathesis, hemoptysis, and menorrhagia. As an antipyretic it has been much used in fevers, but a reaction is setting in against this employment of so powerful a heart-depressant. In rheumatic fever it lowers the temperature, shortens the duration of the disease, and is par- ticularly indicated for any cardiac complications. In spermatorrhoea of the plethoric it may be well combined with Potassium Bromide, and when this affection is complicated with an atonic condition, shown by feeble erections, frequent emissions and cold feet and hands, it is a serviceable anaphrodisiac. Finally, Digitalis is said by high authority to be particularly adapted to blondes and persons of sanguine and indolent temperament. DIOSCOREA, Wild Yam, Colic-root (Unofficial),—is the rhi- zome of Dioscorea villosa, a creeping plant of the nat. ord. Dioscoracese, indigenous to the eastern U. S. It contains an acrid resin, and is re- ported to be expectorant and diaphoretic in action, as well as stimulating to the intestinal canal, and in large doses to cause general neuralgic pains with erotic excitement. It is used with great success in bilious colic; and in the cramps of cholera morbus, spasmodic hiccough, dysmenorrhoea and nocturnal emissions of sthenic type it is said to be very efficient. A powdered extract named Dioscorein is on the market, of which the dose is gr. j-iv. A fluid extract made according to the pharmacopoeial rule may be administered in doses of npxv-xxx. 202 DITA BARK DROSERA DUBOISIA. DITA BARK (Unofficial),—is the bark of Alstonia scholaris, a tree of the nat. ord. Apocynacese, growing in the Philippine Islands. It con- tains two active alkaloids, Ditaine and Ditamine, the former of which has an action identical with that of Curare. The bark is considered tonic and antiperiodic, and is used in the East as a remedy for intermittents. It may be given in doses of 3j~iv, in powder or as fluid extract. DROSERA, Sundew (Unofficial).—A fluid extract of Drosera rotundifolia, the round-leaved Sundew, is said to have been successfully used in phthisis pulmonalis. It is certainly a most useful agent in whoop- ing-cough and other spasmodic coughs; especially when marked by vio- lent paroxysms, the cough being loud and harsh, and followed by bleed- ing from the nose or mouth, and perhaps by vomiting of the contents of the stomach. The expressed juice has been applied to warts and corns, for the purpose of curing them. Dose of the fluid extract, n^v-xx. DUBOISIA (Unofficial),—is the leaf of Duboisia myoporoides, an Australian tree of the order Solanacese. It contains a poisonous alkaloid, Duboisine, which is believed to be identical with Hyoscyamine, and strongly resembles Atropine. Preparations. Extractum Duboisice (Unofficial),—Dose, gr. ■ Tinctura Duboisice (Unofficial),—Dose, rtpv-xx. Duboisines Sulphas (Langenberg’s), Unofficial,—Dose, gr. Physiological Action. The actions of Duboisia are in all respects similar to those of its con- gener, Belladonna, except that 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. On man its action is said by some authorities to be more powerful than that of Atro- pine, but less powerful on frogs. Antagonists and Incompatibles. These are the same as for Belladonna, for which see ante, p. 127. Therapeutics. Duboisine has not been much used except by ophthalmologists who employ it as a mild mydriatic. Its advantages over Atropine in ocular therapeutics are its more rapid action in paralyzing accommodation and effecting mydriasis, the shorter duration of its effects and its slight irrita- tion of the conjunctiva. It has been well employed in puerperal mania, and may be used in place of Atropine in many conditions, especially the night-sweats of phthisis, respiratory neuroses and cardiac failure. It is an efficient antagonist to Morphine. DULCAMARA ELATERINUM. 203 DULCAMARA, Bittersweet,—the young branches of Solatium Dulcamara, or Woody Night-shade, a shrub of the nat. ord. Solanacege, growing in Europe and N. America. Occurs in short sections % inch thick, covered with a pale green bark, of slight odor, and taste at first bitter, afterwards sweet. It contains the glucoside Dulcamarin, a pecu- liar principle named Picroglycion, and the alkaloid Solanine, which exists in the stems of other species of Solanum, viz.—S. tuberosum (potato), A. Lycopersicum (tomato), and S. nigrum (black nightshade). Solanine is of bitter taste, alkaline reaction, crystalline in minute prisms soluble in 125 of boiling alcohol but very insoluble in water. It is a narcotic poison, but exists in very small quantity in the plant. Preparations. Extraction Dulcamarce Fluidum,—Dose, 3 j. Decoctum Dulcamara (Unofficial),—may be made of the official 10 per cent, strength and given in doses of §j-ij. Physiological Action. Dulcamara is but imperfectly understood. In overdoses it has pro- duced nausea and vomiting, vertigo, convulsive muscular movements, pruritus and erythematous eruptions on the skin, languid circulation with a dusky color of the face and hands. In children who have eaten the berries there have been observed signs of severe enteralgia, abdominal tenderness, nausea, thirst, heat in the throat and chest, great prostration, rapid pulse, quick and painful respiration. In very large doses it is a narcotic poison, causing paralysis by depression of the central nervous system, with lowered activity of the heart and respiration. It is believed by some authorities to be anaphrodisiac, diaphoretic and diuretic. Therapeutics. Dulcamara was formerly used in a variety of affections, as herpetic diseases, chronic rheumatism, gout, jaundice, etc. It is now chiefly employed in obstinate scaly skin diseases, as psoriasis and pityriasis, in which it is unquestionably serviceable. It is also serviceable in the diar- rhoea of children when produced by exposure to cold and damp, in mania with strong venereal propensities, chronic bronchitis and whooping- cough. As a diaphoretic it has been used with benefit in rheumatic and venereal disorders, and is often beneficial in nasal, pulmonary and vesical catarrhs. It is said to be particularly useful in affections of a rheumatic or catarrhal nature, when caused by exposure to damp weather. ELATERINUM, Elaterin, C20H28O5,—is a neutral principle ex- tracted from Elaterium, a substance deposited by the juice of the fruit of Ecballium Elaterium, or Squirting Cucumber, a cultivated European 204 ERGOTA. plant of the nat. ord. Cucurbitacese. Elaterium is no longer official by reason of its variable quality. Elaterin occurs in small, colorless scales or prisms, of bitter taste and neutral reaction, insoluble in water, soluble in 125 of alcohol and in solutions of the alkalies. Dose, gr. -^0-112. Preparation. Trituratio Elaterini,—Elaterin 10, Sugar of Milk 90 parts, thoroughly mixed by tritu- ration. Dose, gr. ss-j. Physiological Action and Therapeutics. Elaterin is the most powerful of the .hydragogue cathartics, causing profuse, watery stools, and when given in large doses great prostration and gastro-intestinal irritation, nausea and vomiting. On the lower ani- mals it does not produce purgation, but profoundly impresses the nervous system, causing irregular breathing, convulsions and death. Its chief use is to produce free watery discharges in ascites, anasarca, uraemia and cerebral disorders, but while the most efficient agent we possess for this purpose it must be used with great caution in the aged and feeble, as it is very depressant. ERGOTA, Ergot, Ergot of Rye,—is the sclerotium (compact mycelium or spawn, intermediate fibrous stage) of Claviceps purpurea (nat. ord. Fungi), growing within the flower and replacing the grain of Secale cereale, Rye (nat. ord. Graminaceae). It occurs in fusiform, curved, grain-like bodies, about an inch long, three-furrowed, obtuse at the ends, of purplish-black color, peculiar and heavy odor, and oily, dis- agreeable taste. It should be preserved in a dry place, and should not be kept longer than a year. Dose, gr. x-3j. Composition of Ergot. The composition of Ergot and the nomenclature of its supposed con- stituents is a subject upon which there exists a great diversity of opinion, and about which there is nothing settled. The following synopsis gives the views of the different persons who have examined into the matter. Wenzell (1864) named two alkaloids, Ecboline and Ergotine, which he claimed to be the active principles, and to be combined with Ergotic Acid, a volatile body yielding crystallizable salts. He also claimed the presence of Trimethylamine as a Phosphate. Tanret (1877) isolated a crystallized alkaloid, which he named Ergoiinine, C35H40N4O6 (dose, gr. Ay-jo )> also a volatile camphoraceous substance. Dragendorff and his pupils (1875-1879) stated the active principles to be two in number, Sclerotinic Acid, a very powerful body, yellow-brown, amorphous, tasteless and well adapted for hypodermic use in doses of gr. Scleromucin, a colloid sub- stance, also quite active. Besides these they held that Ergot contained various coloring matters (Sclererythrin, Scleroxanthin, etc.), also a non-drying Oil, a peculiar sugar (Mykose), a number of alkaloids (Trimethylamine, etc.), and other principles, all inert. Robert (1885) announces that Ergot contains three active principles, viz., Ergotinic Acid, the chief constituent of Sclerotinic Acid, having no ecbolic action, but affecting the nervous system, the heart and the respiration ;—Sphacelinic Acid, which is non-nitrogen- ERGOTA. 205 ous and soluble in alcohol, stimulates the vaso-motor centre and is the active agent in producing gangrenous ergotism;—Cornutine, an alkaloid, produces convulsions and peri- staltic contractions of the uterus, and is the active agent in causing convulsive ergotism. Tanret’s Ergotinine has been proven to have no action on the uterus. The Ergotin of Bon jean, Wiggers and Tanret is not a fixed compound, but a mixture. The Ecboline of Wiggers is also a mixture. Sclerotinic Acid is said by many authorities to act on the uterus, but this is positively denied by many others. It is probably a very uncertain preparation. For the Ergotin of commerce see below. Preparations. Extractum Ergotce Fluidum,—prepared with diluted Hydrochloric Acid, Alcohol and Water. Dose, 3 ss-ij. Extractum Ergotce, Extract of Ergot, commonly called Ergotin,—is prepared by evaporating 5 parts of the fluid extract at a temperature not above 1220 F. until reduced to 1 part. Dose, gr. ij-xx. Vinutn Ergotce,—strength 15 per cent. Dose, Is made by an improved method and is more reliable than that formerly official. Ergotin (Unofficial),—is the name of several watery extracts found on the market, and varying much in action both from each other and from the parent drug. That made by Squibb is about the same strength as the official extract, and represents the general powers of Ergot. It may be used hypodermically in doses of gr. v. The Ergotin of Bonjean is also an aqueous extract, but is very variable in quality and frequently inert. Wiggers’ Ergotin is insoluble in the ordinary menstrua, and inert on the vascular appa- ratus, but causes colic and gastro-enteritis. Physiological Action. Ergot is an excito-motor and a hemostatic, chiefly affecting the spinal cord, circulation, respiration, intestinal and uterine muscular fibres. Its principal actions are the production of an artificial anaemia, and tetanic contraction of unstriped muscular fibre. Its phenomena are divided into two sets, named respectively Acute and Chronic Ergotism, according as the drug is administered in large doses, or in small quantity for a consid- erable length of time. Acute Ergotism. In large doses Ergot acts as a gastro-intestinal irritant, causing nausea and vomiting, gastralgia, colic, thirst, difficult micturition and purging. It slows the heart, raises the arterial tension greatly, dilates the pupils and produces pallor, vertigo and frontal head- ache. Its action on the circulation is due to its inducing arterial anaemia, but whether this is done by contraction of the arterioles through direct action on their muscular fibres or by central stimulation of the vaso-motor system, or by producing active venous dilatation, thus draining the arte- rial system, is a much disputed question. It certainly stimulates the con- traction of unstriped muscular fibre, especially affecting the sphincters and the uterus, causing continuous labor pains and tonic contraction of the sphincter vesicae, making micturition difficult if not impossible. It also produces cerebral and spinal anaemia, coldness of the surface, tetanic spasms and violent convulsions, but very large doses (several ounces) are 206 ERGOTA. necessary to such results. As much as Siij of the fluid extract has been given daily for a week or more, without producing any marked effect. Chronic Ergotism occurs in two forms, (i) the Convulsive, (2) the Gangrenous,—either usually excluding the other. The convulsions are tetanoid spasms of the flexor muscles, the uterus, the intestinal fibres, and the muscles of respiration, ending in coma and death by asphyxia. The gangrenous form begins with coldness and numbness of the limbs, formi- cation of the skin all over the body, loss of sensibility and abolishment of the special senses, bullae of blood and ichor, followed by dry or moist gangrene of the lower extremities, buttocks and other parts, epileptiform convulsions, coma and death. Autopsies show changes in the posterior columns of the cord, resulting probably from the spinal anaemia. Experiments with the various derivatives of Ergot show that no one of its constituents represents the power of the drug itself. Those which come nearest to it in action are the Ergotinine of Tanret and Sclerotinic Acid. Antagonists and Incompatibles. Amyl Nitrite, Aconite, Veratrum Viride, Tobacco and Lobelia antagonize its action on the circulation. Caustic alkalies and metallic salts are chemically incompatible. Therapeutics. Ergot has a wide field of application. Its most familiar use is to pro- mote uterine contraction in labor, but as the contractions produced by it are continuous instead of the natural intermittent ones, it is highly dan- gerous when there is any obstacle in front of the child, the probable results being rupture of the uterus, paralysis of the foetal heart, and severe laceration of the perineum. At the end of the second stage, when the head is born, is the best time for its use (if employed in labor at all), in order to promote firm uterine contraction, thereby guarding against post- partum hemorrhage, and promoting the expulsion of the placenta. The tendency, however, of obstetrical teaching, is against its employment at all in labor; while, in practice, the teaspoonful of Ergot is almost in- variably administered as soon as possible after the child is born. In many uterine affections, as chronic metritis, subinvolution, congestive dysmenorrhoea, menorrhagia, fibroids and polypi, Ergot is well em- ployed, producing firm contraction of the womb and promoting absorp- tion of inflammatory products. It is extremely useful in amenorrhoea due to plethora, and in the atonic form of spermatorrhoea. In con- junctivitis, gonorrhoea, and inflammations of mucous membranes gen- erally, it is of striking benefit, if used both locally and internally. It is also an excellent remedy in acute and chronic dysentery, chronic diar- rhoea, atonic hemorrhages of arterial type, mania due to cerebral hyper- aemia, headache and migraine of congestive form, myelitis, spinal con- gestion, cerebro-spinal meningitis, splenic enlargement, lax sphincters of ERIGERON ERIODYCTION. 207 rectum and bladder, and in incontinence of urine from paralysis of the sphincter vesicae. Hemorrhoids are well treated by its local application, but here it should not be used internally as it promotes venous congestion. In aneurism it aids coagulation by slowing the blood-current, and in car- diac hypertrophy without valvular lesion it acts well by slowing the heart. In diabetes insipidus full doses of Ergot are often curative, and it has been used with benefit in diabetes mellitus. Hypodermically, the aqueous extract dissolved in water and free from alcohol or any other irritating substance, is in many cases much more prompt in action than when given per orem, especially if injected near to the seat of the affection. This is particularly true in post-partum and other hemorrhages, prolapse of the rectum, chronic metritis and subinvo- lution of the womb, uterine fibroids, varicocele and varicose veins. When so administered it will frequently so contract the sphincter of the bladder as to produce retention of urine, and require the use of the catheter. ERIGERON, Fleabane (Unofficial),—is the flowering plant Eri- geron canadense, a weed of the nat. ord. Compositse, growing in N. America. It contains a Volatile Oil, which is official, also tannic acid and a bitter extractive. Oleum Erigerontis, Oil of Fleabane,—a pale yellow liquid, of sp. gr. about 0.850, becoming darker by age and exposure to air, of peculiar and persistent odor, pungent taste and neutral reaction, readily soluble in alcohol. Dose, npx-gss. Oil of Erigeron has the same action as Oil of Turpentine but is less irritant and less efficient. It has considerable reputation as a hemostatic, especially in menorrhagia and intestinal hemorrhage of passive form, as in typhoid fever. It is also used with benefit in diarrhoea and dysentery, and in hemoptysis without fever or other evidence of irritation it is a very valuable remedy. ERIODYCTION, Yerba Santa (Unofficial),—the leaves of Erio- dyction glutinosum, a Californian shrub of the nat. ord. Hydrophyllaceae. They are from 2 to 4 inches long, shining green as if varnished on the upper surface, white and hairy beneath, of fragrant odor, aromatic taste, and contain an acrid Resin and an aromatic Volatile Oil. Extractum Eriodyctii Fluidum (Unofficial),—Dose, rtpxv-^j. Extractum Eriodyctii (Unofficial),—Dose, gr. ij-x. Eriodyction is expectorant, and covers the taste of Quinine in a re- markable manner, for which purpose it is combined in mixture with Gly- cyrrhizin, under the title “Veloutine,” as a proprietary preparation (see ante, page 182). It is used with fair success in bronchial and laryngeal affections, also in asthma. Combined in syrup with Grindelia it is very efficient for coughs. 208 ERYTHROXYLON. ERYTHROXYLON, Coca, Cuca,—the leaves of Erythroxylon Coca, a small shrub of the nat. ord. Erythroxylacese, indigenous to the mountains of Peru and Bolivia, and extensively cultivated in those and other S. American states. It has numerous purplish-brown branches; small, yellowish, 5-petalous flowers, and a scarlet red, oblong fruit, con- taining a single seed. The leaf resembles a large tea-leaf, being 2 to 3 inches long, oval-shaped, obtuse at the apex, reticulate on both sides, with a prominent midrib, on either side of which is seen a curved line on the leaf from base to apex; odor tea-like, taste slightly bitter and aro- matic. It contains a crystalline alkaloid Cocaine, C17H21N04, which when heated with HC1 is split up into Benzoic Acid, Methylic Alcohol and another alkaloid Ecgonine. Other constituents are a volatile, liquid alkaloid of herring-brine odor, alkaline reaction and burning taste, named Hygrine, an aromatic Oil, and Coca-tannic Acid. Coca should not be confounded with Cocoa, the seed of the chocolate-tree, Theobroma Cacao. Dose of the leaves, 3j~iv- Preparations. Extractum Erythroxyli Fluidum,—Dose, 3 ss-ij. Leaves of good quality are so difficult to be obtained that Dr. Squibb, the well-known pharmaceutist, recently omitted the fluid extract from his trade-list, with the explanation that “ it is impossible to get Coca of proper quality for medical use.” Cocaina, Cocaine, C17H21N04 (Unofficial),—crystalline, colorless and of bitter taste, very soluble in ether, almost insoluble in water or alcohol, and of decided basic proper- ties, combining with acids to form salts. It exists in the leaves in very small quantity, viz.—from 0.02 to 0.04 per cent. Dose, gr. j^-ij. Cocaines Hydrochloras, Hydrochlorate of Cocaine, C17H21N04C1 (Unofficial),—more properly Chloride of Cocaine,—is used in aqueous solutions of 2 to 5 per cent, as a local anaesthetic to mucous surfaces or by subcutaneous injection. Dose, internally, gr. %-i). Cocaines O/eas, Oleate of Cocaine (Unofficial),—a 10 per cent, solution of the alka- loid in Oleic Acid, for external use. Wines, Lozenges, Elixirs, Glyceroles, Pastes, etc., of Coca are being manufactured and marketed in great variety. The Citrate and Salicylate of Cocaine are recent products of the laboratory and may be obtained in the shops. Physiological Action. Coca is an aromatic bitter tonic, a diuretic and a cerebral and nervous stimulant, though locally used one of the most efficient nerve sedatives. Small doses improve digestion, stimulate respiration, increase the heart’s action after a brief depression, raise the arterial tension, and increase the excitability of the sensory nerves. It stimulates the brain by increasing its blood-supply, producing wakefulness, a sense of well-being, and a marked diminution of the senses of fatigue, hunger and thirst. Under its daily use a considerable amount of labor and want of sleep can be borne without suffering. Though diuretic, it lessens the quantity of urea eliminated by checking the processes of waste. Very large doses produce impaired coordination, hallucinations and delirium. Cocaine acts upon the lower animals similarly to Caffeine. It tetanizes frogs, and in large doses paralyzes their sensory nerves and the posterior ERYTHROXYLON. 209 columns of the spinal cord. It kills rabbits and dogs by paralysis of the respiratory centre. In proper doses it raises arterial tension by stimulating the vaso-motor centres and the cardiac motor system. On man, in small doses Cocaine is a cerebral, cardiac, respiratory and nervous stimulant, and a diuretic. It improves digestion, stimulates res- piration, 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 embarrass- ment 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 “ tightness” about the chest is very marked;—the skin grows cold and clammy, and the subject is seized with a sense of impend- ing dissolution. Death 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 coordi- nation, 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 Ancesthetic 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 pro- found degree of anaesthesia is thought by some to be caused by its para- lyzing 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. 210 ERYTHROXYLON. 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 antago- nist is Chloral, so also are Chloroform and Ether. Morphine is also directly antagonistic at almost all points. The Cocaine-Habit. Cocainism, or the Cocaine-habit, is now presenting itself to observation, numerous instances of persons addicted to its excessive use being met with. Loss of digestive power, absolute insomnia, enfeeblement of the intellect, great emaciation, ascites, general maras- mus, nausea, decay of the teeth, an excessively fetid breath, amblyopia, visual hallucina- tions and complete anorexia form a consensus of symptoms which rival the worst effects of the opium habit. Some observers report the most extraordinary mental changes result- ing from Cocainism, and exceeding those produced by any other drug. The most intense selfishness, utter disregard of all social and domestic duties, the most debasing habits, complete destruction of all noble qualities, and a general condition of depravity, are some of the results which are being charged to this drug. The habit is acquired, in almost all cases, by persons previously addicted to the use of Morphine, who go to Cocaine in the hope of finding help in their struggle against the tyranny of the former drug. In this hope, however, they are always disappointed, especially when the drugs are in their own hands. The victim soon finds that one of these agents antagonizes the other to a great extent, while, at the same time, it sets up peculiar troubles of its own: and that there is a constant need of more Morphine to counteract the Cocaine-symptoms, and of more Cocaine to antagonize the increased amount of Morphine. The result of any such attempt will be that one who is only using a moderate daily amount of Morphine, will, if Cocaine be added, soon be using a very great amount of Morphine, as well as of Cocaine, and “the last state of that man is worse than the first.” Therapeutics. Coca-leaves are chewed by the Peruvians for the purpose of sustaining them during arduous labors and long journeys, and were so highly esteemed as to have been represented on the coat-of-arms of that nation, by whom they are used much as we do tea, coffee or tobacco. This example was imitated by Weston the pedestrian, who is said to have been detected chewing the coca-leaf during one of his protracted walks. Cocaine is a useful stimulant to the brain and the nervous system in many morbid conditions, particularly cerebral and spinal anaemia, neuras- thenia, melancholia, hysterical and hypochondriacal insanity, and in protracted mental depression with suicidal tendency. It maybe employed with benefit in wasting diseases to retard waste and to stimulate digestion, in convalescence from fevers and other acute maladies, and in migraine and neuralgia due to depression of the nervous system. It is very beneficial in some cases of the vomiting of pregnancy, in stomatitis and gastralgia, and in functional impotence due to general atony of the system. A wine of the leaves is thought by singers and speakers to relieve hoarse- ness, to tense the vocal cords and improve the timbre of the voice. Coca- ERYTHROXYLON. leaves may be smoked in cigars or cigarettes to obtain the exhilarating effects of the drug, and for the relief of asthma, hay-fever and many irritable throat affections. The Oleate of Cocaine is an efficient palliative application to painful hemorrhoids, fissures of the anus, burns, boils, and irritable ulcers ; also in pruritus pudendi et ani and skin diseases attended with intolerable itching. Hydrochlorate of Cocaine has achieved notoriety as a local anaes- thetic, and promises to be of the greatest value in many operations on the eye and ear, nasal passages, uterus and urethra. A 2 to 4 per cent, solu- tion is brushed lightly over the mucous surface or injected into the ure- thral canal, the application being repeated within 5 or 10 minutes if profound local anaesthesia is required. After about fifteen minutes any superficial operation may be performed without giving the slightest pain. Its anaesthetic action is so entirely local and generally free from unpleas- ant after-effects that it is considered the most efficient and desirable agent of the kind which is known. It has been used in the same manner with decided benefit in congestion of the nasal passages from acute catarrh and hay-fever; and has been applied to the cervix uteri to relieve the first pains of labor, to the ear for tinnitus aurium, and by inhalation to strengthen the vocal cords, relieve hoarseness and cough, and to improve the quality of the voice. It is injected hypodermically around the pre- puce to prevent pain during circumcision, into the vicinity of the supra- orbital and infra-orbital foramina to cut short neuralgia of those nerves, and into hemorrhoids previous to their ligation. It may be injected into the bladder before lithotrity, into the urethra before the passage of sounds or catheters or to relieve chordee, and it is an excellent application to the gums of teething infants. To be efficient it must reach the terminal fila- ments of the sensory nerves in sufficient concentration. Rhus poisoning, by either the oak or ivy, is promptly controlled by the application of a 5 per cent, solution of oleate, freely over the affected surface. It gives instant relief from the burning and itching, and speedily reduces the dermatitis. 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 accom- modation, moreover, is greatly reduced, but not entirely paralyzed, and is quickly regained. As an Antagonist Cocaine is of especial value in narcotic poisoning by Chloral or Opiates, where depression of the cardiac and respiratory cen- tres exists. It is also indicated in chronic depressant poisoning from the 212 EUCALYPTUS. Bromides, and in spinal paralyses. In these cases it has all the advantages of Strychnine without its poisonous character. It has no value in the proper treatment of Morphinism except to antagonize certain heart symptoms, for which purpose it should be administered only by the phy- sician in charge of the case; and never, by him, as a regular remedy, at regular intervals of time. EUCALYPTUS,—the leaves collected from rather old trees, of Eucalyptus globulus, or Blue Gum-tree (nat. ord. Myrtacese), a native of Australia, now grown in California, Italy, etc. The leaves are 6 to 12 inches long, gray-green, lanceolately scythe-shaped, studded with oil- glands ; of camphoraceous odor and bitter, aromatic taste. They contain tannic acid, a resin, a fatty acid and a Volatile Oil. The latter consists of three different oils which distil over at different temperatures, the first product being named Eucalyptol, C12H20O, which by the action of Phos- phoric Acid is converted into Eucalyptene, a substance allied to Cymene, and Eucalyptolen. Preparations. Extraclum Eucalypti Fluidum,—alcoholic. Dose, Ttpx-gj. Oleum Eucalypti,—the volatile oil, distilled from various species of Eucalyptus, that from E. amygdalina being considered wanting in Eucalyptol. Dose, rrLv-xxx in capsules or emulsion. Tinctura Eucalypti (Unofficial),—Dose, 3 ss-ij. Physiological Action. The taste of Eucalyptus is warm, aromatic, bitter and camphoraceous. It increase’s the flow of saliva, the gastric juice and the intestinal secre- tions, and in small doses promotes appetite and digestion, increases the heart’s action and lowers arterial tension. In large doses it produces eructations, indigestion, diarrhoea, nausea and vomiting, lowered tempera- ture, great muscular weakness, and if continued will irritate and congest the kidneys, and induce a feverish state with symptoms of cerebral con- gestion, and great constitutional disturbance. Toxic doses are fatal by paralysis of respiration through direct action on the spinal cord. It is powerfully antiseptic, and destructive to low forms of life, a stimu- lating expectorant and an efficient diaphoretic. By some authorities it is believed to reduce the size of an enlarged spleen, and to possess anti- malarial properties by absorbing noxious germs as well as by draining the soil of its water, and by its aseptic emanations purifying the atmosphere in its vicinity. It is largely cultivated in malarial districts for these properties, and is reported to have rendered habitable a portion of the deadly Roman Campagna. Eucalyptus is eliminated by the skin, bronchial mucous membrane and the kidneys, imparts its odor to the breath and the urine, and is more or less irritant at the points of its elimination. EUONYMUS—EUPATORIUM. 213 Therapeutics. Eucalyptus is an efficient stomachic in atonic dyspepsia, chronic gastric and intestinal catarrh, and in conditions of the intestinal canal which favor the development of worms. In chronic catarrhal conditions of the genito-urinary organs, the broncho-pulmonary mucous membrane, and especially the bladder, it is very useful, acting as a stimulant and disinfec- tant to the mucous membranes. It is equally beneficial in chronic bron- chitis and bronchorrhcea, in cachectic states generally, and in convales- cence from acute diseases. In hysteria, chorea and asthma it is beneficial, in the latter affection being advantageously smoked in cigarettes with Stramonium or Belladonna Leaves. In malaria as a reconstructant it is better than Quinine, and it has considerable utility in obstinate intermit- tents where it is desirable to stop the use of Cinchona preparations. As an antiseptic it is highly valued in dilute solution for application to ulcers, and as a substitute for Carbolic Acid on gauze in the antiseptic treatment of wounds. It is also used in dilute solution locally as a stimulating dis- infectant in stomatitis and in the subacute stages of pharyngitis and ton- sillitis. An aqueous preparation is highly recommended as a vehicle for alkaloids in solutions for hypodermic use, to prevent the development of the penicillium which rapidly destroys the alkaloid present. EUONYMUS, Wahoo ,—is the bark of Euonymus atropurpureus, a shrub of the nat. ord. Celastraceae, growing in the U. S. Occurs in quills or curved pieces, about J-y inch thick, of ashy-gray color and acrid, sweetish taste. It contains an amorphous, bitter principle named Euony- min, also Resins, Enonic Acid, and Asparagin, fixed oil, etc. Extractum Euonymi,—Dose, gr. j-v. Euonymin (Unofficial),—the eclectic preparation, consists of the fixed oil and resin, and is given in doses of gr. ss-v. Euonymus is classed with Rhubarb, Jalap, Aloes, etc., as a tonic-astrin- gent and resin-bearing purgative. It is said to be also diuretic and expec- torant, and a very efficient cholagogue. Its cathartic action is similar to that of Rhubarb but milder. It has been employed with benefit in some cases of dropsy, also in habitual constipation, torpid liver, and pulmonary affections. In overdoses it will set up considerable gastro-intestinal irri- tation. EUPATORIUM, Thorough-wort, Boneset,—the leaves and flowering tops of Eupatorium perfoliatum, an American plant of the nat. ord. Compositse, having lanceolate leaves, two united at the base, each 4 to 6 inches long, of weak, aromatic odor and bitter, astringent taste. It 214 EUPHKASIA FEL BOVIS. contains a neutral, bitter principle, named Eupatorin, tannic acid, a vola- tile oil, etc. Extracti Eupatorii Eluidum,—Dose, lqpc-^j. Boneset is a bitter tonic and efficient diaphoretic, also in full doses emetic and aperient. It has been supposed to have antiperiodic and tseniafuge powers. A warm infusion (Boneset tea) is a popular diapho- retic in remittent and typhoid fevers, and at the onset of an attack of acute catarrh or general cold. As a bitter tonic it may be used with ad- vantage in dyspepsia and general debility. Its common name is derived from its supposed power to relieve the bone pains of dengue or the “ break- bone fever.” Another variety of Eupatorium, E. purpureum, or Gravel-root, is reputed to have decided power over the uric acid diathesis. EUPHRASIA, Eye-bright,—is a small annual plant of the nat. ord. Strophulariaceae, growing in Europe and the U. S., odorless, of astringent taste, and containing Euphrastic Acid, tannin, etc. It was formerly of great repute in various eye-affections, and may be of utility as a mild astringent in catarrhal conjunctivitis. Its chief value, however, is to abort an attack of acute nasal catarrh with lachrymation, for which purpose a few drops of the tincture every two hours is remarkably effi- cient. In hay-fever also it is of decided utility in mitigating the catarrhal symptoms, and in the acute coryza of measles it will be found an excel- lent remedy. A tincture (i to 9) of the fresh plant should be used, and given in doses of n^j-v. FEL BOVIS, Ox-gall, —the fresh gall or bile of Bos Taurus, is a dark-green, viscid liquid, of peculiar odor, bitter taste, and neutral or faintly alkaline reaction. Sp. gr. 1.018 to 1.028. It contains Glyco- cholate of Sodium, Taurocholate of Sodium, Cholesterin and coloring matter. Preparations. Eel Bovis Inspissatum, Inspissated Ox-gall,—100 parts of fresh Ox-gall evaporated to 15 parts, after straining. Dose, gr. v-xv. Eel Bovis Purification, Purified Ox-gall,—3 of Ox-gall and I of Alcohol evaporated to pilular consistence, after standing 24 hours, decanting, filtering, etc. Dose, gr. v-xv. Physiological Action and Therapeutics. Bile is tonic, antiseptic and purgative. It assists in the emulsification of fats, and stimulates the absorbent powers of the mucous membrane. In the stomach it neutralizes the gastric juice, precipitating the pepsin, and is apt to cause nausea and vomiting. Recently it is found to act well in stimulating the resolution of hypertrophies when locally applied to the FERRUM. 215 part, as the mammae, tonsils, pannus, etc. It is used as a laxative in con- stipation when the natural secretion of bile is deficient, but has no advan- tage over other purgatives. FERRUM, Iron, Fe,—is metallic Iron in the form of fine, bright and non-elastic wire. Ferrum Reductum, Reduced Iron,—consists of metallic Iron in fine powder, obtained by reducing the Sesquioxide by hydrogen at a dull red heat. It is a very fine, gray-black, lustreless powder, odorless, tasteless, and insoluble in water and alcohol, but soluble in dilute sulphuric acid with the evolution of nearly odorless hydrogen gas. Dose, gr. j-v, after meals. Iron Compounds and iheir Preparations. Liquor Ferri Acetatis,—is an aqueous solution of Ferric Acetate, containing 33 per cent, of the anhydrous salt. A dark red-brown transparent liquid of acetous odor, sweet ish and faintly styptic taste, reaction slightly acid. Action,—stimulant, ferruginous, little if any astringency. Used to prepare the following tincture. Tinctura Ferri Acetatis,—has of the preceding 50 parts, Alcohol 30, Acetic Ether 20. A clear, dark red-brown liquid, of acetous odor, acidulous and slightly astringent taste, and slight acid reaction. Miscible with water in all proportions. Dose, rr^x-gij. Svrupi Ferri Bromidi,—is a syrupy liquid containing 10 per cent, of Ferrous Bro- mide, FeBr2. A pale green, odorless liquid, of sweet ferruginous taste and neutral reac- tion. Action,—a sedative chalybeate tonic, especially recommended in nervous disorders, and by Da Costa in chorea. Irritant in large doses. Dose, tryv-xxx. Ferri Carbonas Saccharatus,—has at least 15 per cent, of ferrous carbonate. A green- ish-gray powder, of sweetish taste at first, changing to ferruginous. Partially soluble in water, but soluble in dilute hydrochloric acid with evolution of C02. Action,—slightly stimulant to digestive tract. Dose, gr. ij-x with food. Massa Ferri Carbonatis,—Vallet’s Mass,—Sulphate of Iron 100, Carbonate of Sodium no, Honey 38, Sugar 25, Syrup, Distilled Water, each q. s. ad 100 parts. Has 42 per cent, of ferrous carbonate. Action,—non-astringent, unirritating, ferruginous tonic. Dose, gr. iij-v after food. Mistura Ferri Composita, Griffith’s Mixture,—Sulphate of Iron 6, Myrrh 18, Sugar 18, Carbonate Potassium 8, Spirit of Lavender 50, Rose water 900 parts. Is really a solu- tion of the carbonate, with sulphate of potassium to suspend the iron salt. Is an excel- lent mixture, but disagreeable. Dose, ss. Pilulce Ferri Composita, Griffith’s Pills,—Sulphate of Iron gr. Carbonate of Sodium Myrrh gr. jss, Syrup q. s. in each pill answering in composition to the preceding. Dose, ij-vj. Ferri Chloridum, Perchloride of Iron, Fe2Cl6.i2H20,—orange-yellow, deliquescent, crystalline pieces, of styptic taste and acid reaction, freely soluble in water, alcohol or ether. Action,—strongly astringent, hemostatic. Never used internally. Liquor Ferri Chloridi,—an aqueous solution of the preceding, containing 37.8 per cent, of the anhydrous salt, with some free IICl acid. Action,—strongly astringent and styptic. Rarely used internally. Dose, Tffiij-x, well diluted. Tinctura Ferri Chloridi,—has of the preceding 35 parts in 65 of Alcohol. A bright, brownish liquid, of ethereal odor, styptic taste and acid reaction. Is used in Mistura Ferri et Ammonii Acetatis. One of the best preparations of iron. Action,—ferruginous tonic. Dose, in water, syrup or glycerin. Ferri Citras, Fe2(C6H507)2.6H20,—garnet-red, transparent scales, slowly soluble in water, not in alcohol. Action,—mildly stimulant. Dose, gr. ij-v. Formed by evapor- ating the following: Liquor Ferri Citratis,—is an aqueous solution of the preceding, containing about 35J per cent, of the anhydrous salt. A dark-brown liquid, of slightly ferruginous taste and acid reaction. Action,—as Ferri Citras. Dose, Tt^v-xv. Vinum Ferri Citratis,—made from the Citrate of Iron and Ammonium 4, Tincture of FERRUM. Sweet Orange-peel 12, Syrup 12, stronger White Wine 72 parts. An iron elixir. Dose, 3 j-ij- Ferri Hypophosphis, Fe2(H2P02)6, Ferric Hypophosphite,—a white or grayish-white powder, odorless, tasteless, slightly soluble in water, freely so in HC1 acid or in a solution of sodium citrate. Action, ferruginous tonic. Dose, gr. v-x. Ferri Iodidum Saccharatum,—a yellowish-white powder, very hygroscopic, odorless, of sweetish, ferruginous taste, and slightly acid reaction, soluble in 7 of water at 590 F., insoluble in alcohol. Action,—ferruginous tonic. Dose, gr. v-xxv in pill or elixir. Pilulce Ferri lodidi,— made with Reduced Iron, Iodine, Licorice, Sugar, Acacia and Water, covered with a coating of Balsam of Tolu in Ether. “ Blancard’s Pills” only differ from these by being covered with a coating of reduced iron to protect the interior from oxidation, but it also protects them from the solvent action of the gastric juice. Dose, 1 or 2 pills ter in die. Syrupus Ferri lodidi,—is a syrupy liquid containing 10 per cent, of ferrous iodide. A transparent, pale-green liquid, of sweet, ferruginous taste and neutral reaction. Action,— ferruginous tonic. Dose, rt\v-xxx. Ferri Lactas, Fe(C3H503)2.3H20, Ferrous Lactate,—pale, greenish-white, crystal- line grains, soluble in 40 of water at 590 F., freely in citrate of sodium, almost insoluble in alcohol. Action,—feebly ferruginous tonic Dose, gr. j-iij in pill or syrup. Is a constituent of Syrupus Hypophosphitum cum Ferro. Liquor Ferri Nitratis,—is an aqueous solution of Ferric Nitrate, Fe2(N03)6, con- taining about 6 per cent, of the anhydrous salt. A transparent, amber colored liquid, of acid, styptic taste, and acid reaction. Action,—medium as to irritation, astringent and hemostatic. Dose, tl\v-xv, well diluted. Ferri Oxalis, Ferrous Oxalate, FeC204.H20,—a pale yellow, crystalline powder, very slightly soluble in water. Dose, gr. ij in a pill. Ferri Oxidum Hydratum, Ferric Hydrate, Fe (HO)6, is a brown-red magma wholly soluble in HC1 acid without effervescence. Should be freshly prepared from the Solution of Tersulphate of Iron 10 parts and Water of Ammonia 8 parts. Is the chemical anti- dote for Arsenic. Dose,' a teaspoonful in water frequently repeated. The solutions should be kept ready for use. Ferri Oxidum Hydratum cum Magnesia,—is made by mixing when required for use (1) Solution of Tersulphate of Iron 1000 grains, Water, 2000 grains. (2) Magnesia 150 grains, Water xxxij. This should be administered as directed under the preceding head. It is more convenient and a more efficient antidote for Arsenic than the simple ferric hydrate, as the excess of the alkaline precipitant is non-irritant and is itself an anti- dote to arsenic. Emplaslrum Ferri, Strengthening Plaster,—has of Hydrated Oxide of Irion, dried, 10 parts, Canada Turpentine 10, Burgundy Pitch 10, Lead Plaster 70. Trochisci Ferri,—each has of Hydrated Oxide of Iron, dried, gr. v, Vanilla gr. y Sugar, and Mucilage of Tragacanth. Dose, j-iij, ter die. Ferri Phosphas,—Bright-green, transparent scales, of acidulous, saline taste, soluble in water, not in alcohol. Used as an adjuvant to laxative pills to prevent the after reaction- ary constipation. Dose, gr. v-x. Made by reaction between the Citrate of Iron and the Phosphate of Sodium. Ferri Pyrophosphas,—Green, transparent scales, of acidulous taste, soluble in water but not in alcohol. Is almost tasteless and unirritating, and non-constipative. Dose, gr. ij-v. Made by reaction between the Citrate of Iron and the Pyrophosphate of Sodium. Ferri Sulphas, Ferrous Sulphate, FeS04-7H20,—large, pale bluish-green prisms, efflo- rescent, of saline, styptic taste, and acid reaction, soluble in 1.8 of water at 590 F., insoluble in alcohol. Is chiefly used to make the Dried Sulphate and other preparations. Ferri Sulphus Exsiccatus, Dried Ferrous Sulphate, FeS04.H20,—a grayish-white powder, nearly soluble in water, consisting of the preceding salt, heated gradually to 300° F., until it ceases to lose weight. The most astringent and irritating ferrous salt, but an excellent one in small doses. Is a constituent of Pil. Aloes et Ferri. Dose, gr. ss-ij in pill. Ferri Sulphas Prcecipitatus, Precipitated Ferrous Sulphate, FeS04-7H20,—is the same salt as above described, precipitated by Alcohol from solution in dilute sulphuric acid. Dose, gr. ss-ij. Liquor Ferri Suhsulpkatis, Monsel’s Solution,—is an aqueous solution of Basic Ferric Sulphate, Fe40(S04)5, containing 43.7 per cent, of the salt. A dark reddish-brown, almost syrupy liquid, of very astringent but not caustic taste, and acid reaction, mixing with water or alcohol in all proportions without decomposition. Is but slightly irritating FERRUM, 217 and powerfully astringent, chiefly used locally as an astringent and hemostatic, but may be given internally in doses of rt\^iij—x, well diluted. Liquor Ferri Tersulphatis,—is an aqueous solution of Normal Ferric Sulphate, Fe2(S04)3, containing 28.7 per cent, of the salt. Has the same properties as described for the preceding, but a less sp. gr. Is used to make other preparations of Iron. Ferri Valerianas, Fe2(C3Hg02)6,—a dark, tile-red, amorphous powder, of faint, valerianic odor, and mildly styptic taste, insoluble in cold water, decomposed by hot water, readily soluble in alcohol. Of doubtful value as a valerianate. Dose, gr. j-iij in pill. Preparations of Compound Iron Salts. Ferri et Ammonii Citras, Ammonio-ferric Citrate,—prepared from Solution of Citrate of Iron 3 parts, Water of Ammonia 1, mixed and evaporated. Transparent, garnet-red scales, deliquescent, soluble readily in water, insoluble in alcohol. Dose, gr. ij-v. Ferri et Ammonii Sulphas, Ammonio-ferric Alum,—pale, violet crystals, efflorescent, of styptic taste and slightly acid reaction, soluble in 3 of water at 590 F., insoluble in alcohol. Is the least astringent of the sulphates of iron, but more so than any of the salts formed by vegetable acids. Dose, gr. iij-xv. Ferri et Ammonii Tartras, Ammonio-ferric Tartrate,—made from Liq. Ferri Tersul- phatis 90, Tartaric Acid 60, Aq. Ammonise 72, Ammonium Carbonate, Water q. s. Transparent, reddish brown scales, slightly deliquescent, of sweetish and slightly ferru- ginous taste, very soluble in water, insoluble in alcohol. Contains an equivalent of about 25 per cent, of Ferric Oxide, and has but slight irritant qualities. Dose, gr. v-xx. Ferri et Potassii Tartras, Potassio-ferric Tartrate,—made from Liq. Ferri Tersulphatis 12, Potassii Bitart. 4, Aq. Destil. 32, Aq. Ammonise, et Aquae q. s. Transparent, garnet- red scales, slightly deliquescent, of sweetish and slightly ferruginous taste, very soluble in water, insoluble in alcohol. Is the least disagreeable in taste of all the iron preparations, and contains a little more ferric oxide than the preceding salt. Is but slightly astringent and is not constipating. Dose, gr. v-x. Ferri et Quinince Citras,—prepared from Ferri Citras 88, Quinine, dried, 12, Aq. Destil. q. s. ad 100, mixed and evaporated. Thin, transparent yellowish-brown scales, slowly deliquescent, of bitter taste, slowly soluble in water, slightly soluble in alcohol. Contains 12 per cent, of dry quinine. Action,—astringent and stimulant to the digestive tract. Dose, gr. iij-v. Liquor Ferri et Quinince Citratis,—made directly from Ferri et Ammonii Citras 65, Quinine, dried, 12, Ac. Citric. 28, Alcohol 30, Aq. Destil. q. s. ad 200. A greenish- brown liquid, of bitter taste and slightly acid reaction. Contains 6 per cent, of quinine. Is very slowly soluble and of doubtful value. Dose, tt\v-xv. Vinum Ferri Amarum, Bitter Wine of Iron,—has of the preceding 8 parts, Tinct. Aurantii Dulcis 12, Syrup 36, Stronger White Wine 44. May replace the various “ elixirs of iron and calisaya.” Dose, gj-iv. Ferri et Strychnines Citras,—Ferri et Ammonii Citras 98, Strychninse 1, Ac. Citric 1, Aq. Destil. 120, mixed and evaporated. Transparent, garnet-red scales, deliquescent, readily soluble in water, slightly so in alcohol. Contains 1 per cent, of Strychnine. Action,—astringent and stimulating. Dose, gr. j-iij. Syrupus Ferri, Quinince et Strychnines Phosphatum, Syrup of the Phosphates of Iron, Quinine and Strychnine. [Described under Phosphorusl\ Syrupus Hypophosphihim cum Ferro, Syrup of Hypophosphites with Iron. [Described under Phosphorus. ] Mistura Ferri et Ammonii Acetatis, Basham’s Mixture,—is properly a Liquor, and is prepared from Tr. Ferri Chloridi 2, Ac. Acet. Dil. 3, Liquor Ammonii Acet. 20, Elixir Aurantii 10, Syrup 15, Water 50 parts. An elegant and agreeable preparation, having some power as a diuretic and a diaphoretic. Dose, 3 ij-v, well diluted. Unofficial Preparations of Iron. Ferri Albuminas, Albuminate of Iron,—a cinnamon-brown powder, soluble in water acidulated slightly with HC1. Dose, gr. x-xxx, in simple aqueous solution, or in pill. Ferri Arsenias, Ferrous Arseniate, Fe3As208,—a green, tasteless powder, insoluble in water, soluble in HC1 acid. Its activity is due to the arsenic alone. Dose, gr. tV~£- Ferrum Dialysatum, Dialysed Iron,—composition varies from Fe2Cl6.i2Fe203 to Fe2Cl6.95Fe203, and is a 10 per cent, solution of Ferric Oxychloride in water. Prepared by treating a solution of Chloride of Iron with Ammonia, ferric hydrate being precipitated, 218 FERRUM. this being dissolved by agitation is placed in a dialyzer and suspended in water, which is renewed as long as it shows a trace of HC1 acid. It is a reddish-brown liquid, free from astringent, styptic taste, but is a very feeble chalybeate, incapable of absorption except by change into a hydrated sesquioxide in the alimentary canal. Is used as a chalybeate, and as an antidote to Arsenic, but is not considered an eligible preparation. Dose, TT^x—xxx. Syrupus Ferri et Manganesii lodidi, Syrup of the Iodide of Iron and Manganese,—is a pale, straw colored liquid, containing a little sulphate of potassium, and in each fluid has 50 grains of the mixed iodides in the proportion of Iodide of Iron 3 parts, to 1 of Iodide of Manganese. Dose, TT\,x-xxx- gj Syrupus Ferri et Manganesii Phosphatis, Syrup of the Phosphate of Iron and Man- ganese,—as used by Dr. Simpson of Edinburgh, contains in each g of syrup 2 grains of the Phosphate of Iron and 1 grain of Phosphate of Manganese. Dose, gj. Mistura Ferri Aromatica,—Pale Bark 4, Calumba 2, Cloves 1, Iron wire 2, Tr. Car- damomi Co. 12, Tr. Aurantii Cort. 2, Aq. Menth. Pip. 50,—Macerate the first 4 in the last one for 3 days, filter, add the tinctures and make up to 50. Dose, Mistura Ferri Laxans,—Ferri Sulph. gr. ij, Magnesii Sulph. gj, Ac. Sulphurici Dil. Ttpiij, Spt. Chloroformi U\xx, Aq. Menth. Pip. ad gj. Mistura Ferro-salina,—Magnesii Sulph. Potassii Bitart, gj, Ferri Sulph. Exsic. gr. x, Aquae quart j. Dose, a wineglassful. Notes on the Preparations. Oxides and Carbonates, including Ferrum Reductum, Ferri Car- bonas Saccharatus, Mistura Ferri Composita, Pil. Ferri Comp., Massa Ferri Carb., Ferri Oxidum Hydratum, Ferri Oxidum Hyd. cum Mag- nesia, and Mist. Ferri Aromatica,—possess the haematinic action of iron with but little astringency, and are therefore selected to restore the blood in anaemia, chlorosis and amenorrhoea, with tendency to dyspepsia and constipation. The Hydrated Oxides are only used as antidotes in arsenical poisoning. Ferrum Reductum is one of the best forms for internal use, but gives rise to sulphuretted or phosphoretted eructations which are very disagreeable. The Subcarbonate is little more than the Red Oxide, but in the Massa Ferri Carb. the oxidation is prevented by the sugar. Mineral Acid Salts and their preparations comprise the Sulphate in its 3 forms, the solutions of the Subsulphate and Tersulphate, the Phos- phate, Pyrophosphate and Hypophosphite, the Chloride and its prepara- tions and the Liquor Ferri Nitratis. They are characterized by their astringent and corrugating action, and are used locally especially as hemostatics, the Solution of the Subsulphate being preferred for topical use as it is powerfully styptic but not corrosive. The Tincture of the Chloride is one of the best preparations for internal use, and is most agreeable in the form of Creuse’s tasteless preparation, which is made as follows,—Liq. Ferri Chloridi gj, Acidi Citrici 544 grains, Sodii Carb. 1000 grains or q. s., Aquae Destil. 3j> Alcoholis q. s. Dissolve the citric acid in the distilled water and heat to the boiling point, gradually adding sodium carbonate until the acid is saturated ; mix this with the iron solu- tion and make up to Siv with alcohol. Of the Phosphates the best is the Pyrophosphate, which is easily assimilated, readily soluble and entirely unirritating. FERRUM. 219 Vegetable Acid Salts and their preparations comprise the Lactate, Citrate and its preparations, Oxalate, and the preparations of the Acetate and the Tartrate. They are the least irritating to the stomach but are also the least efficient as chalybeates. They may be administered in white wines, or with alkalies and vegetable acids in effervescing mix- tures. The Albuminate is considered by several authorities to be the most readily assimilated of all the iron preparations. Other Compounds are those in which Iron is combined with bodies equally active, as the Syrup of the Bromide, the preparations of the Iodide, those with Quinine, Strychnine, etc. Generally these prepara- tions are used for a two-fold purpose, namely to relieve anaemia and at the same time act upon the specific ailment on which the anaemia depends. Physiological Action. Metallic Iron is not inert, for in the stomach it acquires molecular activity through its oxidation, setting hydrogen free. It is a normal con- stituent of the blood (i part to 230 of red corpuscles), existing probably as an oxide in combination with haematin, which is not formed without it. It is also found in the bile, lymph, chyle, gastric juice, in the pigment of the eye, in the milk and the urine. Given medicinally in small doses it promotes appetite and digestion, and improves the quality of the blood, increasing the number of the red corpuscles. In the stomach all the salts of iron are converted into the Chloride and in the duodenum into an alka- line albuminate, entering the blood along the whole length of the ali- mentary canal. Large doses, or small ones long-continued are directly unfavorable to digestion, nausea and vomiting are produced by the soluble preparations, the per-salts are actively irritant, the Iodide, Chloride, Nitrate and Sulphate being active poisons, highly astringent, and act injuriously on the teeth. Only a small portion of iron is absorbed, the rest being eliminated by the intestinal canal, blackening the faeces by conversion into a sulphide. Of the portion absorbed from the alimentary canal, only a small part reaches the systemic circulation and is eliminated by the kidneys, the greater part being excreted by the liver with the bile. Locally most of the iron salts are more or less constringing to the tissues and the mucous membranes, acting as hemostatics and astringents by virtue of their power to coagulate albumen, and acting injuriously on the teeth. The Tincture of the Chlorate is considered diuretic. Incompatibles. Alkalies and their carbonates, acids, acidulous salts and vegetable astringents are incompatible with most preparations of iron, the latter group being so by virtue of their tannic and gallic acids which form a deep blue-black precipitate (tannate of iron) with the per-salts. The Tincture of the Chloride is decomposed by alkalies, alkaline earths 220 FERRUM. and their carbonates, astringent vegetable infusions, and by mucilage of acacia, which latter produces therewith a brown, semi-transparent jelly. The chief indication for the internal administration of Iron is anaemia; when plethora exists it is contraindicated. It should always be given after meals, and occasionally suspended for a time, to avoid deranging the stomach. When appetite and digestion are promoted by Iron it will do the greatest amount of good, many authorities holding that the prin- cipal benefit derived from its use, even in anaemia, is due to its stimulating digestion and the primary assimilation. The Sulphate is here probably the most efficient salt and is well used in combination with aloes when there exists any intestinal torpor, especially as it increases the cathartic power of the latter drug, economizing it, and conferring upon it a permanence of action, which alone it does not possess. In pseudo-leuco- cythaemia, chorea of anaemic girls at the age of puberty, epilepsy and neuralgia of the anaemic, amenorrhoea and other menstrual disorders of the same class of subjects, and in acute rheumatism of pale, cachectic persons, the chalybeates are generally very efficient remedies, especially the Tincture of the Chloride. The same preparation is extensively employed in erysipelas and diphtheria with good results. In albumi- nuria with chronic disease of the kidneys the Tinctures of the Chloride and of the Acetate are useful as chalybeate diuretics. In many cardiac diseases of the anaemic, fatty heart, weak heart, dilatation, mitral disease, etc., ferruginous preparations are often of signal advantage. In the syphilitic cachexia, chancroid, and sloughing phagedena, the Iodide gives good results, particularly when the subject is one of debilitated constitution. In the nocturnal incontinence of children the Syrup of the Iodide is one of the most efficient remedies. In all chronic affections of the respiratory organs, when hemorrhage is not existing or threatened, the Phosphate of Iron, Quinine and Strychnine is used with much benefit. In passive hemorrhages, especially when due to anaemia, the Tincture of the Chloride is very effective, and in all active bleeding the Solution of the Subsulphate locally used is a prompt and efficient hemostatic. A weak solution of this preparation (3j ad Sviij) used in the form of spray is the most serviceable astringent in obstinate epistaxis, and in hematemesis the same solution may be swallowed in small quantities at short intervals. In chronic diarrhoea and dysentery the Solution of the Nitrate is an efficient astringent, and a weak solution of the Chloride is used as a rectal injection against thread-worms. In arsenical poisoning the most effective antidote is the Hydrated Oxide, which forms with Arsenious Acid an almost insoluble compound. The solutions used in its preparation should be kept on hand and only mixed when wanted for use. Therapeutics. FICUS FCENICULUM FRANGULA. 221 FICUS, Fig ,—is the fleshy receptacle of Ficus Carica, bearing fruit upon its inner surface. The fig-tree is a member of the nat. ord. Urtica- ceae and a native of the shores of the Levant, but is cultivated in Southern Europe and in other warm countries. Figs contain about 62 per cent, of grape sugar, also gum, fat, etc., and are a constituent of the official Confectio Sennse. Figs are demulcent, laxative and nutritious. They are used in their fresh state as an aliment, but if eaten in quantity may produce flatulence, enteralgia and diarrhoea. They are chiefly used as an article of diet in habitual constipation, but maybe employed as an ingredient of demulcent decoctions, and locally as a poultice to gum-boils. FCENICULUM, Fennel, —is the fruit of Foeniculum vulgare, a European cultivated plant of the nat. ord. Umbelliferse. It is to yz of an inch long, oblong, slightly curved, separable into 2 mericarps, and having 5 ribs, and several oil-tubes, odor and taste aromatic. It contains a volatile oil, united with a terpene, and is a constituent of Pulvis Glycyr- rhizae Compositus. Oleum Fceniculi,—the volatile oil a light-yellow colored liquid, having the odor of fennel, a warm taste and neutral reaction, soluble in alcohol. It is an ingredient of Spiri- tus Juniperi Compositus. Dose, Trpij-v. Aqua Fceniculi,—contains 2 parts of the oil in 1000 of distilled water percolated through cotton. Dose, gss-^j. Fennel is an aromatic stomachic and a mild stimulant. It is chiefly used as an agreeable carminative in flatulence and colic, and as a corri- gent to Senna, Rhubarb, and other disagreeable medicines. An infusion is often used as an enema to expel flatus in infants. FRANGULA, Buckthorn,—the bark, collected at least one year before being used, of Rhamnus Frangula, or Alder Buckthorn, a Euro- pean shrub of the nat. ord. Rhamnaceae. Occurs in quilled pieces inch thick, outer surface of gray-brown color, with numerous small warts. It contains several principles, of which the only important one is Frangulin, or Rhamnoxanthin, a lemon-yellow, odorless and tasteless glucoside, in- soluble in water and but sparingly so in alcohol or ether, and thought to be identical with Cathartin, the active principle of Senna. Another species of the genus Rhamnus is described under the title Cascara Sagrada, see ante, p. 158. Extractum Frangulce Fluidum,—Dose, 3 ss-ij. Frangula-bark when fresh is a violent irritant to the gastro-intestinal tract, producing vomiting, purging, and much pain. The old dried bark 222 FUCHSIN—FUCUS VESICULOSUS GALBANUM. is a safe purgative without irritant qualities, and is much used in the con- stipation of pregnancy, and other conditions requiring purgation. The fluid extract is the best form for administration. FUCHSIN, Ros6ine, Magenta, Anilin Red (Unofficial),—is the Hydrochlorate of Rosanilin, C20H10N3.HC1, occurring in brilliant, elongated crystals having a green lustre, readily soluble in water and therein making a bright red solution. Given internally it has produced salivation, vomiting, and diarrhoea; and when injected intravenously it has caused trembling, staggering, albuminuria and fatty degeneration of the kidneys, symptoms which are thought to be possibly due to the presence of Arsenic or Anilin as impurities. It imparts a magenta color to the urine, and is excreted by the kidneys, liver and salivary glands. It has been found to be very efficient in reducing albuminuria, in many instances having entirely arrested it. It is best administered in pill with a vegetable extract as Licorice or Gentian, and in doses of gr. according to age. FUCUS VESICULOSUS, Bladder-wrack, Sea-wrack (Un- official),—is a perennial plant of the nat. ord. Algae, growing on the shores of the Atlantic and Pacific Oceans as a sea-weed. It has a flat leaf, with a midrib throughout its length, and small spherical vesicles, filled with air, in the leaf. It contains mucilage and much Soda in saline com- bination, also Iodine, but less of the latter than other algae growing in deeper water. A decoction of the fresh plant is the best form for admin- istration. Fucus Vesiculosus is one of a number of marine plants which are used in various parts of the world as food for man and cattle and as manure. The species under consideration is considered alterative and tonic, and has been employed in goitre, glandular and joint enlargements and psoriasis, but especially to produce absorption of adipose tissue in the obese. An extract is sold under the title “Anti-fat.” GALBANUM ,—is a gum-resin obtained from Ferula galbaniflua, an Asiatic plant of the nat. ord. Umbelliferse, and probably from other allied plants. It occurs in minute tears, agglutinated into a hard mass, of balsamic odor and acrid, bitter taste. It contains a Volatile Oil iso- meric with Turpentine, a Gum, and a mixture of Resins which yield by dry distillation a blue oil and Umbelliferon, a tasteless substance in satiny crystals. Dose, gr. x-xx, in pill or emulsion. GALLA GAULTHERIA. 223 Pilulce Galbani Composite,—each pill contains of Galbanum i]/z grain, Myrrh \)A grain, Asafetida ]/2 grain, and Syrup. Dose, ij-iij. Emplastrum Galbani,—Galbanum 16, Turpentine 2, Burgundy Pitch 6, and Lead- plaster 76 parts. Galbanum is also an ingredient of Emplastrum Asafoetidae. Galbanum is stimulant, expectorant and antispasmodic, acting much like Ammonia and Asafetida, and usually given with either of these sub- stances. It is used in chronic bronchitis and catarrh of mucous mem- branes generally, in amenorrhcea and chronic rheumatism. The plaster is used as a stimulant application to indolent swellings. GALLA, Nutgall ,—is an excrescence on Quercus lusitanica, the Dyer’s Oak, a shrub of the nat. ord. Cupuliferae, growing in Western Asia, and is caused by the puncture and deposited ova of the insect Cynips Gallce tinctoricz. Galls are hard, globular bodies, from yi to inch in diameter, of blackish-gray color, tuberculated on the surface, having a central cavity, and an intensely astringent taste. They contain from 15 to 75 per cent, of Tannic Acid, about 5 per cent, of Gallic Acid, and other unimportant constituents. Dose, gr, v-xv. Tinctura Galte,—strength 20 per cent. Dose, 3 ss-iij. Unguentum Galte,—strength 10 per cent. The action of Nut-galls is powerfully astringent, due to the Tannic and Gallic Acids contained in them. Having no special action or use of their own, their qualities may be learned by consulting the articles Acidum Tannicum and Acidum Gallicum, ante, pages 74 and 63. GAULTHERIA, Wintergreen ,—is the leaf of Gaultheria pro- cumbens, an American evergreen plant of the nat. ord. Ericaceae, having a peculiar flavor, a fragrant odor, and an aromatic and astringent taste. Its active principle is the Volatile Oil, which is official. It also contains Tannic Acid, Arbutin, Urson, Ericolin, etc. Oleum Gaultherice, Oil of Wintergreen,—is the volatile oil, a liquid of peculiar and aromatic odor, sweetish, warm taste, and a slightly acid reaction. It is readdy soluble in alcohol, and consists of Methyl Salicylate 90 per cent., and Gaultherilene, a hydrocarbon, 10 per cent. Dose, npiij-x. Spiritus Gaultherice,—has of the oil 3 per cent., dissolved in 97 of alcohol. Used for flavoring. Dose, 3 ss—ij. Gaultheria is stimulant and slightly astringent. Its chief value is as one of the sources of the oil named after it, which is also found in the sweet birch and many other plants, and, containing so large a proportion 224 GELSEMIUM. of Methyl Salicylate or Methylsalicylic Acid, is powerfully antiseptic and antipyretic. In large doses it is irritant to the stomach, in one case 3j having caused death by violent gastritis. Oil of Gaultheria is used successfully as a substitute for Salicylic Acid in many conditions, especially in rheumatic and gouty disorders. The plant has been used as an emmenagogue and a galactagogue, but its prin- cipal employment is in the form of the spirit as an agreeable flavoring agent. GELSEMIUM, Yellow Jasmine,—is the rhizome and rootlets of Gelsemium sempervirens, a climbing plant of the nat. ord. Loganiaceae, with showy yellow flowers, which grows in the forests of the southern U. S. forming festoons from one tree to another. The rhizome is cylin- drical, long, about an inch thick, of a light yellowish-brown color, an aromatic, heavy odor and a bitter taste. It contains a volatile oil, a resin and an alkaloid Gelsemine in combination with Gelsemic Acid. Dose, gr. ij-xx. Preparations. Extractum Gelsemii Fluidum,—alcoholic. Dose, rtyij-xx. Tinctura Gelsemii,—strength 15 per cent. Dose, tryx-^j. Gelsemina, Gelsemine, CjjHjgNO,, (Unofficial),—an amorphous, colorless, inodorous, nearly insoluble solid, of intensely bitter taste, and strong basic properties, neutralizing the strongest acids and with them forming soluble salts. Dose, gr. Physiological Action. Gelsemium is a powerful motor-depressant, causing paralysis of motility and depression of sensibility by central action on the spinal cord. It is also antispasinodic and diaphoretic. In moderate doses it produces languor, slowing of the cardiac rate, enfeebled muscular action, impaired sensibility, drooped eyelids and dilated pupils, with some diaphoresis. In toxic dose, as a teaspoonful of the fluid extract, it produces vertigo, diplopia, drooped eyelids and dilated pupils (paralysis of 3d nerve), labored respiration, slow and feeble heart, dropped jaw, staggering gait, extreme muscular weakness and almost complete anaesthesia, profuse diaphoresis, loss of articulation, and death by asphyxia from paralysis of the muscles of respiration, consciousness being preserved until C02 nar- cosis sets in. Convulsions occur in animals with backward movements, but not in man. Motion is affected before sensibility in warm-blooded animals, sensibility before motion in frogs. Gelsemium is not an arterial depres>ant, although it lowers the heart- rate, and is not irritant to the gastro-intestinal tract, but it produces a decided lowering of the body temperature. The effects of a moderate dose pass off in about three hours. GENTIANA. 225 Antagonists and Incompatibles. Morphine is the most complete antagonist, so are also Digitalis, Ammonia, Alcohol, and to some extent the tincture of Xanthoxylum fraxineum. Emetics, heat, faradization of the respiratory muscles and artificial respiration are measures of prime importance. The caustic alkalies and tannic acid are chemically incompatible. Therapeutics. Gelsemium is indicated in all conditions of exalted nerve function, and contra-indicated whenever there is a weak heart. It is best used in cerebro-spinal meningitis, mania with great motor excitement and persist- ent insomnia, delirium tremens, many forms of sleeplessness, pneumonia and pleurisy if the heart be strong, coughs of convulsive and spasmodic character, neuralgia of the fifth nerve, remittent fever, after-pains, ovarian neuralgia, dysmenorrhoea, irritable bladder of women, and incontinence of urine from spasm of the vesical muscular fibres. In most of these affections the remedy must be pushed to the inducing of some physio- logical symptoms, but its action should not be carried beyond the produc- tion of drooped eyelids, diplopia and muscular debility. It has also been used with varying success in intercostal neuralgia, myalgia, sciatica, spasmodic asthma, sick headache, eczema, pruritus and tetanus. Its espe- cial field, however, is in remittent and typho-malarial fevers and cerebro- spinal meningitis. It is not suitable to low fevers and has not sufficient power as a cardiac depressant to be of much use in sthenic forms. There is much evidence for the claim made for the drug Gelsemine, of singular efficiency in antagonizing the mental condition occasionally manifested by an unusual degree of dread, in regard to some approach- ing ordeal, or ordinary trial of life ; as for example, that of a woman concerning her impending confinement, or of a student in reference to his examinations. In very many such cases, the use of Gelsemine, in small doses frequently repeated (gr. T ter die), has seemed to remove the state of abnormal fear entirely. GENTIANA, Gentian ,—is the root of Gentiana lutea, the Yellow Gentian, one of a numerous family of plants (nat. ord. Gentianaceae), which inhabit the mountainous districts of Europe. An American species, G. Catesbcei, Blue Gentian, is considered nearly equal in value to the official species. Gentian occurs in cylindrical pieces or longitudinal slices of the root, which is y? to x inch thick and several inches long, brown externally, yellowish-brown within, of faint, peculiar odor, and taste at first sweetish, afterwards persistently bitter. It contains an active, bitter glucoside, Gentopicrin or Gentianin, C2oH30012, which is crystalline 226 geranium. and soluble in water, also an inert, amorphous body Gentianic or Gentesic Acid, gum, considerable sugar, and a trace of a volatile oil, but no tannin. Preparations. Extractum Gentiance,—aqueous. Dose, gr. j-v. Extractum Gentiance Fluidum,—Dose, 3 ss-j. Tinctura Gentiance Composita,—Gentian 8, Bitter Orange Peel 4, Cardamom 2, Di- luted Alcohol to 100. Dose, 3 ss—ij. Unofficial Preparations. Infusum Gentiance Compositum,—contains Gentian 10, Bitter Orange Peel 2]/2, Cori- ander 2Alcohol 40, Water to 320. Dose, 3j-^j. Mistura Gentiance Alkalina,—Ac. Hydrocyan. Dil. TTLiij, Sodii Bicarb, gr. xv, Infusum Gentian® Co. to §j. One dose. Mistura Gentiance et Sennce,—Infusum Sennse 3 iij, Tr. Cardamomi Co. 3j, Infusum Gentian® Co. 3 vj. One dose. Physiological Action and Therapeutics. Gentian is a simple bitter without astringency or aroma, its action cor- responding to that of Calumba (see ante, page 145), but it is more apt to disagree with the stomach. In addition, like Cornus, a member of the same class, it has considerable repute as an antiperiodic and febrifuge. Gentian has been considered a valuable tonic throughout all Europe from the earliest historical times. It is highly esteemed as a stomachic tonic in dyspepsia connected with a gouty diathesis, in hysteria, jaundice, and in convalescence from acute diseases and from malarial fever. The compound tincture is an excellent vehicle for cod-liver oil, and the now unofficial infusion is a good vehicle for the administration of chalybeates, mineral acids and neutral salts. The discoloration which iron salts make with gentian preparations is probably due to Gentesic Acid and not to tannin, as it contains none of the latter. GERANIUM, Cranesbill-root, —is the rhizome of the indigenous perennial Geranium maculatum (nat. ord. Geraniaceae). It is 2 or 3 inches long, horizontal, contorted and tuberculated, with thin, fragile rootlets, inodorous, taste astringent. Its active constituents are tannic and gallic acids. Preparatio7i. Extractum Geranii Fluidum,—Dose, n\v~3j. Physiological Action and Therapeutics. Geranium is an efficient astringent, and its action corresponds with that of Tannic Acid (see ante, page 74). Having no unpleasant taste it is a useful agent for infants and others having delicate stomachs, and is a very popular domestic remedy in many parts of the country. It is especially used in diarrhoeas, dysentery, cholera infantum, hemorrhages, relaxed conditions of mucous membranes, gleet and leucorrhcea. GLYCERINUM. 227 GLYCERINUM, Glycerin, —is a liquid obtained by the decom- position of fats or fixed oils, containing not less than 95 per cent, of absolute Glycerin, C3H5(HO)3, which exists in fats and fixed oils in com- bination with the fatty acids. Glycerin is clear and colorless, of syrupy consistence, hygroscopic, non-drying, odorless, of warm and very sweet taste, neutral reaction, sp. gr. 1.250, soluble in water and alcohol, but insoluble in ether, chloroform and fixed oils. It dissolves tannin, gallic acid, carbolic acid, salicylic acid, bromine, iodine, etc., and with the aid of heat metallic salts and oxides, alkaloids, etc. With strong Nitric Acid it forms Nitro-glycerin, and it reduces potassium permanganate, chromic acid and chlorinated lime with great violence. An impurity frequently present in it is Acrolein, formed by the use of too high a heat in its manufacture, and which is very acrid and poisonous. Glycerin is a constituent of Glyce- ritum Amyli, Glyceritum Vitelli, Pilulte Phosphori, Mucilago Tragacanthae, Massa Hy- drargyri, and several extracts and fluid extracts. Dose, 3 j —ij, diluted. Physiological Action. Glycerin is highly antiseptic, abstracts water from tissues with which it comes in contact, and unless pure is often very irritating to the skin. It is freely absorbed by all surfaces, cutaneous and mucous, and is decom- posed in the system, passing out as formic and other acids. On the stomach it has no particular action, but in large quantities it is laxative and is said to cause the solution of the red blood corpuscles and hoerno- globinuria. The urine of persons using glycerin contains a body which acts like sugar in the copper and fermentation tests, but is not sugar. Glycerin is a good emollient and is considered nutritive by many au- thorities. Therapeutics. Glycerin has been used as a substitute for Cod-liver Oil in wasting dis- eases, but with little benefit. It has also been tried as a remedy in diabetes, but with unsatisfactory results so far as reported, except as a sweetening substitute for sugar in the dietary of those afflicted with that disease. It is said to be fatal to intestinal trichinae, and to be an efficient internal remedy in acne and flatulence. In chronic constipation, most excellent results are obtained from rectal enemata of Glycerin, or from suppositories thereof made with soap or gelatin (y to give them consis- tency. As a vehicle it is used for many drugs, and is a good ingredient of solutions for hypodermic use, promoting the solubility of many alka- loids and acting as an antiseptic. It is also employed to preserve and aid the action of the digestive ferments, Pepsin and Pancreatin, as well as to prevent the decomposition of vaccine lymph. Locally it is valuable in many cutaneous affections as an emollient and softening agent. In acute coryza it gives great relief if applied by a brush or as a spray to the nasal mucous membrane. It is used on cotton to the cervix uteri as a depleting agent, and mixed with an infusion of flaxseed as an enema to relieve tenesmus in acute dysentery. With tine- 228 GLYCYRRHIZA. ture of Benzoin it is an excellent application to chapped hands or lips and fissured nipples. In the external auditory canal it is usefully employed to soften cerumen, diminish the secretion of pus, deplete the tissues, and keep the surface moist. [For other uses of Glycerin in combination see Glyceritum Vitelli, Glyceritum Amyli, and Glyceritum Acidi Tannici, under the titles of their respective bases.] GLYCYRRHIZA, Liquorice Root, —is the root of Glycyrrhiza glabra, a plant of the nat. ord. Leguminosse, native in southern Europe and Asia, but largely cultivated in many other parts. It occurs in long pieces, } to 1 inch thick, longitudinally wrinkled, of a grayish-brown color externally, tawny-yellow internally, pliable and tough, and of a somewhat acrid, sweet taste. It contains a yellow, amorphous glucoside, Glycyrrhizin, C24H3609, also Glycyrrhizic Acid, A spar agin, sugar, resin, gum, etc. Glycyrrhizin when boiled with dilute acids yields glucose and a very bitter substance named Glycyrretin. Extraction Glycyrrhizce,—is the commercial extract of the root, occurring in glossy- black rolls, of sweet, peculiar taste. Not less than 60 per cent, of it should be soluble in cold water. Extraction Glycyrrhizce Purum,—made with Aqua Ammonia and Water, by percola- tion and evaporation to a pilular consistence. Dose, indefinite. Extraction Glycyrrhizce Eluidum,—made with Aqua Ammonia and diluted Alcohol. Dose, indefinite. Mistura Glycyrrhizce Composita, Brown Mixture,—has of the Pure Extract 3 parts, Sugar 3, Acacia 3, Tr. Opii Camph. 12, Vinum Antimonii 6, Spt. Altheris Nitrosi 3, and Water 70. Dose, gj-^ss. Pulvis Glycyrrhizce. Compositus,—Senna 18, Glycyrrhiza 16, Fennel 8, Washed Sul- phur 8, Sugar 50 parts. Dose, a teaspoonful. Trochisci Glycyrrhizce et Opii,—each has of Extract of Glycyrrhiza gr. ij, Extract of Opium gr. Acacia, Sugar and Oil of Anise. Dose, j-ij every hour. Glycyrrhizinum Ammoniatum, Ammoniated Glycyrrhizin,—the sweet principle of Liquorice rendered soluble and therefore tasteable by Ammonia, believed to be the form in which Glycyrrhizin exists in the root. Occurs in brownish-red scales, very sweet, and soluble in water or in alcohol. Dose, gr. v-xv. Is a constituent of Veloutine, for which see page 182. Preparations. Physiological Action and Therapeutics. Liquorice is demulcent and mildly laxative. It has an agreeable taste, and increases the flow of saliva and mucus when slowly chewed or sucked, the increased secretions acting as emollients to the throat. It is used in many pharmaceutical preparations, covering the taste of Senna, Senega, Hyoscyamus, Turpentine, Chloride of Ammonium, bitter Sulphates, and to some degree the bitterness of Quinine. The powdered extract or root is used as an excipient in pills and troches. The Compound Mixture is an efficient expectorant, much employed in acute bronchitis and catarrhal laryngitis, but owing its power over cough mainly to the Opium contained in it. The Compound Powder is a gentle laxative, of which Senna is the GOSSYPIUM. 229 most active ingredient. The Troches are used for cough, but must be carefully prescribed to children as they contain gr. of Extract of Opium in each. GOSSYPIUM, Cotton,—is the hair of the seed of Gossypium her- baceum, and of other species of Gossypium (nat. ord. Malvaceae), freed from adhering impurities and deprived of fatty matter. In this form it is known as Purified or Absorbent Cotton, is insoluble in water, alcohol or ether, but is soluble in an ammoniacal solution of Cupric Sulphate. Cot- ton-fibre is familiar in appearance to every one, but when examined microscopically, it shows as flattened, hollow and twisted bands, spirally striate, and slightly thickened at the edges. It is a modification of Cel- lulose, C12H10O10, and corresponds therewith in all its ordinary chemical properties. Preparations of the Cotton Plant. Gossypii Radicis Cortex, Cotton Root Bark,—thin bands or quilled pieces, brownish yellow exteriorly, white interiorly, of slightly acrid and astringent taste. Dose, gr. XXX-3J- Extraction Gossypii Radicis Fluidum,—made with Glycerin and Alcohol, by macera- tion and percolation. Dose, ttkxxx-^j. Oleum Gossypii Seminis, Cotton-seed Oil,— the fixed oil expressed from the seeds and purified. Is yellow, odorless, of bland taste and neutral reaction, soluble in ether, but slightly soluble in alcohol. Is introduced into the pharmacopoeia for the reason that it constitutes most of the “ Olive Oil ” sold in foreign-shaped bottles and under foreign- appearing labels. It is directed to be used in the official Liniments of Ammonia, Lime, Camphor, and Sub-acetate of Lead. Pyroxylinum, Pyroxylin, Soluble Gun-cotton,—is official for the purpose of making Collodium. It is prepared by macerating Cotton in a mixture of Sulphuric and Nitric Acids, washing, draining and drying. Collodium, Collodion,—made by dissolving Pyroxylin 4, in Ether 70 and Alcohol 26 parts. Collodium Flexile, Flexible Collodion,—Collodion 92, Canada Turpentine 5, Castor Oil 3 parts. Collodium Stypticum, Styptic Collodion,—Collodion 55, Ether 20, Alcohol 5, Tannic Acid 20 parts. Collodium cum Cantharide, Cantharidal Collodion,—Cantharides 60, Flexible Collo- dion 85, Chloroform q. s. Physiological Action. Cotton-root is believed to be an efficient emmenagogue and oxytocic by Southern practitioners, also somewhat of a galactagogue, but experi- ments on pregnant animals have not confirmed this view of its action. The Oil of the seed is very bland and may be applied to all the purposes for which Olive Oil is used. Cotton itself, when freed from oily matter, is remarkably absorbent of water, and is a good agent for excluding air from injured surfaces. Pvroxylin is highly inflammable, and explosive at 300 F. Collodion is also inflammable, and rapidly dries on exposure to the atmosphere by evaporation of its ether, leaving a transparent film of Pyroxylin on the surface to which it has been applied ; which film, if the flexible collodion be used, does not contract on drying or readily 230 granatum. crack, making it an excellent protective application. Styptic Collodion is a solution of Tannin, and is an excellent hemostatic. Cantharidal Collodion is a convenient blistering agent, suitable for cases where the patient is inclined to remove a blister if applied in the ordinary way. Therapeutics. Absorbent Cotton is a valuable agent in surgical practice, being em- ployed as an application in burns and scalds, erysipelas, articular rheuma- tism, etc., to exclude the atmosphere, allay pain, and when covered with oiled-silk or rubber cloth to keep up local perspiration. It may be car- bolated, borated or salicylated by soaking in the respective solutions, and then used as an antiseptic dressing for wounds, ulcers, etc. It is employed by the pharmacist in funnels to filter oils, and for the preparation of the official waters. Cotton-root Bark is much employed by the negroes of the southern states in decoction as a supposed abortifacient, oxytocic and emmena- gogue. It is used in the south for intensifying uterine action in normal labor, in dysmenorrhoea and amenorrhoea. A decoction of % iv in a quart of water boiled to a pint is the favorite preparation, administered in wineglassful doses. Collodion is used as a protective covering for superficial burns, ulcers and wounds, slight cuts, cracked nipples, anal fissures, and erysipelas. For these affections the flexible collodion should be used, but where it is desirable to produce pressure on the part the ordinary form is best, as it contracts in drying with considerable force. This property makes it highly useful in drawing the edges of wounds together, bringing pressure on buboes, incipient boils, carbuncles, etc. Styptic Collodion has many uses as a hemostatic and protective which will suggest themselves, and the Cantharidal form is a convenient epi- spastic for uneven surfaces, the therapeutics of which are detailed under Cantharis. (See ante, page 152.) GRANATUM, Pomegranate,—is the bark of the root of Punica Granatum, a small tree of the nat. ord. Granataceae, cultivated in sub- tropical countries. It occurs in thin quills of yellowish-gray color, warty or ridged on the external surface, inodorous, of astringent and slightly bitter taste. It contains Tannic and Punico-tannic Acids, Mannite and an active liquid alkaloid Pelletierine, C8H13NO, which is soluble in water, alcohol, ether, chloroform, etc., and has strong basic properties. There are no official preparations. Extractum Granati Fluidum,—Dose, 3 ss-jss. Decoctum Granati,— 3 xvij of bark from the fresh root in 5 xvij of boiling water, Unofficial Preparations. GRINDELIA. boiled down to § xij and strained. Dose, 3 iv-vj every hour, preceded and followed in a few hours by a brisk cathartic. The decoction of the Br. Phar. is of 1 to 8 strength and is given in doses of ij-iv. Pelletier hue Tannas, Tannate of Pelletierine,—Dose, gr. v-xx, taken fasting and fol- lowed in 15 minutes by a sharp purgative. Granatum and its alkaloid are tgeniafuge, and very efficiently so, rarely failing to bring away the whole worm. The decoction is usually em- ployed, but lately Pelletierine has been coming into fashion, a proprietary form being sold as “Tanret’s Pelletierine” in bottles containing one adult dose at three dollars each. The decoction, in full doses, causes nausea and vomiting, flatulence, purging, and sometimes cramps in the legs, giddiness, dimness of vision, general numbness of the limbs and in- crease of the quantity of urine. For the expulsion of tape-worm a mixed treatment by Pomegranate- root bark, Pumpkin seeds and Oleo-resin and Male-fern is preferred by many practitioners. The following formula has proved very efficient. R. Granati 5ij, Aquae Ojss, boiled to SvijPepinis Sj> deprived of outer coats and beaten to a paste with fine-powdered sugar; Oleoresinae Aspidii, gr. xxx, made into emulsion with Acacia and the above decoction of Granatum, then added to the paste of Pepo, and flavored with Syrups up to Six, one-third of this to be taken in the morning after a light diet and a laxative on the previous day. If not successful the second and third portions may be taken at intervals of 3 hours. The worm should be passed sitting in a tepid sitz-bath to prevent the expelled portion tearing off”*the head by its weight. Physiological Action and Therapeutics. GRINDELIA,—the leaves and flowering tops of Grindelia robusta, an herbaceous Californian plant, of the nat. ord. Compositae, having a branched stem, lower leaves spatulate and tapering at the base, upper leaves oblong, pointed and have broad bases, flowers yellow, odor bal- samic, taste pungently aromatic and bitter. It contains a resin, a volatile oil, and an alkaloid with basic properties. Preparation. Extractum Grindelice Fluidum,—Dose, npx-gj. Grindelia is antispasmodic and a motor-depressant, inducing paralysis in small animals beginning in the hind extremities. It slightly slows the heart and respiration, and produces mydriasis and hypnotic effects if given in sufficient quantity, with reduced cutaneous sensibility and slug- gish reflexes. It has a pungent taste, creates a sense of warmth in the stomach, and in small doses promotes appetite and digestion. It is elimi- Physiological Action. 232 GUAIACUM. nated by the pulmonary mucous membrane and the kidneys, and is markedly diuretic. Therapeutics. Grindelia has been used chiefly in spasmodic asthma, bronchitis and whooping-cough, which it greatly relieves. It is a useful remedy in spas- modic coughs, dyspnoea of various pulmonary and cardiac affections, hay-fever, and chronic cystitis. Locally it is highly efficient as a sedative lotion (1 part of the fluid extract to 10 of water) in poisoning by Rhus toxicodendron, and in skin diseases attended with itching and burning sensations. GUAIACUM, Lignum Vitae,—is official in two forms, Guaiaci Lignum, the heart-wood, and Guaiaci Resina, Guaiac, the resin of the wood of Guaiacuin officinale, a large West Indian tree of the nat. ord. Zygophyllaceae. The Resin is the important constituent, and itself con- sists of three resins, namely,—Guaiaconic Acid, C19H20O5, 70 per cent., Guaiac Acid, C6H803, resembling Benzoic Acid, and Guaiarec Acid, C20H26O4; also an indifferent resin. The wood also contains a yellow coloring matter, gum, etc. Guaiaci Lignum, Guaiacum Wood,—generally used in the form of raspings of greenish-brown color containing whitish particles, of resinous odor, taste slightly acrid. Is a constituent of Decoctum Sarsaparillge Compositum. Guaiaci Resina, Guaiac,—occurs in large masses of a greenish-brown or reddish-brown color, feebly aromatic, taste somewhat acrid, fracture having a glassy lustre, insoluble in water, soluble in alcohol, ether, chloroform and alkaline fluids. Dose, gr. v-xxx, in wafer. Preparations. Tinctura Guaiaci,—Guaiac 20 per cent. Dose, in mucilage or syrup, as the resin is precipitated by water. Tinctura Guaiaci Ammoniata,—Guaiac 20, Aromatic Spirit of Ammonia 80 parts. Dose, rtbv-^ss. Guaiac is diaphoretic, expectorant and alterative. Its taste is acrid and very disagreeable. Internally it is a local stimulant, producing salivation, an acrid sensation in the throat, warmth in the epigastrium, increase of the gastric and intestinal secretions and the flow of bile, and reflex stimu- lation of the heart. Its continued use causes gastric catarrh, and in large doses it is a gastro-intestinal irritant, causing vomiting, purging and severe congestive headache. Though a colloidal body it enters the blood, stimulates the liver and other excretory glands and the production of bronchial mucus, and causes increased circulation and diaphoresis. Sometimes it fails to act on the skin and then is markedly diuretic. Physiological Action. GUARANA—GURJUN BALSAM. 233 Incompatibles. Mineral Acids and Spirit of Nitrous Ether are chemically incompatible with Guaiac preparations. Therapeutics. Guaiacum was first used as an antisyphilitic, being used in decoction and in large quantity, with a spare diet and external warmth. It acquired a great reputation in this disease during the 16th century, but it is now abandoned for this purpose except as an ingredient of the Compound Decoction of Sarsaparilla. It is a very efficient remedy in tonsillitis, given in 5 ss doses of the tincture in emulsion with mucilage or yolk of egg, to abate the inflammation and abort the disease. It has considerable reputation in neuralgic dysmenorrhoea, amenorrhcea, chronic rheumatism, gout, lumbago and sciatica. The ammoniated tincture in water makes a cleanly and not very disagreeable gargle. GUARANA ,—is a dried paste prepared from the crushed or ground seeds of Paullinia sorbilis, a climbing plant of the nat. ord. Sapindaceae, growing in Brazil. It occurs in brown cakes or sticks, having an odor of chocolate and a bitter, astringent taste, partly soluble in water and in alcohol. It contains 25 per cent, of tannic acid, gum, albumen, starch, and a greenish fixed oil, also an alkaloid Guaranine (5 per cent.), which is identical with Caffeine. The specimens of Guarana in the market are very untrustworthy, unequal in quality and expensive, it being a secret mixture prepared in Brazil. Hence it has been omitted from the list of Squibb’s preparations, and a fluid extract of green coffee substituted in its place. Preparation. Extracium Guarance Fluid urn,—Dose, uyx- g ij. Physiological Action and Therapeutics Guarana has similar actions to those of Coffee, the active principles of both plants being identical, both chemically and physiologically. It is chiefly employed in the treatment of nervous sick-headache (migraine) administered in half-drachm doses of the fluid extract when the attack is developing. It has been used in the diarrhoea of phthisis, convalescence from acute diseases, and generally in conditions requiring tonic treatment. GURJUN BALSAM, Wood Oil, Balsamum Dipterocarpi (Unofficial),—is an oleoresin obtained from incisions in various trees of the genus Dipterocarpus, growing in India. It is thick, opaque and grayish-brown by reflected light, soluble in chloroform and partly so in alcohol, ether and volatile oils, odor balsamic, taste bitter. It contains 234 GUTTA PERCHA—H^MATOXYLON. from 40 to 70 per cent, of a Volatile Oil, a Resin and Gurjunic Acid. Dose, nbx-3ij, in emulsion, or in capsules. Physiological Action and Therapeutics. The properties of this balsam are similar to those of Copaiba, but it is less disagreeable and less apt to upset the stomach, also less actively diu- retic. It has been used with good success in leprosy, given internally in full doses and used locally at the same time. Mixed with 4 parts of Lime- water it is well applied in chronic eczema, lupus and psoriasis. GUTTA-PERCHA ,—is the concrete exudation of Isonandra Gutta, a large tree of the nat. ord. Sapotaceae, growing in the Malay peninsula and adjoining islands. Occurs in tough but somewhat flexible pieces, of grayish or yellowish color, plastic above 140° F., soft at 212° F., insol- uble in water or alcohol, soluble in chloroform, oil of turpentine, carbon bisulphide, benzin and benzol. It contains a hydrocarbon Gutta, Ci0H16 (80 per cent.), two Resins named Fluavil and Albau, also a volatile oil, salts, fat and coloring matter. Preparations. Liquor Gutta-Perchce,—a solution of Gutta-Percha 9, Carbonate of Lead 10, in Chlo- roform um Venale 91 parts. Used as a protective application to eruptions and slight wounds, the evaporation of the menstruum leaving behind a thin adhesive and non-irrita- ting pellicle. Traumaticine (Unofficial),—is the name given to a 10 per cent, solution of Gutta-percha in Chloroform, which forms on drying a permanent, unirritating, adhesive, flexible and non-contractile skin for the treatment of skin affections and slight wounds. It forms an excellent basis for the application of Chrysarobin to psoriasis. Uses. Gutta-Percha has neither physiological action nor therapeutics, being used for its physical qualities alone. In surgical practice it has several applications, making a good material for splints, as it can be softened in hot water and adapted to any surface while pliable. From it are manu- factured pessaries, specula, stethoscopes and other instruments. The solution may be used as a protective covering for excoriations and slight wounds, to prevent pitting in small-pox, and to paint over the line of suture after post-mortem examinations. Log-wood,—is the heart-wood of Hcema- toxylon campechianum, a tree of the nat. ord. Leguminosae, native of tropical America, but naturalized in the West Indies. It occurs in chips or powder of a dark brown-red color, often with a greenish lustre, of feeble and agreeable odor, taste sweet and astringent, and colors the saliva a dark pink when chewed. It contains tannic acid, and a sweet, crystal- hamamelis. 235 line coloring principle named Hattiatoxylin, C10HuO6, which is colorless when pure, but turns red on exposure to light. Extractum ILematoxyli,—Dose, gr. v-xx. Decoctum Hcematoxyli (Unofficial),—strength I in 17. Dose, j—ij. Preparations. Physiological Action and Therapeutics. Logwood is mildly astringent, its properties depending on the tannin contained in it. As it is devoid of irritating qualities it is well adapted to the diarrhoeas and hemorrhages of young children. It does not pro- duce constipation nor disorder the bowels, but colors the urine and stools blood-red, and has caused phlebitis. It has been used as an hemostatic in bleeding of the lungs, and hemorrhages from the uterus and intestines, and as an astringent in leucorrhcea. HAMAMELIS, Witch-hazel,—the leaves, collected in autumn, of Hamamelis virginica, a shrub of the nat. ord. Hamamelaceae, growing in the United States, having yellow flowers and oval-shaped leaves about 4 inches long, which are inodorous, but of a bitter and astringent taste. They contain about 8 per cent, of tannic acid, a bitter principle and probably some volatile matters, but the chemistry of the plant has not been fully studied. Preparations. Extractum Hamamelidis Fluidum,—Dose, is the only official preparation, and is prepared from the leaves. Hamamelin (Unofficial),—is an uncertain extract of very indefinite composition. Dose, gr-j-ij- Distilled Extracts, so-called, but really Waters distilled from the bark, are sold by various manufacturers, and are said by the vendors to contain the volatile principles of the plant. Pond's Extract is such a preparation, said to be made by distilling the bark with a very dilute alcohol, and is a proprietary medicine of uncertain composition. Physiological Action and Therapeutics. No trustworthy experimentation has yet been made with this drug. It is tonic, astringent, styptic and sedative, owing most of its properties to its tannin, but appears to possess some special influence over the venous circulation similar to that of Aconite on the arterial system. In full doses it may produce severe throbbing pain in the head. It is used both internally and locally with great benefit in hemorrhoids, particularly those of the bleeding variety, varicose veins and ulcers, varicocele, venous con- gestions and threatening local inflammations. It is highly recommended in hemorrhages from the nose, stomach, lungs, rectum and kidneys, threatened abortion, and externally for sprains and bruises, foul ulcers, the pruritus of eczema, leucorrhcea and gonorrhoea. An Ointment of Witch-hazel is found in the shops, and suppositories may be prepared 236 HEDEOMA—HELLEBORUS. extemporaneously by evaporating the fluid extract and incorporating the residue with cocoa-butter. HEDEOMA, Pennyroyal,—the leaves and tops of Hedeoma pule- gioides, a plant of the nat. ord. Labiatae, common to all parts of the U. S., having a four-sided, hairy stem, pale blue flowers, leaves inch long, glandular on the under surface, odor strong and mint-like, taste pungent. Its only important constituent is the Volatile Oil, which is official. Oleum Hedeomce, Oil of Pennyroyal,—is the volatile oil, readily soluble in alcohol. Dose, rtpij-x. Spiritus Hedeomce (Unofficial),—contains I part of the oil in 9 of alcohol. Used ex- ternally or as spray. Preparations. Hedeoma is a stimulant aromatic, also somewhat carminative and emmenagogue. Its odor is extremely repulsive to insects, especially fleas and mosquitoes. In warm infusion it is a popular remedy for amenorrhoea and flatulent colic. It may be used as a corrective with other medicines, and the spirit is well employed on the hands and face to keep away mos- quitoes. The writer has known death by narcosis to result from an over- dose of the oil taken to produce an abortion. Physiological Action and Therapeutics. HELLEBORUS, Hellebore (Unofficial),—the rhizome and root- lets of Helleborus niger (Black Hellebore) and Helleborus viridis (Green Hellebore), plants of the nat. ord. Ranunculacese, natives of Europe. A third variety, Helleborus occidentalis, growing in Greece, is probably the true Hellebore of the ancients. The rhizome is i to 3 inches long, knotty, with transverse rings, of rancid odor when freshly bruised, and bitter, acrid taste. Its most important constituents are two glucosides, Helleborin and Helleboreln, both crystalline and very poisonous. Preparations. Extractum Hellebori Nigri (Unofficial),—Dose, gr. j-x, cautiously. Exlractum Hellebori Nigri Fluidum (Unofficial),—Dose, tryj-xv. Helleborin, C36H4206 (Unofficial),—crystalline, insoluble in water, soluble in alcohol and chloroform. Helleborein, C26H44015 (Unofficial),—crystalline, very soluble in water, slightly so in alcohol, insoluble in ether. Dose, gr. iV Physiological Action. Black Hellebore is a drastic, hydragogue cathartic, and an emmen- agogue. In overdoses it is a violent gastro-intestinal irritant, producing vomiting, hypercatharsis, vertigo, cramps and convulsions, which may re- sult fatally. Locally applied, the fresh root is violently irritant to the skin, producing inflammation and vesication. HOANG-NAN. 237 Helleborin is an active poison, acting on the tongue like Aconite, and on the nervous system as a narcotic, producing in animals paresis of motion and sensation, cerebral and spinal congestion, dilated pupils and death. It is less irritant than Helleborein to the mucous membranes. Helleborein is less actively toxic to animals, but is very irritant, producing conjunctivitis, sneezing, salivation, nausea, vomiting and purging. It affects the heart like Digitalis, small doses frequently re- peated slowing its action, but large ones quicken it and then suddenly paralyze it through the pneumogastric nerve. Respiration is at first accelerated, then slowed and rendered laborious. Diuresis is a constant result, the kidneys and uterus are congested, gradual paralysis and severe convulsions follow, and death occurs by paralysis of the heart. Black Hellebore is an old remedy, having been highly esteemed by the early physicians in insanity, dropsies, worms, cutaneous affections and amenorrhcea. It has at present gone out of fashion, but might be usefully employed in dropsies and as a revulsant in acute cerebral affections. Recently Hellebore'in has come into notice as a substitute for Digitalis in cardiac affections, as being of less bulk and more definite composition. Its action on the heart is obtained by doses much smaller than those necessary for its irritant effects on the gastro-intestinal canal. Its solu- bility in water and the freedom with which it can be used hypodermically are important qualities to recommend it. Therapeutics. HOANG-NAN, or Hwang-Nao,—is the bark of Strychnos Gaul- theriana, or Tropical Bind-weed, a creeping vine of the nat. order Loganiacese, found in the mountains of Tonquin. It contains the alka- loids Strychnine and Brucine, thus resembling in composition its con- geners Nux-Vomica and Ignatia, but differing from them, as they do from each other, in the proportional quantities in which the alkaloids are contained,—Brucine predominating in this plant, as Strychnine does in the other two. Like the other members of the Strychnos family, Hoang-Nan is an active tetanizer, its action generally corresponding with that of Nux- Vomica. It was first brought into notice by the missionary fathers stationed in the French colonies in Asia, they having found its employ- ment general among the natives for leprosy and hydrophobia. Along the coast of Tonquin and Cochin-China, and in Pondicherry, Trinidad, Physiological Action and Therapeutics. 238 HUMULUS. Venezuela, etc., it has an established reputation in the two terrible diseases mentioned, also as a remedy for the bites of venomous serpents and other reptiles, scrofulous and syphilitic ulcers, indolent sores, etc. It has been used successfully for malarial fevers, in lieu of quinine, and is highly spoken of by Father Brosse, as a stimulant to the intellect, without producing any subsequent depression. The Dose of the powdered drug is about gr. iij-v;—of the aceto- alcoholic Extract, gr. ;—and of the concentrated Tincture, npj-v. HUMULUS, Hops, —the strobiles (fruit-cones) of Humulus Lupu- lus, a cultivated creeping plant of the nat. ord. Urticacese. They are ovate, 1 to inch long, and consist of a hairy, undulating axis and several membranous, greenish scales, odor aromatic, taste bitter, aromatic and slightly astringent. Its constituents are wax, resins (50 per cent.), tannin (5 per cent.), a liquid volatile alkaloid Lupuline, a Volatile Oil (2 per cent.) which consists in part of Valerol and Trimethylaitiine, and a crys- talline, bitter principle Lupulinic Acid (11 per cent.). These, except tannin, are more abundant in the glandular powder of the strobiles, which is named Lupulin. Tinctura Humuli,—strength 20 per cent. Dose, gj-ij. Lnfusum Humuli (Unofficial),— 3 ss to the pint. Dose, 3 j-iv. Lupulinum, Lupulin,—is the glandular powder separated from the strobiles, of bright brownish-yellow color, aromatic and bitter taste. The Volatile Oil resides in the Lupulin grains, and contains Valero!, which is changed into Valerianic Acid by long exposure, giving a disagreeable odor to old hops. Dose, gr. v-xv. Extradum Lupulini Fluidum,—alcoholic. Dose, Tfipc-gj. Oleoresina Lupulini,—an ethereal extract. Dose, gr. ij—v. Tinclura Lupulini (Unofficial),—strength *4. Dose, g ss-ij. Mineral acids and metallic salts are chemically incompatible with preparations of Hops. Preparations. Humulus is a bitter tonic, a feeble hypnotic, and somewhat diaphoretic, astringent and anaphrodisiac. It increases the cardiac action and the cutaneous circulation. After slight cerebral excitement it produces calm and a soporific disposition, especially if the solution administered be strongly alcoholic. The stomachic and tonic effects are due to the bitter principle, lupulinic acid, and are found in bitter ale. The primary stimulant and secondary sedative effects are due to the volatile oil and are also possessed by ales and beer. Hops are used as a tonic and calmative in delirium tremens, in which a combination of the tincture with Tr. Capsici is very efficient and is an excellent substitute for alcohol. In dyspepsia of atonic form Humulus is an excellent stomachic tonic, and in nervous irritability the fluid extract of Lupulin may be used as a calmative and hypnotic, or the hop-pillow, which certainly exercises considerable influence, imaginary or other- HYDRANGEA HYDRARGYRUM. 239 wise. A poultice of hops is a favorite domestic application in inflammations and pain. Lupulin has been used with benefit in irritable bladder, alcoholism, and as an ana- phrodisiac in the treatment of chordee, gonorrhoea, spermatorrhoea and other affections of the genito-urinary organs. HYDRANGEA (Unofficial),—is the root of Hydrangea arborescens, a plant of the nat. ord. Saxifragacege, growing in the southeastern U. S. It is a white, tough root, having a thin brown bark which peels off in spots, inodorous, taste insipid, afterwards pungent. It contains gum, albumen, starch, resin, and a ferrous salt, with other salts. Dose, 5ss-5ij, best in fluid extract. A decoction of the root may be used in doses of §j-ij. Hydrangea has been long used by the Cherokee Indians in calculous affections, and reports of cases by competent observers show that it is of unquestionable utility in this class of disorders, promoting the removal of gravel from the bladder, and relieving pain during the passage of renal concretions through the ureters. Large doses produce vertigo, oppression of the chest, and considerable cerebral disturbance. HYDRARGYRUM, Mercury, Quicksilver, Hg,—is a shining, silver-white metal, fluid and slowly volatile at ordinary temperatures, solidifies at —40° F., boils at 662° F., volatilizes without residue, insoluble in ordinary solvents, wholly soluble in nitric acid, of sp. gr. 13.5, odorless and tasteless. Preparations of Mercury. Hydrargyrum cum Creta, Mercury with Chalk, Gray Powder,—has of Mercury 38, Sugar of Milk 12, Prepared Chalk 50, Ether and Alcohol, triturated together to a uniform gray powder. Dose, gr. ss-x. Massa Hydrargyri, Blue Mass, Blue Pill,—contains of Mercury 33 parts, Liquorice 5, Althaea 25, Glycerin 3, Honey of Rose 34. Each grain contains gr. of Mercury. Dose, gr. ss-xx. Unguentum Hydrargyri, Mercurial Ointment, Blue Ointment,—Mercury 450, Lard 225, Suet 225, Compound Tincture of Benzoin 40, Old Mercurial Ointment 100 parts, triturated until globules of Mercury cease to be visible under a magnifying power of 10 diameters. Emplastrum Hydrargyri, Mercurial Plaster,—Mercury 30, Olive Oil 10, Resin 10, Lead Plaster 50 parts. Emplastrum Amtnoniaci cum Hydrargyro,—see ante, page 93. Chlorides and their Preparations. Hydrargyri Chloridum Corrosivum, Corrosive Chloride of Mercury, Bichloride, Mercuric Chloride, Corrosive Sublimate, HgCl2,—heavy colorless crystals, of acrid, metallic taste, acid reaction, soluble in 16 of water and 3 of alcohol at 590 F., in 2 of boiling water, 1.2 of boiling alcohol and in 4 of ether. Dose, gr. 3^-TV HYDRARGYRUM. Hydrargyri Chloridum Mite, Mild Chloride of Mercury, Subchloride, Mercurous Chloride, Calomel, Hg2Cl2,—a heavy, white, impalpable powder, insoluble in water, alcohol or ether, odorless and tasteless. Is an ingredient of Pil. Antimonii Co. and Pil. Catharticse Co. Dose, gr. Hydrargyrum Animoniatum, Ammoniated Mercury, White Precipitate, Mercur- ammonium Chloride, NH2HgCl,—is a white, insoluble powder, odorless and tasteless. Only used externally. Unguentum Hydrargyri Ammoniati, White Precipitate Ointment,—Ammoniated Mercury 10, Benzoinated Lard 90 parts. Hydrargyri Oxidum Flavum, Yellow Oxide of Mercury, Precipitated Oxide, HgO,— an orange-yellow, heavy, impalpable powder, odorless and tasteless, insoluble in water or alcohol, but wholly soluble in nitric or hydrochloric acid. Used to prepare: Unguentum Hydrargyri Oxidi Flavi,—strength I to 9 of Ointment. Oleatum Hydrargyri,—Yellow Oxide 10, Oleic Acid 90. Hydrargyri Oxidum Rubrum, Red Oxide of Mercury, HgO,—a heavy, orange red crystalline powder, having the same properties as the yellow oxide, from which it differs only in being crystalline and not in such a minute state of subdivision. Dose, gr. 33-xV Unguentum Hydrargyri Oxidi Rubri,—strength 1 to 9 of Ointment. Oxides and their Preparations. Lodides and their Preparations. Hydrargyri Iodidum Rubrum, Red Iodide of Mercury, Biniodide, Mercuric Iodide, Hgl2,—a scarlet-red, crystalline powder, almost insoluble in water, soluble in 130 of alcohol, in solution of iodide of potassium or of mercuric chloride. Prepared by double decomposition between Iodide of Potassium 11 parts and Mercuric Chloride 9 parts. Dose, gr. 33-tV Liquor Arsenii et Hydrargyri Lodidi, Solution of Iodide of Arsenic and Mercury, Donovan’s Solution,—see ante, page 117. Hydrargyri Iodidum Viride, Green Iodide of Mercury, Protiodide, Mercurous Iodide, Hg2I2,—a dull green or greenish-yellow powder, insoluble in alcohol or ether and almost so in water. Dose, gr. Liquor Hydrargyri Nitratis, Solution of Mercuric Nitrate,—a liquid containing in solution about 50 percent, of Mercuric Nitrate, Hg(N03)2, with some free Nitric Acid. Prepared from the Red Oxide of Mercury 40, by Nitric Acid 45, and Distilled Water 15 parts. Used as a caustic. Unguentum Hydrargyri Nitratis, Citrine Ointment,—prepared by dissolving Mercury 7, in Nitric Acid 17, and adding Lard Oil 76. Hydrargyri Subsulphas Flavus, Yellow Subsulphate of Mercury, Basic Mercuric Sulphate, Turpeth Mineral, Hg(PIg0)2S04,—a heavy, lemon-yellow powder, insoluble in water or alcohol, soluble in nitric acid and in 20 parts of hydrochloric acid without residue. Dose, as an emetic, gr. ij-v. Acid Combinations and their Preparations. Sulphide and Cyanide. Hydrargyri Sulphidum Rubrum, Red Mercuric Sulphide, Cinnabar, HgS,—Red, crystalline masses, or a fine, scarlet powder, insoluble in ordinary solvents, but soluble in nitro-hydrochloric acid with separation of sulphur. Used only for mercurial fumigation. Hydrargyri Cyanidum, Mercuric Cyanide, Hg(CN)2,—colorless, prismatic crystals, of bitter, metallic taste, soluble in 12.8 of water and in 15 of alcohol at 590 F. Dose, gr. 1 _ 1 Tffty To- These may be prepared according to the general formula under “ Triturationes ” in the Pharmacopoeia, io parts of the substance to 90 of Sugar of Milk. Mercury itself or any of its salts may be so treated with excellent results, the particles being much finer and therefore more easily absorbed than if rubbed up with any other agent. Triturations. HYDRARGYRUM. Unofficial Preparations. Lotio Hydrargyri Flava, Yellow Wash,—prepared by adding Corrosive Sublimate gr. xviij to Lime-water gx, producing the yellow oxide, a favorite application for syphilitic sores. Lotio Hydrargyri Nigra, Black Wash,—prepared by adding Calomel gr. xxx, to Lime- water gx, producing the black oxide, and used as an application to syphilitic sores. Unguentum Hydrargyri Nitratis Rubrum,—Red Ointment of Mercuric Nitrate, Brown Citrine Ointment,—differs from the official ointment only in being made with Cod-liver Oil, which gives it a brown color, and a more agreeable odor. Mercury is tonic, purgative, alterative, antiphlogistic and sorbefacient, but not directly cholagogue. Some of its salts are corrosive poisons, others are local caustics, all produce by long-continued administration the peculiar cachexia termed Hydrargyrism. The metal itself is inert, but by combination with the acids and fluids of the body becomes active, and is easily absorbed in any form, passing into the blood from the skin, mucous membranes, lungs and stomach, in each case probably as an Oxyalbuminate of Mercury. Entering the stomach in any form it is first converted into a double Chloride of Sodium and Mercury, then uniting with the albuminous juices to form a complex molecule of Mercury, Sodium, Chlorine and Albumen, which being soluble in an excess of sodium chloride or albumen, exists in solution, and is easily absorbed, being decomposed in the blood and changed to the oxyalbuminate. Entering the intestines a purgative action is soon set up, of more or less severity according to the preparation used, a small portion only is absorbed, the rest being converted into a Sulphide and excreted with the faeces, unless combined with opium which delays its progress through the intestines and permits of its greater ab- sorption. In the blood its effects are tonic in small doses, but in quantity it indirectly produces impoverishment thereof, impairs the ozonizing function, diminishes the red corpuscles, and consequently disorders nutri- tion and deranges digestion. From the blood it enters the tissues, where it remains for an indefinite period, exerting a peculiar influence, termed “ alterative ” on all processes characterized by growth of young cells, but not producing any definite anatomical changes either in the viscera or the nervous tissue, though in the latter a low form of inflammation arises, resulting in loss of coordination-power. It stimulates most of the glands of the body, especially the salivary glands and the pancreas, to the pro- duction of pathological secretions, and is excreted with comparative slowness by all the secretory organs, being found in the saliva, sweat, milk, urine and bile. It tends to accumulate in the liver, while stimulating its cells, and is not a cholagogue, though stimulating the flow of bile already secreted by reflex action on the bile-ducts due to its direct purgation of the duodenum. Its excretion is hastened and completed by the use of the iodide of potassium. In small doses administered for a short time the mercurial preparations Physiological Action. 242 HYDRARGYRUM. are blood-tonics, improving its general condition, increasing the number of red corpuscles and the body weight. They soon begin to promote waste by stimulating the lymphatic system, and if the small doses are long continued or the quantity is increased, symptoms of mercurial poisoning being to manifest themselves. The first symptoms of Hydrargyrism are fetid breath, swollen and spongy gums having a bluish line along their margins, stomatitis, sore and loosened teeth, inflamed and tender salivary glands pouring out a peculiar, thin saliva of foul odor in large quantity, and a metallic taste in the mouth. Anorexia, diarrhoea and fever follow, also ulceration and in some cases even gangrene of the lips and tongue. If the use of the drug be continued nutrition will be greatly impaired through the extreme promotion of ret- rograde metamorphosis, and various nervous disturbances will follow, the effects being emaciation, pallor, oedema, ulcerated skin, erythematous, vesicular or pustular eruptions, headache, insomnia, neuralgia, tremor through paresis of the muscles of the head and extremities, epilepsy, coma and convulsions. In pregnant women abortion will occur by reason of the impoverishment of the blood. Indeed, as Dr. Ringer said in the earlier editions of his Handbook of Therapeutics, the phenomena produced by mercury are singularly similar to those which will result from syphilis, and the serious symptoms known as secondary and tertiary syphilis can be produced both by syphilis and by mercury. The drug is probably a true vital antidote against the syphilitic virus, and is capable of bringing about a radical cure of the disease, if introduced into the system in considerable quantity and its use protracted over a very long time, the action of the drug in all cases being kept short of ptyalism or any pronounced physio- logical effects. Salivation is most readily produced by Blue Mass, next by Calomel, and less easily by Gray Powder. Individuals differ greatly in their sus- ceptibility to the action of mercury, some persons having been affected after a single moderate dose. Children are not easily salivated. Inhala- tion of mercurial vapors is apt to affect the nervous system most, its internal administration and that by inunction are more likely to produce salivation. The observations on the antiphlogistic and sorbefacient actions of Mercury are clinical rather than physiological, but it is generally agreed that exhibited in inflammation mercurials antagonize the increase of the hsemic fibrin which is so constant an effect of the inflammatory process, and that in chronic diseases attended by the formation of semi-organized deposits, a mild mercurial course will almost insensibly remove the new- formed material. A not uncommon result of full doses of Blue Pill is an acute coryza of very severe character, which the writer has frequently observed to follow hydrargyrum. 243 on neglect of the old-fashioned precaution to “work off” the mercurial by a saline cathartic. The symptoms produced are those of a severe attack of influenza, epistaxis, conjunctivitis and obstinate muco-purulent discharge from the nasal passages being especially marked. Similar effects have been observed during physiological experiments with mercury on animals by Overbeck and Bennett. Notes on The Action of the Preparations. Metallic Mercury is not used internally except in the finely-divided form obtained in Blue Pill and Gray Powder, which are capable of pro- ducing all the effects above described. Mercurial Ointment is the pre- paration generally used for inunction, a piece the size of a small nut being daily rubbed into the soft skin at the flexures of joints. The Oleate painted over the surface is a more cleanly method of making the same application. Both these preparations are efficient parasiticides. The Bichloride is the most actively toxic of the mercurial salts. It is probably the most active zymoticide and parasiticide, a solution of i part in 2000 being efficiently antiseptic for use as injections or dressings, and one of i to 250 being the usual strength for use against epizoa and parasitic skin affections. It is a very active gastro-intestinal irritant, in toxic dose producing nausea, retching and vomiting, a metallic taste, constriction of the fauces, burning pain in the stomach, suppression of urine, bloody diarrhoea, collapse and death often preceded by convulsions. It affects specifically the lower bowel [Calomel preferring the upper intestine], and produces inflammation and ulceration of the rectum. It is, however, one of the most manageable and efficient of the mercurials when used in proper doses. The Subchloride (Calomel) is very insoluble and unirritating, taste- less, laxative in grain doses, decomposed by the alkaline contents of the intestines, the Oxide of Mercury being formed, and acts especially on the excrementitious glandular appendages of the upper intestine, stimu- lating the liver by indirect reflex action as a duodenal purgative. In the presence of alkaline chlorides it is converted into the Bichloride, but not in sufficient quantity to render it dangerous in the gastro-intestinal.canal. Externally applied it is very sedative to the mucous membranes and the skin. Calomel is a very efficient diuretic. Ammoniated Mercury is an Ammonio-Chloride, and a useful stimu- lant and parasiticide when used locally in the form of ointment. The Iodides are actively poisonous, the Red being much the most irritant, in overdoses producing symptoms and results very similar to those caused by the Bichloride. The Cyanide is also actively poisonous. The Yellow Subsulphate is a prompt and usually harmless emetic, but has occasionally produced fatal results by local irritant action. The 244 HYDRARGYRUM. Oxides are irritant, the Red being the most so, and are rarely used inter- nally. The Acid Nitrate is a good escharotic, the pain caused by it being transient though severe, and its caustic action being comparatively superficial. The Ointment of the Nitrate (Citrine Ointment) is more irritant than that of the Ammoniated Mercury, and generally needs dilu- tion. All these preparations may produce the constitutional effects of mercury, and their administration should be carefully watched for the first symptoms of mercurialization. Antidotes and Incompatibles. Albumen in some form, the white of one egg to gr. iv of the bichloride, forms the albuminate, which must be at once evacuated by emesis or the stomach pump, as it is soluble in excess of albumen or in the alkaline contents of the intestines. The Chlorides are incompatible with very many agents, and the Bichloride should be administered in distilled water or pill by itself, being easily decomposed. Calomel is decomposed by alkaline Iodides or Bromides. The combination of Calomel with Hydro- chloric Acid or Chlorides is apt to produce Corrosive Sublimate. In the “ mixed treat- ment ” of syphilis, a mercurial is combined in solution with Iodide of Potassium, and the Red Iodide is the preparation usually selected, as the Bichloride is decomposed by the Potassic Iodide, Red Iodide of Mercury being precipitated. All trouble regarding incom- patibility can be avoided by using sugar of milk triturations according to the general official formula. In this form, says Piffard, “ a larger proportion of the drug is utilized for specific purposes, while but a small amount remains to give rise to local irritation.” Therapeutics. Mercury is undoubtedly a specific in syphilis, but is not applicable to the tertiary form of that disease. It is best administered in very small doses carefully watched and stopped just short of ptyalism, but renewed and so continued for a long time. Fumigation by Calomel volatilized by heat, or inunction by the Oleate or by Mercurial Ointment may be used when the stomach will not bear any mercurial. The hypodermic method is also used, employing a solution of the Bichloride gr. j to 5j each of glycerin and distilled water, of which the dose is npx once daily; or the Albuminate in solution with Sodium Chloride. The Green Iodide in doses of gr. to jf thrice daily with Opium is the best preparation for internal use. Accuracy of diagnosis is an absolutely necessary prelimi- nary to the administration of Mercury, for where there is no syphilitic virus to be antagonized the constitutional effects of mercurials will become manifest sooner and may do great harm in feeble subjects, besides the risk of mistaking them for the results of the disease supposed to be present. Tonsillitis, parotitis and other acute glandular inflammations of the throat and neck may often be rapidly cured by Calomel gr. -fa or Gray Powder gr. y every two hours. In irritable stomach with obstinate vom- iting the same small doses of Calomel every half hour are very efficient. The dysentery of adults with slimy and bloody stools is best treated by small doses (gr. Tyy) of the Bichloride, and in the diarrhoea and dysen- tery (ileo-colitis) of infants Gray Powder gr. £ or Calomel gr. will be HYDRARGYRUM. 245 found very effective. In gastric ulcer and in the first stage of hepatic cirrhosis, the Bichloride in doses of gr. fa to fa thrice daily is a good remedy. Typhoid fever is treated in Germany by daily doses of Calomel, gr. x, for three days as an antipyretic. Diphtheria is by many practition- ers considered to be best antagonized by Calomel in large doses, and in this affection the Cyanide has many advocates, given in doses of gr. fa every hour, a weak solution being at the same time used as a gargle. Asiatic cholera is frequently treated by small, repeated doses of Calomel with Opium from the start. Inflammations of sthenic character in the stage of exudation, especially when affecting serous membranes, are con- sidered by many authorities to be best met by the free use of mercurials, but this treatment is fast going out of favor, excepting in cases of iritis, which, however, is very often of syphilitic causation, and pneumonia, which is frequently treated according to the best American authorities with sedative doses (gr. xv-xx) of Calomel. In the general condition known as “biliousness,” manifested by whitish or clay-colored stools, constipation, nausea, anorexia, coated tongue, slight jaundice, etc., mercurial purgatives have long been a rou- tine remedy, but mild saline purgatives are by many authorities considered equally efficient. As an antiseptic to the gastro-enteric tract in many forms of stomach and intestinal disorders (dyspepsia septica), the admin- istration of minute doses of the Yellow Oxide of Mercury will be found remarkably efficient. It is best used in trituration with sugar of milk, i to 1000, and in daily doses of gr. fa-fa. By the use of these small doses failing digestion and nutrition may almost certainly be improved. In membranous laryngitis or true croup the Subsulphate as an emetic is by many considered to have some specially beneficial influence. Locally, an ointment of Calomel 5j to Sj of Lard is an excellent antipruritic, and ointments of the Chlorides and Iodides are much used in skin diseases, particularly psoriasis, herps, acne, and pityriasis. In parasitic affections a lotion of the Bichloride, gr. ij to §j of distilled water, or a 5 per cent. Oleate with }ith part of Ether, are very efficient. The Oleate is a serviceable application to syphilitic indurations, but is not deemed advisable when ulceration exists. In conjunctivitis Calomel may be used as a sedative application, or still better an Ointment of the Yellow Oxide, gr. x to 3j of Vaseline, triturated to the utmost fineness before mixing. Goitre and enlarged spleen are often speedily reduced by rubbing into the skin covering them the Ointment of the Red Iodide somewhat diluted and applied before a hot fire or in the direct sunlight. The Acid Nitrate Solution is one of the best caustics for destroying chancroid and syphilitic warts and vegetations. Black and Yellow Wash are used as applications to syphilitic erosions and ulcerated indurations. As an antiseptic injection or application to dressings a solution of the 246 HYDRASTIS. Bichloride, gr. vijss in a quart of hot water is probably the most efficient that can be used, and still weaker solutions are sufficiently antiseptic for most purposes. HYDRASTIS, Golden Seal,—the rhizome and rootlets of Hydrastis canadensis, a small plant of the nat. ord. Ranunculaceae growing in most parts of the U. S. The rhizome is inch long, rough, bent and branched, externally of a yellowish-gray color, internally a bright reddish-yellow, having numerous thin, brittle rootlets, a slight odor and a bitter taste. It contains an unnamed Resin and 3 alkaloids, Hydrastine, C22H23N06, white and crystalline, soluble in alcohol, ether, etc., Berberine, C20H17NO4, yellow crystals soluble in hot water and alcohol, but not in ether (see page 130), and Xanthopuccine, also yellow and crystalline. All these alkaloids unite with acids to form salts. Preparations. Extractum Hydrastis Fluidum,—Dose, rrpv-xxx. Tinctura Hydrastis,—strength 20 per cent. Dose, g ss-ij. Hydrastin (Unofficial),—an impure extract precipitated by Hydrochloric Acid from the alcoholic solution, chiefly consisting of Muriate of Berberine. Dose, gr. ij-v. Physiological Action. Hydrastis is a simple bitter and a stomachic tonic. It promotes appetite and digestion and increases the secretions of the gastro-intestinal tract and the flow of bile, but if long used it will derange digestion and produce constipation. It is possessed of antiperiodic powers, and is a protoplasmic poison, arresting the movements of the white blood-corpuscles. By many observers it is also considered alterative to the mucous membranes, deob- struent to the glandular system, cholagogue, diuretic and antiseptic. The alkaloid Hydrastine produces effects on the nervous system somewhat similar to those caused by Quinine, but seems to be devoid of toxic power, large doses only producing a sense of warmth in the epigastric region, and noises of a rushing character in the ears. Incompatibles. Tannic Acid, Hydrochloric Acid and the Alkalies are chemically incompatible with preparations of Hydrastis. Therapeutics. Hydrastis is chiefly used as a stomachic tonic, an antiperiodic, a mild laxative and an antiseptic. Its alkaloid (Hydrastine) and extract (Hydrastin) are ranked high in the treatment of intermittents and chronic malaria, though much less efficient than Quinine. It is an excellent remedy locally and internally in all forms of catarrh, especially that of the stomach, duodenum, gall-ducts, bladder, uterus and vagina. Internally it is efficient in many glandular swellings, in chronic constipation due to HYDROCOTYLE HYOSCYAMUS. 247 a sluggish state of the liver or deficiency of the other intestinal secre- tions, in chronic dyspepsia, and as a substitute for alcohol in dipsomaniacs when a catarrhal state of the stomach has been induced. In gonorrhoea, gleet, and chronic nasal catarrh it is locally employed with much benefit, also in syphilitic affections of the mouth, throat and nares. As a local alterative and antiseptic application it is highly recommended for unhealthy ulcers and sores, cancerous ulcerations, mercurial and aphthous stomatitis, rectal fissure, fistula and prolapse, internal and external hemorrhoids, cracks, fissures and abrasions of the nipples, erosion and ulceration of the cervix uteri, and in conjunctivitis with muco purulent discharge. In gonorrhoea a very efficient injection is an infusion of Hydrastis, 3j of the powdered root to §viij of boiling water, or the fluid extract diluted in the proportion of 3ss or 5j to the pint of water, but it should not be used until the acute stage has subsided. HYDROCOTYLE, Pennywort (Unofficial),—is the leaf of Hydrocotyle asiatica, a small plant of the nat. ord. Umbelliferse, a native of southern Africa and India. It contains a peculiar, oleaginous sub- stance Vellarine, which has a bitter, persistent taste, and is thought to be the active principle. It has long been used in its native countries as an alterative to purify the blood, and has lately been found of great service in eczema, lupus, psoriasis, syphilitic and scrofulous sores, and in leprosy. An ounce of the dried plant or leaves is given daily in infusion. It causes great itching over the whole body, ovarian pain in females, and urinary irritation. In one case in which the drug was being given for lupus of the hand a severe orchitis was set up without any other apparent cause. It certainly exerts a markedly special influence on the genito-urinary tract. HYOSCYAMUS, Henbane,—the leaves, collected from plants of the second year’s growth, of Hyoscyamus niger, a biennial plant of the order Solanacese, growing in Europe and the northern U. S. The leaves are ovate, often io inches long and 4 broad, of grayish-green color, glandular-hairy, midrib prominent, odor heavy and narcotic, taste bitter and acrid. It contains an alkaloid Hyoscyamine, C17H23N03, which is isomeric with Atropine and identical with Daturine and Duboisine, occur- ring as an oily liquid or in tufted crystals of silky lustre and yellow color, soluble in hot water, alcohol or ether. Another substance, Hyoscine, is by some authorities considered a derivative of Hyoscyamine, by others a second alkaloid. It is semi-liquid, isomeric with Atropine, and yields Tropic Acid and Pseudotropine. Hyoscyamus leaves also contain a fatty Oil and much Potassic Nitrate, while from their destructive distillation an empyreumatic Oil is obtained which is a powerful narcotic. 248 HYOSCYAMUS. Preparations. Abstradum Hyoscyami,—Dose, gr. iij-v. Extradum Hyoscyami Alcoholicum,—Dose, gr. j, when active. Extractum Hyoscyami Eluidum,—Dose, rtyv-xx. Tindura Hyoscyami,—strength 15 per cent. Dose, as a hypnotic 3 ss-j is necessary. All the preparations of Hyoscyamus are uncertain in strength and in activity, so much so that the effective dose of the extract (no longer o'fficial) ranged from 2 to 250 grains. Hyoscyamince Sulphas,—Sulphate of Hyoscyamine (C17H23N03)2.H2S04,—occurs in small, yellow scales or crystals, which are deliquescent, of bitter taste, and very soluble in water and in alcohol. It varies much in purity of the base and consequently in activity. A grain of the commercial article, which was formerly very impure, has been given with impunity, but gr. of the pure alkaloid has produced violent poisoning. Dose, hypodermically, should not exceed gr. by the mouth gr. may be given in urgent cases. Hyoscyamine of good quality is difficult to procure and is very expensive, while Duboisine is easily obtained in any quantity, so that if these alkaloids prove to be physio- logically as well as chemically identical as is now claimed, the latter will be used to the exclusion of the former. Hyoscina Hydrobrotnas, Hydrobromate of Hyoscine (Unofficial).—Merck’s is the only reliable preparation on the market. Dose, hypodermically, gr. ; by the mouth gr. 1 _ 1 Physiological Action. Hyoscyamus has similar action to that of Belladonna, Duboisia and Stramonium, except that it is the least powerful and irritant of the group, but the most calmative and hypnotic. The delirium produced by it is never furious and is without hyperaemia, but is accompanied by insomnia. It is more stimulant to the vaso-motor system and to the cardiac accele- rator apparatus than is Stramonium, but is less active on the pneumo- gastric. It has decidedly laxative and carminative effects on the. intestines and a very marked sedative influence on the urinary passages. Hyoscyamine corresponds in action to the plant and its congeners, being considered by many authorities as almost identical with Atropine, but less powerful. No death has directly resulted from it. Except in very large doses it is more an anodyne or anaesthetic than a narcotic or soporific. It is a mydriatic, excites the cerebral functions and depresses the spinal. Many observers deny that it has any soporific influence. Hyoscine is a powerful hypnotic, lowers the pulse-rate and lessens the frequency of the respirations. It especially affects the motor tract of the spinal cord and the cerebral cortex, slightly depresses the heart, but para- lyzes respiration. It is free from irritant qualities and may be used hypodermically. Its habitual use brings on muscular paralysis and delirium of violent character. It is coming into use as a hypnotic by alcoholics and nervous subjects, and will probably ere long be responsible for many deaths. As a mydriatic its reputation is doubtful, some observ- ers claiming greater power for it in this respect than that of Atropine, while others say that mydriasis may follow its use but is not always pro- duced by even large doses. ICHTHYOCOLLA. 249 Antagonists and Incompatibles. These are the same as for Belladonna (see ante page 127). Liquor Potassae though incompatible is frequently prescribed in combination with Hyoscyamus. All the fixed caustic alkalies decompose its alkaloid as also those of the allied plants. Therapeutics. Hyoscyamus is a valuable narcotic and is chiefly used as a hypnotic and anodyne when Opium is contraindicated, and for children. It is by far the best agent to use in acute mania with high motor excitement, obsti- nate insomnia and varied hallucinations. Chronic mania has been more benefited by it than by any other drug, and it is very efficient in insanity characterized by frequent delusions. In delirium tremens and the delir- ium of fevers it is an excellent hypnotic, and the monomania of hypo- chondriacs is alleviated and often cured by it. Whooping cough, nervous coughs, and especially a dry, tickling night-cough, are greatly alleviated by full doses of Hyoscyamus. It is also efficient in colic of various forms, to palliate the trembling of paralysis agitans and mercurial tremor, and to relieve the pains and disordered coordination of locomotor ataxia. In constipation it is a good remedy, the extract being much employed in combination with other purgatives to render them more efficient and less drastic, but the quantity used is generally too small to be of any particu- lar benefit. The tincture is an efficient remedy in irritability of the bladder from any cause. Hyoscyamine may be used for the same purposes as Atropine, but being liable to considerable variation in purity and activity, it is not a popular agent with the profession. Hyoscine has been used in neuralgia, whooping-cough, insomnia from cerebral excitement, delirium tremens, asthma and enteralgia, also in ophthalmic practice as a mydriatic. Doses of gr. are given by the stomach, gr. hypodermically. ICHTHYOCOLLA, Isinglass ,—is the swimming-bladder of Aci- penser Huso, and of other species of Acipenser (Sturgeon). It occurs in horny sheets, semi-transparent, iridescent, soluble in 24 parts of boiling water, forming on cooling a transparent jelly. It is the purest form of Gelatin known. Preparation. Emplastrum Ichthyocollcz, Court Plaster,—consists of Isinglass 10, Glycerin I, Alcohol 40, Water and Tincture of Benzoin, spread on taffeta and allowed to dry. Physiological Action and Therapeutics. Isinglass is slightly nutritious, but has no advantage over any other form of gelatin. It is used for clarifying liquids, and in solution as a test for tannin. The plaster is a common protective application. 250 IGNATIA—ILLICIUM. IGNATIA, St. Ignatius’ Bean,—is the seed of Strychnos Ignatii, a small tree of the nat. ord. Loganiacese, native in the Philippine Islands, and also called Ignatia Amara. The seed is about an inch long, ovate, irregularly angular, hard and horny, enclosing an irregular cavity con- taining an oblong embryo, inodorous, taste very bitter. It contains the alkaloids Strychnine and Brucine, about i per cent, of each, for a descrip- tion of which see the title Nux Vomica. Preparations. Abslractum Ignaties,—Dose, gr. ss-j. Tinctura Ignaties,—strength io per cent. Dose, rtyij-x. Physiological Action. Ignatia closely resembles Nux Vomica in action, a poisonous dose pro- ducing the same exaltation of the spinal functions, muscular writhing, te- tanic spasms, and death by asphyxia through tetanic fixation of the respi- ratory muscles, but containing a greater quantity of Strychnine than the latter it is more powerful in the same dose. It especially exalts the sus- ceptibility of the sensory nerves, and of the nerves of special sense, for a time, but an opposite condition soon succeeds, manifested by numbness and torpor with great mental depression. It causes a feeling of constric- tion about the throat and a sensation of intense anguish at the pit of the stomach. Its antagonists and incompatibles are the same as for Nux Vomica. Therapeutics. Ignatia is recommended for hysteria, to control the general hyperaesthe- sia, insomnia, clavus hystericus, mental excitement or depression, aphonia, diseased appetite, convulsive crying or laughing, etc. It will often re- move the intercostal neuralgia of hysterical subjects and the sensation as of a ball rising to the throat (globus hystericus). Cerebro-spinal irrita- bility is diminished by small doses though excited by large ones, Ignatia being probably the most efficient controller of functional phenomena of the cerebro-spinal axis. In the convulsions of children from intestinal irritation without cerebral congestion, and in insomnia from nervous erethism, small doses of Ignatia are used with the happiest results. It is by many practitioners preferred to Nux Vomica as a stomachic tonic, and is useful in the treatment of dyspepsia, hyphochondriasis and various ner- vous affections. IL.LICIUM, Star Anise,—is the fruit of Illiciutn anisatum, an Asiatic shrub of the nat. ord. Magnoliacese, and is formed by 8 boat- shaped carpels arranged in a star-shaped whorl around a central axis which is the top of the stalk. Each carpel contains a single seed, flat, oval, glossy, and of a brownish-yellow color. It contains a Volatile Oil which INULA IODUM. 251 is chemically and practically identical with the Oil of Anise. Another species, Illicium religiosum, is very poisonous, causing vomiting, epilepti- form convulsions, dilated pupils and cyanosed countenance. Its carpels are more woody, shrivelled and wrinkled, and end in a curved beak. Illi- cium is recognized officially as a source of the Oil of Anise, and has simi- lar actions and uses to those of Anisum (see ante, page 101). INULA, Elecampane,—is the root of Inula Helenium, a plant of the nat. ord. Compositae, growing in Europe and N. America. It occurs in slices or sections, externally grayish-brown, internally white, fleshy and full of resin cells, of peculiar, aromatic odor, pungent and bitter taste. It contains a volatile oil, a resin, a crystalline substance named Helenin, C6H80, and a peculiar principle resembling starch, Inulin, which is found in Arnica, Taraxacum and other plants. * Having the same chem- ical composition as starch, Inulin differs from the latter in being colored yellow by iodine, and depositing from its solution in hot water as the solu- tion cools. It is contained in Elecampane in large quantity, from 19 to 44 percent., the latter in autumn. There are no official preparations, but a decoction (gss to Oj) may be given in doses of Sj-ij* Dose of the powdered root, gr. xx-3j- Physiological Action and Therapeutics. Inula is a gentle stimulant to the secretory organs, and is said to be ex- pectorant, diaphoretic and diuretic. In large doses it causes nausea and vomiting. It was formerly supposed to be emmenagogue and was much used in amenorrhoea. It is now chiefly employed as a domestic remedy in chronic bronchitis and dyspepsia, and to promote the eruption in exanthe- matous fevers. IODUM, Iodine, I, —is a non-metallic element, existing in sea-weed, sea-water, some fresh waters and fresh-water plants, also in sponge, oysters, eggs, cod-liver oil, rock salt and several ores. It occurs in bluish- black rhombic plates, of metallic lustre, peculiar odor, acrid taste and neutral reaction, sparingly soluble in water (x in 7000), readily so in ether, and in 11 of alcohol at 590 F., also in a solution of potassic iodide or sodic chloride. It volatilizes slowly at ordinary temperatures, and produces a dark-blue color with gelatinized starch in a cold solution. Internally it is generally administered in the form of an Iodide or as the Compound Solution of Iodine. Dose, gr. ss-j. Preparations of Iodine. Tinctura lodi,—strength 8 per cent. Dose, but it is generally used as a local application or for injection into cavities. 252 IODUM Liquor Iodi Compositus, Lugol’s Solution,—is a solution of Iodine 5 and Iodide of Potassium 10 in Distilled Water 85 parts. Dose, tt\j-x, well diluted. Uguentum Iodi,—has of Iodine 4, Iodide of Potassium 1, Water 2, Benzoinated Lard 93 parts. Amylum Iodatum, Iodized Starch,—contains of Starch 95, Iodine 5, Distilled Water q. s. ad 100 parts, triturated together, dried, and rubbed to a fine powder. Intended to enable Iodine to be given without irritating the stomach. Dose, £}-§]■ Iodized Phenol, Carbolate of Iodine (Unofficial),—a mixture of Iodine and crystallized Carbolic Acid in varying proportions, generally 1 of the former to 4 of the latter, for local use. Iodides and their Preparations. Ammonii Iodidum, NPI4I,—a deliquescent, granular, white salt, soluble in 1 of water and in 9 of alcohol at 590 F. Dose, gr. ij-x. Potassii Iodidum, KI,—a colorless, deliquescent, crystalline salt, of saline and bitter taste, soluble in 0.8 of water and in 18 of alcohol at 59° F. Dose, gr. v-.^j. Unguentum Potassii lodidi,—has of the Iodide 12, Hyposulphite of Sodium 1, Boil- ing Water 6, Benzoinated Lard 81 parts. Sodii Iodidutn, Nal,—deliquescent, minute crystals, soluble in 0.6 of water and in 1.8 of alcohol. Dose, gr. v-5 ij. Iodoformum, Iodoform, Iodide of Formyl,—small lemon-yellow crystals, of saffron- like and penetrating odor, unpleasant and iodine-like taste, sp. gr. 2000, soluble in 80 of alcohol at 590 F., and in chloroform, ether, benzol, benzin, carbon bisulphide, fixed and volatile oils, not perceptibly soluble in water. Its solutions have a neutral reaction. To remove its odor without forming a compound the best agents are Thymol (gtt. ij ad §j), Oil of Mirbane (gtt. vj ad gr. xv), Oil of Bitter Almonds, or Oil of Rose (gtt. j ad Dose, gr. j-v. Unguentum Iodoform,—Iodoform, finely pulverized, 10, Benzoinated Lard 90 parts, thoroughly mixed by trituration. Iodol, Tetra-iodo-pyrol (Unofficial),—is 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. Other Iodides and preparations thereof are—Argenti Iodidum, Arsenii Iodidum, Liquor Arsenii et Hydrargyri Iodidum, Hydrargyri Iodidum Rubrum, Hydrargyri Iodidum Vi- ride, Syrupus Ferri lodidi, Pilulse Ferri lodidi, Plumbi Iodidum, Sulphuris Iodidum and Zinci Iodidum. As these preparations are allied in action and uses less to Iodine than to the other elements in their composition, they are described under other titles. (See Ar- gentum, Hydrargyrum, etc.) The Iodide of Ethyl or Hydriodic Ether is described under Hither (see ante, page 81.) . Preparation of Hydriodic Acid. Syrupus Acidi Hydriodici,—contains I per cent, of absolute Hydriodic Acid, HI. Dose, well diluted. Physiological Action. Iodine is irritant to the mucous membranes and to the skin. Applied to the latter it stains a deep yellowish-brown color and combines with the albumen of the tissue, causing considerable pain and subsequent exfolia- tion of the epidermis. Vesication may be quickly produced if the quan- tity used be large. Inhaled its vapor irritates the respiratory mucous membrane, producing sneezing, cough, dyspnoea, also pain in the chest and over the frontal sinuses. In the gastro-intestinal canal it is equally irritant, but is gradually converted into the iodide or iodate of sodium, in which form or as an albuminate it is absorbed into the blood. Iodine decomposes organic molecules, and in the presence of phosphoretted or sulphuretted gases it acts like chlorine but more feebly, uniting with their hydrogen and thus breaking up those noxious compounds it is disinfectant and deodorant. IODUM 253 The Iodides of Sodium, Potassium, etc., are very diffusible and are as rapidly excreted ; setting free nascent oxygen (Ozone) and Iodine at the points of their elimination, they are remotely irritant to the mucous mem- branes, setting up violent coryza, with soreness of the throat, acute con- junctivitis, profuse mucous discharges, headache and irritation of the kidneys and the skin. If used for any length of time they induce great waste and rapid elimination of waste products, causing anaemia, emacia- tion and mental depression. They combine with certain poisons in the system, particularly Lead, Mercury, and the products of the syphilitic disease, hastening their elimination. lodism is the term applied to the general condition produced by these agents, and comprises the symptoms above noted together with frontal headache, ptyalism, a saline taste in the mouth, dysphagia, temporary impotence, and an acneform eruption on the face and limbs. Sometimes the eruption is furuncular or even purpuric. Copiously diluting these salts with water promotes their excre- tion and to a great extent prevents the development of these results. Iodoform contains from 94 to 97 per cent, of Iodine and naturally resembles the latter in action. Locally its action is anaesthetic and pow- erfully antiseptic. It is one of the best agents to prevent decomposition and to destroy the germs of putrefaction and of disease, but must be carefully employed, as when used in quantity on an extensive raw surface it has often produced fatal results with symptoms of narcotic poisoning. The first sign of its dangerous absorption is increase of temperature, which may reach 104° or more, then headache, quick and feeble pulse, marked anxiety and restlessness, and suddenly collapse and death may supervene. The quantities which have produced fatal results from local absorption' have varied from 525 to 4500 grains. In small doses internally it is con- sidered to be a tonic and alterative, wasting does not occur, but the body weight increases and the general condition improves. In these respects its action markedly differs from that of Iodine or the Iodides. Iodol 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 as quickly diffused through the system. Ethyl Iodide (see ante, pages 79 and 81) is used by inhalation to bring the system rapidly under the influence of Iodine. It is a good antispas- modic and general stimulant and a very slow anaesthetic. Antagonists and Incompatibles. Restorative agents and vaso-motor tonics, Quinine, Digitalis, etc., are therapeutically antagonistic. Starch is the antidote to free Iodine, but the stomach must be evacuated as the Iodide of Starch is not inactive. The mineral acids, metallic salts, ammonia and vegetable alkaloids are incompatible with Iodine, and if the Potassium salt be prescribed with Potassium Chlorate a poisonous compound will result. In chronic poisoning by the iodides a free salivary flow induced by chewing Pyrethrum root will hasten the elimina- tion of the drug. 254 IODUM Therapeutics of Iodine. The tincture or the compound solution are much employed locally as counterirritants and by injection into cavities as alterative applications, instances of which are their use in glandular tumors, hypertrophied ton- sils, cervical and ovarian cysts, empyema, hydrocele, etc. In various skin diseases, as chloasma, lentigo, lupus, etc., the tincture or a glycerite is well applied, and in many splenic and hepatic disorders of chronic type the ointment or tincture is a favorite counterirritant application. In sores, ulcers, fissures, etc., the Iodide of Starch or a mixture of Iodoform and Tannin, are strongly recommended, and the tincture is much used locally to promote absorption of the products of acute inflammations. In acute catarrh and hay-fever inhalations of iodine-vapor, or that from Iodized Phenol are very serviceable, and in the vomiting of pregnancy i to 5 drop-doses of the tincture every hour are often efficient. The compound solution well diluted is given thrice daily in typhoid fever with good results in many cases, and in malarial fevers the same preparation com- bined with Carbolic Acid has remarkably curative power. In strumous conditions Iodine internally is much more efficient than any of the Iodides. Therapeutics of the Iodides. The Iodide of Potassium is the most frequently used, and is the form in which Iodine is generally administered internally. It is usually admin- istered in simple solution or in the compound infusion or syrup of Sarsa- parilla. Though its mode of action has never been explained satisfactorily, it is known by clinical experience to counteract many pathological condi- tions, to promote the absorption of morbid products, and the elimination of several metallic poisons. It is almost of specific rank in tertiary syphilis and its results, as neuralgiae, paralyses from gummata, ulcerations, syphiloma of the internal viscera, lupus, chronic rheumatism and sciatica, in all of which when of syphilitic origin this iodide in large doses (50 to 150 grains daily) to saturation of the system will speedily cause improve- ment. So in mercurial poisoning and other chronic metallic toxaemiae, the best treatment is by rapid saturation with Potassic Iodide. The pro- ducts left behind by pneumonia, pleurisy and pericarditis often yield to moderate doses (5 grains), which if used for a prolonged period seem to retard the changes of chronic nephritis. It is the best remedy for the early stage of hepatic cirrhosis, and acts as a most efficient expectorant in chronic bronchitis. Aneurisms are often cured by large doses (20 to 30 grains) of Potassic Iodide, the sac becoming perfectly solid by fibrinous deposit. In acute catarrh and hay-fever, it is useful with Arsenic, the Iodized Phenol being at the same time used locally in weak solution. In tonsillitis and simple sore throat a weak solution (gr. ij-v ad 5) is a good gargle, and in large doses it is often very efficient in spasmodic asthma when induced by bronchial catarrh. IODUM 255 The Iodide of Ammonium in grain dose repeated frequently is an ex- cellent remedy in acute catarrh, hay fever, duodenal catarrh and its accompanying jaundice, in chronic and capillary bronchitis, and in catarrhal pneumonia to prevent caseation of the products. In the first stage of hepatic cirrhosis and in chronic malarial poisoning it is equally efficient administered in conjunction with Arsenic. Being somewhat more irritating than the other iodides it is usually given in smaller quan- tity, but being less stable it is more energetic in action. The Iodide of Sodium may be used instead of the potassium salt, and the same may be said of the Syrup of Hydriodic Acid if freshly prepared. Hydriodic Acid is used as a substitute for Iodine and the Iodides. As an alterative it is believed by some to possess all the powers of Iodine while it is much less offensive to the taste and the stomach. It has been used with benefit in asthma and bronchitis. The acid itself is not now official, as it is liable to change by the development of free Iodine. Therapeutics of Iodoform and Iodol. Iodoform is chiefly employed in local diseases as an antiseptic, anaes- thetic and alterative agent. It may be dusted in fine powder over a wound or sore, or used in ethereal solution to saturate gauze or absorbent cotton. It is particularly useful as an application to sloughing and phagedenic ulcers, gunshot wounds, chancroids, fistulae, sinuses and painful affections of the rectum or uterus. Internally it may be used as a general tonic and alterative in syphilis and other cachexise, also for neuralgia, and is fre- quently prescribed with Iron. Triturated with Tannin it forms a useful application to the cervix uteri in erosions and ulcerations thereof, or an Iodo-tannin may be prepared by saturating the Tincture of Iodine with Tannic Acid, and applied on a cotton tent to the uterine mucous mem- brane in many chronic affections of that organ. Iodol, if equally efficient, as is claimed, will doubtless replace Iodoform largely as a topical application. Internally they are both highly esteemed as remedies in chronic gastric catarrh, and intestinal catarrh, ulceration of the gastro-intestinal mucous membrane, etc. Iodol may be given midway between meals. In bronchitis, bronchial catarrh, and various respiratory neuroses, Iodol has been found highly useful. Tuberculosis is successfully treated by Iodoform, which certainly does check the activity of the bacillus of that disease, also by Iodol in many cases. Diabetes has been apparently cured by Iodoform. Syphilis will be combated successfully by Iodoform or Iodol, in lieu of the Iodide of Potassium. 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. 256 IPECACUANHA. IPECACUANHA, Ipecac,—is the root of Cephaelis Ipecacuanha, a small shrubby plant of the nat. ord. Rubiaceae, growing in Brazil. The root is of the thickness of a small quill and about 4 inches long, of dull gray-brown color, contorted and finely wrinkled, internally white, tough and ligneous; odor slight but nauseous, taste acrid, bitter and nauseating. It contains starch, gum, a trace of volatile oil, a crystalline alkaloid, Emetine, C2oH30N05, and a glucoside named Ipecacuanhic Acid. Dose of the powdered root, as an expectorant gr. ss-ij, as an emetic gr. xv-xxx. Preparations. Extractum Ipecacuanhce Fluidum,—Dose, nyj-v. Syrupus Ipecacuanha,—strength 5 per cent. Dose, gj-£ss. Vinum Ipecacuanha,— strength 7 per cent. Dose rryj- 3 j. Trochisci Ipecacuanha,—each contains gr. of Ipecac. Trochisci Morphina et Ipecacuanha,—each contains of Morphine Sulphate gr. Gf Ipecac gr. Jj, with oil of Gaultheria, Sugar, etc. Pulvis Ipecacuanha et Opii, Dover’s Powder,—consists of Ipecac 10, Pulvis Opii 10, Sugar of Milk, 80 parts. Dose, gr. ij-xv. Tindura Ipecacuanha et Opii,—Deodorized Tincture of Opium 100 parts evaporated to 85, Fluid Extract of Ipecac 10, Alcohol q. s. ad 100. Dose, rrpv-xxx. Emetina, Emetine (Unofficial),—a crystalline alkaloid, white becoming yellow, odor- less, bitter, nearly insoluble in water, but forming with acid salts which are readily soluble. Is powerfully poisonous in large doses. Dose as an expectorant, gr. xiv~io » as an emetic, gr. Physiological Action. Ipecac is nauseant, emetic, expectorant, cholagogue, diaphoretic, hemo- static, sternutatory and counterirritant. Applied to the skin it produces pustulation, and used as snuff it excites violent sneezing and reflex mucous secretion, in some persons the smallest inhalation of the dust ex- citing an asthmatic paroxysm. Internally small doses (gr. }£-}{) act as a stomachic tonic and increase the gastric secretions; larger doses (gr. v-xx) are nauseant and emetic in from 20 minutes to half an hour, but the emesis produced is not violent nor is it followed by much depres- sion. If these doses are repeated a tolerance of the stomach to the drug becomes established and a cathartic action is produced, the stools having a peculiar bilious character. The circulation is only slightly affected by Ipecac, but it relaxes the skin and increases the broncho-pulmonary mucus, being diaphoretic and expectorant. In large doses it is decidedly irritant to the intestinal canal, but here also it is capable of the same tol- erance as in the stomach. In poisonous doses it has frequently produced hemoptysis and other hemorrhages. Emetine, the active principle, causes death in animals by cardiac paralysis, and the autopsies show evidences of gastro-intestinal irritation and hyperaemic lungs with patches of hepatization. Antagonists and Incotnpatibles. Narcotics generally antagonize the emetic action, so also do Bismuth, Carbolic and Hydrocyanic Acids. The salts of Lead and Mercury, Vegetable Acids and astringent infusions are incompatible with Ipecac. IRIS. 257 Therapeutics. Ipecac is much used as an emetic, being safe, efficient and non-depres- sant, though slow of action. It is the best agent of the kind to relieve the stomach in acute indigestion and bilious sick-headache, and an ipecac- vomit is frequently very serviceable at the commencement of eruptive, continued and periodical fevers. The syrup is a favorite domestic emetic to cut short an attack of spasmodic laryngitis, and it may be used bene- ficially in membranous croup and capillary bronchitis. Dysentery is a disease in which large doses of Ipecac (gr. xx every 4 hours) are used with great success, especially in the epidemic form, and in the summer dysentery of teething children. Tolerance must be estab- lished to produce its curative action. In small doses (ny of the wine) frequently repeated, it will relieve many kinds of vomiting, especially those of nervous origin, perhaps through a sedative action on the pneu- mogastric. As an antihemorrhagic it has been efficiently employed in post-partum hemorrhage, menorrhagia, epistaxis, hemoptysis, etc., and it is considered very useful in night coughs, acute catarrh and bronchitis, spasmodic asthma and hay fever. In most of these affections slightly nauseating doses must be used. IRIS, Blue Flag,—is the rhizome and rootlets of Iris versicolor, an indigenous plant of the nat. ord. Iridacese, growing in moist meadows and on the borders of swamps, having large blue flowers and a horizontal rhizome, 2 to 4 inches long, with long rootlets, slight odor but an acrid, nauseous taste. It contains tannin, sugar, starch, gum, an acrid resin, fixed oil and traces of an alkaloid. Dose of the powdered root, gr. v-xx. Preparations. Extractum Iridis,—Dose, gr. j-v. Extractum Iridis Fluidum,—Dose, rrpv- j. Iridin or Irisin (Unofficial),—is a so-called resinoid found in the shops, of undetermined composition, but probably an oleoresin precipitated by water from an alcoholic preparation. Dose, gr. j-v. Physiological Action. Iris when fresh is actively purgative, emetic and diuretic, producing severe nausea and prostration. Iridin has been the subject of experimen- tation upon dogs, and is shown to be a powerful hepatic stimulant with considerable influence on the intestinal glands, being more purgative than Euonymin and less irritant than Podophyllin. In very small doses it causes obstinate constipation by producing rectal inactivity. Therapeutics. Iris is very serviceable in duodenal catarrh with obstruction of the bile- ducts and consequent jaundice, also in malarial poisoning, bilious remit- tents, and jaundice of malarial origin. It is used in many hepatic and 258 JALAPA. intestinal disorders as a cholagogue and purgative of mild but efficient action, also as a diuretic in dropsies. In small doses (iqj of a tincture) it is strongly recommended in a peculiar blinding headache in the right supra- orbital region with nausea or vomiting, supposed to be of hepatic origin. JALAPA, Jalap ,—is the tuberous root of Exogonium purga, a Mexi- can plant of the nat. ord. Convolvulaceae. It is large, turnip-shaped, externally dark-brown and wrinkled, internally grayish-brown with numer- ous concentric circles composed of small resin-cells, odor slight, taste sweetish and acrid. It contains 15 to 20 per cent, of the official Resin, which is composed of two resins, Jalapin, soft, soluble in ether, and Convolvulin, C31H50O16, which is hard, insoluble in ether, and the most active of the two. Preparations. Abstraction Jalapce, — is an ingredient of Pil. Cathartic* Composite, gr. j in each. (See ante, page, 185.) Dose, gr. j-v. Resina Jalapce,—prepared by precipitation by water from a tincture. Insoluble in water, soluble in alcohol, Dose, gr. ij-v. Pulvis Jalapce Compositus,—Jalap 35, Potassium Bitartrate 65 parts, triturated together. Dose, gr. x-gj. Physiological Action. Jalap is an active cathartic, producing copious and watery stools, with considerable tormina and tenesmus, also sometimes nausea. It does not produce hemorrhoids, but does increase the secretions of the intestinal canal and the flow of bile. Its action is not due to any one of the contained principles, but all the active constituents are found in the resin. Com- pared with other agents of the same class its action most resembles that of Scammony. It is more drastic than Senna and less irritant than Gam- boge, but in overdoses may produce dangerous hypercatharsis. Convolvulin in sufficient dose is an active irritant poison, producing gastro-enteritis and narcotism. Its action as a purgative seems to be wholly local, as from its intravenous injection no catharsis results, yet it exerts little if any irritant action on the conjunctiva, nasal mucous mem- brane or skin. It is not eliminated in the urine or the faeces, and is there- fore probably destroyed in the system by oxidation. Therapeutics. In olden bowel-moving times Jalap and Calomel were used together in doses of gr. x each (“ ten and ten ”), as a routine purgative prescription. Less ponderous doses are now considered equally efficient, and one grain of each agent with the same quantity of Extract of Hyoscyamus as a correct- ive may be used with advantage at the onset of fevers and inflammations. As the compound powder it is much employed to produce free watery evacu- ations in ascites and anasarca. Being nearly tasteless it is a useful cathartic for children, and may be administered in Syrup of Rhubarb (gr. ij-v in JUGLANS JUNIPERUS. 259 Sss). As a vermifuge it is efficient as an adjunct to more powerful agents, and is employed with Calomel and Santonin for the expulsion'of lumbrici. Jalap is contraindicated in all inflammatory conditions of the intestinal mucous membrane, but in proper doses it is one of the most manageable and efficient cathartics. JUGLANS, Butternut,—is the inner bark of the root, collected in autumn, of Juglans cinerea, the Butternut or White Walnut, an indigenous forest tree of the nat. ord. Juglandaceae. It occurs in flat or curved pieces, the outer surface smooth, dark-brown, mottled, and nearly free from corky remnants of the outer bark, odor feeble, taste bitter and acrid. It contains an orange-yellow, crystalline and acrid substance named Ju- glandic Acid or Nucin, resembling Chrysophanic Acid, also some resin, volatile acid, etc., but neither tannin nor any alkaloid. Preparation. Extractum Juglandis,—Dose, gr. v-xx or more. Physiological Action and Therapeutics. Juglans is a mild cathartic operating without the production of pain or irritant symptoms. It is never used in substance, but the extract is a good laxative in doses of gr. v-x, and a purgative in larger doses. It has considerable reputation in dysentery and chronic constipation. JUNIPERUS, Juniper ,—is the fruit of Juniperus communis, an evergreen shrub of the nat. ord. Conifer®, growing in Europe and N. America. The fruit or berry is dark-purple with a bluish-gray bloom, having a three-rayed furrow at the apex, internally pulpy, containing 3 triangular, bony seeds. It contains a Volatile Oil which is official and consists of terpenes and camphors in complex combination, also a non- crystallizable principle named Juniperin, and grape sugar, resin, formic, acetic and malic acids, etc. Preparations. Oletim Juniperi,—the volatile oil, a colorless or faintly greenish-yellow liquid, of sp. gr. about 0.870, of terebinthinate and sweetish taste, and the odor of juniper, soluble in 12 of alcohol. Dose, tr^v-xx. Spiritus Juniperi,—has of the oil 3 parts in 97 of alcohol. Dose, 3 j-75 j. Spiritus Juniperi Compositus,—approximates closely to the best grade of “ Gin ” (see ante, page 86). It contains Oil of Juniper 10, Oil of Caraway 1, Oil of Fennel 1, Alco- hol 3000, and Water sufficient to make 5000 parts. Dose, ss-j. Infusum Juniperi (Unofficial)—Juniper Berries 3 j in Oj of boiling water. Dose, 25 ss—ij. Oleum Cadini, Oil of Cade (Unofficial),—is a tar obtained by the destructive distilla- tion of Juniper wood, but is of uncertain purity. The official Oleum Picis Liquidse (Oil of Tar) is just as efficient for all purposes to which the Oil of Cade has been applied. 260 kamala. Physiological Action. Juniper is a stomachic tonic, diaphoretic, diuretic and aphrodisiac. The oil is the active principle, and is readily diffused, exciting increased cardiac action, stimulating the renal functions and the action of the skin, and causing a subjective sense of heat throughout the system. It is elimi- nated chiefly by the kidneys, and may set up renal irritation, in large doses producing stranguary, priapism, hematuria, suppression of the and uraemic convulsions. It imparts a violet odor to the urine, and will produce diuresis when inhaled. Therapeutics. The Oil of Juniper is used to flavor gin and to impart the diuretic power popularly ascribed to that liquor. The medicinal use of the juniper preparations (spirit and compound spirit) is restricted to their employ- ment as vehicles for less irritant diuretics. The oil acts therapeutically like the Oil of Turpentine, and may be used in chronic pyelitis and cys- titis, prostatorrhoea, gleet, etc., but it is contraindicated in all cases where acute inflammation of the kidneys exists. Oil of Cade is used locally in chronic skin diseases as a stimulant application. It is too active for acute eruptions, but has been used with benefit in chronic eczema and psoriasis. The official Oil of Tar (see Pix) is equally efficient. KAMALA, Rottlera,—the glands and hairs from the capsules of Mallotusphilippinensis, or Rottlera tinctoria, a small tree of the nat. ord. Euphorbiaceae, growing in Abyssinia, Arabia, India, China, etc. It occurs as a granular, mobile, brick-red powder, inodorous and nearly tasteless, partly soluble in alcohol and ether. It contains several resins, one of which is named Rottlerin, CuH10O3, also tannin, starch, gum, red coloring matter, etc. There are no official preparations. Dose, 5ss-iij. Kamala is anthelminitic and purgative, sometimes causing nausea and colic, seldom vomiting. It is used as a taeniafuge and to expel lumbrici and ascarides vermiculares. One or two drachms are given suspended in water, mucilage or syrup, and repeated in 4 hours if necessary. A tinc- ture (Svj in xvj of alcohol) may be used in doses of 5j~Sss. In India it is used locally in scabies and other skin affections, and has been found of especial service in herpetic ringworm. As a remedy against tapeworm it is perhaps next after Male-fern in efficiency, and requires no preparatory treatment. Physiological Action and Therapeutics. KINO KRAMERIA. 261 KAVA-KAVA, Ava-Kava (Unofficial),—the root of Piper methys- ticum, a shrub of the nat. ord. Piperaceae growing in South America and the South Sea Islands. The root is large, weighing from 2 to 20 pounds, fibrous, light and spongy, and contains a crystalline principle, Kavahin or Methysticin, which is analogous to Piperin, an acrid, greenish-yellow resin Kawin, which is probably the active principle, also a Volatile Oil. Dose, 3ss—j, macerated in water, or the same quantity of a fluid extract. Physiological Action and Therapeutics. Kava is intoxicant, diuretic and motor-depressant. A beverage is pre- pared in the Sandwich Islands by chewing the root and then infusing it in water or cocoanut milk, which produces a drowsy intoxication with pleasant dreams often of erotic character, and followed by severe head- ache. A moderate dose is tonic and stimulant, lessening the sense of fatigue and sharpening the mental faculties. It is highly recommended in gonorrhoea and gout, also in chronic gleet and obstinate cystitis. KINO ,—is the inspissated juice of Pterocarpus Marsupium, a tall tree of the nat. ord. Leguminosse, growing in India. It occurs in angular, brown-red pieces, shining and brittle, inodorous, taste astringent and sweetish, soluble in alcohol. It contains 75 per cent, of a variety of tan- nin named Kino-tannic Acid, Ci8H1808, which gives a greenish precipitate with persalts of iron, also a crystalline, neutral substance, Kinoin, CMHuO 6> and Kitio-red, formed from Kino-tannic Acid by oxidation, besides gum, pectin, etc. There are several other varieties of Kino in the market, brought from S. America, Africa, Australia, etc., which are products of other trees than the official one. Preparations. Tinctura Kino,—strength 10 per cent. Dose, n\x-gij. Pulvis Kino Compositus (Unofficial)—Kino 15, Opium 1, Cinnamon 4 (has of Opium I in 20). Dose, gr. v-xx. Physiological Action and Therapeutics. The action of Kino is the same as that of Tannic Acid, though less powerful (see ante, page 74), and may be used for the same purposes, both internally and locally. It is chiefly employed as an astringent gargle and as a constituent of diarrhoea-mixtures. KRAMERIA, Rhatany, is the root of Krameria triandra and Krameria tomentosa, shrubs of the nat. ord. Polygalacese, growing in S. America, the first-named in Peru and the latter in New Granada. It is about an inch thick, branched below, more or less knotty, covered with 262 KUMYSS. a brownish bark which is very astringent; and contains 20 to 45 per cent, of Rhatania-tannic Acid, C54H24021, and Rhatanine, C10H13NO3, an alka- loid,—also wax, gum, etc. Preparations. Extractum Krameria:,—aqueous. Dose, gr. v-x. Extractum Kramerice Fluidum,—Dose, rrpv-sjss. Tinctura Kramerice,—20 per cent. Dose, Ttpv— j. Syrupus Kramerice,—Fluid Extract 35, Syrup 65. Dose, g ss-^ss. Trochisci Kramerice,—each troche contains gr. j of the extract, with Tragacanth, Sugar and Orange-Flower Water. Physiological Action and Therapeutics. Krameria possesses the same astringent qualities as Tannic Acid (see ante, page 74), and may be employed for the same purposes except as an antidote to Antimony. It has long had a high reputation as an injection for fissure of the anus, as a local application to spongy gums, and as a tonic for debilitated subjects. KUMYSS, Koomiss (Unofficial),—is an effervescing fermented liquor originally prepared by the Tartars from mare’s milk, but now imitated with cow’s milk by adding sugar of milk, fermenting in open tanks, skimming off the casein and butter, then bottling during active fermentation. Wolff’s formula for its preparation in small quantity is as follows,— Dissolve 25 ss (a tablespoonful) of grape sugar in 25 iv of water. Dissolve gr. xx (a teaspoonful) of Fleischmann’s compressed yeast or well washed and pressed-out brewer’s yeast in ij of cow’s milk. Mix the two solutions in a quart champagne bottle, and fill to within 2 inches of the top with good cow’s milk. Cork well, secure the cork with wire, keep it in a cellar or ice chest, maintaining a temperature of 50° F. or less, and agitate thrice daily. In three or four days it is ready for use, but should not be kept longer than four or five days. Draw it with a champagne tap. The following table of analysis shows the average composition of milk, koumiss and kefir :— Cow’s milk. Koumiss. Kefir. Albumen, 48 II.2 38 Butter, 38 20.5 20 Sugar of milk, .... 41 22. 20 Lactic acid, — II.5 9 Alcohol, — 16.5 8 Water and salts, . . . 00 918.3 905 Physiological Action and Therapeutics. The taste of Kumyss is acidulous and peculiar. In large quantity it takes the place of food, each quart equalling four ounces of solids. It is said to be a powerful diuretic especially in cold weather, and in warm weather to produce free diaphoresis. It is stimulating and tonic, increases the body nutrition and produces considerable somnolence. The stomach LACTUCARIUM LANOLINUM. 263 is very tolerant of it, and retains it when any other food will be rejected. It is easily assimilated and very nutritious. Kumyss is an invaluable article of diet in many wasting diseases, espe- cially phthisis. It is also of great benefit in dyspepsia, the diarrhoea of children, convalescence from acute maladies, chronic affections of the kidneys, chronic bronchitis, and other cachexiae. In cases of feeble digestive power 3j every hour is sufficient, but as its digestion and assimi- lation increase it may be given almost ad libitum, and when used with other food a half-pint may be taken after each meal. Kefir is the name of a fermented drink prepared from the milk of a cow or mare by the addition of a mushroom-like ferment found near the snow-line in the Caucasian mountains. It is used by the natives of the Asiatic plains as a remedy for struma, anaemia, lung and stomach diseases. Kefir is richer in albumen than Kumyss, is less alcoholic and less acid. LACTUCARIUM, Lettuce ,—is the concrete milk-juice of Lactuca virosa, or Acrid Lettuce, a biennial European plant, of the nat. ord. Compositse. It occurs in sections of cakes or irregular pieces showing the form of the vessel in which it hardened, externally reddish-brown, internally white or yellowish and of waxy lustre, odor heavy and narcotic, taste bitter, partly soluble in alcohol and in ether, and yielding a turbid mixture when triturated with water. Lactucarium is a mixture of several substances, the most important being Lactucerin, 42 per cent., a crystalline, tasteless body, resembling caoutchouc, insoluble in water and probably inert; Lactucin, 0.3 per cent., a neutral principle, crystallizing in pearly scales, insoluble in cold water, persistently bitter; Lactucic Acid, bitter, amor- phous, but crystallizes after long standing. Preparations. Extractum Lactucarii Fluidum,—Dose, for a child rr\j-iij, for an adult rtyx- 3 j, according to the activity of the drug. Syrupus Lactucarii,—5 per cent. Dose, 3 j— j. Physiological Action and Therapeutics. Lactucarium is feebly hypnotic, somewhat sedative and diuretic. It is supposed to act similarly to Opium, but very feebly and without depressing after-symptoms. Its preparations are very uncertain in activity, and are chiefly used as placebos, to allay cough and quiet nervous irritability. The syrup is a good vehicle for expectorants and antispasmodics. LANOLINUM, Lanolin ,—is a cholesterin fat obtained from the suds from the washing of sheep’s wool, by a process patented in the United States by Prof. Liebreich, the discoverer of Chloral; and though a very old medicament, being mentioned by Ovid, Herodotus, Pliny and Aristo- 264 LAPPA LAVANDULA. phanes, it is now being introduced to the medical world as the best basis for ointments. It contains 25 to 30 per cent, of water, and readily unites with no percent, of its own weight of water; differing from all other fatty substances, chiefly in resisting saponification and the action of water, having no tendency to become rancid. It readily passes through the integument, carrying with it any medicament with which it is charged. It is a perfectly neutral base, and hence is not liable to decompose any ordinary substance. The difficulty about its use has been its very disagreeable sheepy smell, but recent samples, exhibited to the British Medical Association, seem to have been devoid of this objectionable quality. It is particularly useful in chronic skin diseases where there is infiltration, and a penetrative action is desired for medicaments. In a few cases of acute and subacute eczema it has proved irritating, but as a rule it is perfectly bland. Where a simple protective action is desired it is inferior to Lard, Vaseline or Cold Cream. LAPPA, Burdock,—is the root of Lappa officinalis, the common Burdock, a coarse-looking biennial weed of the nat. ord. Compositse, found in waste places and along roadsides in Europe, Asia and N. America. Three varieties are recognized,—Lappa major L. tomentosa and L. minor, of which the first-named is most frequently met with in this country. The root about a foot long, an inch thick, has a feeble odor and a muci- laginous, bitterish taste, and contains a bitter principle, traces of a volatile oil, also inulin, resin, tannin, mucilage, sugar, etc. There are no official preparations. Dose, in infusion, decoction or tincture. Dr. Squibb recommends a tincture of the seed, lb j of ground seed to gall, j of whiskey, allowed to stand for 2 weeks before decanting, and used in doses of 5ij—iij before meals. Physiological Action and Therapeutics. Lappa promotes all the secretions and is considered aperient, diuretic and diaphoretic, without irritating qualities. In decoction it has been a popular domestic remedy for many morbid conditions, especially rheuma- tism, gout, pulmonary catarrhs and chronic cutaneous affections. By several practitioners it is praised as an alterative in constitutional diseases, as syphilis and scrofula, also as an external application to swellings, hemorrhoids and chronic sores. A tincture of the seed has proved re- markably efficient as a stomachic tonic and has cured several cases of psoriasis inveterata. (See Squibb’s Ephemeris, vol. i, page 116.) LAVANDULA, Lavender,—the flowers of Lavandula vera, a small European shrub of the nat. ord. Labiatse, largely cultivated in England. They have a bluish-gray tubular calyx, a violet-blue corolla, a LEPTANDRA LICOPERDON GIGANTEUM. 265 fragrant odor, and an aromatic, camphoraceous taste, and contain resin and tannin, also a Volatile Oil which is official. Lavender is a constitu- ent of Vinum Aromaticum. Oleum. Lavandula,—is a volatile oil distilled from the flowering tops or the whole herb. It is much coarser than the oil of lavender flowers and more stimulant. Dose, rt\j-v. Oleum Lavandula Florum,—is a volatile oil distilled from fresh Lavender, and having the fragrant odor of the flowers. Sp. gr. 0.890, soluble in alcohol and in acetic acid of 90 per cent. It is a constituent of Spiritus Odoratus. (See ante, page 86.) Dose, tqj-v. Spiriius Lavandula—has of the Oil of Lavender Flowers 3 parts in 97 of Alcohol. A perfume and flavoring, Dose, Tinctura Lavandula Composita,—an aromatic stimulant composed of Oil of Lavender 8, Oil of Rosemary 2, Cinnamon 18, Cloves 4, Nutmeg 10, Red Saunders 8, Alcohol 680, Water 270, Diluted Alcohol q. s. add 1000 parts. Dose, gss-ij. Is a constituent of Liquor Potassii Arsenitis. Preparations. Physiological Action and Therapeutics. Lavender is aromatic, stimulant and carminative, but is rarely used alone as a medicine. It is an agreeable flavoring and perfume, in the form of the official spirit, which is sold under the name of “ Lavender- water,” after the addition of Oil of Bergamot and Essence of Ambergris. The compound tincture, formerly called the compound Spirit of Lavender, is a very agreeable compound of spices, and is much used as a remedy for gastralgia, nausea, flatulence, etc., and as an adjuvant or corrigent of other medicines. LEPTANDRA, Culver’s Root,—is the rhizome and rootlets of Leptandra virginica, an indigenous perennial plant of the nat. ord. Scrofu- lariacese. The rhizome is horizontal, about 5 inches long and % inch thick, bent and branched, with thin, wrinkled rootlets, inodorous, taste bitter and feel acrid. It contains a glucoside named Leptandrin, which is probably the active principle, also Saponin, resin, tannin, etc. The Leptandrin of the shops is an impure alcoholic extract. Extractum Leptandrce,—Dose, gr. j-iij. Extraction Leptandrce Fluidum,—Dose, Ttpxx-gj. Preparations. Leptandra is tonic, laxative, and like other resin-bearing purgatives is decidedly cholagogue. The recent root is a violent cathartic, but in the dried state it is less active. It is indicated in duodenal indigestion and chronic constipation with insufficiency of the biliary and intestinal se- cretions. Physiological Action and Therapeutics. LICOPERDON GIGANTEUM, Puff-Ball,—is a common fungus of the nat. ord. Trichogastres, found in hilly and wooded districts. 266 LIMON. The dust, which consists of the capillitium and spores, is a valuable hemostatic, and dusted over bleeding surfaces acts promptly in arresting hemorrhage. It has been proposed as a surgical dressing, but while use- ful in emergencies where other agents are unattainable, the fetor which results from its application to wounds will prevent its use becoming general for this purpose. It may prove of value as an internal hemostatic in hematemesis and the hemorrhage of typhoid fever. LIMON, Lemon ,—is the fruit of Citrus Limonum, a tree of the nat. ord. Aurantiacese, native in Asia but cultivated in southern Europe and many other countries. It is official in the two forms described below. The Orange ( Citrus vulgaris and C. Aurantiuni), the Citron (Citrus med- icci), and the Lime (Citrus acris), all belong to the same genus as the Lemon (Citrus Li)nonu??i). Limonis Cortex, Lemon Peel,—is the rind of the recent fruit, and contains a Volatile Oil, C10H16, which is official, and a bitter crystalline glucoside, Hesperidin, C22H26012, chiefly contained in the white portion of the rind. Limonis Succus, Lemon Juice,—is the freshly expressed juice of the ripe fruit, each lemon yielding from to i fluid ounce. It contains about 7 percent, of free Citric Acid, besides Phosphoric and Malic Acids, Citrates of Potassium and of other bases, etc. Dose, Bss-iv. Acidum Citricum, Citric Acid, H3C6H507.H20,—is obtained from the juice of the Lemon or the Lime by adding chalk to form the Citrate of Calcium, which is then decomposed by dilute Sulphuric Acid. It occurs in colorless, rhombic crystals which are very soluble in water. A solution of gr. xvij in §ss of water corresponds to Sss of fresh lemon-juice, and this quantity of either will neutralize of Potassium Bicarbonate gr. xxv, of Sodium Bicarbonate gr. xx, and of Ammonium Carbonate gr. xivss. Dose, gr. x-xxx. Citrates of Bismuth, Bismuth and Ammonium, Iron, Iron and Ammo- nium, Iron and Quinine, Iron and Strychnine, Lithium, Potassium, eight in all, are official. They are described under their respective bases, to which rather than to the acid their medicinal qualities are due. Preparations. Oleum Limonis, Oil of Lemon, C10H16,—is the volatile oil, isomeric with oil of tur- pentine, and extracted from fresh lemon peel by mechanical means. It is used for flavor- ing and is an ingredient of Spiritus Limonis, Spiritus Odoratus, and Spiritus Ammoniae Aromaticus. Dose, TT\j-v. Spiritus Limonis, Essence of Lemon,—prepared by macerating 6 parts of the oil and 4 of the peel in 90 of alcohol. Used for flavoring. Dose, according to the alcohol required to be given. Syrupus Limonis,—Lemon-juice 40, Lemon-peel 2, Sugar 60, Water q. s. ad 100 parts. Dose, indefinite. Syrupus Acidi Citrici,—Citric Acid 8, Water 8, Spirit of Lemon 4, Syrup 980 parts. Dose, indefinite. LINUM 267 Physiological Action. Lemon-Peel is bitter and probably tonic to the stomach, but is only used for flavoring purposes. Lemon-Juice, on the other hand, is refrig- erant and antiscorbutic, entering the blood as alkaline citrates, potassium salts and phosphoric acid, the citrates being therein partly oxidized into C02 and H20, while the potassium salts and phosphoric acid probably act upon the red corpuscles. Citric Acid has the same general action as Acetic and the other vege- table acids (see Acidum Aceticum, ante, page 58). It is wholly decom- posed in the blood, and appears to be non-toxic in man, but used inter- nally it may precipitate uric acid and thus promote the formation of calculi. Lemon-juice is employed largely in the treatment and prevention of scurvy, in which disease it possesses powers of specific rank, but whether its action therein is due to the citric acid, the phosphoric acid or the salts of potassium is not known. Lime-juice is equally efficient but Citric Acid itself is not so. As refrigerants and diuretic mixtures in fevers, Lemon-juice and Citric Acid are much used, entering into the composition of lemonades, efferves- cing draughts, etc., to allay thirst and subdue restlessness, and to pro- mote the action of the skin and the kidneys. For acidity of the stomach they are efficient if given in small doses before meals, but the mineral acids are usually preferred for this purpose. Long-continued they will impair digestion and impoverish the blood. Atheromatous degeneration of the vessels is said to be retarded by the daily use of lemon-juice, which is supposed to dissolve the excess of organic matter and to aid its excre- tion. Obesity may be reduced by using the juice of limes or lemons in large quantity, but it will be done at the expense of the digestion. Lemon- juice has been found of service in acute rheumatism, probably through the alkalies which it conveys into the blood. As a local application it has been found efficient in pruritus scroti, sunburn, post-partum hemor- rhage, and as a gargle in diphtheritic sore throat. Therapeutics. LINUM, Flaxseed, Linseed,—is the seed of Linum usita/issimum (flax), a cultivated annual plant of the nat. ord. Linaceae. The seeds are small, flattened, oblong-ovate bodies, brown and glossy, inodorous, taste mucilaginous and bitter; and contain 15 per cent, of Mucilage in the epithelium, also 30 to 40 per cent, of Fixed Oil in the embryo. Ground Flaxseed should yield not less than 25 per cent, of the fixed oil. Oleum Lini, Linseed Oil,—the fixed oil expressed from flaxseed without the use of heat. A yellow, oily liquid, of slight odor, bland taste, and neutral reaction, soluble in Preparations. 268 LITHIUM. 5 of absolute alcohol and in 1 ]/2 of ether. Consists chiefly of the Glyceride of Linoleic Acid C]6I12804, which having a powerful affinity for oxygen becomes resinoid on expo- sure to the air, making it a “ drying oil.” Dose, ss-ij. Infusum Lini, Linseed Tea (Unofficial),—Flaxseed 3 iij, Liquorice-root 5j, Boiling Water £ x, infused for 4 hours and strained. Dose, indefinite. Carron Oil (Unofficial),—is made by emulsifying equal parts of Linseed Oil and Lime- water. The official Linimentum Calcis is intended for the same purposes. Physiological Action and Therapeutics. Flaxseed is demulcent, emollient, expectorant and diuretic. The oil is laxative in a dose of 5j> and in smaller doses is oxidized in the system and excreted as a resinoid body by the kidneys, which it stimulates slightly. The infusion contains the mucilaginous principle and a small portion of the oil, and is advantageously used in inflammations of the mucous membrane of the throat, the gastro-intestinal tract and the urin- ary passages. It is an excellent demulcent in coughs of various kinds, and will be found very serviceable in cystitis, irritable bladder, renal colic, strangury, etc. The oil may be administered internally as a laxa- tive but is usually given as an enema, and has considerable reputation as a remedy for hemorrhoids in doses of Sij twice daily. Externally it is a favorite application to burns when made into an emulsion with lime- water. The ground seed (flaxseed meal) is one of the best agents for use in poultices, and is universally employed for that purpose. LITHIUM, Li,—is represented in the Pharmacopoeia by five of its salts, of which the Carbonate is but slightly soluble while the others are readily so. The low atomic weight of this metal (7) makes its saturating power greater than that of other alkaline metals, hence the value of its salts in medicine. Salts of Lithium. Lithii Benzoas, Benzoate of Lithium, LiC7H502,—is classed with the Benzoates and described under Benzoic Acid. (See ante, page 129.) Lithii Bromidum, Bromide of Lithium, LiBr,—is classed with the Bromides and described under Bromine. (See ante, page 133.) Lithii Carbonas, Carbonate of Lithium, Li2C03,—a light, white powder, permanent in the air, odorless, of alkaline taste and reaction, soluble in 130 of water, insoluble in alcohol. Dose, gr. ij-xv. Lithii Citras, Citrate of Lithium, Li3C6H507,—a white, deliquescent powder, odor- less, of faintly alkaline taste and neutral reaction, soluble in of water, slightly in alcohol. Dose, gr. v-xxx. Lithii Salicylas, Salicylate of Lithium, 2LiC7H503.H20,—is classed with the Salicy- lates and described under Salix. The Lithium salts have strong alkaline qualities and act on the system in the same manner as other alkalies (see under Potassium). The high saturating power of this metal makes its salts more alkaline than those of Potassium, Sodium or Calcium, hence more efficient in alkalinizing the Physiological Action. LOBELIA. 269 urine. The Urate of Lithium is the most soluble of the urates, hence the value of lithium salts in the uric acid diathesis. The Carbonate and Citrate are the salts referred to in this connection, the others partaking more of the qualities of their acid factors. Both these salts are antacid and strongly diuretic, the Carbonate being but slightly soluble is given in wafer or in carbonic acid water, and the Citrate in solution. The latter may be extemporaneously prepared by adding Citric Acid to an aqueous solution of the Carbonate, and in the organism is decomposed, the citric acid being oxidized and the carbonate formed. Many mineral waters contain small quantities of the carbonate, varying from a mere trace to o.oi grain to a pint, an amount so minute as to be practically inert in comparison with the much greater quantities of potassium and sodium salts in the same waters. Therapeutics. The Carbonate and Citrate of Lithium are extensively used in gout and the lithsemic diathesis, for the purpose of holding the uric acid in solution as urate of lithium, and preventing its deposit in the tissues as urate of sodium which is less soluble. Their prolonged administration is so efficient in this affection that they have been credited with the power of dissolving uric acid calculi and called lithontriptics. They are also highly useful in the indigestion and rheumatism of obese subjects, and in irritable bladder from excess of acid in the urine. Lithiated Arsenical Water has been lately praised as a remedy in diabetes. LOBELIA, Indian Tobacco,—the leaves and tops of Lobelia inflata (nat. ord. Lobeliacese), collected after a portion of the capsules have become inflated. The plant is a common annual weed growing on roadsides throughout the United States, having pale-green, alternate leaves, a single, erect and very hairy stem, with hairy branches and small, pale-blue flowers, odor slight but irritating, taste at first mild, afterwards burning and acrid. It contains gum, resin, fixed oil, wax, lignin, salts of lime, potassium and iron, a liquid alkaloid Lobeline, which is the narcotic principle of the plant, also Lobelic Acid, and an acrid substance named Lobelacrin. Extraction Lobelice Fluidum,—Dose, trpj-x. Tinctura Lobelice,—20 per cent. Dose, npv-xxx. Acetum Lobelice,—io per cent. Dose, upv- j. Infusion Lobelice (Unofficial),— to a pint. Dose, Lobelin (Unofficial),—an impure resinoid. Dose, gr. ss-j. Preparations. Physiological Action. Lobelia has an acrid, nauseous taste, and a heavy, unpleasant odor. It is expectorant, diaphoretic, emetic, purgative, antispasmodic, motor- 270 LYCOPODIUM. depressant and narcotic. It excites an abundant flow of saliva, much gastric mucus, profuse urination and sweating, with nausea, vomiting and great depression. The heart’s action is enfeebled, and the blood-pressure, at first increased, soon falls; muscular debility, reduced temperature and coma follow, and death occurs by paralysis of the respiratory apparatus. The drug produces paralysis of the motor nerve-trunks, the peripheral vagi, and probably the respiratory and vaso-motor centres also. It strongly resembles tobacco in its action, and is highly dangerous in full medicinal doses, having caused many deaths when administered thera- peutically, the most important instance of its fatal results being the case of Ezra Lovett, Jr., who in 1809 was poisoned by Lobelia administered by the founder of the Thomsonian sect of medical practitioners. The responsible party escaped conviction on the plea that he gave the drug in ignorance of its qualities. Tannic Acid to form the insoluble tannate. Strychnine, Picrotoxine and Thebaine antagonize its action on the nervous system;—the vaso-motor excitants, as Alcohol, Digitalis, Belladonna, Ergot, etc., antagonize its effects on the circulation. Caustic alkalies are incompatible, decomposing the alkaloid. Antidotes and Incompatibles. Lobelia was a favorite remedy with the Indians at the time of the first settlement of the United States, and was introduced into regular practice as an anti-asthmatic, after having served as the main stock-in-trade of the irregular practitioners for many years. Its principal therapeutic action is that of an antispasmodic, and in cautious hands it is extremely useful in paroxysmal spasmodic asthma, as well as in dry cough with constant tick- ling in the throat. As an enema in cases of strangulated hernia the infu- sion is much safer than Tobacco and fully as efficient, and may overcome the obstruction in intussusception, while the tincture in 2-drop doses every hour will often relieve a case of impacted caecum. In constipation from atony and deficient secretion a io-minim dose of the tincture at bed- time acts excellently, and in the poison-oak eczema the infusion is a good local application. As an emetic it is entirely too depressant for child- ren’s use. Therapeutics. LYCOPODIUM ,—is a very mobile, pale-yellow, fine powder, con- sisting of the sporules or seeds of the Club-moss, Lycopodium clavatuvi, and of other species of Lycopodium (nat. ord. Lycopodiacese). The plant is a native of Europe and the U. S., has a trailing stem several feet long, with smooth, deep-green, pointed leaves, flowers in terminal spikes, and yellow capsules which contain the seeds. Lycopodium is odorless, tasteless, floats on water, which does not wet it, and burns quickly when MAGNESIUM. 271 thrown on a flame. It should be free from pine-pollen, starch, sand and other impurities, which are detected by means of the microscope, the seeds being about of an inch in diameter, four-sided and reticulated, with short projections on the edges. They contain about 47 per cent, of a bland, fixed oil. Physiological Actions and Therapeutics. The plant was formerly considered to be diuretic and anti-spasmodic, and was used in rheumatism, epilepsy and pulmonary and renal disorders. The powder is now employed quite extensively in pharmacy to facilitate the rolling of a pill-mass and to prevent adhesion of pills to each other. It makes an excellent absorbent and protective powder when dusted over an excoriated surface, as seen between the thighs of infants. By the homoeopathic practitioners Lycopodium is elevated to the rank of an active drug when triturated with sugar of milk sufficiently long to break up the seeds and liberate their oily contents. In their first centesi- mal trituration it is said to have produced symptoms of high excite- ment of the circulation and irritation of the urinary organs, and they profess to use it with benefit in many affections of the mucous tracts, dys- pepsia, pyrosis, flatulence, constipation, ileo-colitis of infants, hepatic congestion, aneurism, chronic affections of the lungs and bronchi, diph- theria, lithiasis, intertrigo, porrigo capitis, plica polonica and pruritus ani, in all of which as an internal remedy and in high attenuation. MAGNESIUM, Mg.—This metal is represented by its Oxide, Car- bonate, Citrate, Sulphate and Sulphite, of which the Sulphate occurs native in sea-water, caves, etc., the others being prepared from it. The first two are almost insoluble in water or alcohol. Its salts are either white or colorless, and those which are official are as follows:— Magnesia, Light Magnesia, Oxide of Magnesium MgO,—made by heating the light carbonate in a crucible to expel nearly all the carbonic acid. A white, light and very tine powder, almost insoluble in water, insoluble in alcohol, and gelatinizes with 15 of water after standing hour, having become hydrated. Is a constitutent of Pulvis Rhei Com- positus, Massa Copaibse and Ferri Oxidum Hydratum cum Magnesia. Dose, gr. x-^j. Magnesia Ponderosa, Heavy Magnesia, Oxide of Magnesium, MgO,—is a white, dense and very fine powder, corresponding in other properties and reactions with Magnesia, ex- cept that it does not gelatinize with water. It is made by calcining the heavier variety of the carbonate, and is much slower in action than the light magnesia. Dose, gr. x-^j. Magnesii Carbonas, Carbonate of Magnesium, (MgC03)4Mg(H0)2.5H20,—light, friable masses, or powder, odorless and tasteless, insoluble in alcohol, almost insoluble in water. Dose, gr. x-gj. Magnesii Sulphas, Sulphate of Magnesium, Epsom Salt, MgS04.7H20,—colorless prisms or acicular needles, slowly efflorescent, odorless, of cooling, saline taste, and neu- tral reaction, very soluble in water, insoluble in alcohol. Is a constituent of Infusum Sennse Compositum. Dose, Magnesii Sulpkis, Sulphite of Magnesium, MgS03.6H20,—a white, crystalline pow- Official Salts of Magnesium. 272 MAGNESIUM. der, becoming oxidized on exposure to air, of sulphurous and slightly bitter taste, and neutral or slightly alkaline reaction, soluble in 20 of water, insoluble in alcohol. Dose, gr. x-xxx. Magnesii Citras Granulatus, Granulated Citrate of Magnesium,—prepared from the Carbonate with Citric Acid, Sugar, Bicarbonate of Sodium, Alcohol and Distilled Water. A coarsely granular, white salt, deliquescent, of acidulous taste and acid reaction, soluble with copious effervescence in 2 of water, insoluble in alcohol. Dose, gij-If j. Liquor Magnesii Citratis,—prepared from the Carbonate gr. 200, Citric Acid gr. 400, Syrup of Citric Acid gr. 1200, Potassium Bicarbonate gr. 30, Water q. s. ad xij. Dose, 3 iv-vj, repeated for catharsis. Trochisci Magnesii,—each troche contains of Magnesia gr. 3, Nutmeg gr. 0.15, with Sugar and Mucilage of Tragacanth. Dose, indefinite. Mistura Magnesice et Asafcetidce, Dewees’ Carminative,—contains of the Carbonate 5 per cent., Tincture of Asafoetida 7, Tincture of Opium 1, Sugar 10, and Distilled Water 77. Dose, gss-iv. Used for flatulent colic and diarrhoea in infants. Preparations. Physiological Action. Magnesia and the Carbonate of Magnesium are mildly laxative and antacid, neutralizing free acids in the stomach and forming therewith lax- ative salts. If used in large quantity for any length of time it may become hydrated and produce intestinal concretions. The freshly-pre- cipitated hydrate (see above, Magnesia) is an antidote to Arsenic in solution, but less effective than the Hydrated Sesquioxide of Iron, with which it is combined in the official Ferri Ox. Hydratum cum Magnesia. (,See ante, page 216.) Magnesia may also be used in acid or phosphorus- poisoning. The Citrate and Sulphate are saline cathartics, the latter being the most powerful, producing prompt and free watery discharges, with but little griping or irritation, but frequently a sense of coldness and depres- sion. The purgative action is chiefly due to increase of the intestinal fluids by an outward osmosis from the vessels, and not from increase of the secretions of the glandular appendages. If the purgative action should not take place a diuretic one will result, but to secure the desired catharsis the drug should be administered in a considerable quantity of water. Sulphate of Magnesium is the principal aperient constituent of many of the popular laxative mineral waters, as Friedrichshall, Piillna, Hunyadi, etc. The Sulphite shares the actions and uses of the other sulphites, and is more properly considered with them. (See ante, page 73.) Magnesia and the Carbonate are used as antacids and laxatives, in acid- ity, sick headache, flatulent colic, etc., and as antidotes in poisoning by acids, arsenic, phosphorus, mercuric and cupric salts. The Citrate is an agreeable laxative, cooling and acceptable to the stomach. The Sulphate is the most efficient of the saline cathartics and has a wide field of appli- cation. In acute inflammatory conditions, renal and cardiac dropsy, Therapeutics. MAGNOLIA MALTUM. 273 ascites from obstruction of the portal circulation, increased blood-pressure within the cranium, intestinal obstruction without acute inflammation, the constipation of lead poisoning, and habitual constipation from deficiency of the intestinal secretions, this agent will be found to be exceedingly serviceable. Acute dysentery is well treated by Magnesium Sulphate combined with diluted Sulphuric Acid, and followed by Opium and starch enemata. Bleeding from hemorrhoids and uterine hemorrhage are often relieved by the same combination when other agents fail. The ferro- saline mixture (see ante, page 218) is a very useful laxative in the consti- pation of anaemic women. The bitter taste of Epsom Salt is best covered by coffee. MAGNOLIA ,—is the bark of Magnolia glauca (Sweet Bay, Swamp Sassafras), M. acuminata (Cucumber-tree), and M. tripetala (Umbrella- tree), all of which belong to the nat. ord. Magnoliaceae, and are indi- genous to the eastern and southern States. It occurs in quilled or curved pieces, of orange-brown color externally, whitish or a pale-brown inter- nally, taste astringent, pungent and bitter. It contains a crystalline prin- ciple named Magnolia, which is insoluble in water, but soluble in alcohol, ether, etc. Dose of the powdered bark, 3 ss-j. There are no official preparations. Physiological Action and Therapeutics. Magnolia is an aromatic bitter tonic and diaphoretic, usefully employed in chronic rheumatism, remittent and intermittent fevers. In the latter affection it will arrest the paroxysms if used freely. MALTUM, Malt ,—is the seed of Hordeum distichum, Barley (nat. ord. Graminaceae), caused to enter the incipient stage of germination by artificial means and dried. The germination is allowed to go far enough to develop the maximum amount of Diastase, the peculiar ferment by which the starch of the grain is converted into Glucose. Malt is the source of beer, ale and whiskey, and is composed of the germinated, dead grains with their acrospires and radicles. It should be fresh, not darker in color than a pale amber, and of agreeable odor and sweet taste. Preparations. Extractum Malti,—a liquid of the consistence of thick honey, containing all the soluble principles of malt in permanent form. It consists chiefly of diastase and glucose. Dose, 3j-iv. Horlick's Food (Unofficial),—is like Mellin’s and many other foods for children, a granulated Extract of Malt. Hoff's Malt Extract is another such preparation, contain- ing alcohol, and corresponding to a concentrated beer. 274 MANACA MANGANUM. Physiological Action and Therapeutics. Malt Extract is directly nutritive, containing good food elements, and indirectly so from the presence of the ferment Diastase, which converts the starch of bread or other farinas into sugar. It is usefully employed in wasting diseases, and mixed with milk or oleaginous foods it aids their digestion and assimilation. It may be used to form a syrupy mixture with preparations of Iron or Cinchona. MAN AC A (Unofficial),—is the root of Franciscea uniflora, a shrub of the nat. ord. Scrophulariacese, indigenous to Brazil, where it is known as Mercurio-vegetal, or Vegetable Mercury, a name applied by charlatans to a number of widely differing plants. Very little is known about Manaca, but it is extensively advertised as an unfailing remedy for sub- acute and chronic rheumatism. It is also considered purgative, diuretic, emmenagogue and antisyphilitic, being official in the Brazilian Dispensa- tories, and noticed as follows in the Diet, de Botan. Brazileira. “ This whole plant, but especially the root, excites powerfully the lymphatic system, eliminating morbid matter by the skin and kidneys. It is antisyphilitic; the interior bark is nauseating and stimulates the throat. In small doses it is resolvent; in larger purga- tive, diuretic and emmenagogue. In large doses it is an acrid poison.” A fluid extract is on the market, the average dose of which is 14 x three or four times daily. MANGANUM, Manganese, Mn.—This metal is represented in the Pharmacopoeia by two of its salts, viz.—the native Black Oxide and the Sulphate, as follows,— Mangani Oxidw)i Nigrum, Black Oxide of Manganese, Dioxide of Manganese,—is native, crude Binoxide of Manganese, containing at least 66 per cent, of the pure Oxide, Mn02. A heavy, grayish black powder, odorless and tasteless, insoluble in water or alco- hol, giving off oxygen gas at a red heat, and if heated with hydrochloric acid it causes the evolution of chlorine gas. Is used in preparing Chlorine Water. Dose, gr. ij-x. Mangani Sulphas, Sulphate of Manganese, MnS04-4H20.—colorless prisms, of slightly bitter and astringent taste, faintly acid reaction, very soluble in water, insoluble in alcohol. Dose, gr. ij-v. Preparations. Potassii Permanganas, Permanganate of Potassium, K2Mn208,—deep, purple-violet prisms, of sweet and astringent taste, neutral reaction, soluble in 20 of water with a scanty, brown residue, decomposed by alcohol. It should be kept in well-stoppered bottles, and should not be triturated nor combined in solution with organic or readily oxidizable substances. Dose, gr. ss-ij, in distilled water. Syrupus Mangani Iodidi, Syrup of the Iodide of Manganese (Unofficial),—contains about 3j of the iodide in each Dose, For formula see U. S. D., page 1691. Syrupus Ferri et Mangani Iodidi, Syrup of the Iodide of Iron and Manganese (Un- official),—each g contains gr. 50 of the mixed iodides in the proportion of 3 of the Iodide of Iron to 1 of that of Manganese. Dose, For formula see U. S. D., page 1692. MANGANUM. 275 Ferri et Mangani Cardonas Saccharatus, Saccharated Carbonate of Iron and Man- ganese (Unofficial),—is a tasteless, reddish-brown powder. Dose, gr. v-xx. For formula see U. S. D., page 1693. Physiological Action. The salts of Manganese in small doses improve the appetite and the digestion and stimulate the action of the heart. Used in larger doses and for considerable length of time they lower the heart’s action, paralyze the muscular system, especially the muscular coat of the arteries, causing pro- gressive wasting, paraplegia, and acute fatty degeneration of the liver. They are gastro-intestinal irritants, and the Sulphate is emeto-cathartic and decidedly cholagogue. Manganese is closely associated with Iron in the blood, bile, etc., in the proportion of about 1 to 20. The Black Oxide is an efficient emmenagogue. Permanganate of Potassium is an active oxidizer, containing as it does a large proportion of oxygen which it yields very readily in the form of ozone, and then becomes the binoxide of manganese. This property gives it the qualities of an antiseptic, a disinfectant and a deodorant. It is considered by some authorities to be an efficient emmenagogue. Used internally it must be instantly decomposed in the stomach, and probably is not absorbed in its own state. Therapeutics. The salts of Manganese are used by those practitioners who affect to see a manganese-anaemia in cachectic subjects, and they are always combined with ferric preparations. In amenorrhcea, gastrodynia and pyrosis the purified oxide is a good remedy in doses of io to 15 grains, and the same preparation is used as an ointment in many skin diseases. In jaundice of malarial origin or catarrh of the biliary passages the sulphate gives good results. Permanganate of Potassium is used as an antiseptic and oxidizing agent in diphtheria, scarlatina, septicaemia, erysipelas, etc., given internally and used locally at the same time. It is given with apparent benefit in dys- pepsia, flatulence, lithaemia and obesity, and has often seemed to be of service in acute rheumatism. In amenorrhoea it is reported to be very efficient, and has lately been used with success as a remedy for the bites of venomous serpents and for other animal poisons. Locally it is fre- quently employed (3 j to the pint) to correct fetor in cancer, ulcer, caries, abscesses, ozsena, and it will destroy the odor of a foul breath or that of the fetid perspirations of the feet. It is used both as a test and as a cor- rigent for organic impurities in drinking-water. Manganese is becoming more of an acknowledged remedy in derange- ments of the menstrual function, as irregular or scanty menstruation, amen- orrhoea, menorrhagia, and even metrorrhagia. By some authorities, the emmenagogue power of Potassium Permanganate is ascribed to its large 276 MANGO MANNA. proportion of Oxygen, which it is supposed to give up to the uterus; as, until recently, Potassium Chlorate was supposed to do by the system at large. According to the views of others who have studied its action, Man- ganese should be classed with the excito-motors, increasing arterial ten- sion, and specifically acting upon the uterus. The best preparation is the Binoxide, in freshly-made pills of two grains each, of which 1 to 3 or 5 pills may be taken twice or thrice daily. The Permanganate of Potassium has generally been the preparation given when the effects of Manganese were desired; but as it causes great gastric irritability, with abdominal pains and burning sensations, besides other decidedly unpleasant symp- toms, it is a difficult matter to get patients to take it for any length of time. MANGO (Unofficial),—is the bark of Mangifera indica, an Indian tree of the nat. ord. Guttiferae. It is supposed to be an astringent with special tonic action upon mucous membranes. It is highly recommended by its vendors for nasal catarrh, hemorrhages, and muco-purulent dis- charges from the intestines, uterus, vagina and bronchi. A fluid extract is sold, which may be used in doses of npx-5j. Mango-Fruit or\ATangosteen, is the fruit of Garcinia mangostana, nat. ord. Guttiferse, also from India. It is a powerful astringent, and is used for nasal catarrh, diarrhoeas, dysentery, leucorrhoea, etc. MANNA ,—is the concrete, saccharine exudation of Fraximis Ornus, or Flowering Ash, a tree of the nat. ord. Oleaceae, growing in Southern Europe. Manna is produced also by several other trees, and substances resembling it are exuded by many plants. The official Manna occurs in three-edged, flattish pieces, brownish-white and glutinous externally, white and crystalline internally, odor honey-like, taste sweet, slightly bitter and faintly acrid. It contains from 40 to 90 per cent, of Mannit, C6HuOe, or Manna-sugar, which does not undergo vinous fermentation, and is chemically allied to the alcohols and to glycerin. Manna also contains glucose, mucilage, some acrid resin, and a small quantity of the fluores- cent glucoside Fraxin, C16H18O10. There are no official preparations, but Manna itself may be given in doses of 3 j—ij. Manna is a mild laxative, with some tendency to produce flatulence and colic. It is usually combined with other purgatives, as Senna, Rhu- barb, Magnesia, etc., to disguise the taste and increase the effect. It is a constituent of the official Infusum Sennae Compositum. Manna may be eaten by children if of good quality, or may be readily dissolved in milk and so administered. Physiological Action and Therapeutics. MARRUBIUM MASTICHE MATICO. 2 77 MARRUBIUM, Horehound,—the leaves and tops of Marrabiwn vulgare, a plant of the nat. ord. Labiatse, native in Europe, but natural- ized in America. It contains a bitter principle named Marrubiin, also a volatile oil, resin, tannin, lignin, etc. There are no official preparations. Dose, 5ss-j. Physiological Action and Therapeutics. Horehound in large doses is-laxative, diuretic and diaphoretic, and in ordinary dosage it is a gentle tonic and stomachic. It is generally used in catarrhal states of the air-passages, over which it seems to have a sooth- ing effect, and is much employed in confectionery as an ingredient in “ cough-drops.” MASTICHE, Mastic, —is a concrete, resinous exudation from Pistacia Lentiscus, a tree of the nat. ord. Terebinthacese, growing in the island of Scio. It occurs in globular tears, covered with a whitish dust, of weakly resinous odor and slightly terebinthinate taste. Alcohol dis- solves about 90 per cent, including the resin Mastichic Acid, C20H32O3, the remainder consisting of another resin Mastichin, which is soluble in ether and resembles copal. There are no official preparations, but Mastic is an ingredient of the official Pil. Aloes et Mastiches (see ante, page 90). Physiological Action and Therapeutics. Mastic was formerly used for supposed properties analogous to those of other oleo-resins, but now its application is confined to dentistry, being employed as a temporary filling for carious teeth, a solution in ether being applied on cotton with moderate pressure, and remaining as a firm plug after evaporation of the solvent. MATICO,—the leaves of Artanthe elongata (Piper angustifolium), a Peruvian shrub of the nat. ord. Piperaceae. They are 4 to 6 inches long, and prominently venated on the under surface, the veins forming deep, angular meshes. Matico contains a crystallizable acid named Artanthic Acid, also resin, tannin, and a volatile oil. Its odor is aromatic, and its taste astringent, spicy and somewhat bitter. Extractum Matico Fluidum,—Dose, g ss-ij. Tinctura Matico,—io per cent. Dose, ss-ij. Preparations Matico is an aromatic tonic and stimulant, also aphrodisiac, vulnerary and hemostatic. It acts, like cubebs, on the urinary passages, and is an excellent alterative stimulant to mucous membranes. It has been used Physiological Action and Therapeutics. 278 MATRICARIA—MEL. with considerable success in mucous catarrhs, as gonorrhoea, leucorrhoea, chronic cystitis, etc., also in epistaxis, hemorrhoids menorrhagia, hemop- tysis, hematemesis and other hemorrhages. The under surface of the leaf is so formed as to promote coagulation of blood if applied to a bleeding surface, and therefore it is a good local hemostatic for trivial cuts or wounds. MATRICARIA, German Chamomile,—the flower-heads of Matricaria Chamomilla, a European annual plant of the nat. ord. Com- positse. They are small, yellow flowers, with white ray-florets, the recep- tacle being hollow, naked and conical, of strongly aromatic odor and bitter taste ; and contain per cent, of a blue Volatile Oil (the color of which is due to Azuleti), also a bitter extractive, tannin, etc. There are no official preparations, but the flowers may be eaten or a decoction or in- fusion used almost ad libitum. Physiological Action and Therapeutics. Matricaria is a mild tonic, in large doses emetic, anthelmintic and antispasmodic. It is much used in Germany, and in this country is a popular domestic remedy among German people, who use it in infusion as a diaphoretic, etc. This plant is the “ Chamomilla” of the homoeopaths, who find in it remarkable power over morbid impressionability of the sensory and excito-motor nerves, and administer it in various pains, aggra- vated at night and by warmth, clonic spasms of pregnancy, irritability of teething-children, flatulent colic, etc. MEL, Honey,—is a saccharine secretion deposited in the honey- comb by Apis mellifica, the honey-bee ; occurring as a pale-yellowish, syrupy liquid, gradually becoming crystalline and opaque, of peculiar and heavy odor, and a very sweet, faintly acrid taste. It is a strong aqueous solution of several sugars (cane and grape sugar, levulose), with wax- pollen, coloring and odorous matters, etc. The sugars, which may be resolved into Levulose and Dextrose, amount to 70 or 80 per cent. Honey is frequently adulterated with starch and artificial glucose, which maybe detected by the official tests (see U. S. Phar.). Dose indefinite. Mel Despumatum, Clarified Honey,—is honey heated, skimmed and strained. It is an ingredient of Confectio Rosas, Mel Rosae, and Massa Ferri Carbonatis. Dose, indefinite. Mel Rosce, Honey of Rose,—Red Rose 8, Clarified Honey 93, Diluted Alcohol q. s. Dose, indefinite; generally used as a local application to the throat for its astringency and flavor, in combination with more active agents. Preparations. MELISSA—MENISPERMUM—MENTHA PIPERITA. 279 Physiological Action and Therapeutics. Honey is emollient, nutritive and laxative, in some persons giving rise to pyrosis, flatulence and colic, and in others to an eruption of urticaria, but generally constituting an agreeable article of diet. It is sometimes actually poisonous from the presence of toxic agents extracted by the bee from certain plants, in this country generally the Mountain Laurel (.Kalmia Latifolia'). Honey is chiefly used as an emollient in diseases of the throat, to relieve dryness, pain, cough and dysphagia. A mixture of Honey 8 parts to 1 each of Acetic Acid and Water is official in the Br. Phar. under the title Oxymel, and forms a pleasant addition to gargles or a vehicle for expectorant medicines. Honey of Rose is somewhat astrin- gent, and is used in gargles for the throat and in mouth washes. MELISSA, Balm,—the leaves and tops of Melissa officinalis, a European plant of the nat. ord. Labiatse, growing also in America. It has a perennial root, which annually gives forth several stems from i to 2 feet high, with leaves about two inches long, deeply serrate, hairy and glandular, and white or yellowish flowers in axillary whorls of four or five around half the stem. It contains gum, tannin, bitter extractive, and a fragrant essential oil in very small quantity to per cent.). There are no official preparations. Physiological Action and Therapeutics. Balm has little or no action, except to flavor hot water for use as a beverage or a mild diaphoretic. MENISPERMUM, —is the rhizome and rootlets of Menispermum canadense, or Canadian Moonseed, a woody, climbing plant of the nat. ord. Menispermacese, native of the eastern U. S., having peltate three- to seven-lobed leaves, greenish-yellow flowers in small clusters, and a kidney- shaped fruit. The rhizome is several feet long, % inch thick, finely wrinkled, rootlets numerous, taste bitter. It contains starch, Berberine, and a white alkaloid which is soluble in alcohol and in ether. There are no official preparations. Dose, gr. v-xx, in infusion. Menispermum is reputed to have tonic properties, and is used in some of the Southern States in domestic practice as a substitute for Sarsa- parilla in scrofulous conditions. Little is known about it of a definite character. Physiological Action and Therapeutics. MENTHA PIPERITA, Peppermint, —the leaves and tops of Mentha piperita, a perennial herbaceous plant, of the nat. ord. Labiatse, 280 MENTHA PIPERITA. native of Britain, but largely cultivated elsewhere. The leaves are about 2 inches long, ovate-lanceolate, sharply serrate, of aromatic odor, and pungent, cooling taste. They contain 1 to per cent, of a Volatile Oil which is official, and a little tannin. Oleum Me 711ha Piperita, Oil of Peppermint,—is the volatile oil distilled from the fresh herb ; a colorless or pale yellow fluid of sp. gr. about 0.900, having the odor of pepper- mint, a strongly aromatic taste followed by a cold sensation when air is drawn into the mouth. It consists of a liquid terpene, and a stearoptene named Menthol or Peppermint Camphor, C10H20O. Dose, Tflj-v. Aqua Mentha Piperita, Peppermint Water,—has of the oil 2 parts in 1000 of Distilled Water. Dose, indefinite. Spiritus Mentha Piperita, Essence of Peppermint,—is an alcoholic solution containing 10 per cent, of the Oil and 1 per cent, of the powdered herb. Is an ingredient of Mistura Rhei et Sodas. Dose, Ttyx-xxx. Trochisci Mentha Piperita, Peppermint Troches,—each troche contains gr. of the Oil, with Sugar and Mucilage of Tragacanth. Dose, indefinite. Menthol, Peppermint Camphor, C10H20O (Unofficial),—is a stearoptene deposited by Oil of Peppermint on exposure to cold. Used externally. Preparations. Physiological Action. Peppermint is an aromatic stimulant, carminative and antispasmodic. The oil possesses these qualities in greater degree and is also a local ano- dyne and anaesthetic when applied locally, especially if its evaporation be prevented. The Chinese oil is particularly anodyne and contains a large quantity of Menthol. The oil is best administered internally in its alcoholic solution, the spirit. Menthol is antiseptic and locally anaesthetic, but not corrosive, and acts also as a vascular stimulant when applied to the surface. Therapeutics. Peppermint is used internally for the relief of nausea and colic, and to expel flatus by its local stimulant and after sedative action on the bowels. It is an agreeable corrigent for combination with purgatives to prevent griping, and efficiently covers the taste of many nauseous sub- stances. The spirit is the best form for internal use. The oil is used locally to relieve the pain of superficial neuralgia, a cloth being wet with it, laid along the course of the affected nerve, and covered with oiled silk to restrain evaporation. It is also efficient in rheumatism as an anodyne counterirritant. Menthol is highly vaunted as an external application in various neuralgiae, sciatica, pleurodynia, toothache, etc. For neuralgia it is used in saturated alcoholic solution painted over the affected nerve. For toothache a crystal introduced into the carious cavity is promptly ano- dyne. As an antiseptic it promises well as an application in parasitic skin- diseases. As the Chinese have used their Oil of Peppermint for ages as an application in neuralgise, and as this oil contains a large quantity of Menthol, the latter preparation will probably prove a very efficient agent in these affec- tions if the cupidity of the manufacturers will allow of its being obtained pure. MENTHA VIRIDIS MEZEREUM. 281 MENTHA VIRIDIS, Spearmint, — the leaves and tops of Men- tha viridis, the “mint” of the kitchen garden, a plant of the nat. ord. Labiatae, indigenous to England, but naturalized in many countries. Its constituents and properties are identical with those of peppermint, but its odor and taste differ therefrom. Oleum Mentha Viridis, Oil of Spearmint,—is the Volatile Oil distilled from the plant. Dose, tTLij-v. Aqua Mentha Viridis, Spearmint Water,—has 2 parts of the Oil in 1000 of Distilled Water. Dose, indefinite. Spiritus Mentha Viridis, Essence of Spearmint,—is an alcoholic solution containing 10 per cent, of the Oil and I per cent, of the powdered herb. Dose, Ttpx-xl. Preparations. Physiological Action and Therapeutics. Spearmint corresponds in action to Peppermint, but is generally less powerful. It is usually employed to correct flatulence and to relieve colic, and makes an agreeable flavoring for many mixtures. MEZEREUM, Mezereon,—is the bark of Daphne Mezereum and of other species of Daphne, plants of the nat. ord. Thymelaceae, growing in mountainous districts of Europe and Asia and cultivated as a garden shrub in Britain. The bark occurs in long, thin bands, rolled into disks, brownish-yellow on the surface, whitish and silky within, inodorous, very acrid. It contains an inert, fixed oil, an inactive glucoside Daphnin and an acrid Resin, which is the anhydride of a resinous acid named Meze- reinic Acid. Mezereum is an ingredient of the compound decoction and the compound fluid extract of Sarsaparilla. Dose, gr. j-x. Extractum Mezerei,—is only used to prepare the Linimentum Sinapis Compositum. Extractum Mezerei Fluidum,—is too acrid for internal use, but from it is prepared the following. Unguentum Mezerei,—has of the preceding 25 parts, Lard 80, Yellow Wax 12. An irritant ointment. Preparations. Mezereon is a sialogogue, and an intensely acrid, irritant poison, pro- ducing violent vomiting, purging, nephritis and gastro-enteritis. In small doses it is laxative and diuretic, and has had considerable reputation as an alterative. Externally the recent bark is a powerful local irritant, speedily producing vesication. Physiological Action. Mezereon is rarely used internally by itself, but is employed in mix- tures with Sarsaparilla, etc., as an alterative in syphilis, rheumatism and some skin diseases of chronic type, but with doubtful efficacy. It has been used with good effect in toothache and as a masticatory in paralysis Therapeutics. 282 MORRHUAE OLEUM. of the tongue. Its principal use is as a local irritant to keep up the dis- charge from issues or blisters, and to stimulate indolent ulcers. MORRHUAE OLEUM, Cod-liver Oil,—is a fixed oil obtained from the fresh livers of Gadus Morrhua (Cod-fish) or other species of Gadus. It is a colorless or pale yellow, thin, oily liquid, of slightly fishy odor and taste, and faintly acid reaction, soluble in ether; sp. gr. 0.920 to 0.925. It consists chiefly of Olein and Margarin, with a peculiar prin- ciple named Gaduin, also Trimethylamine, free fatty Acids (oleic, pal- mitic, stearic), traces of Iodine, Bromine, Sulphuric and Phosphoric Acids, the ordinary inorganic salts of animal tissue and products, and perhaps bile constituents. When saponified it does not yield Glycerin but Oxide of Propyl. Three kinds or varieties are found in the market, the pale, the light-brown and the dark. The pale is the official oil and the purest. Dose, oj-ip on a full stomach, increased as assimilated. Unofficial Preparation. Glyconin Emulsion of Cod-liver Oil,—01. Morrhuae 3 iv, Glyceritum Vitelli 3 ix, Aromatic Spirit of Ammonia g j, Sherry Wine Diluted Phosphoric Acid giv, Es- sence of Bitter Almond ( s;j of the Volatile Oil in Oss Alcohol) £ij. The Cod-liver Oil is to be added to the Glyconin very slowly with brisk stirring, and the other ingredients added in the order named. Physiological Action. The action of Cod-liver Oil is that of any other fat, except that it is more easily assimilated than any member of the class. Fats in small quan- tity are necessary for the digestion of nitrogenous food, and form the molecular basis of the chyle, being prepared for absorption by the pancre- atic juice and the bile, especially by the latter. Fat is an essential con- stituent of the products of tissue formation, whether physiological or path- ological, and is the principal material concerned in the production of force. After oxidation it is excreted as carbonic acid and water. Lo- cally applied fats reduce the body temperature. Cod-liver Oil is the most easily digestible of fats, penetrating animal membranes with comparative ease after being emulsified by the pancreatic and biliary secretions, hence entering the lacteal vessels readily and ap- pearing to bring with it the oily and nitrogenous elements of the food. The result is facilitation of the digestive process, increase of the red blood-corpuscles and of the body-weight, and stimulation of healthy cell- formation throughout the tissues. The properties of this oil have been ascribed to its contained biliary constituent, Iodine, free Oleic Acid, etc., but no satisfactory explanation has yet been offered for the difference be- tween its action and that of other animal or vegetable oils. The use of Cod-liver Oil is that of a nutrient wholly, this action being Therapeutics. MOSCHUS. 283 most marked in wasting diseases. In high febrile states or catarrhal con- ditions of the gastro-intestinal tract its use is contraindicated, but in phthisis a slight degree of fever will not interfere with its beneficial em- ployment. It is found to be of most value in chronic forms of phthisis, chronic bronchitis and emphysema, chronic rheumatic disorders, atheroma of the arteries, strumous skin diseases and diarrhoea, syphilodermata, neu- ralgia, chorea and epilepsy. In many disorders referable to exhaustion or debility of the nervous centres it is of great value as a nerve tonic, and in convalescence from acute diseases it is of marked benefit. It should always be considered as a supplementary food, and if its use endangers the appetite for other food it should be abandoned. The administration of this valuable agent is a serious matter, as many patients cannot overcome their repugnance to its taste and smell. Various emulsions are on the market, but they are objectionable because in no case do they conceal the taste, and the efficacy of the oil is seriously impaired by the processes used in their preparation. Moreover, the temptation is very great to employ an inferior grade of the oil or to adulterate it with other fish-oils in the manufacture of these preparations, and when the commercial spirit of gain is remembered one can never be sure of the quality of the oil so prepared. The oil itself is the best form for use, in small doses, say a teaspoonful thrice daily for an adult, after meals, in black coffee, beer or lemon-juice. The essential Oil of Eucalyptus in the pro- portion of i part to ioo of cod-liver oil will effectually extinguish the odor and taste to many persons. Alkaline stomachics given before meals, the oil after, and a teaspoonful of the “Liquor Pancreaticus” given half an hour afterwards, would be a good routine in most cases, the latter agent preventing the fishy eructations which often give so much trouble. Ex- temporaneous emulsions may be prepared with Glycerite of Yolk of Egg (see ante, page 282), White of Egg, Mucilage of Tragacanth, Extract of Malt, or any syrup, and flavored with Lemon, Cinnamon or Bitter Almond. The addition of npiv of Ether to each 5 of the oil promotes its digestion by stimulating the pancreatic secretion, and enables a patient to take it with whom it had previously disagreed. Inunction by Cod-liver Oil is a method of value in the wasting diseases of children. A tablespoonful may be rubbed into the skin of the abdo- men twice a day, and covered with a flannel binder with oiled silk or mackintosh-cloth outside. It readily passes through the skin and is ab- sorbed, producing valuable and lasting results. MOSCHUS, Musk ,—is the dried secretion from the preputial follicles of Moschus moschiferus (the Musk Deer), an animal inhabiting the mountainous region of Central Asia. It occurs in irregular, unctuous grains, of a reddish-brown color, peculiar and penetrating odor and 284 MYRCIjE OLEUM—MYRISTICA. bitterish taste, contained in oval sacs about 2 inches in diameter, mem- branous on one side, hairy on the other. About 10 per cent, is soluble in alcohol, 50 per cent, in water. Chinese Musk in the pods or sacs is the most valuable, but all varieties are much adulterated, the price of the drug being very high. The odor is destroyed by drying, but returns again on the addition of moisture. Trituration with Camphor or Hydro- cyanic Acid also destroys it. The odorous principle has not been isolated, it is probably a product of decomposition which is constantly being formed. The constituents of Musk are a bitter resinous substance, ammonia, fat, cholesterin, etc. Dose, gr. ij-x. Tindura Moschi,—10 per cent. Dose, iqss-sjjss. Preparation. Physiological Action and Therapeutics. Musk is a very diffusible stimulant, acting directly on the nervous and circulatory systems, but without much energy. It is also an antispasmodic, and is used with benefit in general prostration of the system with nervous agitation or irregular muscular action. It has been used with advantage in laryngismus stridulus, insommia, the collapse of typhoid and typhus fevers, spasmodic affections of the stomach, obstinate hiccough and con- vulsions of children due to intestinal spasms. The pure Musk is very difficult to obtain, and its high price makes it an extremely expensive medicine, so that it is seldom used except as a perfume. MYRCI./E OLEUM, Oil of Myrcia, Oil of Bay,—is a volatile oil distilled from the leaves of Myrcia acris, or Bayberry, a tree of the nat. ord. Myrtacese, native of the West Indian Islands. It is a dark- brown liquid, of aromatic odor, pungent taste, slightly acid reaction, and soluble in an equal weight of alcohol. Sp. gr. about 1.040. It contains a hydrocarbon and Eugenic Acid. Used as a perfume. Preparation. Spiritus Myrcia, Spirit of Myrcise, Bay Rum,—contains in 1800 parts Oil of Myrcia 16, Oil of Orange-peel 1, Oil of Pimento 1, Alcohol 1000, Water 782 parts, filtered through Carbonate of Magnesium. Used as a wash or perfume. The Oil of Bay is an agreeable perfume used to prepare bay-rum and in other cosmetic preparations. The spirit, known as “Bay-rum,” is used principally as a refreshing perfume, and is thought to relieve head- ache, faintness, etc., by application to the forehead or to the nostrils. Physiological Action and Therapeutics. MYRISTICA, Nutmeg, —is the kernel of the seed of Myristica fragrans deprived of its testa. The nutmeg tree is cultivated extensively MYRRHA. 285 in the East and West India Islands, belongs to the nat. ord. Myristicaceje, and is a native of the Banda Islands in the Malayan Archipelago. The Nutmeg is about an inch long, oval or roundish-ovate, reticulately fur- rowed, internally pale-brown or grayish-red with dark-brown veins, hav- ing a strongly aromatic odor and a somewhat bitter taste. It contains 4 to 9 per cent, of the official Volatile Oil, and 30 per cent, of a concrete oil, commonly called “Oil of Mace,” which is a compound of fluid glycerides of Oleic and Butyric Acids, and the solid glyceride of Myristic Acid, some resin and volatile oil. Dose, gr. v-xx. Macis, Mace,—is the arillus or fleshy covering of the fruit of Myristica fragrans, the Nutmeg-tree. It occurs in narrow bands about an inch long, branched and lobed, of brownish-orange color, fragrant odor, warm and aromatic taste. It yields a fixed oil by pressure and a volatile oil by distillation, the latter being probably identical with Oil of Nutmeg. Oleum Myristicce, Oil of Nutmeg,—is the volatile oil, and consists chiefly of a terpene and an oxygenated oil Alyristicol. It is colorless or pale-yellow, of hot, spicy taste and neutral reaction, and is soluble in alcohol. Dose, tr\j-v. Spiritus Myristicce, Spirit or Essence of Nutmeg,—is a 3 per cent, solution of the oil in alcohol. Dose, gj-ij. Nutmeg is an ingredient of Acetum Opii, Pulvis Aromaticus, Tr. Lavandulae Co., Syr. Rhei Aromat., Trochisci Cretae, Trochisci Magnesiae and Trochisci Sodii Bicarbonatis. Preparations. Physiological Action and Therapeutics. Nutmeg is an aromatic stomachic of agreeable flavor. In small doses it stimulates the production of gastric juice, and thus promotes digestion and increases appetite. It also relieves intestinal spasm and flatulence. In large doses it is powerfully narcotic, acting directly on the cerebrum, and producing stupor and delirium. It is used chiefly for flavoring pur- poses, and generally in substance, grated as required, but has been employed as a carminative, anodyne and astringent in diarrhoeas and dysentery, as well as to relieve nausea and vomiting. The Volatile Oil is decidedly rubefacient when used externally, and has narcotic powers if used internally in sufficient quantity. It is occasionally employed as an external stimulant in paralysis and chronic rheumatism. Mace is stimulant, carminative and aromatic. It is used solely as a spice or condiment. Dose, gr. v-xx. MYRRHA, Myrrh ,—is a gum resin obtained from Balsamodendron Myrrha, an Arabian tree of the nat. ord. Burseraceae, collecting spon- taneously upon the bark, and occurring in roundish tears, having a waxy fracture, a balsamic odor, and an acrid and bitter taste. Triturated with water it yields a brownish-yellow emulsion; with alcohol it yields a brownish-yellow tincture which turns purple on the addition of nitric 286 naphthaline. acid. It contains 60 per cent, of gum, 35 per cent, of Myrrhin a resin, and about 2 per cent, of an oxygenated ethereal oil Myrrhol, C10HuO. Dose, gr. x.-xxx. Preparations. Tinctura Myrrhce,—20 per cent. Dose, ITLx-xxx. Myrrh is also contained in Mist. Ferri Co., Pil. Aloes et Myrrhae, Pil. Ferri Co., Pil. Galbani Co., Pil. Rhei Co., and Tr. Aloes et Myrrhae. Myrrh in small doses stimulates the gastro-intestinal mucous membrane ; in large doses it is an irritant thereunto, producing vomiting and purging. It quickens the action of the heart and diminishes the bronchial secretion. It is a uterine stimulant and emmenagogue, a stimulant expectorant, and is thought to increase the number of leucocytes in the blood. Locally it is stimulant and disinfectant to mucous membranes and ulcerated surfaces. Myrrh is used internally in the various combinations noted above for anaemia and amenorrhoea, bronchial catarrh, etc. It has been supposed to diminish excessive secretion from the mucous surfaces of the uterus, vagina, bladder, and bronchi, and to have an especially beneficial in- fluence on chronic pharyngitis. Locally, the tincture has a good tonic action on diseased mucous surfaces, and is applied to spongy gums, relaxed throat, aphthous patches and unhealthy ulcers. The tincture diluted with water makes an excellent disinfectant and stimulant gargle in ulcerated sore-throat. Myrrh has long been used as an ingredient of dentifrices. Physiological Action and Therapeutics. NAPHTHALINE, C10H8 (Unofficial),—is one of the many products of the distillation of coal-tar, and is one of the benzene derivatives, being formed by the union of two benzene groups in an overlapping ring. (See ante, page 179.) It occurs as colorless, micaceous crystals, obtained from the destructive distillation of coal-tar, having a peculiar smell,—in- soluble in water, dilute acids or alkalies, and but sparingly so in alcohol. The dose of Naphthaline is from gr. ij-gr. viij, up to gr. lxxx per diem for adults;—and for chilren gr. j-gr. 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 Naphthaline we have these unofficial substances— Naphthol, C10H,OH, Beta- or Iso-naphthol,—one of several kinds of Naphthol: is sparingly soluble even in hot water, but is soluble in alco- hol, ether, chloroform, olive oil and vaseline. Used as ointment, i to 5 for adults, but for children not over 2 per cent. Hydronaphthol, C16H7OH,—glistening, micaceous scales, sparingly nux vomica. 287 soluble in water, freely soluble in alcohol, oils, etc. Used as an anti- septic, and in ointment or powder locally, diluted with oxide of zinc, 1 to 50. Physiological Actions. Naphthaline is destructive to all forms of low life, and hence is anti- septic 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 spar- ingly 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 naphthol and perhaps some as phenol. Naph- thol is more easily absorbed, and causes vomiting, hematuria, convul- sions, and unconsciousness. Hydronaphthol is a powerful and non- irritating antiseptic, non-poisonous, non-corrosive, freely soluble in alcohol, glycerin, fixed oils, etc., in cold water, i 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 antiseptic as alcohol, and that it is entitled, as a true antiseptic, to stand next to mercuric chloride in the comparative tables (Levis.) Naphthaline 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 antiseptic, for indolent ulcers, sloughing wounds, open cancers, pus cavi- ties, etc. Painted over organic remains it effectually prevents the rav- ages of insects. Naphthol is employed like tar for a therapeutic action upon the skin, in hyperidrosis, scabies, eczema and local sweating, in y2 to 5 per cent, alcohol solution, or as a io per cent, ointment. Hydro- naphthol is also highly esteemed for 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. Therapeutics. NUX VOMICA ,—is the seed of Strychnos Nux-vomi'ca, an East India tree of the nat. ord. Loganiacege, having white, funnel-shaped flowers, and a fruit about the size of an orange, with many seeds in a juicy pulp. The seeds are flattened and nearly circular, about one inch in 288 NUX VOMICA. diameter, ashy-gray in color, covered with short, satiny hairs, internally translucent, tough and horny, with a large cavity, inodorous, taste in- tensely bitter. It contains two alkaloids, Strychnine, 0.2 to 0.5 per cent., and Brucine, 0.1 to 1.0 per cent., with a crystalline acid, Igasuric or Strychnic Acid, and a yellow coloring matter, a concrete oil, gum, starch, wax, earthy phosphates, etc. A third alkaloid, Igasurine, is claimed to exist by some authorities and is denied by others. Preparations. Abstractum Nucis Vomicce,—Dose, gr. }/x, gradually increased. Extractum Nucis Vomicce,—Dose, gr. Extraction Nucis Vomicce Fluidum,—Dose, TT\j—v. Tinctura Nucis Vomicce,—20 per cent. Dose, TT^v-xx. Strychnina, Strychnine, C21H22N202,—is an alkaloid prepared from Nux Vomica, Ignatia, and other plants of the order Loganiaceae; crystalline, intensely bitter even in 1 to 700,000 solution, of alkaline reaction, soluble in 6 of chloroform, no of alcohol, 6700 of water, almost insoluble in ether. It is a constituent of Ferri et Strychninae Citras, and of Syrupus Ferri Quininas et Strychninae Phosphatum. Dose, gr. Ar—sV Slrychnince Sulphas, Sulphate of Strychnine (C21H22N202)2H2S04.7lI20,—crys- talline, efflorescent, odorless, of intensely bitter taste even in 1 to 700,000 solution, neu- tral reaction, soluble in 10 of water and 60 of alcohol at 590 F. Dose, gr.'Ay-2V Brucina Brucine, C23H26N204 (Unofficial),—colorless prisms, pearly flakes, or masses, soluble in water, less so in alcohol; as compared with Strychnine it is less bitter, 12 times weaker and three times slower physiologically. Is thought to be a compound of strychnine and resin, corresponding with the other alkaloid both physiologically and therapeutically. Is seldom used. Dose, gr. Physiological Action. The actions of Nux Vomica are those of its alkaloid Strychnine. In small doses, it acts as a bitter tonic, stimulates respiration, secretion, appetite and digestion, and sharpens the vision. It increases peristalsis, stimulates both the motor and the inhibitory apparatus of the heart, and raises the arterial tension by stimulating the vaso-motor centres, thus con- tracting the arterioles, though by full doses the arterioles are relaxed. By a full dose (Strychnine, gr. TY), the pupils are dilated, the limbs jerk, respiration becomes spasmodic and the lower jaw stiff, a sensation of cerebral tension, sudden shuddering and anxiety follow, the face wearing an unmeaning smile. A toxic dose (Strychnine gr. for an adult) on an empty stomach quickly produces heightened reflexes; tonic spasms, especially of the extensor muscles, on the least irritation quickly succeed each other with intervals of repose, resulting after two or three hours at most in death by asphyxia, from tetanic fixation of the muscles of respiration, consciousness being preserved until carbonic acid narcosis sets in. Strychnine exalts all the functions of the spinal cord,—reflex, motor, vaso-motor and sensory,—the latter being the least affected. It has a selective action on the large multipolar ganglia in the anterior columns, which it first stimulates and then paralyzes by over-stimulation. A large dose destroys the spinal functions as by one blow. It does not affect the NUX VOMICA. 289 brain directly, Thebaine, one of the alkaloids of Opium, is a powerful spinal exaltant and acts very similarly to Strychnine. From the spasms of tetanus those of Strychnine may be differentiated by their intermittency, the former being constant. Moreover, the mean- ingless smile, the less marked trismus, the absence of a wound, and the rapid course of the symptoms, all point to the action of Nux vomica. The excretion of Strychnine takes place very slowly, and by the urinary, salivary and cutaneous channels. Rapidly absorbed but very slowly* excreted, it accumulates in the system if even a small dose be frequently repeated. On the eye Strychnine has marked effects, augmenting the excitability of the retinal elements, increasing the sharpness of vision and enlarging the visual field. Antagonists and Incompatibles. The antidote is Tannic Acid, to form the very insoluble tannate, or a soluble salt of Iodine. Then emetics or the stomach pump, followed by perfect quiet which is very im- portant. Antagonists are Chloral, Tobacco, Chloroform inhalations or Ether, and Potas- sium Bromide, the latter being almost too slow of action to be of much use in practice. Chamomile oil should antagonize the reflex excitability. The bladder must be frequently evacuated to prevent re-absorption of the poison, and artificial respiration maintained as necessary. Incompatibles are Bromides, Chlorides and Iodides in the same solution, the Strychnine being precipitated as hydrobromate, hydriodate, etc. Therapeutics. Nux Vomica and its chief alkaloid are used as a stomachic tonic and as a respiratory, cardiac, muscular and nervous stimulant. As the quan- tity of Strychnine in Nux Vomica varies greatly, it is best to use the alka- loid when its physiological action is desired, as more definite dosage may thus be obtained. The tincture in 5-drop doses is excellent in atonic dyspepsia and gastric catarrh, especially in drunkards, and in constipation from atony of the bowels it may be given in io-drop doses with good results, not as a purgative but to increase peristalsis. The extract is much used in laxative pills for habitual constipation. In the vomiting of preg- nancy the tincture is frequently an efficient remedy, and in the vomiting of phthisis Strychnine is one of the very best agents. Nux vomica is a very useful remedy in many nervous derangements, such as periodical coughs, especially night-coughs, irregular cardiac action and over-action of the heart, in asthma, the nervous movements of pregnancy, hypochondriasis, etc. Its undoubted action upon the pneumogastric makes it very valuable in all sorts of coughs, whether from bronchitis, pneumonia, phthisis or em- physema. Epidemic diarrhoeas and dysentery are well treated by Strych- nine, and in anaemia and chlorosis it is invaluable, combined with Iron and Quinine. In neuralgiae, especially the visceral, tetanus of the idio- pathic type, cardiac failure from any cause, and in intermittents as an adjunct in Quinine, it is always a useful drug. Local paralyses of various 290 NYMPHtEA ODORATA— OLEUM. forms are well treated by injecting Strychnine hypodermically into the affected muscles, and diphtheritic paralyses are almost invariably cured by it. Strychnine is an excellent remedy in hemiplegia when degeneration has not yet set in, and when the paralyzed muscles are completely relaxed; but it is of no avail in recent cases, nor when the muscles have lost elec- trical contractility. In amaurosis from lead, tobacco or alcohol, it has proved remarkably useful, and in the dyspnoea of pulmonary affections it may be employed with benefit as a respiratory stimulant. Strychnine is a physiological antagonist to Chloral, Physostigmine and Morphine, and may be carefully administered in poisoning by these substances while the ordinary methods are also employed. In many eye diseases Strychnine is injected into the tissues about the temple with great benefit, especially in amblyopia due to functional dis- order of the retina without lesions, and in atrophy of the optic nerve. Used in the same manner it is highly recommended in infra-orbital neu- ralgia, and in other neuralgiae characterized by debility and anaemia. NYMPH/EA ODORATA, Sweet scented Water-lily, (Un- official),—is a well-known American plant of the nat. ord. Nymphseaceae, the root of which is very bitter and highly astringent, containing much Gallic and Tannic Acids, to which its actions and uses are due. A de- coction of 3 j to the pint may be used in doses of 3 ss-j, or a fluid extract in doses of 3 ss-j. For the physiological actions and therapeutics of this vegetable astringent see Tannic Acid, ante page 74. OLIV./E OLEUM, Olive Oil, Sweet Oil, Salad Oil,—is a fixed oil expressed from the ripe fruit of Olea europcea, the olive tree (nat. ord. Oleaceae), which is cultivated in southern Europe, California and Austra- lia. It is a pale-yellow or greenish-yellow, oily liquid, of nutty, oleagin- ous taste, and neutral reaction, sparingly soluble in alcohol but readily soluble in ether. Sp. gr. about 0.916. Olive Oil consists of 72 per cent, of Olein (a fluid oil) and 28 per cent, of Palmitin (a solid oil or stearoptene), which are compounds of the base Glyceryl, C3H5 with Oleic Acid, C,9H3402, and Palmitic Acid, C17H3102, respectively. It is frequently adul- terated with cheaper fixed oils, especially poppy oil, lard oil, and cotton-seed oil, quan- tities of the latter being exported every year to Italy, whence it is returned to us as Olive Oil under a French label. (See GossYPiUM, ante, page 229.) It is an ingredient of Ce- ratum Camphorse, Ceratum Cetacei, Emplastrum Plumbi and Unguentum Diachylon, and is the source of the official Soap. Dose, 3 ss-j. Physiological Action. Externally used Olive Oil is a good protective from the air, and ren- ders the skin soft and flexible. If rubbed into the integument it is ab- sorbed by the lymphatics and is directly nutritive in effect. Internally it OPIUM 291 is also nutritious and mildly laxative, and in quantity acts as a protective to the mucous membrane against acrid or poisonous substances. Like other oils it is partly emulsified, partly saponified in the intestines, its gly- cerin being set free and its fatty acids combining with the free alkalies to form soap, which with the emulsion forms the molecular basis of the chyle, entering the blood through the lacteals and being finally oxidized into carbonic acid and water, though an excess will appear unchanged in the urine. Oils are therefore a food within certain limits, increase the fat of the tissues, furnish force, and save the waste of nitrogenous tissue, but are unable of themselves to support life. Therapeutics. Olive Oil possesses no very marked therapeutic power above any other bland oil or fat. It is a good laxative for infants administered internally, and may be used as an enema followed by warm water. Its chief employ- ment is as a local application. Applied to burns and acute inflammations of the skin it is an excellent protective, coating the surface and excluding the air; and as an ingredient of liniments it acts as a diluent for more active agents. It is used to facilitate friction over enlarged or stiff joints, and in the desquamative stage of scarlet fever is a very useful and grateful application. As an antidote in corrosive poisoning it acts mechanically by protecting the mucous membrane of the stomach and preventing absorp- tion. In pharmacy its bland, unirritating qualities have procured its common employment as an ingredient of liniments, plasters, ointments and cerates, but the foreign article is so frequently adulterated with inferior oils that Cotton-seed Oil is now directed in its place in many official preparations. OPIUM, —is the concrete, milky exudation, obtained in Asia Minor by incising the unripe capsules of the White Poppy, Papaver somniferum, an annual herb of the nat. ord. Papaveraceae, indigenous to Western Asia but cultivated extensively elsewhere. Its capsules are globular, two or three inches in diameter, and are crowned by a sessile, stellate stigma, which distinguishes them from Colocynth and Bael fruits. Opium occurs in irregular lumps or cakes, of dark-brown color, sharp, narcotic odor, and bitter taste; and in its normal, moist condition should yield not less than 9 per cent, of Morphine when assayed by the process official in the Pharmacopoeia. Composition of Opium. Opium contains 17 alkaloids, 2 neutral substances and 2 organic acids, together with sugar, gum, resin, pectin, extractives, odorous principles, water and other constituents of plants. Its most important alkaloids are the following: 292 OPIUM, Morphine, C17H19NOs, 5 to 20 per cent.—the principal alkaloid, occurring in the drug in the form of the tribasic meconate. Its properties are anodyne, hypnotic and nar- cotic. From it by a process of dehydration by heat and hydrochloric acid is prepared the artificial alkaloid Apomorphine, a powerful emetic. (See ante, page 107.) Codeine, C78H21N03, 0.3 to 0.5 per cent.,—is calmative and when pure a not very active alkaloid, but is frequently contaminated with other alkaloids. Apomorphine may be prepared also from it. Narcotine, C22H23N07, 2 to 10 per cent.,—is antiperiodic and a tetanizer, but wholly devoid of narcotic properties. Thebaine or Paramorphine, C19H21N03, 0.15 to 0.20 per cent.,—is a powerful spinal exaltant and tetanizer, resembling Strychnine in its action. Narceine, C22H29N09, 0.02 per cent.,—closely resembles Morphine in action, but is probably more hypnotic, and is not followed by many of the disagreeable after-effects of Morphine. It is extremely difficult to obtain this alkaloid pure. Papaverine, C21H21N04, 1 per cent.,—is reported inert on man by some observers, a narcotic and convulsant by others. Other Alkaloids at present acknowledged are—Cryptopine, Pseudomorphine, Protopine, Hydrocotarnine, Laudanine, Codamine, Rhoeadine Meconidine, Laudanosine, Lan- thopine and Gnoscopine. Many of them are probably to be regarded as derivatives from Morphine. Besides the above-named alkaloids the most important of the constitu- ents of Opium are the following acids and neutral principles, viz. ; Acids are—Meconic Acid, C7H407, 4 per cent., and Lactic Acid, C3Hg03, 1% per cent., which exist in combination with the alkaloids as meconates, bimeconates, etc. The second acid is generally called Thebolactic, but has been recently shown to be identical with lactic acid. Neutral Principles are—Meconin, C10H10O4,0.01 per cent., white, crystalline, neutral, but very acrid; Meconoiosin, C8H10O2, also crystalline, and Porphyroxin, which is now said not to be a proximate principle but a very complex combination of several alkaloids. Smyrna, Turkey or Levant Opium is the best grade. Constantinople Opium is of uncertain quality, while of the other varieties in the market Egyptian, Persian and Indian samples are those most frequently met with. All varieties are more or less adulterated with fruits and leaves of other plants, starch, pitch, clay, wax, gum, liquorice, etc. Preparations of Opium. Pulvis Opii, Powdered Opium,—is Opium dried at a temperature not exceeding 185° F., and reduced to a moderately fine powder. It should contain not less than 12 nor more than 16 per cent, of Morphine when assayed by the official process. Dose, gr. ss-iij, an average adult dose being about one grain. Opium Denarcotisatum, Denarcotized Opium,—is powdered Opium freed from the constituents which are soluble in ether, namely—the odorous matters and Narcotine, which are supposed to cause the unpleasant after-effects of Opium. It should yield 14 percent, of Morphine, and therefore is by no means “ denarcotized,” but is a good prepa- ration, being a purified Opium having a fixed Morphine standard. Dose, gr. ss-iij, an average adult dose being about one grain. The proprietary article named Svapnia is a similar preparation. Extractum Opii,—an aqueous extract containing Glycerin to keep it soft, and freed from some disturbing principles which are insoluble in water. Dose, gr. %-). Pilulce Opii,—each pill containing gr. j of powdered Opium with gr. of Soap. Dose, Ht. Tinctura Opii,—Laudanum,—Opium-strength 10 per cent., average Morphine- strength gr. vj, (equaling gr. vijss of the Sulphate) to the fl 5 . Has about gr. xliv of Opium to the %. rt\xj (gtt. xxij) = gr. j of Opium or gr. 14 of Morphine Sulphate. Sixty minims yield on the average 120 drops. Dose, as per effect required. Tinctura Opii Deodorata, Deodorized Tincture of Opium,—an aqueous extract shaken with ether, which being separated the residue is dissolved in water, and enough OPIUM 293 alcohol is added to preserve it. An excellent liquid preparation, being freed from all the noxious and useless ingredients soluble in alcohol and ether. McMunn's Elixir is a similar preparation, so also is a recent nostrum named Papine. Opium-strength 10 per cent., average Morphine-strength gr. vj to the . Dose, as Tinct. Opii. Drops of this preparation nearly equal minims. Vinum Opii, Wine of Opium, Sydenham’s Laudanum,—Opium-strength 10 per cent., with the aromatics Cinnamon and Cloves of each 1 per cent., in Stronger White Wine. A vinous tincture decreased somewhat in strength from the wine of 1870. Dose, as Tinct. Opii. Drops of this preparation are larger than those of the tincture. Acetum Opii, Vinegar of Opium, Black Drop,—Opium-strength 10 per cent., with Nut- meg and Sugar in Dilute Acetic Acid. Is now X weaker than formerly, having the same strength and dose as Tinct. Opii. Tinctura Opii Camphorata, Camphorated Tincture, Paregoric,—has of Powdered Opium 4, Benzoic Acid 4, Camphor 4, Oil of Anise 4, Glycerin 40, Diluted Alcohol q. s. ad 1000 parts. ss contains nearly one grain of powdered Opium, and is about the strength of Laudanum. Dose, for an infant gtt. v-xx, for an adult gj-iv. [Note.—According to the U. S. Pharmacopeia of 1880 the official dried Opium should contain 12 to 16 per cent, of Morphine instead of 10 per cent, as required by the Pharma- copeia of 1870. The liquid preparations, except Paregoric, are now directed to be of the uniform Opium-strength of 10 per cent, by weight, making the Wine less strong by 2 per cent., the Acetum fully X less in strength, and the other liquid preparations stronger by X 'n Morphine than formerly. So that if the full anodyne dose of Tincture or Deo- dorized Tincture be taken at 24 minims, equalling gr. of Morphine Sulphate, the cor- responding dose under the new system will be 16 minims.] Liquor Opii Compositus, Compound Solution of Opium (Squibb), Unofficial,—has the same strength as the official tinctures, namely gr. vj of Morphine, (equalling gr. vijss of the Sulphate) to each fluidounce. Ttpxvj = gr- X °f Morphine Sulphate. Tinctura Opii Composita, Squibb’s Diarrhoea Mixture (Unofficial),—has of Tinct. Opii, Spt. Camphoras and Tinct. Capsici of each, Purified Chloroform giij, Stronger Alcohol q. s. ad g v. Each fig or teaspoonful contains about 100 drops or rr[xij of each of the first three ingredients and rtpivss or 18 drops of Chloroform. Dose, for infants gtt. j-x, for children gtt. x-xxx, for adults gj. Emplastrum Opii,—Extract of Opium 6, Burgundy Pitch 18, Lead Plaster 76 parts. Pulvis Ipecacuanha et Opii, Dover’s Powder,—Ipecac 10, Powdered Opium 10, Sugar of Milk 80, triturated to a fine powder. Dose, gr. v-xv, ten grains equalling one grain each of Ipecac and Opium. Tinctura Ipecacuanha et Opii,—Deodorized Tincture of Opium 100 parts evaporated to 85, Fluid Extract of Ipecac 10, Diluted Alcohol q. s. ad 100. Intended to represent Dover’s Powder in a liquid form. Dose, rtpv-xv. Trochisci Glycyrrhiza et Opii,—each troche contains Extract of Opium gr. p6 with Extract of Liquorice, Acacia, Sugar and Oil of Anise. Dose, j-iv. Preparations of Morphine. Morphina, Morphine, C17H19N03.H20,—white, prismatic crystals or a crystalline powder, odorless, of bitter taste and alkaline reaction, almost insoluble in water, soluble in ioo of alcohol. Its comparative insolubility makes the salts preferable for use, and as a very small proportion of acid neutralizes it, the dosage is about the same for the alkaloid and its salts, viz., gr. j. Gr. about equal to one grain of Opium of medium Morphine-strength. [Compare Morphina Sulphas, below.] Morphince Acetas, Acetate of Morphine,—a white, crystalline or amorphous powder, of faintly acetous odor, bitter taste, neutral or faintly alkaline reaction, soluble when fresh in 12 of water and in 68 of alcohol at 590 F. Dose, gr. Morphince Hydrochloras, Hydrochlorate of Morphine,—white, feathery crystals of silky lustre, of bitter taste and neutral reaction, soluble in 24 of water and in 63 of alcohol at 590 F. Dose, gr. '^-j. Morphince Sulphas, Sulphate of Morphine,—white, feathery, acicular crystals of silky lustre, of bitter taste and neutral reaction, soluble in 24 of water and in 702 of alcohol at 590 F., and in 0.75 of boiling water. Contains about 80 per cent, of Morphine. Dose, gr. ?V"gr- J > being a small dose for an adult, X~X a moderate one, X_X a dose, and X~j a large one. Pulvis Morphina Composilus, Tully’s Powder,—has of Morphine Sulphate 1 part to 20 each of Camphor, Liquorice and Calcium Carbonate. A similar preparation to Dover’s 294 OPIUM Powder minus the Ipecac. Dose, gr. v-xv, ten grains containing gr. § of Morphine Sul- phate. Trochisci Morphines et Ipecacuanha,—each troche contains gr. A of Morphine Sul- phate with about gr. of Ipecac, also Sugar, Oil of Gaultheria and Mucilage of Traga- canth. Dose, one every hour or so, cautiously with children. Injectio Morphince Hypodermica (B. P.),—is a solution of the Acetate, containing gr. j in each ten minims, being thrice as strong as Magendie’s solution. Dose, tt\j-iij. Liquor Morphince Sulphatis, Magendie’s Solution (Unofficial),—has gr. xvj of Mor- phine Sulphate in each fl , or gr. j in n\xxx, or gr. in If made with Benzoic Acid, the solution will not spoil, and is not irritant hypodermically. The same result is attained by adding of Carbolic Acid, trpiij to the £ . Tinctura Chloroformi et Morphince (B. P.),—a substitute for Chlorodyne. See ante, page 169. Oleatum Morphince, Oleate of Morphine (Unofficial),—Morphine-strength ioper cent, with Oleic Acid 90. For local use. Preparations of Other Alkaloids. Codeina, Codeine, C18H2]N03.H20,—white or yellowish-white, rhombic prisms, efflorescent in warm air, of bitter taste and alkaline reaction, soluble in 80 of water at 59° F. and in 17 of boiling water, very soluble in alcohol, chloroform and ether. This alkaloid is official. Dose, gr. ss-ij, but gr. | has caused alarming symptoms in children. The Phosphate of Codeine is sufficiently soluble for hypodermic use, and comparatively unirritant. One part in twenty of water forms the usual solution for hypodermic employ- ment. Narcotince Hydrochloras, Hydrochlorate of Narcotine (Unofficial),—Dose, gr. ij-x, as an antiperiodic. The Tincture of Opium is an ingredient of Mistura Magnesise et Asafoetidse, and the Camphorated Tincture is an ingredient of Mistura Glycyrrhizse Composita. (See ante, pages 272, 228.) Children bear Opium badly, and for them its proportionate dosage should be much below that for other agents. Morphine should not be given to children below io years of age, and never hypodermically to those beneath the age of 15. Opium given to a nursing mother will affect the child, being partly excreted in the milk. Reactions and Incompatibles. An aqueous or alcoholic preparation of Opium reddens litmus paper (free meconic acid) ;—gives a deep red color with Perchloride of Iron (meconic acid);—forms precipi- tates with Acetate and Subacetate of Lead, Nitrate of Silver, Zinc, Copper, and Arsenic (meconates, sulphates and coloring matter);—forms a precipitate with tincture of Galls or astringent preparations (tannates of morphine and codeine); and becomes turbid with the fixed Alkalies, Carbonates, Alkaline Earths, and Ammonia (precipitated morphine and narcotine). Tests for Morphine. Nitric Acid produces a blood-red, turning orange, then yellow, then disappearing. Test-solution of Ferric Chloride gives a blue color changing to green with excess of the reagent, and destroyed by free acids or alcohol, but not by alkalies. Iodic Acid liberates Iodine which may be tested by starch. Opium is analgesic, hypnotic, antispasmodic, diaphoretic and narcotic. It first stimulates then depresses the cerebrum, heart and respiratory appa- ratus, and is classed among the cerebral depressants. In medium dose (gr. j) it arrests all the secretions except the milk and sweat, the latter being increased ; producing dryness of the mouth and throat, retarded digestion from stoppage of the gastric juice, and decided Physiological Action. OPIUM, 295 loss of appetite. The action of the heart is increased, arterial tension raised and the pupils slightly contracted. The cerebral faculties are stimulated by increased blood-supply to a pleasant activity, ideas follow each other rapidly through the mind, and an exhilaration bordering on mild intoxication is experienced, succeeded by a calm of variable length. Sleep generally follows, disturbed, however, by dreams, and after waking headache, malaise, constipation, digestive disturbance and some depression result. The conductivity of the nerves is not affected. Frequently the stage of mental activity is absent, but in persons habituated to the use of Opium it is usually well marked. In some subjects a lengthened period of calm repose takes the place of sleep, in others neither calm nor sleep occurs, but the stimulant action of the drug prevails, the spinal func- tions as well as the cerebral are exalted, and great restlessness is the result. In full dose (gr. iij-v) the same symptoms are produced but in greater intensity; the stage of stimulation is much shorter, digestion is arrested, nausea and vomiting produced, also profuse diaphoresis. The conduc- tivity of the nerves is more or less impaired, the heart and circulation depressed, oxidation being interfered with and the body-temperature lowered. The pupils are contracted by stimulation of the motor oculi through the basal ganglia, intense pruritus is produced especially at the nose, and often spasmodic retention of the urine. Profound sopor soon comes on, with irregular and slow respiration, but in some subjects this is replaced by coma-vigil and delirium. After-effects are nausea, depression, constipation, racking headache, vertigo, anorexia, nasal pruritus, and fetid pathological secretions. A toxic dose produces cold and clammy sweat, very slow pulse, slow and stertorous respiration gradually becoming feeble and irregular, cyanosed face, abolished reflexes, coma gradually deepening, the pupils minutely contracted but dilating as the end approaches, and finally death by paralysis of the respiratory centre due to direct action on the medulla. Post-mortem shows only a wet brain, congested lungs, and engorgement of the venous trunks and of the right heart. The principal action of Opium is exerted upon the nervous system, first affecting the cerebral convolutions which are briefly stimulated and soon depressed,—next the perceptive and sensory centres in the higher brain are more or less blunted and the conductivity of the afferent nerves impared,—soon the ganglia at the base of the brain are involved, evinced by the contraction of the pupils, vomiting, and slowing of respiration,— the cardiac, vascular and other centres are depressed but to a less degree than the respiratory and perceptive,—the gray matter of the cord, at first stimulated, as shown by the increase of reflex excitability, is also depressed, and locomotion becomes difficult, the motor nerves becoming paralyzed from the centre outwards, but muscular irritability is never lost. 296 OPIUM Death generally occurs by paralysis of the respiratory centre rarely by sudden cardiac failure. Metabolism is greatly reduced in activity by Opium, the quantity of urea excreted being markedly lessened, and the biliary and glycogenic functions of the liver being affected, resulting in whitish stools, perhaps jaundice, and certainly decided decrease of the sugar excreted by dia- betics, when given by the stomach. On the uterine and generative functions Opium exerts a marked influ- ence, stopping menstruation if its use be continued, and in men causing impotence. Both male and female functions, however, return as soon as the drug is discontinued. The hypnotic action of Opium is now believed to be produced by a double influence, (i) on the vascular system, causing anaemia of the brain, (2) on the cerebral cells, diminishing their activity, and consequently lessening their demand for blood. Its constipating action is shown experimentally to be produced by stimulation of the inhibitory nerves of the intestines through the splanch- nics. Morphine acts similarly to Opium in general, being the principal alka- loid therein, but when used alone its influence is not complicated with that of the convulsant alkaloids (Thebaine, Codeine, Narcotine), which must affect to a considerable degree the action of Opium. Consequently, as compared with the latter, Morphine acts more quickly, and for a shorter time, has less influence on the intestines and skin, is less constipa- ting, less stimulating, less convulsant and less diaphoretic, but more seda- tive, more anodyne and hypnotic and produces more intense pruritus. Its excretion commences quickly but may not "be completed for as much as 48 hours, and is affected by most of the secretions, especially by the urine. It is probably retained in the system when the action of the kidneys is defective, and hence when given in renal disease may accumulate with fatal results. Codeine may chemically be considered a Methyl-morphine, and like all methyl compounds, has an action like that of Curare, viz.,—a motor- paralyzant. It exalts the spinal cord more than Morphine and affects the cerebrum less, producing muscular tremor in excess of the sedative action. It is anodyne and analgesic, especially to abdominal and pelvic pain, also hypnotic with less general disturbance than produced by Morphine. It markedly reduces the amount of sugar excreted by diabetics, and has a special sedative influence on the pneumogastric nerve. Narcotine should be named Anarcotine, as it has little or no narcotic power. It is a convulsant in animals and an antiperiodic in man. Narceine is said by some observers to be remarkably hypnotic, and free from convulsant action—by others equally deserving of credit it is OPIUM 297 considered almost inert. This alkaloid is difficult to obtain pure; hence the samples heretofore used have probably been contaminated with other alkaloids. Thebaine is a powerful convulsant, exalting the spinal cord almost like Strychnine and Brucine. It is not used medicinally. Fatal Doses. In a child one day old npj of Laudanum caused death. A medicinal dose given to a nursing mother proved fatal to the infant. A few drops of Paregoric have killed a child of nine months. In the adult gr. yi of Morphine in one case, and gr. iv of crude Opium in another, have proved fatal. Antagonists and Treatment of Poisoning. Atropine antagonizes the cerebral action of Morphine, also its action on the pupils, respiration, heart and arterial tension, but if given too freely will endanger the case by substituting Belladonna-narcosis for Opium-narcosis. Gr. T hypodermically every 15 minutes for three doses, is generally sufficient. Caffeine is also physiologically antago- nistic, and is generally used in the form of strong black coffee frequently administered. The chief indications in Opium-poisoning are—to evacuate the stomach, maintain respira- tion and keep up the circulation. Faradization of the chest muscles, cold affusion, and artificial respiration are of great value, and evacuation of the bladder is important. Fla- gellation is a very dangerous procedure, from the exhaustion which may be produced; strong faradic currrents are much more efficient. The anode should be placed over the lowest conjoined root of the phrenic nerve—the cathode three inches below the ensiform cartilage, and a little to the left of the median line. Strychnine is an efficient antagonist to the respiratory paralysis, and may be used in lieu of Atropine, or in connection therewith. Amyl Nitrite should also be used when the heart shows signs of failure. Some of the cerebral effects of Opium, as vertigo and mental confusion, are removed by a full dose of Potassium Bromide, others are antagonized by Quinine, and the general intra-cranial effects of the drug are to some extent opposed by Digitalis and Tartar Emetic. Atropine may be advantageously combined with Morphine in solution for hypodermic injection, in the proportions of gr. to of the former to gr. of the latter, pre- venting the sickness and depression and many other unpleasant after-effects of Morphine while increasing its anodyne, hypnotic and antispasmodic powers. Therapeutics. The chief indications for the use of Opium are (1) to relieve pain from any cause except acute inflammation of the brain,—(2) to produce sleep, particularly in the insomnia of low fevers with delirium, in which the combination of Morphine and Chloral is very efficient,—(3) to allay irri- tation in the various forms of acute nervous erethism,—(4) to check ex- cessive secretion, as in diarrhoeas, dysentery, diabetes, ptyalism, etc.,— (5) to support the system in low fevers and other adynamic conditions, when sufficient food cannot be retained,—(6) as a sudorific, to produce sweating in coryza, etc. It is considered of especial value in any irrita- tion of the stomach, bladder or bronchi, in severe vomiting, both forms of diabetes, gastralgia, colic and muscular spasm. In diabetes mellitus Morphine per orem reduces the sugar promptly, but when used hypodermi- cally it has little or no effect thereon, even in the same case. In perito- nitis and inflammations of other serous membranes, used freely even to 298 OPIUM narcotism it has often saved life. In cerebro-spinal meningitis it is the one remedy if given early, before exudation has set in. Cholera morbus and dysentery are efficiently treated by Morphine and Atropine hypoder- mically (gr. Txy with gr. ytg) after the ingesta have been removed by purg- ing. In acute uraemia its use in large doses is recommended by Loomis to control convulsions and promote diuresis, but here it is a dangerous agent. In muscular rheumatism and acute colds Dover’s powder as a diaphoretic, conjoined with hot drinks and foot-baths, is old but excel- lent treatment. In delirium tremens, acute and chronic mania and melan- cholia, nervous prostration and the delirium of fevers, Opium is probably the best hypnotic. Severe pain from any cause (except cerebritis) is relieved by Opium with an efficiency possessed by no other drug, as the pain of sciatica, neuralgia, lumbago, cancer, renal and hepatic colic from calculi, etc. Cough of harassing and frequent character with but little secretion is best treated by Opium, but when there is profuse expectora- tion it should not be used, as the lowering of excitability of the respira- tory centre which it produces would in such a case be dangerous. In nearly all acute inflammations it is valuable, especially where it becomes advisable to lock up the bowels. Its tranquillizing power over the circu- lation makes it invaluable in the various forms of hemorrhage, while in that from uterine fibroids and cancer the implanting of the Opium-habit is deserving of serious consideration as a most beneficial measure, as it checks and ev.en stops the bleeding, as soon as established. Dyspnoea from any cause is relieved by Morphine, especially that of cardiac disease. “ It gives the power to breathe ” (Huchard). In cardie disease, especially aortic stenosis or insufficiency, with dyspnoea, paroxyms of angina pectoris, or signs of cerebral anaemia,—Morphine hypodermically presents the great- est advantages. Applications of the Various Preparations. Intense pain, as from the passage of calculi, is best met by hypodermic' injection of Morphine Sulphate in full doses (gr. }£-%') with Atropine Sulphate (gr. Either the solution of Morphine or the liquid prepa- rations of Opium may be given by the mouth in corresponding doses for the same purpose. Severe pain enables the system to resist the action of Opium, which in such cases should be repeated at short intervals for effect regardless of dosage. Superficial pain is often alleviated by the Plaster or by extemporaneous liniments containing Laudanum or some other fluid preparation. It is, however, very doubtful whether such applications are of direct value, as Morphine is not absorbed by the unbroken integument; but the Oleate of Morphine is said to be very penetrating. To produce sleep the most efficient preparations are the Deodorized OPIUM 299 Tincture, the Solution of Morphine, Pil. Opii and Dover’s Powder, in doses corresponding to the degree of insomnia and restlessness present. Cough is relieved by the two Trochisci, the Deodorized and Camphor- ated Tinctures, and by the Solution of Morphine in small doses with Syrup of Wild Cherry or Syrup of Tolu. Diaphoresis is best obtained by the use of Dover’s Powder in either of its three forms. Sedative action is obtained by different preparations for different organs. The stomach is best affected by the Solution of Morphine in effervescing mixtures, the Extract in a small pill, or Morphine hypodermically over the epigastrium. The intestines may be influenced by Laudanum in a starch enema, or internally by Dover’s Powder, Pulvis Opii, or Pil. Opii, especially the latter with or without Calomel, as an astringent when the bowel must be paralyzed, as in peritonitis, hernia, intussusception, etc. The rectum and other pelvic organs are promptly affected by a suppository of the Extract of Opium, gr. with gr. of the Extract of Belladonna. The ovaries and the abdominal and pelvic organs generally are markedly susceptible to the analgesic action of Codeine in doses of gr. ss to gr. j for an adult in severe pain. Administration. Probably no drug in the Materia Medica is so useful as Opium, or has so wide a range of application. At the same time no drug requires such careful handling, by reason of the many influences which modify its action and uses. As before pointed out, children are extremely susceptible to its narcotic action, and women are more easily affected by it than men. Many persons are found with idiosyncrasies in respect to Opium, some being easily narcotized, others being remarkably insusceptible to its action, and many suffer from a decided shock after its hypodermic administration, which may even produce alarming symptoms of collapse. In subjects of kidney disease it may accumulate and act more powerfully than expected, and generally it may be said to be contraindicated or to be used with great care in alcoholism, congestion of the brain, and advanced disease of the respiratory organs, heart and kidneys. The conjoint administration with opiates, of the Spiritus gEtheris, Spiritus Comp., or Spiritus Nitrosi, an equal part with Tinctura Opii Deodorata, will prevent the nausea often excited by the latter, and correct the “drying-up ” effects of opium, due to its checking secretion. Morphine and Atropine are sufficiently antagonistic to each other to make their combination extremely valuable as a therapeutic measure, and their use as mutual antidotes in poisoning by either a most efficient procedure if employed with due precautions. When Morphine is given as a hypnotic or an anodyne, Atropine should always be administered at the same time in the proportion of gr. °f the latter to gr. of the former. By this means the anodyne and hypnotic qualities of Morphine are increased, while the nausea and depression with the subsequent dyspepsia and constipation due to it are avoided. Moreover, as in the doses above mentioned Atropine is a cardiac and respiratory stimu- lant, it will counteract the depressing tendency of Morphine on the heart and respiration in subjects who have undue susceptibility to its action. 300 ORIGANUM PANCREATINUM PAPAIN. ORIGANUM, Wild Marjoram ,—is the plant Origanum vulgare, a perennial herb of the nat. ord. Labiatae, native of Europe and America, having a stem branched above, petiolate leaves about an inch long and hairy beneath, pale purple flowers, aromatic, pungent and bitterish. It contains a Volatile Oil, some tannin, resin, and a bitter principle. The oil was formerly much used and was official, but it is now entirely super- seded by the Oil of Thyme. Origanum is an ingredient of Vinum Aro- maticum. There are no official preparations. Dose, 5j_ij> in infusion. Physiological Action and Therapeutics. Origanum is gently tonic, also carminative, stimulant and emmena- gogue. It was formerly much employed as a diaphoretic, etc., but is now rarely administered. PANCREATINUM, Pancreatin, (Unofficial),—is the juice of the pancreas, and consists of four ferments : (i) Pancreatic Diastase, the amylolytic ferment, (2) Trypsin, the proteolytic ferment, (3) a fat emulsi- fying and (4) a milk-curdling ferment. It is marketed in various forms, named Pancreatine, Pancreatic Emulsion, and Liquor Pancreaticus, of which the last-named is the most efficient preparation. Liquor Pancreaticus, Pancreatic Solution (Unofficial),—prepared by digesting a finely- chopped pig’s pancreas with 4 times its weight of dilute alcohol. Is a nearly clear alcoholic solution, with little taste or smell. Dose, gj-^ss. Physiological Action and Therapeutics. Pancreatic preparations are active digestives of proteid and amyloid foods, converting proteids into peptones, and emulsifying fats, in the presence of an alkaline solution (Pepsin requiring an acid one). Pan- creatin is digested by Pepsin, and hence probably never passes into the duodenum in its own character. Trypsin affects albuminoids even in a slightly acid solution. Liquor Pancreaticus is used to partially digest (peptonize) milk, gruel, soups and other foods, before their administra- tion in cases of great digestive debility. These peptonized foods may be administered per orem vel rectum, and are valuable in intestinal dyspepsia, wasting diseases, and convalescence from acute affections. A teaspoon- ful taken after the administration of Cod-liver Oil will prevent the dis- agreeable eructations which are so offensive to some patients, and will aid in the digestion of the oil. Trypsin, unlike Pepsin, will dissolve mucin, and like Pepsin it is inert towards nuclein, horny tissues and amyloid matter. Used as a spray on diphtheritic membrane it has proved a very efficient solvent. PAPAIN, Papaiva (Unofficial),—is a ferment obtained from the milky juice of Carica Papaya, a S. American fruit-tree of the nat. ord. PARALDEHYDE PAREIRA. 301 Papayacese. It is soluble in water but not in alcohol, and has active digestive powers. It softens and dissolves fibrin in liquids which may be either acid, or neutral, or slightly alkaline, in this respect differing greatly from Pepsin. It also acts at higher temperatures and more rapidly than Pepsin. It is a rapid solvent of false membranes and intestinal worms. It has been injected into tumors, dissolving the tissues in its vicinity, but with much pain and considerable febrile reaction. It is not used internally, as it is feared that it may digest the gastro-intestinal mucous membrane as well as its contents. Papaw Milk is the milky juice of the fruit, coagulating into two parts, a pulpy mass and a liquid serum. When mixed with alcohol an amorphous powder is precipitated, which when dried forms Papain. PARALDEHYDE, C6H1203 (Unofficial),—is a polymeric modifi- cation of Aldehyde, fluid above 510 F., solidifying below that tempera- ture, soluble in 50 of water. Dose, trLxx-5j. It is powerfully hypnotic and diuretic, but has no diaphoretic action. It possesses many of the qualities of Chloral with none of its dangers, strengthening and slowing the heart, instead of weakening it. A toxic dose paralyzes the medulla and the respiratory centre. As compared with Chloral its action is not so persistent and it requires more frequent repetition, but it is un- questionably safer. As a hypnotic it has been used with great benefit in fevers, rheumatism, acute mania, hysteria, and insomnia from various causes. The above-mentioned maximum dose has frequently been given without any ill-effect, and with no digestive or cerebral dis- turbances afterwards. For formula see under Insomnia, in Part III. PAREIRA, Pareira Brava, —is the root of Chondodendron tomen- tosum, a climbing, woody vine of the nat. ord. Menispermacege, with very large leaves and grape-like fruit, inhabiting Peru and Brazil. Occurs in sub-cylindrical, tortuous pieces, 4 to 6 inches long, dark brownish- gray externally, with transverse ridges, fissures and furrows; internally pale-brown, interior woody, porous, in concentric circles with medullary rays. It contains Pelosine or Cissampeline, an alkaloid identical with the Berberine of Neciandra and the Buxine of Buxus sempervirens (Box- wood). Several other Pareiras are on the market, that from the West Indies (1Cissampelos Pareira) being the plant formerly official in the Br. Phar- macopoeia. Preparations. Extractum Pareira Fluidum,—Dose, Infusum Pareirce (Unofficial),—I in 17. Dose, j-ij. 302 PEPO—PEPSINUM. Physiological Action and Therapeutics. Pareira is diuretic and laxative, stimulating peristalsis and the action of the kidneys. It is eliminated by the renal secretion, and passing over the mucous membrane of the genito-urinary tract, it acts thereon in a tonic and soothing manner, especially on the bladder. It is particularly useful in chronic cystitis, suppurative kidney diseases, gonorrhoea and gleet, but must be used internally, as when injected locally for gonorrhoea and cystitis it has not proved successful. Formerly Pareira was considered an efficient lithontriptic, and in Brazil it is used as a cure for bites of poisonous serpents, being employed both internally and locally to the wound. PEPO, Pumpkin-seed,—is the seed of Cucurbita Pepo, or common Pumpkin (nat. ord. Cucurbitacese), about ‘iff inch long, white, flat, oval, inodorous, bland and oily. The active principle is a resin contained in the endopleuron or envelope immediately surrounding the embryo. It also contains an alkaloid Cucurbitine, a fixed oil, starch, sugar, etc. There are no official preparations. Dose, of the resin, gr. xv ; of the seeds, Sj-ij, beaten up in emulsion with sugar and water. Physiological Action and Therapeutics, Pumpkin-seed is an efficient agent for the removal of tapeworm (taenia- fuge), and its use is not followed by unpleasant symptoms. The outer coat of the seed should be removed, and an emulsion then made by tritu- ration with sugar and water. This, if taken on an empty stomach and followed by a brisk cathartic, will generally prove effective. Dr. Squibb maintains that the seeds should not be decorticated, but that husks and all should be swallowed. According to some observers the expressed oil is equally efficient in doses of gss repeated twice or three times, and fol- lowed by a cathartic. PEPSINUM, Pepsin,—is a hypothetical name for the digestive principle of the gastric juice, and as a definite body is unknown, the vari- ous preparations, official and unofficial, being mere approximations, and vary much from each other. They are usually obtained from a solution prepared by digesting the mucous membrane scraped from the rennet-bags of sheep or the stomach of the pig in acidulated water for several days. The so-called “Pepsin” is then precipitated by Chloride of Sodium {Scheffer), Acetate of Lead {Boudault), or by drying the peptones on glass plates {Beale). It may also be precipitated by alcohol. By Scheffer’s process it occurs as a tough, gray, leathery substance, partially soluble in water, one grain dissolving 3000 grains of albumen in a few days. Jen- PEPSINUM. 303 sen’s “ Crystal Pepsin,” probably prepared after Beale’s method, is in yellowish, translucent scales, soluble in water, and reputed to be many times stronger than any other preparation yet obtained. Preparations. Pepsinum Saccharatum, Saccharated Pepsin,—is Pespin obtained from the mucous membrane of the hog, and mixed with powdered Sugar of Milk. One part dissolved in 500 of water acidulated with of Hydrochloric Acid, should digest at least 50 parts of hard-boiled egg-albumen in 5 or 6 hours at a temperature of ioo° to 104° F. Dose, gr. v-£j, soon after meals. Liquor Pepsini, Liquid Pepsin,—contains of Saccharated Pepsin 40 parts, Hydrochloric Acid 12, Glycerin 400, Water q. s. ad 1000 parts. Dose, 3 ij—iv, after meals. Lactopeptine (Unofficial),—claimed to contain Pepsin, Diastase or Ptyalin, Pancreatin, Lactic and Hydrochloric Acids, and that % j will digest viij-x of albumen, fibrin, casein, or gelatin, will emulsionize xvj of cod-liver oil, and convert iv of starch into glucose. A proprietary preparation. Dose, gr. v-xv. Is said to break a glass, if stirred therein with water. Ingluvin (Unofficial),—is a preparation obtained from the gizzard of the domestic fowl, which owes its activity to no ferment corresponding to Pepsin, but to a peculiar bitter principle. Dose, gr. x-xxx. [Every manufacturer has his own preparation of Pepsin, and his peculiar name there- for, such as “ Liquid Pancreopopsine,” “ Lacto-peptine,” “ Gluco-pepsine,” “ Golden Scale Pepsin,” “ Peptogenic Milk Powder,” etc. They vary considerably in their prop- erties, but all have the power in some degree of digesting albumen or fibrin. Physiological Action. Pepsin is not a solvent but a ferment, and is a normal constituent of the gastric juice, converting albuminoids (casein, albumen, fibrin, etc.) into peptones for assimilation, with the aid of the Lactic and Hydro- chloric Acids associated with it. This it will do out of the body or in cavaties as the rectum, if warmth, acidity and moisture be present. Pan- creatin, on the other hand, is destroyed by acids and requires an alkaline medium in which to exercise its powers. As the food passes out of the stomach in 2 or 3 hours, Pepsin should be administered within, and Pan- creatin after that period to be effective. Incompatibles. Alcohol destroys the activity of Pepsin. Alkalies and many mineral salts precipitate it. Therapeutics. Dyspepsia in its various forms is the malady for which Pepsin is chiefly employed, but it is also extremely useful in the apepsia of infants, gas- tralgia, anaemia, chlorosis, gastric ulcer and cancer, the diarrhoea of infants and 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, particularly fatty tumors, for the purpose of arresting their growth and promoting their absorption. It has been injected into the bladder to break down a blood- clot, and has been suggested as an atomized inhalation in diphtheria and croup to digest the membrane without injuring the living tissues. 304 PETROLATUM—PHOSPHORUS. Ingluvin is particularly useful against vomiting and has been found exceptionally efficient in the vomiting of pregnancy, given in 20-grain doses before meals. [Compare Pancreatin, ante, page 300.] PETROLATUM, Petroleum Ointment,—is a semi-solid sub- stance, consisting of hydrocarbons, obtained from Petroleum by distil- ling off the lighter portions and purifying the residue. It is a yellowish, fat-like mass, somewhat fluorescent, amorphous, odorless and tasteless, of neutral reaction, insoluble in water or alcohol, soluble in ether, chloro- form, fixed and volatile oils, benzin, etc. Its melting point is from 104° F. to 1250 F., the first being the softer, and the second the firmer variety. Commercially, it is known as Cosmoline, Vaseline, etc., and is largely prepared from residuums or sediments deposited in tanks containing crude petroleum. Physiological Action and Therapeutics. Petrolatum is a valuable protective dressing, and an excellent basis for ointments, having no acridity and no liability to become rancid. It is readily miscible with many active agents, as the alkaloids, phenol com- pounds, etc., but it does not penetrate the skin as readily as animal fats and fixed oils. Uncombined, it forms an excellent bland application in all irritated conditions and injuries of the skin. PHOSPHORUS, Phosphites and Phosphates,—are best studied together, as the supplying of the element Phosphorus to the body is the aim of the administration of these agents. Phosphorus, P,—is a non-metallic element obtained from bones, and occurs as a translucent, nearly colorless solid, of waxy lustre, and usually the consistence of beeswax, insoluble in water, soluble in 50 parts of any fatty oil, in 80 of absolute ether, 350 of absolute alcohol, and freely in carbon bisulphide. It has a disagreeable odor and taste, melts at 1 ii° F., is luminous in the dark, ignites in the air, and should be kept under water in a cool place, protected from light. It usually contains Arsenic and sometimes Sulphur, the limits of which are fixed by the phar- macopceial tests. Dose, gr. -jqnnVj thrice daily. Pilulce Phosphori, Pills of Phosphorus,— each contains gr. of Phosphorus, dis- solved in Chloroform, mixed with Althaea and Acacia in Glycerin and Water, and coated by shaking with a solution of Balsam of Tolu in Ether. Dose, j-v. Oleuvi Phosphoratum, Phosphorated Oil,—has of Phosphorus I part, /Ether Fortior 8, Expressed Oil of Almond q. s. ad ioo parts. Dose, ny j-v thrice daily. Acidum Phosphoricutn and Acidum Phosphoricum Dilutum,—are described on page 71, ante. Tinctura Phosphori (Thompson’s), Unofficial,—Phosphorus gr. j, Absolute Alcohol Preparations of Phosphorus. PHOSPHORUS, PHOSPHITES AND PHOSPHATES. 305 3 v, Glycerin Alcohol 3ij, Spt. Menthte Piperitse Of this contains gr. J.r of Phosphorus. Tincturi Phosphori (Bellevue Hospital), Unofficial,—Phosphorus gr. xxxij, Absolute Alcohol Essence of Vanilla j, Oil of Orange 3 iij, Alcohol q. s. ad Jxlviij. Of this 3 j contains gr. of Phosphorus. Zinci Phosphidum, Phosphide of Zinc, Zn3P2,—crystalline fragments or a gray-black powder, insoluble in water or alcohol, but completely soluble in hydrochloric or sulphuric acids with evolution of phosphoretted hydrogen. Is very irritant to the stomach. Dose, gr- TtWu- Preparations of Phosphites. Calcii Hypophosphis, Hypophosphite of Calcium, Ca4(P02)3,—colorless prisms, or thin, pearly scales, of nauseous taste, soluble in 6.8 of water, insoluble in alcohol. Is an ingredient of the Syrupus Hypophosphitum. Dose, gr. x-xxx. Ferri Hypophosphis, Ferric Hypophosphite, Fe2(H2P02)6,—a white or grayish-white powder, odorless and tasteless, slightly soluble in water, freely so in hydrochloric acid or a solution of sodium nitrate. Dose, gr. v-x. A ferruginous tonic. Potassii Hypophosphis, KH2P02,—white masses, or a white, granular powder, deli- quescent, odorless, of saline taste and neutral reaction. Soluble in 0.6 of water and in 7.3 of alcohol at 590 F. Dose, gr. v-x. Sodii Hopophosphis, NaH2P02H20,—small plates, or a white, granular powder, deli- quescent, odorless, of sweetish, saline taste, and neutral reaction. Soluble in 1 of water and 30 of alcohol at 590 F. Dose gr. v-x. Syrupus Hypophosphitum, Syrup of Hypophosphites,—has of the calcium salt 35, of the Sodium and Potassium salts each 12, Citric Acid 1, Spirit of Lemon 2, Sugar 500, Water q. s. ad 1000 parts. Dose. Syrupus Hypophosphitum cum Ferro, Svrup of Hypophosphites with Iron,—has of the preceding 99 parts with I of the Lactate of Iron, dissolved by trituration. Dose, j. Preparations of Phosphates. C-alcii Phosphas Prcecipitatus, Precipitated Phosphate of Calcium, Cas(P04)2,—a light, white, amorphous powder, odorless and tasteless, insoluble in water or in alcohol. Dose, gr- Syrupus Calcti Lactophosphatis, has of the preceding 22 parts, Lactic Acid 33, Orange- flower Water 80, Sugar 600, Hydrochloric Acid, Water of Ammonia, Water, aa q. s. ad 1000. The Phosphate of Calcium is dissolved by the acid, but does not enter into the chemical combination suggested by the title. Dose, Sodii Phosphas, Na2HP04 I2H20,—large, monoclinic prisms, efflorescent, of saline taste and alkaline reaction. Soluble in 6 of water at 56° F., insoluble in alcohol. Dose, Sodii Pyrophosphas, Na4P207.ioH20,—colorless, monoclinic prisms, of saline taste and alkaline reaction. Soluble in 12 of water at 590 F., insoluble in alcohol. Dose, 3 ss- 3SS- Syrupus Ferri, Quinines et Strychnince Phosphatum,—has of the Phosphate of Iron 133, Quinine 133, Strychnine 4, Phosphoric Acid 800, Sugar 6000, Distilled Water q. s. ad 10,000 parts. A powerful tonic. Dose, tjj-ij. Syrupus Phosphatum Compositus, Compound Syrup of Phosphates, Parrish’s Chemical Food (Unofficial),—has in each 3 Phosphate of Iron gr. 2Phosphate of Calcium gr. j. Dose, 3j-ij. Ammonii Phosphas, Ferri Phosphas and Ferri Pyrophosphas are respectively described on pages 94 and 216. Physiological Action. Phosphorus in small doses stimulates the brain and circulation, the functions of the stomach and the genital organs, and the growth of bones. It aids digestion by irritating the end-organs of the gastric nerves, and produces eructations of Hydrogen Phosphide. Its fumes cause necrosis of the upper or lower maxillae, especially in those whose teeth are decayed, but they may be prevented by the inhalation of fumes from old acid tur- pentine. In poisonous doses it is a powerful irritant of the gastro-intestinal 306 PHOSPHORUS, PHOSPHITES AND PHOSPHATES. tract, causing vomiting and purging with great depression of the vital forces. Reaching the blood as Phosphorus, it is partly oxidized at the expense of the oxygen of the red corpuscles, causes acute hemorrhages from fatty degeneration of the arterial walls, rapid steatosis of the stomach, liver and heart, with deep jaundice,—then delirium, convulsions, coma and death usually from gradual failure of the respiration and circulation. Acute yellow atrophy of the liver resembles acute phosphorus poisoning so much that it is generally impossible to distinguish between them. Its effect on metabolism is to increase the nitrogenous products, to diminish the excretion of carbonic acid, reduce the glycogen of the liver to almost nothing, and to raise the temperature. While generally increas- ing metabolism it so influences that process as to arrest it at the stage of conversion of proteids into urea and oil, instead of allowing it to proceed to the final oxidation of oil into carbonic acid and water, hence leading to fatty degeneration of epithelial, glandular and muscular protoplasm throughout the body. Phosphate of Calcium is an essential ingredient of all the tissues and fluids of the body, and forms more than 50 per cent, of the bones. Lactic and Hydrochloric acids dissolve it in small quantities. It increases the alkalinity of the blood as well as its power of holding Carbonic Acid, and diminishes the excretion of urea. Phosphate of Sodium acts on the blood and on the excretion of urea similarly to the calcium salt. It increases secretion generally, especially of the bile, being an excellent cholagogue and thereby aiding in the digestion of fats. In ounce doses it is laxative. It is a normal constituent of the blood, and possesses the property of increasing the capacity of any fluid to hold Carbonic Acid in solution. The Hypophosphites are generally tonic, and are supposed to con- stitute a safer form in which to administer Phosphorus than in the unoxid- ized state. They are probably converted into phosphates in the stomach. Antidotes and Antagonists. Antidotes are hydrated magnesia, lime-water, powdered charcoal, sulphate of copper and old acid turpentine. Sulphate of Copper is the best emetic, forming a comparatively insoluble phosphide of copper; 3-grain doses should be given every 5 minutes in dilute solution until emesis occurs. Hydrated Magnesia as a quickly-acting purgative. Lime- water or Charcoal to prevent the action on the tissues. Crude French Acid Turpentine is the best antidote, which may be given rapidly in an emulsion of gum. Opiutn to counteract the depression of the heart and system. Transfusion has proved efficient where the blood is affected. No oils or fats should be used, as they dissolve Phosphorus and promote its absorption. Therapeutics. Phosphorus is chiefly used to promote the nutrition of osseous and nervous tissue. It is useful in chronic nervous exhaustion when the nerve centres are implicated, in osteomalacia, rachitis and progressive locomotor ataxia. In threatened cerebral softening it affects the nerve centres as no physostigma. 307 other drug does, and in paraplegia of myelitic origin from excessive venery it is often very efficient. Progressive pernicious ansemia has sometimes been arrested by Phosphorus in very small doses, while in impotence of functional character there is no remedy so effective. In wakefulness of the aged and that due to cerebral ansemia small doses of the pill or tincture are sometimes remarkably beneficial. In certain skin diseases (acne, psoriasis, lupus), it is an excellent substitute for Arsenic. Neuralgia is often cured by Phosphorus, but large doses are necessary, at least gr. every 4 hours. Phosphate of Calcium and the Hypophosphites are used with benefit in all diseases of mal-nutrition, and where the repair or development of the bones is required. They are particularly useful in protracted suppu- ration, osteomalacia, rachitis, caries, scrofulosis, chronic phthisis, and in the anaemia and bone-softening of lactation. The Hypophosphites are much employed in nervous and general debility and in chronic lung dis- eases, and are supposed to act in the same manner as free Phosphorus, but without irritation. They are probably converted into Phosphates in the stomach, and hence may be expected to promote the growth and healing of bones, to stimulate the hepatic and intestinal secretions, and to affect the lymphatic glands and adenoid tissue. The Compound Syrup of the Hypophosphites is an excellent remedy in acne indurata. Phosphate of Sodium in drachm-doses thrice daily for adults, gr. x-xxx for children, is extremely useful as a laxative in conditions depend- ing on catarrh of the bile-ducts and duodenum, as headache, jaundice, chalky stools, etc. Gall-stones may be prevented from forming by scruple or drachm doses before meals for months at a time. It is also an efficient agent in obesity, hepatic diabetes, incipient hepatic sclerosis, chronic infantile diarrhoea, cerebral debility, bilious sick headache, and the pasty, white stools of ill-conditioned children. Vichy-water contains this salt in the proportion of gr. to the pint, and is considered a valu- able water in hepatic colic and kindred conditions. Finally for the con- dition of the system producing a crop of boils, Phosphate of Sodium is probably the best remedy. PHYSOSTIGMA, Calabar Bean,—is the seed of Physostigma venenosum (nat. ord. Leguminosae), a woody creeper of Calabar, West Africa, where it is used by the natives as an ordeal for witches, etc., vom- iting after its ingestion being held to establish the innocence of the accused. It is about an inch long, irregularly kidney-shaped, with two flat sides and a furrow along its convex margin ending in an aperture near one end. It contains an alkaloid, variously named Eserine, Physostig- mine, and Calabarine, C15H21N302, which is obtained as a crystalline, an amorphous or a syrupy body. Some authorities apply the above names 308 PHYSOSTIGMA. to different bodies, but acknowledge that they agree in physiological action though not in physical qualities. Preparations. Extractum Physostigmatis,—an alcoholic extract, of which the dose is from gr. to gr- j- Tinctura Physostigmatis,—strength 10 per cent. Dose, upv-xx. Physostigmine Salicylas, Salicylate of Physostigmine,—colorless, columnar crystals, of bitter taste and neutral reaction, soluble in 130 of water and in 12 of alcohol at 590 F. Dose, gr. Eserina, Eserine (Unofficial),—perhaps the same as Physostigmine, but is considered as representing the powers of the plant. Dose, gr. Physostigma is a direct spinal paralyzer, producing complete general paralysis, and abolished reflexes, but not affecting muscular irritability or the cerebral functions. It stimulates secretion, excites nausea and vomit- ing, salivation and diaphoresis, and is laxative by stimulating the muscular coat of the intestines to increased peristalsis as well as by increasing the intestinal secretions. If first lowers then raises arterial tension, increases the frequency of the heart-beat, but depresses the power of the cardiac muscle though not destroying it. It produces dyspnoea by a tetanic ac- tion on the respiratory muscles, causing carbonic acid narcosis and death by paralysis of respiration. It contracts the pupil (how, is disputed), and the ciliary muscle, producing marked myosis. It is eliminated chiefly by the kidneys, the urine of the animal affected poisoning another. Physiological Action. Atropine is antagonistic as to the effects on the respiration, heart and pupils. Chloral is also antagonistic and over a greater field of action, but to be effective must be admin- istered before the ingestion of the Physostigma. The vegetable astringents, tannic acid and the caustic alkalies are chemically incompatible. Antagonists and Incompatibles. The applications of Physostigma are not many. It is efficient in con- stipation due to torpor of the bowels, in which condition it is usually combined with Belladonna and Nux-vomica. In tetanus it has been used with advantage to diminish reflex excitability in grain-doses of the extract repeated every 2 hours and the dose modified according to the effect pro- duced. Progressive paralysis of the insane is apparently retarded by it, and while antagonistic theoretically in atropine and strychnine poisoning, practically it is not of much value. Eserine is now used locally by ophthalmologists for many purposes in affections of the eye. In a solution of gr. ij to the 5 of water dropped into the eye, it is efficient in breaking up or preventing adhesions of the iris, diminishes intraocular tension, prevents suppuration after operations, contracts the pupil, diminishing the entrance of light in photophobia, etc., and empties the vessels of the eye. It is very useful in keratitis, Therapeutics. PHYTOLACCA. 309 glaucoma, strumous ophthalmia, and neuralgia of the eye-ball. The salts of Eserine or Physostigmine in neutral solution may be used for these purposes, as well as to counteract the effects of Atropine on the pupil. Gelatin disks medicated with Eserine may be obtained in the shops, and are a convenient form in which to use the drug for ophthalmic purposes. PHYTOLACCA, Poke, —is official under two forms, the berry and the root of Phytolacca decandra, a plant of the nat. ord. Phytolaccacege, found in all parts of the United States. It contains a neutral principle Phytolaccin, and an acid Phytolaccic Acid, also tannin, starch, fixed oil, etc. There are no official preparations. Phytolaccae Bacca, Poke Berry,—dark-purple, depressed globular, about Yi inch in diameter, composed of io carpels, each containing one black seed ; juice purplish-red, sweet and slightly acrid. Phytolaccae Radix, Poke Root,—large, conical, branched, fracture fibrous, wood-bundles in concentric circles, inodorous, sweetish and acrid. Dose, as emetic, gr. x-xxx,—as an alterative, gr. j-v. Exiractum Phyiolaccce Fluidum (Unofficial),—Dose, Tffiv-gj. Tinctura Phyiolaccce (Unofficial),—Dose, rt^x-gj. Preparations. Physiological Action. Phytolacca is an emeto-cathartic, acting slowly but persistently, with great nausea and considerable depression. It lowers the rate of respira- tion and of cardiac action, and is a motor depressant, paralyzing the spinal cord and the medulla, death occurring from paralysis of respira- tion, preceded by tetanic convulsions. Several cases of poisoning by this plant have occurred. Its action is antagonized by Alcohol, Ether, Opium, Digitalis, etc. Therapeutics. Alterative powers have been ascribed to Phytolacca, and competent observers have reported curative results from its use in malignant tumors, varicose and other ulcers, obstinate eczema, sycosis, favus and other skin affections, employing it both internally and externally. It is a very serviceable remedy in chronic rheumatism, and given internally has undoubtedly cured cases of granular conjunctivitis. Mastitis is some- times aborted and suppuration of the breasts prevented by the use of the fluid extract internally while a solid extract is locally applied to the seat of the impending inflammation. In tonsillitis and diphtheritic sore throat, also in chronic follicular pharyngitis, it has been much used with good results, especially when there is high fever and pains in the head, back and limbs. In true adynamic diphtheria it will do little good. 310 PICHI PICROTOXINUM. PICHI is the shrub Fabiatia imbricata, a member of the nat. ord. Solanacese, and a native of S. America. Among the Chilians it has been much prized as a remedy in cystitis with calculi and gravel, and in chronic catarrh of the bladder. It seems to have considerable power over the hematuria and pain of renal calculus. It is also highly praised in dyspeptic disorders. Its medicinal virtues reside in oleo-resinous con- stituents which are insoluble in water. An extract is prepared from the leaves, of which the dose is gr. v-x in capsules. Dose of the fluid extract, 3j> but it should not be added to wateY. PICROTOXINUM, Picrotoxin, Picrotoxic Acid, C9H10O4,—is a poisonous, neutral principle obtained from the seeds contained in the berries (Cocculus Indicus, Fish-berries), of Anamirta paniculata (Ana- mirta Cocculus, Menispermum Cocculus), a climbing shrub of the nat. ord. Menispermacese, a native of the East Indies. The berries are somewhat kidney-shaped, of blackish-brown color, wrinkled, brittle, inodorous and nearly tasteless, except the shrivelled embryo which is bitter. They con- tain, besides Picrotoxin, a large quantity of fixed oil and other substances of less interest. In the shell are found Menispermin, an alkaline princi- ple, Paramenispermin, which is neutral and crystalline, and Hypopicrotoxic Acid. Picrotoxin occurs in colorless, flexible crystals, of prismatic form, bitter taste and neutral reaction, soluble in 150 of water and in 10 of alcohol at 590 F., also in acids and in alkaline solutions. Dose by the stomach, gr. cautiously. For hypodermic use a solution in water of gr. ij in %] may be used, in doses of gr. of the principle, rtpiv equalling gr. Tinctura Cocculi,—I in 8. Dose, nyj-xv. Extractum Cocculi Fluidum,—Dose, TT\j-iij. Planat's Tincture of Cocculus,—I in 4. Dose, Tt\j-v. Unofficial Preparations of Cocculus. Physiological Action. Picrotoxin is a cerebro-spinal exaltant, affecting especially the centres in the medulla oblongata, and in its action representing the combined actions of Belladonna and Nux-vomica. It stimulates all the secretions, especially the cutaneous, the salivary and intestinal ; produces nausea and vomiting, and slows the heart and the respiration after transiently ac- celerating both. It causes muscular twitching, incoordination, stupor, delirium, epileptiform convulsions, tonic spasms of the flexor muscles alternating with clonic ones, exalted reflexes and trembling,—then coma, insensibility and death by paralysis of the heart, which is arrested in dias- tole. The action of the drug is on the spasm and vagus centres in the medulla, and on Setchenow’s inhibitory centre, as well as on the cere- PILOCARPUS. 311 bellum and spinal cord, paralyzing the first-named centres and stimulating the reflex centres in the cord. It is eliminated by all the excretory chan- nels, chiefly by the kidneys. The spasms caused by Picrotoxin are choreic and chiefly affect the flexor muscles,—those from Strychnine are tetanic, affecting principally the extensors. The order, succession and character of the phenomena pro- duced by Picrotoxin resemble in marked degree those of the epileptic paroxysms. Cocculus berries are used to stupefy fish, being thrown into ponds con- taining them. They are also employed to adulterate beer and porter in order to make these drinks more intoxicating. Chloral is antagonistic to its cerebral and spinal actions, but synergistic to its depressant power over the heart and the respiration. Acetic Acid gives relief in overdosing, and may have some antidotal power. Ancesthetics antagonize its spasm-producing action. Antagonists. Picrotoxin is used chiefly in nervous diseases. Epilepsy is amenable to it, especially when the attacks are nocturnal, and in anaemic cases and those attributable to onanism. Paralyses of several forms have been greatly benefited by it, especially paralysis of the sphincters, hemiplegia from cold, glosso-labio-laryngeal paralysis, and paralysis agitans. Chorea is well treated by it but requires full doses. It is remarkably efficient in controlling the night sweats of phthisis, and in flatulent colic, also in dys- pepsia with flatulence and severe epigastric pain, and in vomiting with giddiness, headache and intolerance of light and sound. Dysmen- orrhoea is often benefited by Cocculus administered for two days before the period; and leucorrhcea, when the discharge is sero-purulent with lumbar pains, is frequently controlled by it. Parasitic skin diseases are well treated by an ointment of Picrotoxin (gr. x to the 5), which will also kill pediculi, but it must be used cautiously and with special care to avoid an abraded surface. The tincture of Cocculus may be used as a wash to kill body-lice, undiluted. Therapeutics. PILOCARPUS, Jaborandi ,—the leaflets of Pilocarpuspennatifo- lius, a Brazilian plant of the nat. ord. Rutaceae. They are about 4 inches long, ovate-oblong, coriaceous, pellucid-punctate, mostly smooth, some- what pungent and bitter. It contains two alkaloids,—Pilocarpine, Cu H16N202, soft and viscous, slightly soluble in water but soluble in alco- hol, ether and chloroform ; Jaborine, isomeric with Pilocarpine, to which it is antagonistic in action ; also a Volatile Oil and probably a peculiar acid. 312 pilocarpus. Preparations. Extractum Pilocarpi Fluidum,—Dose, rtpv- 3 j. PilocarpincB Hydrochloras,—minute, white, deliquescent crystals, very soluble in water and in alcohol, almost insoluble in ether or chloroform. Dose, gr. Physiological Action. Pilocarpus is a paralyzer of the vaso-motor system, and a stimulant of the peripheral terminations of nerves supplying glands and involuntary muscular fibre, subsequently paralyzing the latter. It is therefore a power- ful 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 perspiration (§ix-xv, in quantity) and salivation (Sx-xxvij), after a pre- liminary flushing of the skin. The nasal, bronchial and lachrymal secre- tions 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 temperature falls from i° to 40. Drowsiness, pallor, chilliness and debility succeed, and last several hours; the pupil is con- tracted and accommodation impaired. The elimination of urea is greatly increased, but not the quantity of urine. The respiratory power is low- ered, 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. Pilocarpine is the principle to which the foregoing actions are due, but Jaborine, though chemically identical, is perfectly antagonistic thereto in its effects on the heart, pupils, lungs and salivary glands, acting precisely like Atropine on these organs. The difference is probably due to a different molecular arrangement. Antagonists and Incompatibles. Atropine is the antagonist to Pilocarpine in dose of gr. y 3 for gr. L of the latter. The antagonism between these two alkaloids extends over the whole range of their action, and is the most complete known to physiological experimentation. Conversely Pilocar- pine is exactly antagonistic to Atropine, but Jaborine acts similarly to the latter drug. Morphine controls the nausea and vomiting. Caustic alkalies, the persalts of Iron and salts of the metals generally, are chemically incompatible. Therapeutics. Jaborandi is used with great benefit in dropsies, especially the renal form, also in eclampsia of renal origin, in uraemia, pleuritis, meningitis and other inflammations of serous membranes, but it is contraindicated when from any cause there is weak heart. In diabetes insipidus it reduces the quantity of urine remarkably, relieving the kidneys by throwing the PIMENTA PIPER. 313 work on the skin. In the acute and chronic forms of Bright’s disease it has been used with great advantage, but being so depressant it must be employed with great caution in this disorder. For alopecia it is the most efficient remedy known, stimulating the skin and improving the color and condition of the hair. In agalactia it stimulates the secretion of the milk, and it often gives prompt relief in parotitis. Ptyalism is frequently relieved by minute doses of Pilocarpine (gr. -fa), which acting on the same gland antagonizes the morbid action ; and similar doses used thrice daily will check profuse perspiration. The hypodermic use of Pilocar- pine will arrest a paroxysm of spasmodic asthma, and is equally efficient in hiccough. Atropine-poisoning is best combated by the use of Pilo- carpine hypodermically. Ophthalmologists employ Pilocarpine with most excellent results in the amblyopia of alcoholism and that from the abuse of tobacco, in detach- ment of the retina, chronic iritis, keratitis, glaucoma, hemorrhage into the vitreous, atrophic choroiditis, white atrophy, to promote resolution and absorption in inflammatory conditions with exudation, and instead of Eserine as a myositic. Erysipelas and diphtheria are diseases in which Pilocarpine has recently proved very efficient, but its depressant action on the heart and respira- tion must not be lost sight of. In the writer’s experience the fluid extract is one of the best agents for breaking up a common cold. It may be given in doses of npx-3j, according to age, at bedtime. Children bear the drug well in respect to all its physiological actions. PIMENTA, Allspice ,—is the nearly ripe fruit ot Eugenia Pimenta, a West Indian tree of the nat. ord. Myrtacege. The berries are nearly globular, about inch in diameter, crowned with the remnants of the calyx, two-celled, each cell containing one reniform seed, odor and taste pungent and aromatic. They contain a Volatile Oil which is official, a green fixed oil, fat, tannin, gum, resin, etc. Dose, gr. x-xl. Oleum Pimentce, the volatile oil, colorless or pale-yellow, of aromatic odor, pungent taste and slightly acid reaction. Is a constituent of Bay Rum (Spt. Myrcke). Dose, "VM'j- Physiological Action and Therapeutics. Allspice is a warm, aromatic stimulant, very useful as a condiment, im- proving digestion by increasing the vascularity of the gastric mucous mem- brane and by stimulating the salivary secretion. The oil is an agreeable remedy for flatulence, nausea and intestinal colic, and is used to prevent the griping of purgatives and to cover the taste of nauseous medicines. PIPER, Pepper, Black Pepper,—is the unripe fruit of Piper nigrum, or Pepper-vine, a perennial plant of the nat. ord. Piperacese, grow- PISCIDIA. ing in India, Siam, Java, Borneo, etc. It is about inch in diameter, of globular shape, reticulately wrinkled, aromatic, of pungent, spicy taste, and contains an alkaloid, Piperine, which is official, also a green, acrid concrete oil, a balsamic volatile oil, starch, lignin, gum, extractive, etc. Dose, gr. v-xx. Preparations. Oleoresina Piperis, Oleoresin of Pepper,—contains almost all the volatile oil and acrid resin extracted by ether, with little of the Piperine. Dose, Ttp^-j. Piperina, Piperine, C17Hl9N03,—a proximate principle of feeble alkaloidal power, prepared from Pepper, and occurring also in other plants of the natural order Piperacese. Occurs in colorless or pale-yellowish prisms, of neutral reaction, almost insoluble in water, slightly so in ether, but soluble in 30 of alcohol at 590 F. Dose, gr. j-x. Physiological Action and Therapeutics. Pepper when applied to the skin acts as an irritant; internally its effects are similar to those of other aromatics, being a warm carminative and stimulant, increasing slightly the action of the heart, stimulating the kid- neys somewhat, and toning up the mucous membrane of the urinary and intestinal passages, by which channels it is eliminated. It has been thought to possess antiperiodic powers, and was formerly much employed in intermittents. Its chief medical use is to correct flatulence, and to excite action of the stomach, being very commonly taken as a condiment with food. It is occasionally employed in gleet, but more extensively in hemorrhoids and other diseases of the rectum. Its active constituents are the concrete oil of resin and the volatile oil, the alkaloid having very slight action on the system, except as an antiperiodic and antipyretic, qualities which it certainly possesses. PISCIDIA, J amaica Dogwood (Unofficial), is the bark of the root of Piscidia erythrina, a tree of the nat. ord. Leguminosae growing in the West Indies. It occurs as a tough, fibrous bark, externally blackish, in- ternally greenish, of a heavy, narcotic odor, and a bitter, acrid and astrin- gent taste, containing a yellowish, resinoid substance named Piscidin. Its active principle has not yet been isolated. A fluid extract is on the market, of which the dose is 3ss-j, carefully increased. Physiological Action. Piscidia has a narcotic effect on many animals, and has been used in Jamaica for many years to stupefy fish, that they may be easily taken. It produces muscular relaxation, incoordination of movement, lowered sensi- bility, increased action of the heart and increase of the arterial tension by stimulation of the vaso-motor centre. Soon, however, the heart is weak- ened, vascular tension falls, and a tetanoid state results from stimulation of the spinal cord, with reduced reflex action. On the brain its effects resemble those of Opium, causing deep sleep without any unpleasant after 315 results. It relieves pain in less degree, however, than Opium does, but its hypnotic action is greater. It also relieves cough and spasm, produces diaphoresis and salivation, and dilates the pupil. From toxic doses death occurs by asphyxia. In man it probably causes the same effects but in decidedly less marked degree. Jamaica Dogwood is used chiefly as a general nervous sedative. Its hypnotic and anodyne powers are somewhat uncertain, but have in many cases been very decided. It is useful in whooping-cough and spasm, and has proved almost specific in many cases of neuralgia, while in others it has caused great gastric distress without the least anodyne effect. Therapeutics. PIX, Pitch ,—is a resinous exudation from the stem of certain trees of the genera Pinus (Pines) and Abies (Firs and Spruces) ; and may also be obtained by the evaporation of wood-tar. [See Pix Liquida below.] The following varieties are official, viz. : Pix Burgundica, Burgundy Pitch,—the prepared, resinous exudation of Abies excelsa or Norway Spruce (nat. ord. Coniferse), a native of Europe and Northern Asia. Occurs in hard, brittle, opaque or translu- cent mass, with a shining, conchoidal fracture, reddish-brown color, aromatic and somewhat empyreumatic, not bitter, almost entirely soluble in glacial acetic acid. It is very fusible, and at the body-heat it softens and becomes adhesive. Used for plasters. Pix Canadensis, Canada or Hemlock Pitch,-—the prepared resinous exudation of Abies canadensis (nat. ord. Coniferae), the Hemlock Spruce of the U. S. and Canada. Its properties are much the same as those of the preceding. Pix Liquida, Tar,—is an empyreumatic oleo-resin obtained by the destructive distillation of the wood of Pinus palustris and other species of Pinus (nat. ord. Coniferae). Is thick, viscid, semi-fluid, blackish- brown, of acid reaction, terebinthinate odor, and sharp, empyreumatic taste, slightly soluble in water, soluble in alcohol, oils, and in solution of potassa or of soda. By distillation it yields an acid liquor named Pyro- ligneous Acid and an empyreumatic oil called Oil of Tar (see Ol. Picis Liquid.®, below), the residue being pitch. Its granular appearance is due to crystals of Pyrocatechin, C6H4(OH)2, which occur either in the Pyroligneous Acid or in the tarry mixture. Dose, 3j_ij daily, in ten- grain doses. Preparations. Oleum Picis Liquidce, Oil of Tar,—a volatile oil distilled from Tar. Dark, reddish- brown (almost colorless when fresh), of tarry odor and taste and acid reaction, readily soluble in alcohol. Contains a great variety of compounds, including Hydrocarbons, Phenols, Paraffin, etc., among the phenols being Creasote and Carbolic Acid. Is used locally and as an atomized inhalation. 316 Syrupus Picis Liquids, Syrup of Tar,—has of Tar 6 per cent., and is a sweetened Tar-water. Dose, gij-^ss. Unguentum Picis Liquids, Tar Ointment,—contains equal parts of Tar and Suet. Emplaslrum Picis Burgundicce, Burgundy Pitch Piaster,—has of Burgundy Pitch 90, Yellow Wax 10 parts. Emplastrum Picis Canadensis, Canada Pitch Plaster,—has of Canada Pitch 90, Yel- low Wax 10 parts. Emplastrum. Picis cum Cantharide, Warming Plaster,—has of Burgundy Pitch 92, Cerate of Cantharides 8 parts. Infusum Picis Liquidce, Tar Water (Unofficial),—made by shaking Tar 1 with Water 4 frequently during 24 hours, decanting and filtering. Is stimulant and diuretic. Dose, Oj-ij daily. Vinum Picis Liquidce, Wine of Tar (Unofficial),—Tar g xvj, Glycerin, White Wine, Honey, aa viij, Acetic Acid % j, Boiling Water Ovj, shaken together and digested in a close vessel for two hours at 150° to 160°, then macerated for a few days, frequently shaken, strained and filtered. Oleum Pini Sylvestris, Oil of Scotch Fir (Unofficial),—a colorless, fragrant oil, dis- tilled from the leaves of Pinus sylvestris, resembling Turpentine in action. Used by inhalation (gss to Oj of boiling water), or locally. Concentrated Extract of Pinus Canadensis (Unofficial),—is an aqueous, non-irritant astringent, prepared from the Abies Canadensis or Hemlock Spruce. It is said to have a specific tonic action upon mucous membranes. Two kinds are sold, one being called the “ White ” Extract.—in reality a golden yellow,—and the other the “ Dark ” Extract, —the former intended for use when it is desirable to avoid staining the linen. This preparation received the endorsement of Dr. J. Marion Sims, and has been extensively employed both locally and internally, as a topical application in uterine and vaginal catarrhs, and as a systemic remedy in catarrhal inflammation of the gastro-intestinal and broncho-pulmonary mucous membranes. Physiological Action and Therapeutics. Pitch is a gentle rubefacient when applied to the skin, but in some constitutions the Burgundy variety causes a vesicular and pustular inflam- mation if used extensively. It is generally employed as a basis for plasters, and is of benefit in lumbago, rheumatism, chronic pleurisy, pain- ful joints, superficial neuralgias, etc., protecting the part from variations of temperature, and perhaps by the gentle pressure exercised stimulating the lymphatics and promoting absorption. It is supposed to have a special influence on the rectum, and in pill with Tar has been employed as a remedy for hemorrhoids. In applying adhesive plasters the hair should first be shaved off, and when about to be removed the plaster should be warmed, and a little Oil of Turpentine inserted between its edge and the skin. Canada Pitch is too soft for plasters, but is employed for the same purposes as the preceding. A volatile oil obtained from the same tree (Oil of Spruce, Oil of Hemlock) has been used for abortifacient pur- poses, endangering the life of the subject. Tar is a complex mixture of resins and hydrocarbons, containing Creasote and Carbolic Acid which give to it irritant qualities. Internally it is expectorant and produces gastro-intestinal irritation, sometimes severe headache, giddiness and febrile phenomena. It is eliminated by the kidneys chiefly, which it stimulates, and may cause their congestion and increased diuresis. Externally it is a decided stimulant to the skin, PLANTAGO PLUMBUM. 317 often giving rise to considerable irritation and pain. It is also antiseptic, and in most of its effects it resembles the turpentines. Tar is used as a local application in chronic scaly skin diseases, especially psoriasis and chronic eczema. As an atomized inhalation it is of decided benefit in bronchitis, pharyngitis, laryngitis and winter cough. Internally it may be employed with advantage in these affections, in hemorrhoids, bronchial catarrh, and phthisis. The best preparation for internal administration is the syrup, which is a sweetened tar-water, the sugar forming with the Tar a soluble compound. PLANTAGO, Plantain (Unofficial),—istheleaf oi Plantago major, and Plantago lane eo lata (nat. ord. Plantaginaceae), the common “Ribbed Grass.” The pounded leaves applied as a paste, or the dry leaf powdered, are actively hemostatic, stopping hemorrhages speedily. Among the ancients it had a good reputation as a remedy for toothache and earache, which still adheres to it in Switzerland and many other parts of Europe. In many other painful affections it is extremely efficient, especially in mastitis, rhus-poisoning, erysipelas, burns, scalds, wounds and bruises. A poultice of the leaves may be applied to the affected part, and an infusion administered internally. A fluid extract is sold in the shops, of which the dose is npv-xv. PLUMBUM, Lead, Pb, —is not official, but several of its salts are, namely,—the Acetate, Carbonate, Iodide, Nitrate and Oxide, of which the Acetate is the only one administered internally, the solutions of the Subacetate are the only liquid preparations, the Oxide (Litharge) is used as Emplastrum Plumbi, the Nitrate is used as a local stimulant or escha- rotic, the Iodide as an ointment for absorbent purposes, and the Carbonate as an astringent locally to inflamed surfaces. The metal occurs in nature chiefly as a Sulphide named Galena, also as an Oxide rarely, and in various saline combinations. Plumbi Acetas, Acetate of Lead, Sugar of Lead, Pb (C211302) 2.3112*0,—colorless, shining, prismatic crystals or scales, efflorescent, of faintly acetous odor and acid reaction, and a sweetish, astringent and metallic taste. Soluble in 1.8 of water and in 8 of alcohol at 590 F., in 0.5 of boiling water and in 1 of boiling alcohol. Dose, gr. ss-v. Plumbi Carbonas, Carbonate of Lead, White Lead, (PbC03)2Pb(H0)2,—a heavy, white, opaque powder, odorless, tasteless and insoluble in water or alcohol, but soluble with effervescence in dilute nitric acid. Used locally as ointment, powder, or white paint. Plumbi Iodidum, Iodide of Lead, Pbl2,—a heavy, bright citron yellow powder, odor- less and tasteless, fusible and volatilizable by heat, soluble in about 2000 of water at 590 F., and in about 200 of boiling water. Used externally as an ointment. May be given internally in doses of gr. twice daily. Plumbi Nitras, Nitrate of Lead, Pb(N03)2,—colorless, opaque, octahedral crystals, odorless, of sweetish, astringent and metallic taste and acid reaction, soluble in 2 of water at 590 F., almost insoluble in alcohol. Used locally as an astringent and deodorizer in solutions up to 1 per cent., also as an escharotic and a disinfectant. Official Salts of Lead. 318 PLUMBUM. Plumbi Oxidum, Oxide of Lead, Litharge, PbO,—a heavy, yellowish or reddish-yellow powder, odorless, tasteless and insoluble in water or alcohol, but almost wholly soluble with slight effervescence in dilute nitric acid. When heated in contact with charcoal it is reduced to metallic lead. Used as Lead-Plaster and sometimes with oil as an external application. Preparations. Liquor Plumbi Subacetatis, Solution of Subacetate of Lead, Goulard’s Extract,—an aqueous solution containing about 25 per cent, of the salt, prepared from Acetate of Lead 170, Oxide of Lead 120, and Distilled water q. s. ad 1000 parts. It is a clear, colorless liquid, of sweetish, astringent taste and alkaline reaction, of sp. gr. 1.228, and when added to a solution of acacia it produces a dense, white precipitate. Used locally as an astrin- gent and cooling lotion, diluted usually with an equal quantity of water. Liquor Plumbi Subacetatis Dilutus, Lead Water,—has of the preceding 3 parts to 97 of Distilled Water. Used locally as a mild astringent and cooling lotion. Linimentum Plumbi Subacetatis,—contains of Liquor Plumbi Subacetatis 40 parts to 60 of Cotton-seed Oil. Used as an anodyne application for itching, etc. Ceratum Plumbi Subacetatis, Goulard’s Cerate,—has of the same solution 20 parts with 80 of Camphor Cerate, freshly prepared, as it becomes rancid easily. Used as an astrin- gent and protective application. Emplastrum Plumbi, Lead-plaster, Diachylon Plaster,—Oxide of Lead 32, Olive Oil 60, rubbed together and boiled with 10 parts of water. Is white, pliable and tenacious, free from greasiness or stickiness, and should be entirely soluble in warm oil of turpentine. A good protective in abrasions and bed-sores, and the basis of many other plasters. Unguentum Diachylon, Diachylon Ointment,—has of Lead Plaster 60, Olive Oil 39, Oil of Lavender 1. Used locally in eczema and other cutaneous disorders. Unguentum Plumbi Carbonatis,—has of the Carbonate in very fine powder 10, Benzo- inated Lard 90. Used as a dressing for burns. Unguentum Plumbi Lodide,—has of the Iodide in very fine powder 10, Benzoinated Lard 90. Used locally to promote absorption of glandular tumors. Oleatum Plumbi, Oleate of Lead (Unofficial),—a 20 per cent, solution of Oxide of Lead in Oleic Acid. A soft, yellowish ointment, for local use. Lead-salts are all more or less poisonous, but metallic Lead is inert until converted into a soluble salt by the acids of the stomach. The Acetate in large doses is emetic, so that acute lead-poisoning is rare. Its chief phenomena are intense gastro-intestinal irritation, vomiting, paraly- sis, coma and collapse. Chronic lead-poisoning (plumbism) has its principal sources in pure water conveyed by leaden pipes, the use of hair-dyes, handling of print- ing-type, working in the smelting of lead ores, etc. It produces loss of appetite, emaciation, pallor and constipation, followed by slowing of the heart’s action, and accompanied by violent colic (enteralgia), muscular impairment evinced by paralysis of the extensor muscles of the forearm (drop-wrist), impaired sensibility and albuminuria. Occasionally apho- nia, vertigo, gastralgia, headache, stupor and convulsions are manifested. Rheumatism without fever or tenderness in the joints, which however are red and swollen, is a frequent symptom. A blue line (sulphide) is seen along the margin of the gums in those who do not clean their teeth. Neuralgic troubles may arise, and amaurosis often occurs from impairment of the optic nerve. The metal becomes deposited in the affected muscles and other tissues, and probably acts by impairing the isolating power of the nerve-fibres, thus enfeebling the nerve-currents. It also produces con- Physiological Actions, PLUMBUM. 319 traction of the smaller vessels, and may affect any muscles of the body, also the brain, producing delirium, coma and convulsions. Abortion is a frequent result, either through an influence on the muscular tissue of the uterus, or from a toxic action on the foetus. Death may occur from ex- tension of the paresis to the muscles of respiration, from gradual impair- ment of nutrition, or from convulsions and coma, a form of disease known as Lead-encephalopathy. Astringency is the chief quality of the lead salts ; they lessen secretion, contract muscular tissue and then destroy its contractile power, slow both the heart and the respiration, and in time destroy the red blood-corpus- cles. Lead enters the blood as an albuminate, in which form also it is retained by the tissues. It is slowly excreted by the liver, kidneys, skin and mammary glands. That which escapes by the bile is reabsorbed by the bowel, is again excreted by the intestinal glands, escaping with the faeces as a sulphide. It lessens the excretion of uric acid. Antidotes and Incompatibles. In acute poisoning, as by the Acetate, the antidotes are Sulphate of Sodium or of Mag- nesium, and Phosphate of Sodium. The stomach should be evacuated, and albuminous drinks and Opium given to allay irritation. Chronic poisoning is best treated by Iodides to saturation of the system. Sulphurated Potassa baths (or more in water) are also very useful. Incompatibles are mineral acids and salts, vegetable acids, alkalies, vege- table astringents, Iodide of Potassium, albuminous solutions, Opium, and all natural waters containing lime, sulphates, carbonates and Carbonic Acid. Therapeutics. Lead salts are chiefly used as astringents and hemostatics. The solu- tion of the Subacetate diluted with 4 parts of glycerin and water is locally employed in many skin-diseases, especially in eczema, lichen, impetigo and erythema; also in catarrhal discharges of muco-purulent character from the ear, vagina and the urethra, particularly in gonorrhoea and leu- corrhoea. Inflammations of external parts are constantly treated by the lotion of “ Leadwater and Laudanum” (Liquor Plumbi Subacetatis Di- lutus, 7 parts to 1 of Tinctura Opii). Though the constituents of this lotion are chemically incompatible, it is a valuable sedative and astringent. The Acetate, in 5-grain doses every three hours, is an efficient internal styptic in various hemorrhages, particularly in hemoptysis, hematemesis and gastric ulcer, lowering the action of the heart and constringing the vessels. Its astringent action is well manifested in bronchorrhoea and other pulmonary affections with excessive secretion. It is well used in diarrhoeas, gr. ij with gr. j of pulverized Opium in choleraic diarrhoea, and smaller doses for the summer complaint of children. In caseous pneumonia the Acetate is highly recommended as the best remedial agent, combined with Opium and Digitalis; and in cardiac hypertrophy it may be often used to lower the action of the heart. It is also serviceable in whooping-cough with profuse bronchial secretion, and in humid asthma. 320 PODOPHYLLUM. Carbonate of Lead is only used externally to protect irritated sur- faces, as erythema, erysipelas, intertrigo, etc., in which it may be dusted over the surface if unbroken. The official ointment, or white paint mixed with linseed oil, is an excellent application to burns or scalds, but if ap- plied on the broken cuticle it may prove rapidly poisonous. The Iodide is employed externally as an ointment to enlarged lym- phatic glands and enlarged spleen, also to chronic eczema and psoriasis. It has been used internally to reduce a malarial spleen. The Nitrate is an efficient application to fissured nipples, gr. x to Sj of glycerin. In powder, dusted over unhealthy granulations, and sani- ous ulcers resulting from onychia, it gives prompt relief after a brief period of pain. It is said to have cured cases of epithelioma when used in the same manner. In solution (gr. x to the 3) it is a most efficient deodor- izer against the fetor from gangrenous sores, ozaena and other offen- sive discharges. Pharmaceutically it is used in the preparation of the Iodide. The Oxide is used in the preparation of plasters, most of the other salts of lead, and Digitalin. It is not employed internally, but may be used as an external application mixed with sweet oil in superficial burns, but care should be taken that it is only applied to the unbroken skin. PODOPHYLLUM, May Apple, —is the rhizome and rootlets of Podophyllum peltatum (Mandrake), an herbaceous perennial of the nat. ord. Berberidacese, growing in the woodlands of Canada and the U. S., having a pale-green stem about a foot high, with a single white flower at its summit. The rhizome is horizontal, inch thick, consisting of joints about 2 inches long, of orange-brown color externally, white and mealy internally, inodorous, taste bitter and acrid. Its active principle is a Resin which is official, and is a compound of several resins. It probably contains the alkaloid Berberine, which is also found in Berberis, Hydrastis and several other plants. Dose, gr. v-xx. Abstraction Podophylli,—Dose, gr. Extraction Podophylli,—Dose, gr. v-x. Extractum Podophylli Fluidum,—Dose, try-xxx. Resina Podophylli, Podophyllin,—is precipitated from a concentrated tincture by acidu- lated water. Soluble in alkaline liquids and partly so in ether. Contains Podophyllotoxin, Picropodophyllin, Podophyllinic and Protocatechuic Acids. Dose, gr. ]/%—), in pill. Preparations. Podophyllum is a tonic-astringent and resin-bearing purgative, having an action similar to that of Jalap but slower, like Calomel, taking 6 to io hours to produce its cathartic effect. It increases the intestinal secretions and the flow of bile, causing copious watery stools, with considerable Physiological Action and Therapeutics. POLYGONUM HYDROPIPEROIDES PONGAMIA. 321 griping pain and some nausea. The powder is irritant to the respiratory passages and the skin. Resina Podophylli is an excellent purgative in cases of habitual con- stipation or portal congestion, and is a useful cholagogue. Laxative effects are produced by small doses (gr. }£-}£), but grain-doses are necessary for its full action. It should be combined with Hyoscyamus, Belladonna or Cannabis Indica, in order to counteract its griping ten- dency. It is an efficient derivative in cases of catarrhal or malarial jaun- dice, and is recommended in very small doses for prolapse of the rectum, remittent fevers of children, dyspepsia, hepatic derangement, bilious vomiting and headache, and in the vomiting and diarrhoea of gastro- enteritis. POLYGONUM HYDROPIPEROIDES, Water - pepper, Smart-weed (Unofficial),—is a plant of the nat. ord. Polygonaceie, indigenous to the U. S., having narrow, lanceolated leaves and slender spikes of whitish flowers. It contains Tannin and an active principle, Polygonic Acid, which is green, crystallizable, insoluble in water, but soluble in alcohol, ether, and chloroform. Preparations. Extractum Polygoni Fluidum (Unofficial),—Dose, npc-gj. Extractum Polygoni (Unofficial),—Dose, gr. j-v. Physiological Action and Therapeutics. Smart-weed has a pungent, acrid taste, producing a sensation of heat in the stomach, and a peculiar tingling throughout the system. It stimu- lates the action of the heart, raises the arterial tension, increases the warmth of the surface, promotes the cutaneous, bronchial and renal secre- tions and the menstrual flow. It is an efficient diuretic, emmenagogue and aphrodisiac. The juice applied to the skin excites inflammation and vesication. Amenorrhcea from functional inactivity of the uterine system is remark- ably benefited by this remedy in 3ss doses of the fluid extract four times daily for a week before the expected period. It has considerable influ- ence over functional impotence, but produces aching pains in the hips and loins, and a sense of weight and fullness within the pelvis. It has also been used with benefit in diarrhoea, dysentery, gravel, and locally in mer- curial salivation and the sore mouth of nursing women. PONGAMIA, Kurung Oil (Unofficial), is a yellow oil expressed from the seeds of Pongamia glabra, an Indian tree of the nat. ord. Legu- minosae. It has been used for many years in India for skin affections, 322 POTASSIUM. and in professional hands has proven an excellent application in pityriasis versicolor, rubbed in twice daily. It promises to be a valuable remedy in parasitic diseases of the skin, is not irritating and does not discolor the surface to which it is applied. POTASSIUM, Kalium, K,—is represented by a number of official salts, which are colorless or white, sometimes anhydrous, and generally readily soluble in water. The metal itself is not official. The chief source of its salts is the ash remaining after the combustion of plants or trees, which contains the Carbonate, from which most of the others are prepared. There are also two subsidiary sources, viz.—the Nitrate, which is found native; and the Bitartrate, which, under the name of Crude Tartar or Argol, is deposited during the fermentation of wine. It is distinguished from all other bases (except Magnesium, Sodium and Ammonium) by not being precipitated by Ammonium Sulphide or Am- monium Carbonate. It is positively known by the violet color it imparts to flame, by its very sparing solubility when converted into the Bitartrate, and by its precipitation by Platinum Perchloride. Potassium Compounds and their Preparations. Potassa, Potassium Hydrate, Caustic Potash, KHO,—a very deliquescent, white, hard and dry solid, of very acrid and caustic taste and strongly alkaline reaction, soluble in 0.5 of water and in 2 of alcohol. It is a powerful and deeply-acting escharotic, and should be kept in well-stoppered bottles made of hard glass. Potassa cum Calce, Potassa with Lime, Vienna Paste,—a grayish-white, deliquescent powder, consisting of equal parts of Potassa and Lime rubbed together. A milder and more manageable caustic than the preceding. Liquor Potasses, Solution of Potassa,—contains about 5 per cent, of Potassium Hy- drate, and is prepared by dissolving 90 parts of Potassium Bicarbonate in 400 of Dis- tilled Water, 40 of Lime in the same quantity of Distilled Water, boiling, mixing the solutions gradually, again boiling, and when cold adding Water up to 1000 parts, strain- ing, settling, and decanting the clear solution. Or, by dissolving 56 of Potassa in 944 of Distilled Water. Is a clear, colorless, odorless liquid of acrid and caustic taste, and strongly alkaline reaction. Dose, 3 ss, well diluted with water. Potassii Aceias, Acetate of Potassium, KC2H302,—a white, satiny, crystalline mass, or a granular powder, very deliquescent, odorless, of pungent, saline taste, and a neutral or faintly alkaline reaction, soluble in 0.4 of water and in 2.5 of alcohol at 590 F. Dose, gr-v-Sj-. Potassii Carbonas, Carbonate of Potassium, (K2COs)2.3H20,—a white, crystalline or granular powder, very deliquescent, odorless, of alkaline taste and reaction, soluble in 1 of water at 590 F., insoluble in alcohol. It is a constituent of Unguentum Sulphuris Alkalinum. Dose, gr. ij-xx. Potassii Bicarbonas, Bicarbonate of Potassium, KHC03,—colorless prisms of saline and alkaline taste and alkaline reaction, soluble in 3.2 of water at 59° F., decomposed by boiling water, almost insoluble in alcohol. Dose, gr. v-xxx. Potassii Chloras, Chlorate of Potassium, KC102,—colorless prisms or plates, of pearly lustre, of cooling, saline taste and neutral reaction, soluble in 16.5 of water at 590 F. and in 2 of boiling water; slightly soluble in alcohol. It should not be triturated with readily oxidizable or combustible substances, nor combined with glycerin in the presence of a free acid. Dose, gr. v-xx. Trochisci Potassii Chloratis,—each troche contains gr. v of Potassium Chlorate, with Sugar, Tragacanth and Spirit of Lemon. Dose, j-iij, slowly dissolved in the mouth. Potassii Citras, Citrate of Potassium, K3C6H50rH20,—a white, granular, deliques- POTASSIUM. 323 cent powder, of cooling, alkaline taste, and a neutral or faintly alkaline reaction, soluble in 0.6 of water at 590 F., slightly soluble in alcohol. Dose, gr. x-xxx. Liquor Potassii Citratis,—contains about 9 per cent, of the salt, with some free Citric Acid and Carbonic Acid gas. Prepared by dissolving 6 of Citric Acid and 8 of Potas- sium Bicarbonate each in 40 of water, filtering and adding to the filters in each case enough water to bring to 50 parts, then mixing the two solutions. Dose, j|ss- qj. Mistura Potassii Citratis, Neutral mixture,— Lemon-juice, fresh and strained 100, Bi- carbonate of Potassium about 10 parts or enough to neutralize the Lemon-juice. Should be freshly made. Dose, Ijss-^j. Potassii Nitras, Nitrate of Potassium, Saltpetre, Nitre, KNOs,—colorless, transparent prisms or a crystalline powder, of pungent, cooling and saline taste and neutral reaction ; soluble in 4 of water at 590 F. and in 0.4 of boiling water; almost insoluble in alcohol. Is a constituent of Argenti Nitras Dilutus. Dose, gr. v-xx, well diluted. Charta Potassii Nitratis, Nitrate of Potassium Paper,—is unsized paper immersed in a solution of 20 parts of the salt in 80 of distilled water, and dried. Used for inhalation, the fumes from the burning paper being inhaled in asthma. Potassii Sulphas, Sulphate of Potassium, K2S04,—colorless, hard, rhombic prisms, of sharp, saline and bitter taste and neutral reaction, soluble in 9 of water at 590 F., and in 4 of boiling water, insoluble in alcohol. Dose, gr. well diluted. Potassii Tartras, Tartrate of Potassium (K2C4H406)2.H20,—small, transparent crystals, or a white powder, somewhat deliquescent, of saline, bitter taste, and neutral reaction, soluble in 0.7 of water, almost insoluble in alcohol. Dose, gr. xx-^ss. Potassii Bitartras, Bitartrate of Potassium, Acid Tartrate of Potash, Creamor Tartar Cream of Tartar, KHC4H406,—colorless rhombic crystals, or a white, gritty powder, of acidulous taste and acid reaction; soluble in 210 of water at 590 F., and in 15 of boiling water, very slightly soluble in alcohol. Is a constituent of Pulvis Jalapae Compositus. Dose, gr. xx-ss. Potassii et Sodii Tartras, Tartrate of Potassium and Sodium, Rochelle Salt,— KNaC4H406.4H20,—colorless, rhombic crystals, or a white powder, of cooling and slightly saline and bitter taste, and neutral reaction; soluble in 2.5 of water at 590 F., very soluble in boiling water, almost insoluble in alcohol. Is a constituent of the follow- ing preparation. Dose, £ ss-j. Pulvis Ejfervescens Compositus, Compound Effervescing Powder, Seidlitz Powder,— each has of the preceding salt 120 grains, of Sodium Bicarbonate 40 grains, mixed in one paper; and of Tartaric Acid 35 grains in another paper. Dose, 1 or 2 pair, dissolved separately in water and the solutions poured together. Potassii Silicas, Silicate of Potassium, Soluble Glass, K2Si03 (Unofficial),—is used in solution of a syrupy consistence for the preparation of immovable dressings for frac- tured limbs, etc. (See under Silicates.) [The Arsenite of Potassium is described under Arsenic, page 116;—the Bromide under Bromum, page 133;—the Bichromate under Acidum Chromicum, page 62;— the Iodide under Iodum, page 252;—the Cyanide and Ferrocyanide under Acidum Hydrocyanicum, page 67 ;—the Hypophosphite under Phosphorus, page 305,—the Permanganate under Manganum, page 274;—the Sulphite under Acidum Sulphu- rosum, page 73;—the Nitrite under Amyl Nitris, page 98;—and Sulphurated Potassa under Sulphur.] Physiological Action. Caustic Potash, like other caustic alkalies, destroys the tissues by combining with their water, dissolving the albumen and saponifying the fats, and converting the tissue to which it is applied into a moist, gray slough, with considerable surrounding inflammation. Internally it acts as a powerful corrosive poison, destroying the mucous membrane of the parts with which it comes in contact, and giving rise to intense pain, diarrhoea, convulsions and delirium. Unless speedily rejected or neutralized it causes death from inflammation of the larynx, the gastro-intestinal lesions, or after some time from stricture of the oesophagus. Liquor Potass.®, containing over 5 per cent, of the pure Potash, possesses in a degree the 324 POTASSIUM. same caustic properties, and should never be administered undiluted. It neutralizes the acids in the stomach, and in the blood exists chiefly as the Carbonate, being eliminated with the urine, which it renders alkaline. If its use be continued too long it impairs the blood, and renders the subject anaemic. Potassium Salts in large doses are cardiac poisons, muscular para- lyzers, poisonous to protoplasm, especially nerve-tissue, and destructive to the ozonizing function of the blood. They increase the saliva, promote oxidation and stimulate retrograde metamorphosis; and are therefore waste-producers. In small doses on an empty stomach they promote the formation of acid gastric juice by favoring the outward osmosis of its con- stituents from the blood ; in larger doses they act chemically on the stomach contents, neutralizing its free acids, and disordering digestion. The Bicarbonate, given on an empty stomach, enters the blood unchanged, meets the neutral phosphate of sodium and is decomposed, acid phosphate of sodium being formed, which renders the urine more acid. On a full stomach it is decomposed by the acids of the gastric juice, increases the alkalinity of the blood and makes the urine less acid. The Salts of Potassium with Vegetable Acids (Acetate, Citrate, Tartrate, etc.) enter the blood in their own form, are there decomposed, forming free C02, and are converted into alkaline carbonates, in which form they are eliminated, alkalinizing the blood and the urine. They are diuretics also, increasing the urinary water and solids, but decreasing the uric acid by causing increased oxidation. The Mineral Salts (Nitrate, Chlorate, etc.) are not decomposed in the blood, but are eliminated in their own form, the Nitrate being a most active diuretic, the Chlorate irritating the kidneys, depressing the heart, causing albuminuria, and impairing the ozonizing function of the blood. In large doses these salts decompose the red blood-corpuscles and paralyze the motor ganglia of the heart. The Chlorate does not part with its oxygen in the system, as generally believed. The Sulphate is chiefly purgative in its action, but acts harshly, and in overdoses has caused death. [The action of the remaining Potassium salts is described under the titles of their acid and other constituents, to which their effects are chiefly referable.] Poisoning by caustic alkalies is treated by the dilute Vegetable Acids, as vinegar, cider, lemon-juice;—then demulcent drinks and oils to protect the mucous membrane, and the usual measures to support vitality. The alkalies and their carbonates are incompatible with the acids and also with metallic salts, and the caustic alkalies decompose most of the alkaloids. Antagonists and Incompatibles. Caustic Potash is used locally to destroy morbid or cicatrical tissue, to cauterize the wounds resulting from bites of animals or stings of insects, to form issues or to open deep-seated abscesses, and to destroy chancres, Therapeutics. POTASSIUM. 325 malignant pustules, ngevi, warts, etc. Its action is deep and severe, and it is best employed in the form of Potassa cum Calce, which is far more manageable. Liquor Potass.® is used internally as a free alkali to neutralize excess of acid in the stomach, blood and secretions, as an antilithic in the uric acid diathesis, also for acne, boils, and obesity. Locally it is employed to soften the nail in in-growing toe-nail, and diluted to relieve pruritus and remove scales in various skin-diseases. In small doses with a vegetable bitter tonic before meals it acts well in atonic dyspepsia, increasing the flow of the gastric juice by direct stimulation of the gastric mucous mem- brane. If given after meals in acid dyspepsia large doses are necessary for temporary alleviation by neutralizing the food acids. These remarks concerning acidity and dyspepsia apply equally well to the Bicarbonate, which is used for the same purpose, and while possessing all the virtues of the potassium salts, is without any corrosive or irritant action. It is also useful in simple gastralgia or cardialgia; and in cystitis, gonorrhoea, etc., where there is acid urine, it renders the urine less irritating and soothes the inflamed surfaces. Acute and chronic rheumatism and rheumatoid arthritis are much benefited by an alkaline treatment in patients of suffi- cient bodily vigor to stand its lowering effects. The Bicarbonate is also used to alkalinize the blood and secretions in lithaemia, jaundice, many cutaneous eruptions, and in diabetes ; also locally as a lotion for fetid perspiration of the feet and axillse, acne and acute eczema. The Car- bonate is diuretic, antacid and antilithic, but is seldom used internally, being too irritant, and the Bicarbonate having all its virtues without its objectionable qualities. Locally a solution (5j to the g) is said to be effectual as a remedy for pruritus vulvge, and one of half the above strength is used in freckles, sunburn and tan of the epidermis, in moist eczema and the itching of urticaria. The Acetate, Citrate and Tartrate are good purgatives in doses of $ij to giv, and in smaller doses are much employed as alkalinizers of the blood and urine, diuretics, etc. Of these vegetable potassium salts the Acetate is the most certain diuretic, the Bitartrate is the most active ca- thartic, while the Citrate is the most reliable diaphoretic and the best agent to use to alkalinize the urine for any length of time, it having the least injurious effect on the blood or on the digestion. In lithgemia these salts are given to promote oxidation, and by keeping the urine alkaline they may reduce small calculi of the uric acid variety. In acute rheuma- tism and fevers they act as antacids in the blood, as febrifuges by promot- ing diaphoresis, and as sedatives to the general nervous system. As an agreeable laxative no preparation surpasses the Bitartrate in 2 to 4 drachm doses made into a paste with orange marmalade or any other conserve. It is also used in Infusion of Juniper as a diuretic in general cardiac dropsy, and without the Juniper in acute desquamative nephritis. 326 POTASSIUM. Potassium Chlorate is much employed locally in solution (3ss to the g) as a deodorizer and detergent wash in inflamed, ulcerated and aphthous conditions of the mouth. On unhealthy mucous membranes generally it exercises an alterative action for the better, but if too long used it will keep up a state of chronic irritation. In mercurial salivation it is of great benefit, and in dilute solution (gr.x to the g) it is an efficient application to unhealthy sores and ulcers, as a wash for foul sinuses or cavities, and as an injection in chronic affections of the bladder. The powdered salt may be applied to aphthae, and dusted over epithelioma will alter the action, diminish the pain, check the growth and promote cicatrization. Inter- nally this salt has been administered in the mistaken idea that it parts with its oxygen in the system, but it is now shown that it is excreted un- changed. Setting up congestion and irritation of the kidneys it is highly dangerous in large doses or if used for any length of time, but is constantly administered in diphtheria, chronic bronchitis, purpura, hematuria, ova- rian tumor, pseudo-membranous laryngitis, scarlatina, typhoid fever, chronic cystitis, etc. When used internally it should be given in small doses (gr. xx in 24 hours for an infant, gr. xxx in 24 hours for a child of 2 to 4 years, and 3iss for an adult in the same time), and the action of the heart and the kidneys should be carefully watched. It should never be prescribed with the Iodide of Potassium lest the poisonous Iodate be formed, nor with the Syrup of the Iodide of Iron, lest it liberate the Iodine, and cause severe gastritis. Strong acids and acid sulphates de- compose it, and it forms explosive compounds with easily oxidizable sub- stances as Sugar, Sulphur, Tannin, Sodium or Potassium Hypophosphites, Catechu, Glycerin, etc. For the combination of the Chlorate of Potassium with the Tincture of the Chloride of Iron, as a gargle, see ante, page 173, under Chlorum. Potassium Nitrate has been much employed as a refrigerant diapho- retic and diuretic in febrile and inflammatory affections, especially in inflammation of the trachea and bronchi, pneumonia and rheumatism, but its action is uncertain and it is now giving place in these disorders to more efficient agents. The fumes of burning nitre paper (Charta Potassii Ni- tratis) are a useful inhalation in some forms of spasmodic asthma. Potassium Sulphate is used in teaspoonful doses in water as an hepatic stimulant and a mild cathartic, increasing the secretions of the intestinal glandular apparatus. Its action is sometimes harsh, and death has resulted from overdoses. The Tartrate of Potassium and Sodium, or Rochelle Salt, is the chief aperient agent in Seidlitz Powders. In doses of 3ss-j it is a gentle and cooling laxative, and in drachm doses frequently repeated it is used to render the urine alkaline, and as an antilithic. [The uses of the other Potassium Salts are described as noted on page 323-] PRINOS PRUNUM PRUNUS VIRGINIANA. 327 PRINOS, Black Alder, —is the bark of Prinos verticillaUis or Win- ter-berry, a shrub of the nat. ord. Aquifoliacese, indigenous in Canada and the U. S., having small, white flowers, and a globose, six-seeded, bright- red berry, which grows in clusters and is persistent all winter. The bark occurs in thin, slender fragments, of a brownish-ash color externally, and a pale-green or yellow internally; taste bitter and slightly astringent. It contains an amorphous, yellow and bitter principle, also tannin, sugar, starch, wax, resin, etc. There are no official preparations, but the bark may be given in substance in doses of 3ss, or a decoction (3ij in Oiij boiled to a quart) in doses of 3j-ij. Physiological Action and Therapeutics. Black Alder is astringent and tonic, and has been used in intermittent fever, diarrhoea, and chronic cutaneous diseases. In the latter class of disorders it may be applied locally. PRUNUM, Prune ,—is the fruit of Prunus domestica, the Plum tree (nat. ord. Rosacese), indigenous to Western Asia, but cultivated in most countries of temperate climate. The dried fruit (Prune) is oblong, shrivelled, of blackish-blue color, having an almond-shaped seed. Prunes contain sugar, pectin, albumen, malic acid and salts. They are a constitu- ent of Confectio Sennse. Physiological Action and Therapeutics. Prunes are laxative and nutritious, and are freely used as a food and sweetmeat, but in excess may give rise to flatulent colic from the indiges- tibility of their skins. Stewed Prunes is an excellent dish for constipation in children, and may be made more effective by the addition of a little Senna. PRUNUS VIRGIN I AN A, Wild Cherry—is the bark of Prunus serotina, or Wild Cherry, a large forest tree of the nat. ord. Rosaceae, growing in Canada and the U. S. The bark should be col- lected in autumn from the large branches only, and comes in curved pieces inch or more thick, of greenish or yellowish-brown color exter- nally, and astringent, aromatic and bitter taste. On maceration in water it develops a distinct odor of bitter almonds. It contains tannin, gallic acid, resin, starch, etc., also Amygdalin and Emulsin, which by their mutual reaction in the presence of water, produce Hydrocyanic Acid and a Volatile Oil resembling that of Bitter Almond. [See ante, Amygdala, page 97, and Acidum Hydrocyanicum, page 67.] Dose of the powdered bark, 5ss-j. 328 PULSATILLA. Preparations. Extractum Pruni Virginiance Pluidum,—Dose, g ss-j. Infusum Pruni Virginiance,—4 per cent. Dose, ss-ij. Should be made with cold water. Syrupus Pruni Virginiance,—12 per cent. Dose, g j-iv. Physiological Action. Wild Cherry is an aromatic bitter tonic, increases appetite, aiding digestion, and thus promoting constructive metamorphosis. The presence of a volatile oil gives it a local stimulating action on the alimentary canal in common with Serpentaria, Cascarilla and other members of the same class. Hydrocyanic Acid being yielded by it in the presence of cold water, results in imparting a sedative action to its preparations, calm- ing irritation and diminishing nervous excitability. Very large doses reduce the action of the heart. Therapeutics. The preparations of Wild Cherry are used in catarrhal conditions of the bronchial mucous membrane, in the hectic of phthisis and scrofula, palpitation of the heart, and debilitated stomach, a collection of symp- toms often observed in consumptive subjects, to whom it is a very useful palliative. Cough is supposed to be especially amenable to its influence, and hence it has become a matter of daily routine to prescribe the syrup as an ingredient of cough-mixtures. The infusion is an excellent stom- achic tonic, and may be administered with great benefit in dyspepsia and in convalescence from acute disease. PULSATILLA, Pasque-flower, Meadow Anemone,—is the herb, collected soon after flowering, of Anemone Pulsatilla and Anemone pratensis (Pulsatilla nigricans), and of Anemone patens (Pulsatilla Nuttal- liana), small herbal plants of the same natural order (Ranunculaceae) to which Aconite belongs. The first-named species inhabit Europe and Siberia, and have large, purple flowers; the last-named is an inhabitant of the United States, and sometimes has whitish-colored flowers; all are inodorous and very acrid. Pulsatilla contains a very acrid yellow oil, which in the presence of water is gradually changed to Anemonin, C15H1206, a volatile, crystallizable, camphoraceous principle, soluble in chloroform, nearly insoluble in ether or water; and Anemonic Acid, C15Hu07, a white, crystalline, tasteless powder, which may be formed also by the action of alkalies on Anemonin. There are no official preparations, but a tincture may be made according to the phar- macopoeia! directions for Tincturae Herbarum Recentium (i in 2), of which the dose is WItV-WIx- The imported homoeopathic tincture has equal parts of the expressed juice and alcohol, and is generally a very good preparation. Anemoninum, Anemonin (Unofficial),—the active principle. Dose, gr. in pill. PULSATILLA. 329 Physiological Action. Pulsatilla is a local irritant, the fresh juice producing numbness and tingling in the part to which it is applied, and may excite violent inflam- mation of the skin with vesicular or pustular eruption, and if swallowed severe irritation of the gastro-intestinal mucous membrane. On the tongue it produces symptoms like those from Aconite, viz.—tingling and burning, followed by numbness. Internally it lowers the heart and arterial tension, reduces respiration and temperature, dilates the pupils, produces nausea and vomiting, diaphoresis and diuresis, and paralyzes motion and sensibility. Stupor, coma and convulsions may be caused by a toxic dose. Most of these effects have been observed on rabbits. The l active principle (Anemonin) is volatile, hence the herb must be fresh to be suitable for medicinal use. Antagonists and Incompatibles. Alcohol, Opium and Digitalis are the physiological antagonists. Incompatibles are the caustic alkalies, Tannic Acid and the metallic salts. Therapeutics. Pulsatilla is a very efficient remedy if a fresh preparation be employed. It was highly praised by Storck for amenorrhoea, corneal opacities, cata- ract, paralyses, rheumatism, old ulcers, constitutional syphilis and scaly skin diseases. On the generative organs it seems to have a specific action, and is an excellent remedy in functional amenorrhcea, dysmenorrhoea, menstrual suppression from fright or chill, leucorrhceal discharges with back-pains and nervous depression. Epididymitis and orchitis are often controlled and even dissipated by very small doses (np every 2 hours. It quickly relieves dyspepsia or subacute gastritis, with white- coated tongue, no taste or a greasy sensation in the palate, nausea, flatu- lence, heartburn, etc. Many acute inflammations of mucous surfaces with mucous or muco-purulent discharges, as coryza, otitis (externa and interna), rhinitis, bronchitis, conjunctivitis, etc., are greatly benefited by 5 to xo-drop doses every 4 hours and locally 3j~ij of tincture to 3 iv water as a lotion. A similar use of this remedy has proven of great bene- fit in many cutaneous affections, especially eczematous eruptions, syphil- ides, and ulcers of indolent character. It is also said to be efficiently employed in acute cerebral and spinal meningitis, subacute rheumatism of the small joints, rheumatic gout, chronic vesical and nasal catarrhs, gastro-enteric symptoms of remittent fever and measles, ophthalmia neona- torum, strumous ophthalmia with profuse but bland discharge, acute and subacute inflammations of the middle ear, and in left-sided clavus, hemi- crania and infra-mammary pain. An extract of the root has proved effi- cient against tapeworm. Coughs which are loose by day but dry and tickling on lying down at 330 PYRETHRUM QUASSIA. night are greatly benefited by Pulsatilla, and Anemonin in doses of gr. y2-j has been found extremely useful in whooping-cough and other coughs of irritative character. PYRETHRUM, Pellitory, —is the root of Anacyclus Pyrethrum, a plant of the nat. ord. Compositae, native of Northern Africa, but culti- vated in Europe. The root is 2 to 4 inches long, y2 inch thick, annu- late above, wrinkled below, externally a dark grayish-brown, internally brownish-white; the bark thick, containing two circles of resin-cells sur- rounding slender wood-bundles and medullary rays; inodorous, pungent and acrid. It contains an alkaloid Pyrethrine, also inulin, tannin, mucil- age, etc., with a brown Resin and two fixed oils. Dose, as a mastica- tory, 3 ss—j. Pyrethrum Roseum, Persian Pellitory (Unofficial),—is indigenous to Western Asia, and resembles Chamomile in appearance. The flower- heads are used in powder to kill insects, 4 grains killing a fly in a vial in 2 or 3 minutes. Preparation. Tinctura Pyrethri,—20 per cent. Not used internally. Physiological Action. Pellitory is an irritant sialogogue. When chewed it causes a pricking sensation in the tongue and fauces with heat, acridity, pungency and a copious flow of saliva and buccal mucus. Large doses may cause bloody diarrhoea, tetanoid spasms, accelerated pulse, and profound stupor. Ap- plied to the skin it acts as a rubefacient, the powder inhaled as a sternuta- tory. It stimulates the local nerves and vessels of the mouth and salivary glands by direct irritant action, but soon depresses the nerves and blunts their sensibility. Pellitory is chewed as a masticatory and sialogogue in paralysis of the tongue, rheumatic and neuralgic affections of the head and face, and pain from carious teeth. Its powder has been recommended as a sternutatory in chronic catarrh of the frontal sinuses. As a gargle or lotion (5iij to Oj) it is very useful for relaxed uvula and as a mouth-wash. When used for toothache a few drops of the tincture should be inserted into the •cavity on cotton or wool. Used as a sialogogue it is an efficient agent to secure the rapid elimination of Iodine from the system in chronic poi- soning thereby. Therapeutics. QUASSIA ,—is the wood of Picrcena excelsa, a large tree of the nat. ord. Simarubaceas, indigenous to Jamaica and other West Indian islands. Surinam Quassia, used in Europe, is the wood of Quassia atnara. Both QUEBRACHO. 331 varieties, as met with in the shops, are in the form of chips or raspings, of a yellowish-white color, inodorous but of intensely bitter taste. The wood is also turned into cups, which are sold under the name of quassia- or bitter-cups. It contains a bitter principle, Quassin, C31H4209, which is crystalline, soluble in hot alcohol and in chloroform, slowly in cold water, faster in alkaline or acidulated water. Dose of the powdered wood, gr. xx-xxx. Extractum Quassia,—aqueous. Dose, gr. j-iij. Extractum Quassia Fluidum,—Dose, 3 ss-j. Tindura Quassia,—strength 10 per cent. Dose, ttyv- 3 j. Infusum Quassia (Unofficial),—made with cold water x, Quassia chips macerated for y2 hour and strained. Or water poured into a quassia-cup and left standing will give a good infusion. Dose, j-iij. Preparations. Quassia is a simple bitter, having no flavor, but is intensely bitter and less agreeable than either Gentian or Chiretta. It is fatal to flies and fish, and makes an excellent anthelmintic enema against the thread-worm. A concentrated preparation is poisonous to rabbits and dogs, and has pro- duced very alarming narcotic symptoms in a four-year old child. As usually administered its action is that of a bitter stomachic tonic, as described under Calumba (see ante, page 145). Physiological Action. The preparations of Quassia contain no tannin and hence may be pre- scribed with salts of Iron. It is chiefly employed in atonic dyspepsia with pain after eating, and vomiting or regurgitation of food, also in atonic diarrhoea depending on indigestion or an irritable condition of the intesti- nal mucous membrane. It is useful in convalescence to promote the appetite and digestion, and with Sodium Bicarbonate in gastric vertigo. As an enema the strong infusion is an effective remedy for ascarides of the rectum. It has been used as a feeble antiperiodic, and in hysteria its repulsiveness is an aid to its medicinal action. Therapeutics. QUEBRACHO (Unofficial), —is the bark of Aspidosperma Que- bracho, a large evergreen tree of the nat. ord. Apocynacese, growing in Chili and the Argentine Republic. The name is one given in S. America to any very hard wood (quebrar hacho, to break the axe), and the par- ticular tree above named is known as Quebracho bianco, from the white color of its wood. It contains several alkaloids, no one of which repre- sents the action of the bark itself; the most important being Aspidosper- mine, C22H30N2O2, and Quebrachine, C21H26N203. Several false Quebrachos are found on the market, that most frequently seen being the bark of 332 QUERCUS ALBA. Loxopterygium Lorentzii, or Quebracho Colorado, an Argentine tree of the order Terebinthaceae. Tinctura Quebracho (Unofficial),—20 per cent. Dose, gj-^ss. Extractum Quebracho Fluidum (Unofficial),—Dose, rtyv- 3 j. Vimim Quebracho (Unofficial),—Quebracho 1, Alcohol 2, White Wine 16 parts. Dose, . Extractum Quebracho (Unofficial),—Dose, gr. ij-viij. Preparations. Physiological Action. Quebracho is a bitter tonic of disagreeable taste, promoting appetite and increasing digestion. It lowers the action of the heart, reduces arte- rial tension, and slows respiration, also decreasing the sensation of need of air after active exercise. In large doses it causes severe salivation, nausea, vomiting, vertigo and headache. In animals it paralyzes the motor nervous system and lowers the reflexes, producing great dyspnoea and finally death apparently from asphyxia. Aspidospermine is actively poisonous to the respiratory apparatus and circulation in both cold- and warm-blooded animals, in the former the respiration being chiefly affected, in the latter the motor ganglia of the heart. Lowered temperature, dyspnoea, stupor and convulsions occur before death. Quebracho has long been used in Chili as an antiperiodic, a stomachic tonic, and a remedy for dyspnoea. In the latter condition it is reported to be remarkably palliative, especially when due to emphysema, uraemic and spasmodic asthma, spasmodic cough and chronic bronchitis. It is not efficient in dyspnoea from organic disease of the heart, nor in that of aged subjects of atheroma. Aspidospermine has been used as an antipyretic, also in cardiac neu- roses and in asthma. Its salts are freely soluble in water, but the alkaloid itself is only soluble in oils and fats, 6 to 8 parts being readily incorpo- rated with ioo of cod-liver oil by the aid of heat. Its average dose is gr- Hj* Therapeutics. QUERCUS ALBA, White Oak,—is the bark of Quercus alba, the White-oak tree (nat. ord. Cupuliferae), and occurs in nearly flat pieces deprived of the corky layer, of pale-brown color, tan-like odor, and strongly astringent taste; or as a coarse, fibrous powder, which does not tinge the saliva yellow. It contains a variety of Tannin named Querci- tatinic Acid, C28H24012, also Pectin and a bitter principle named Quercin, but no Gallic Acid. There are no official preparations, but a decoction (Sj ad Oj) may be used in doses of Sss-j. quillaia. 333 Quercus Tinctoria, Black Oak Bark,—was formerly official. It contains a coloring principle Quercitrin, which stains the saliva yellow when the bark is chewed, also Quer- citannic Acid, etc. Quercus Lusitanica is the source of Galls (see ante, Galla, page 223). Oak-bark is astringent and tonic, but is seldom used internally. Its action and uses are those of Tannic Acid (see ante, page 74). The decoc- tion is much used in country practice as a cheap astringent application for injection in leucorrhoea, prolapsus ani, hemorrhoids, etc., and as a gargle in faucial inflammation and prolapsed uvula. It has also been used as an injection into dropsical cysts, and as a lotion for flabby ulcers and suppu- rating wounds. The powdered bark as a poultice has proved an excellent application in gangrene, and in finely pulverized state it is a useful ingre- dient of tooth-powders. A concentrated fluid extract is used in the Hea- ton-Warren operation for the radical cure of hernia, by injection into the tissues around the margin of the ring, with the object of exciting inflam- mation and occlusion of the opening. Physiological Action and Therapeutics. QUILLAIA, Soap-Bark ,—is the inner bark of Quillaia Saponaria, a tree of the nat. ord. Rosaceae, indigenous to Peru and Chili. It occurs in large, flat pieces, about A inch thick, of a brownish-white color exter- nally, very acrid and sternutatory, but inodorous. It contains Calcium Sulphate crystals, starch, and the glucoside, Saponin, C32H54018, a white, amorphous, sternutatory powder, soluble in water and in dilute alcohol. There are no official preparations, but a tincture may be prepared by ex- hausting one part of the bark with sufficient dilute alcohol to make 5 parts of tincture. Physiological Action and Therapeutics. Quillaia in powder is sternutatory and causes the water in which it is macerated to froth, making emulsions of oils, and being used instead of soap for washing purposes in various affections of the skin, and to stimu- late the growth of the hair in alopecia. Its properties are due to the glu- coside Saponin, which is found also in Senega and in a number of other plants, and is a violent irritant of the respiratory passages, a local anaes- thetic, an antipyretic, a powerful paralyzant of the heart and respiration, and a poison to the voluntary muscles. It has not been made use of in practical medicine. A decoction of the bark (5 to 200) has been employed in doses of 3j-ij according to age, as a substitute for Senega in the treatment of diseases of the respiratory organs where a pleasant expectorant is indicated. Its ex- pectorant properties are well established, and children take it readily. It does not provoke diarrhoea or vomiting, and has a sweetish, agreeable taste. 334 RESINA—RESORCINUM. RESINA, Resin, Rosin, Colophony, C44H6204,—is the residue left after distilling off the volatile oil from Turpentine. It is a transparent, amber-colored substance, of sp. gr. 1.070 to 1.080, hard and brittle, with a glossy and shallow conchoidal fracture, and a faintly terebinthinate odor and taste, soluble in alcohol, ether, fixed or volatile oils, and in its own weight of oil of turpentine. Chemically it is considered as the Anhydride of Abie tic Acid, C44H6405, into which acid it is converted by agitation with warm diluted alcohol. Silvic, Pinic and Palmaric Acids are decomposi- tion products, not constituents of the resin as formerly taught. Other official resins are Resina Copaiba, Resina Jalaps, Resina Podophylli and Resina Scammonii, which are severally described under the titles of the plants forming their respective sources. Preparations. Ceratum Resina, Resin Cerate, Basilicon Ointment,—consists of Resin 35, Yellow Wax 15, and Lard 50 parts. It forms 65 per cent, of Turpentine Liniment, and is a constitu- ent of Savine Cerate. Emplaslrum Resina, Resin Plaster, Adhesive Plaster,—consists of Resin 14, Lead Plaster 80, Yellow Wax 6 parts. Is the common adhesive plaster of surgery, and an ingredient of the official Arnica, Belladonna and Capsicum Plasters. Resin itself is an ingredient of Mercurial Plaster, Cantharides Cerate, and Cerate of the Extract of Cantharides. Physiological Action and Therapeutics. Resin gives consistence and adhesiveness to plasters and cerates, and generally acts as a mild local stimulant, but the writer has seen persons with so susceptible a skin that the ordinary adhesive plaster would pro- duce on them a high degree of cutaneous irritation. It is never employed internally, but in chronic bronchial catarrh the fumes from boiling resin are inhaled with considerable advantage. Resin Cerate is one of the most commonly used applications to promote the healing of indolent ulcers, blistered surfaces, burns, scalds, chilblains, etc. RESORCINUM, Resorcin, Meta - di - hydroxy-benzene, C6H4- (HO)2 (Unofficial),—is a diatomic phenol, isometric with Pyrocatechin and Hydroquinone (see ante, page 180), obtained by fusing certain resins with a caustic alkali, but best prepared by fusing Potassium Benzol-disul- phonate with Caustic Potassa, the salt being decomposed into Potassium Sulphite and Resorcin. It crystallizes in colorless, rhombic prisms or plates of neutral reaction, odorless, and of sweetish, acrid taste, soluble in of water, also in alcohol, ether, etc. Dose, gr. v-xv;—as an anti- pyretic 5j, not repeated for several hours, or gr. v every 2 hours. Physiological Action. Resorcin is closely allied to Carbolic Acid, but possesses the advantage over the latter in that it is odorless, more soluble and almost non-irritant. RESORCINUM. 335 It is equally powerful as an antiseptic and antiferment, arresting decom- position and destroying low organisms. Injected beneath the integu- ment in solution it produces very little irritation, and never causes inflammation or abscess. Vesication results from its application to the mucous membrane. Internally a 30- to 60-grain dose causes a sense of heat, discomfort and oppression, followed by profuse perspiration and languor; if fever be present the temperature of the body is lowered sev- eral degrees, but rises again after a rigor in from 2 to 4 hours. Larger doses (150 grains) have produced deafness, dizziness, salivation, confused vision, vertigo, unconsciousness, general clonic convulsions, and tetanic rigidity of the muscles of the neck, with no decline of temperature in feverless subjects. Toxic doses (gr. xv to each Sxxxv of weight) cause in animals trembling succeeded by epileptiform convulsions, which increase in severity and then decline, the respiration is quickened and enfeebled, the heart’s action becomes rapid, weak, and irregular, and death results from paralysis of respiration, the drug paralyzing the motor tracts in the spinal cord, but not affecting the general sensibility. It is eliminated chiefly by the urine, which it colors a bluish-violet hue and with great rapidity, about one hour serving for its excretion. The best test of its presence is the solution of the Perchloride of iron, which produces with it a dark-violet, almost black color. Atropine and other cardiac and respiratory stimulants, cerebral excitants and agents which raise the arterial tension are physiologically antagonistic. Antagonists. Therapeutics. Resorcin is employed as an antipyretic and antiseptic, being preferred to Carbolic Acid for internal and subcutaneous use. A 3 per cent, solu- tion gives good results in stomach complaints, as gastralgia, gastric catarrh, gastric ulcer, fermentative indigestion, etc. It has given great satisfac- tion to some observers in intermittent fevers and malarial diseases gener- ally, while others have been much disappointed with its action therein. As an antipyretic it has been used in erysipelas, puerperal fever, septicae- mia and diphtheria, and in the latter disease it has been employed locally in crystals with decided benefit. A 2 per cent, solution has given great satisfaction as a local antiseptic application to wounds, parasitic skin dis- eases, cystitis, gonorrhoea, anthrax, and spyhilitic sores of unhealthy character. As spray a similar solution is well applied to catarrhal or ulcer- ative affections of the respiratory passages. As a caustic it may be applied in undiluted form to chancres, papillomata, carbuncles, etc. A saturated ethereal solution is a good application where the caustic action of the drug is required. 336 RHEUM. RHEUM, Rhubarb, —is the root of Rheum officinale, a perennial plant of the nat. ord. Polygonacese, a native of Thibet, and of other undetermined species of Rheum, many of which are cultivated in Europe and America, their leaf-stalks being used as a fruit. The commonly accepted medicinal Rhubarb is the Chinese variety, and is imported from Shanghai and Canton. It occurs in cylindrical or conical segments, sometimes flattened and bored with a hole, of a dirty-brown-yellow color externally, internally marbled with fine waving lines, of peculiar odor, gritty between the teeth, and of a bitter astringent taste. It imparts its virtues to water and alcohol, and contains several substances of greater or less activity, the least important being Phceoretin, C32H32014, the rhu- barb-resin,—Erythroretin, C38H36014, and Chrysophan, C27H30O14, the latter of which is split by acids into Sugar and Chrysophanic Acid. (See ante, Chrysarobinum, page 174.) It also contains Rheo-tannic Acid, C52H320 28 J Rheumic Acid, C40H32O18, and probably a principle which is identical with Cathartic Acid (see Senna), on which its purgative activity may depend. Dose of Rhubarb as a stomachic, gr. j-v; as a purgative, gr. x-xx. Extractum Rkei,—Dose, gr. x-xv. Extractum Rhei Fluidum,—Dose, g ss-ij. Pilulce Rhei,—composed of Rhubarb 3, Soap 1; each pill containing gr. iij of pow- dered Rhubarb. Dose, j—iij. Pilulce Rhei Compositce,—each contains of Rhubarb gr. ij, Aloes gr. 1%, Myrrh gr. j, Oil of Peppermint gr. . Dose, ij-v. A safe and efficient laxative. Tinctura Rhei,—has of Rhubarb 12, Cardamom 2, with diluted Alcohol to 100 parts. Dose, 3j-|ss. Tinctura Rhei Aromatica,—has of Rhubarb 20, Cinnamom 4, Cloves 4, Nutmeg 2, Diluted Alcohol to 100 parts. Dose, g]-gE). Tinctura Rhei Dulcis,—has of Rhubarb 8, Licorice 4, Anise 4, Cardamom 1, Diluted Alcohol to 100 parts. Dose, 3 ss- 3 ij. Syrupus Rhei,—has of Rhubarb 90, Cinnamon 18, Potassium Carbonate 6, Sugar 600, Water to 1000 parts. Or, it may be made extemporaneously thus:—Fluid Extract iij, Simple Syrup xxix. Dose for an infant g j; for older children g ij- 3 ss. Syrupus Rhei Aromaticus,—has of the Aromatic Tincture 10, Syrup 90 parts. Dose, as the Syrup. Vinum Rhei,—has of Rhubarb 10, Calamus 1, Stronger White Wine to 100 parts. Dose, 5 j-g ss. Pulvis Rhei Compositus,—has of Rhubarb 25, Magnesia 65, Ginger 10. Dose, a tea- spoonful. Mistura Rhei et Sodce,—Sodium Bicarbonate 30, Fluid Extract of Rhubarb 30, Spirit of Peppermint 30, Water to 1000 parts. Dose, g ij—3 ij. Preparations. Rhubarb is classed among the tonic-astringent and resin-bearing pur- gatives, which increase the secretions of the glandular appendages of the intestinal canal, and stimulate the muscular layer of the bowel. In small doses (gr. j-v) its action is that of a stomachic and intestinal astringent, the influence of the bitter principle and the rheo-tannic acid probably predominating. In larger doses (gr. xxx-lx), its cathartic action prevails, Physiological Action. RHINACANTHUS RHUS AROMATICA. 337 producing in 6 to 8 hours copious yellow, pultaceous stools, with some griping and considerable hepatic stimulation. After the cathartic prin- ciple is expelled, the astringent quality of its tannin asserts itself and constipation is likely to result. The yellow color of the stools is partly due to the rhubarb pigment and partly to excess of bile, the drug having marked cholagogue properties, in all probability due to its resin, Phseore- tin. Its pigment stains the milk, urine and sweat, the milk acquiring a bitter taste and purgative properties. The cathartic action of Rhubarb may be obtained from its application locally to ulcers, by being rubbed into the moist skin, or applied to the abdomen as a poultice. Therapeutics. Rhubarb is highly esteemed as a cathartic for children, from the mild- ness of its action, as, though occasionally producing quite severe griping, it never inflames the gastro-enteric mucous membrane. Its tonic and astringent action following its catharsis makes it a valuable agent in diarrhoeas due to the presence of irritating matter in the bowel, and to correct atonic indigestion accompanied by diarrhoea. For hemorrhoids with constipation its gentle action makes it peculiarly suitable, its astrin- gent after-effect being entirely overcome by 2 to 4 drachm doses of olive oil nightly. It may be combined with a mercurial or with Bicarbonate of Sodium, the latter being supposed to overcome its astringent action and to disguise its taste in some degree. In small doses the tincture is a very efficient stomachic tonic, improving appetite, increasing the flow of the gastric juice, assisting digestion, and promoting the action of the liver without producing any cathartic results. The preparations most in use for children are the Aromatic Syrup and the Mistura Rhei et Sodae. RHINACANTHUS (Unofficial),—the leaves and root of Rhina- canthus communis, a shrub of the nat. ord. Acanthacese, indigenous to India and China. The root contains a quinone-like body named Rhina- canthin, C14H1804, which forms with alkalies intensely red compounds which are decomposed by benzin. It is known in China as Hong-Pang- Cho?ig, and is employed as a local remedy for ringworm and parasitic skin diseases, the leaves being bruised and mixed with lime-juice. Used internally a tincture of the root has some reputation as a feeble tonic and antiperiodic. The same preparation is applied locally in chronic eczema, tinea and psoriasis. RHUS AROMATICA, Sweet Sumach (Unofficial),—is an in- digenous shrub of the nat. ord. Terebinthacese, growing about 5 feet high, and having yellow flowers in spikes. The root-bark contains a 338 RHUS GLABRA—RHUS TOXICODENDRON. volatile oil, several resins, fat, tannin, etc. A fluid extract is prepared from the bark of the root according to the general pharmacopoeial rule, and may be given in doses of npx-xxx, every 2 or 3 hours. Rhus Aromatica has astringent properties, and seems to possess a selec- tive action upon the urinary tract. Its action is not yet clearly made out. Therapeutically it has been used with advantage in cystitis, night-sweats, hematuria, menorrhagia, diabetes insipidus, diarrhoea and dysentery. As a remedy for incontinence of urine in children it has attracted consider- able attention, having been extremely efficient in doses of upxv of a good fluid extract four times daily, administered in glycerin and water, or any other suitable excipient. It is reported to be equally effective in hysteri- cal enuresis of adults, but larger doses several times a day) are required. Diabetes insipidus is remarkably benefited by its continued use, and even in diabetes mellitus its employment has occasionally seemed to have been followed by curative results. Physiological Action and Therapeutics. RHUS GLABRA, Smooth Sumach,—is the fruit of Rhus glabra, an indigenous shrub of the nat. ord. Terebinthaceae, growing in rocky and barren soil to a height of 8 to 12 feet. The berries are about yi inch in diameter, subglobular, densely hairy, of crimson color and acidulous taste, but inodorous. The leaves and bark have an astringent and bitter taste, and are also used medicinally. It contains tannin, col- oring matter, potassium and calcium malates. Preparation. Extractum Rhois Glabrce Fluidum,—Dose, 3 i-ij Physiological Action and Therapeutics. Sumach-berries form a useful acidulous and astringent drink or gargle in catarrhal pharyngitis, stomatitis, aphthae, etc. An infusion (gj to the pint) may be used, or the official fluid extract as a wash and dressing for ulcers and wounds. Internally they are useful remedies for mild catarrhal affections of the stomach and bowels. RHUS TOXICODENDRON, Poison Sumach,—is the fresh leaf of Rhus Toxicodendron, the poison Oak, and of Rhus radicans, the Poison Ivy, shrubs of the nat. ord. Terebinthaceae, indigenous to Canada and the greater part of the United States east of the Rocky Mountains. The climbing plant (R. radicans) is not a distinct species, but a variety of the erect form, both when wounded exuding a poisonous, acrid, milky juice which turns dark on exposure. The leaves are trifoliate, on peti- RHUS TOXICODENDRON. 339 oles 4 or 5 inches long, the lateral leaflets sessile, entire and glabrous in R. radicans (or variously notched, toothed or lobed, downy beneath, in R. Tox.), inodorous, astringent and acrid. They may be confounded with the leaves of the hop-tree, Ptelea trifoliata, which are quite similiar in appearance, but all its leaflets are sessile. The poisonous principle of the plant is Toxicodendric Acid, which is volatile, and also exists in Rhus venenata or Swamp sumach, Rhus pumila, and Rhus diversiloba, the former of which is probably the most poisonous of the four species. Dose of the leaves is generally placed at gr. j-iv, but if old and dry they will generally prove to be inert. There are no official preparations. Preparations. Tinctura Rhols Toxicodendri (Unofficial),—maybe prepared according to the formula of the Pharmacopoeia for Tincturse Herbarum Recentium (Tinctures of Fresh Herbs), one part of the fresh leaves to two of Alcohol. Dose, HbT1o~ffi,ij- Extractum Rhois Toxicodendri,—has been used in France in large doses. It is prob- ably inert. Physiological Action. The effects of Rhus Toxicodendron upon the skin are familiar to all who have suffered from contact with poison-oak or ivy. Some persons are so susceptible to the poison that the exhalations from the plant will produce on them its characteristic action. Others are apparently insus- ceptible to its influence, and can with impunity rub the juice into their skin, or even chew its leaves. The action of the plant when locally applied is that of a cutaneous irritant, causing redness and swelling of the affected parts, with a vesicu- lar eruption and intolerable itching, which may spread rapidly over the surface of the body and extend to the mucous membranes, producing conjunctivitis, redness and tumefaction of the mouth and throat, thirst, cough, nausea and vomiting, vertigo, stupefaction, etc. Colicky pains are experienced in the abdomen, are worse at night and are aggravated by food or drink. Diarrhoea may occur, with tenesmus and bloody stools, also diuresis, bloody urine, or even complete retention. Fever with delirium is frequently present, and may be typhoid in character, or intermittent with profuse perspiration. Pains of rheumatoid type are ex- perienced throughout the body, but particularly in the joints and lumbar region, apparently intensified by rest and heat. The fibrous structures are evidently the seat of its selective action, and a sensation of numb- ness in the lowTer extremities is frequently experienced. Similar phe- nomena attend its internal administration, but fatal results have not fol- lowed in any case of poisoning recorded. The effects of the poison usually last from ten to fifteen days, and are then followed by desquama- tion of the epidermis. Grindelia Robusta is the best local application in cases of Rhus poisoning, but a solu- tion of Mercuric Chloride is also a very serviceable lotion, and Lime-water with Linseed- Antidotes. 340 RICINI OLEUM. oil, solution of Plumbum Acetate, solution of Chlorinated Soda, and Alum-curd are all very useful. Rest, low diet and laxatives are appropriate, and Opium or strong black coffee to relieve the irritability of the nervous system. Therapeutics. Rhus Toxicodendron was used medicinally by Dufresnoy in France and by Alderson in England about the close of the eighteenth century. The attention of the former was attracted to it by the accidental poisoning of a student who was afflicted with chronic eczema, which disappeared on the subsidence of the Rhus symptoms. It is a favorite remedy with the so-called homoeopathists, who ascribe to it extraordinary virtues in acute cutaneous affections of vesicular type, subacute and chronic rheumatism, vesicular erysipelas and typhoid fever. Among regular authorities it meets with very little favor as a remedial agent, but Dr. Phillips recommends it strongly in rheumatic affections of the fibrous tissues, erythema and ery- sipelas, eczema, herpes zoster and pemphigus. Dr. Piffard corroborates these opinions of its therapeutical value, and states that when rheumatic pain is “ worse at night ” prompt relief may be expected from Rhus. It was used by Dufresnoy in paralyses with a certain degree of success, and Eberle reports a case of paralysis in which it proved curative. It is ad- mitted by many observers to be a useful remedy in paralytic affections of the lower extremities depending on a rheumatic diathesis, or resulting from exposure to cold and wet. As an external application it is efficacious in sprains and other affections of ligaments and tendons, also to extensive but superficial burns, stings of insects and chilblains. For these affections a lotion of about 5ss of the strong tincture to a pint of water is usually employed. RICINI OLEUM, Castor Oil,—is a fixed oil expressed from the seeds of Ricinus communis, a tree of the nat. ord. Euphorbiacese, indigen- ous to India, but extensively cultivated in the United States, where it is an annual plant about 5 or 6 feet high, bearing ovate seeds, smooth and shiny, of gray color marbled with brownish spots and stripes, three con- tained in a pod. The oil is an almost colorless, transparent, viscid liquid, of faint odor, bland or slightly acrid taste, neutral reaction, sp. gr. 0.950 to 0.970, soluble in an equal weight of alcohol, and congealing at about 0.40 F. It consists mainly of Ricinoleic Acid, C18H3403. combined with glycerin, but palmitin, stearin, cholesterin, and probably a resin and an alkaloid also occur in small quantities. Dose, 5j~oj- It is contained in Collodium Flexile (3 per cent.) and in Linimentum Sinapis Co. (15 per cent.). Physiological Action. Used externally pure Castor Oil is perfectly bland. Internally admin- istered it is non-irritant until it reaches the duodenum, where it is decom- RICINI OLEUM. 341 posed by the pancreatic juice, setting free the Ricinoleic Acid, which pro- duces purgation by a mildly irritant action on the bowel, stimulating the intestinal glands and muscular coat, but not the liver. It is a simple pur- gative, acting in four to six hours, producing one or more liquid stools without pain or tenesmus, and followed by a sedative effect on the intes- tines. The leaves are believed to possess galactagogue properties when locally applied as a poultice to the breasts. Ricinoleic Acid enters the blood and the tissues, and is excreted with the various secretions of the body, imparting its purgative qualities to the milk of the nursing mother. Castor Oil is the best of simple purgatives, and is used where a free evacuation of the bowels is alone indicated, or when only a laxative action is desired, as in the constipation of typhoid fever, in pregnancy and post- partum conditions, diarrhoea from the presence of irritating matter in the bowels, and after operations on the abdominal or pelvic organs. It is often used as a purgative for children, also for the aged and infirm. In- fants bear a larger relative dose than adults, probably from their ability to digest a larger quantity of what is taken. It is employed with great benefit as a laxative in irritation or inflammation of the bowels, in hemorrhoids, inflammatory or spasmodic affections of the genito-urinary organs, ne- phritis or cystitis, gonorrhoea, calculi, and stricture of the urethra and rectum. In cases of dysentery io to 20 drops of Laudanum may be added to each dose to counteract the pain, tenesmus and exhaustion resulting from the frequency of the passages. If much depression exists, as shown by lowered arterial tension and a dry, glazed tongue, 5 drops of Turpen- tine should also be added. Castor Oil is much used in the puerperal state and greatly abused. There is considerable evidence in support of the charge that it induces hemorrhoids by congesting the rectal vessels. Its purgative action is milder in proportion to the purity of the sample employed. Externally, the pure oil is employed as a local sedative and protective, as in neutraliz- ing the effects of lime upon the conjunctiva. The leaves of the castor-oil plant are used to promote the secretion of milk. They may be applied to the breast in poultice, and a decoction or fluid extract given internally at the same time. Therapeutics. Administration. The nauseous smell is best concealed by the Essential Oil of Bitter Almonds. Emul- sions are not a success. Capsules containing the requisite dose are easily obtained. In the absence of these the best way to administer a dose of oil is to smear the sides of a clean wineglass with very thick cream, then to pour in the oil, covering it with a little more cream. A teaspoonful of cream being then taken into the patient’s mouth, he is directed to bolt the dose at one gulp. Some prefer it floated on orange-juice, strong coffee, gruel or wine. One of the best vehicles for it is foaming beer. Glycerin increases its purgative power, when given conjointly. 342 ROSA CENTIFOLIA ROSA DAMASCENA—ROSA GALLICA. ROSA CENTIFOLIA, Pale Rose,—the petals of Rosa centifolia, the Cabbage Rose, a well-known cultivated shrub of the nat. ord. Rosaceae. They are of pink color, fragrant odor, sweetish taste changing to slightly bitter and fairly astringent. The odor is due to a minute quantity of a Volatile Oil (Oil of Rose), besides which, the petals contain tannin, fat, resin, sugar, etc. If it is desired to keep Pale Rose fresh for any length of time, it should be mixed with half its weight of Sodium Chloride, pressed into a jar and kept, well closed, in a cool place. Aqua Rosce, Rose-water,—Pale Rose 40, Water 200 parts, mixed and distilled by steam to 100 parts. Dose, indefinite. Unguentum Aquce Rosce, Cold Cream,—has of Expressed Oil of Almond 50 parts, Spermaceti 10, White Wax 10, Rose-water 30. If Glycerin and Benzoic Acid were added, it would keep better and be much more efficient as an emollient and protective. Pale Rose is also an ingredient of the Compound Syrup of Sarsaparilla. Preparations. Pale Rose is only used for odoriferous and flavoring purposes. Rose- water has no strictly medicinal properties, but is an agreeable excipient for lotions, urethral injections and collyria. The ointment, commonly termed “ cold cream,” is an agreeable emollient and protective in chapped hands and other superficial skin affections. Physiological Action and Therapeutics. ROSA DAMASCENA,—is not official, but is the source of the official Oil of Rose. It is largely cultivated in Roumelia on the southern slope of the Balkan Mountains, from whence almost all of the product is supplied to commerce. Oleum. Rosce, Oil of Rose, Attar of Rose,—is a volatile oil distilled from the fresh flowers of Rosa datnascena. It is a pale-yellowish, transparent liquid, having a strong odor of rose, a sweetish taste and a slightly acid reaction, but slightly soluble in alcohol, of sp. gr. about 0.860. Slowly cooled to 50° F., it congeals to a transparent solid, inter- spersed with slender, iridescent, scale-like crystals. Rapidly cooled to 540 F., it congeals to a solid mass of feathery scales or plates. It consists of an aromatic oxygenated elseop- ten and an odorless solid stearopten (rose-camphor). Being very expensive it is much adulterated with other volatile oils. It is used chiefly for perfuming cosmetic preparations, ointments and lotions. ROSA GALLICA, Red Rose,—the petals of Rosa gallica (nat. ord. Rosaceae), collected before expanding. They occur in small cones of roseate odor, and a bitter, slightly acid and distinctly astringent taste, and contain an aromatic oil, tannic and gallic acids, quercitrin, coloring matter, salts, etc. Preparations. Extractum Rosce Fluidum,—Dose, rrpv— 3 ij. Confectio Rosce,—has of Red Rose 8 parts, Sugar 64, Honey 12, Rose-water 16. A basis for pills. ROSMARINUS RUBUS. 343 Mel Rosce, Honey of Rose,—has of Red Rose 8, Honey 92, Diluted Alcohol to 100 parts. For local use. Syrupus Rosce,—has of the Fluid Extract of Rose 10 in Syrup 90. Dose, 5jj-ij, for flavoring. Red Rose is also an ingredient of Pilulae Aloes et Mastiches. Physiological Action and Therapeutics Rosa Gallica is classed among the astringents as it contains an appre- ciable amount of Tannic and Gallic Acids. A compound infusion, con- taining sugar and dilute Sulphuric Acid, was formerly official, and is used as an agreeable gargle for the throat and mouth in inflamed and ulcerated conditions. The chief uses of the rose preparations, however, are as vehicles for other agents, or to impart flavor and odor to extemporaneous prescriptions. ROSMARINUS, Rosemary, —the leaves of Ros?narinus officinalis, a shrub of the nat. ord. Labiatse, cultivated in gardens for the sake of its large pale-blue flowers. The leaves are pungently aromatic and some- what camphoraceous, containing, besides the official volatile oil, a little tannin, resin and a bitter principle. They constitute one per cent, of the ingredients of Vinum Aromaticum (see ante, page 86). Oleum Rosmarini,—\s the volatile oil distilled from Rosemary, a colorless or yellowish liquid, of sp. gr. about 0.900, having the characteristic odor of the plant, a camphoraceous taste, and is readily soluble in alcohol. It consists of a terpene, isomeric with Turpen- tine, C10H16, and a body allied to Camphor. It is an ingredient of Linimentum Sapo- nis, Spiritus Odoratus and Tinctura Lavandulae Composita. Dose, TT\j-v. Rosemary was formerly considered emmenagogue, galactagogue and diuretic, but is now never employed in substance. Its oil is somewhat stimulant and carminative, and in excessive quantity has caused death. It is chiefly employed as an external stimulant in liniments and lotions, especially to the scalp in alopecia, where it is supposed to increase the blood-supply to the hair-bulbs, and is usually combined with cantharides. Inhaled it reduces the body temperature and gives the urine a violaceous odor. Physiological Action and Therapeutics. RUBUS, Blackberry-Bark,—is the bark of the root of Rubus vil- losus, the common Blackberry, Rubus canadensis, the Dewberry, and Rubus trivialis, the Bush Blackberry of the Southern States, all of the nat. ord. Rosaceae. It occurs in thin, tough, flexible bands, blackish- gray externally, pale-brown internally, inodorous, strongly astringent and of somewhat bitter taste. It contains over io per cent, of Tannin. Dose, gr. xv-xxx. 344 RUBUS IDjEUS RUMEX. Preparations. Extractum Rubi Fluidum,—Dose, Ttyx-^j. Syrupus Rubi has of the Fluid Extract 20 parts, Syrup 80. Dose, gj- J j. Syrupus Rubi Aromaticus (Unofficial),—contains the root bark, cinnamon, cloves and mace. Each fli; has gr. xxx of the drug. Physiological Action and Therapeutics. Blackberry-bark derives its virtues from its tannin. It is strongly astringent, and may be used in decoction, wine or the above-named official preparations. It is highly esteemed in summer and infantile diarrhceas. RUBUS IDiEUS, Raspberry,—is the fruit of Rubus idceus, the Raspberry bush, Rubus occidentalism the Thimbleberry, or Rubus strigosus, the wild Red Raspberry, all of the nat. ord. Rosacese. It contains sugar, malic and citric acids, proteids, pectin, etc., also a Volatile Oil consist- ing of compound ethers, to which the odor is due. Its sole use in medi- cine is to prepare a pleasantly flavored syrup. Preparation. Syrupus Rubi Idcei, Raspberry Syrup,—has of Raspberries and Sugar any convenient quantity, boiled (but not in tinned vessels) and strained. Dose, ad libitum. It has a bright-red color, a fruity, agreeable odor, a pleasant, acidulous taste and an acid reaction. It has no special medicinal virtues, but forms an agreeable flavoring for mixtures, and mixed with water a pleasant drink in febrile conditions. The leaves of the wild Red Raspberry (Rubus strigosus) are considerably astringent, and in infusion, 25 j to the pint, are a popular domestic remedy for diarrhoeas. RUMEX, Yellow Dock, —is the root of Rumex crispus, and of other species of Rumex, plants of the nat. ord. Polygonaceae, growing as common weeds along roadsides. Several species of Rumex have sour leaves, and are popularly called Sorrel to distinguish them from the others which are called Dock. The official root is 8 to 12 inches long, inch thick, somewhat fusiform and fleshy, annulate above, deeply wrinkled -below, externally rusty-brown, internally whitish, with fine medullary rays; fracture short, odor slight, taste bitter and astringent. It contains tannin, mucilage, starch, calcium oxalate, and two principles named Rumicin and Lapathin, which are shown to be identical with Chrysophanic Acid. (See ante, page 336). Its constituents are nearly identical with those of Rhubarb. Dose, gr. xv-5j. Extractum Rumicis Fluidum,—Dose, TT^xv—gj. Decoctum Rumicis (Unofficial),— 5 ij of the lresh root, or 5 j of the dry root to Oj of water. Dose, j—ij • Preparations. RUTA 345 Physiological Action and Therapeutics. Rumex is astringent, tonic and laxative. It has also been considered alterative and anti-scorbutic. It has been employed chiefly in chronic cutaneous disorders, glandular swellings, and other symptoms of the stru- mous diathesis. It seems to possess a selective action on the mucous membrane of the larynx, and in many cases of laryngeal irritation with catarrhal symptoms, dry, violent cough, and a sense of soreness behind the sternum, it will give prompt relief. The Rumex Acetosa has a popu- lar reputation as a local application for cancer. RUTA, Rue ,—is the source of the official Oil of Rue, which is dis- tilled from the leaves of Ruta graveolens, an herbaceous perennial of the nat. ord. Rutacete, growing wild throughout Southern Europe, and fre- quently cultivated in gardens for its yellowish flowers. The fresh leaves only should be used, and as drying impairs their qualities the oil is gen- erally employed. Oleum Rutce, Oil of Rue,—the volatile oil distilled from Ruta graveolens ; a colorless, or greenish-yellow liquid, of disagreeable but aromatic odor, pungent acrid taste and neu- tral reaction, sp. gr. about 0.880, soluble in an equal weight of alcohol. Dose, rry-v, in mucilage. Physiological Action and Therapeutics. Rue is an active irritant, locally a rubefacient, the oil producing heat, inflammation and vesication. In the ordinary dose it causes a sensation of heat in the stomach and skin, increases the action of the heart, and stimulates the bronchial, cutaneous and renal secretions, the odor of the oil being distinctly perceptible in the breath, sweat and urine. After toxic doses of the oil violent gastro-enteritis results, with extreme pros- tration, convulsions, strangury and suppression of the urine. Abortion may be produced by large doses, but with great danger to life. Rue is an efficient emmenagogue, and in men aphrodisiac; it is also considered antispasmodic and carminative. The Oil of Rue is employed internally in amenorrhcea, menorrhagia and metrorrhagia, hysteria, convulsions and flatulence. As an emmenagogue it is very efficient when the condition is one of functional inactivity of the uterus and ovaries. In small doses it has been well used in metror- rhagia from debility and after abortion. A decoction of the fresh leaves is often employed by injection against ascarides, and internally to remove lumbricoid worms. Externally the same preparation has been applied to the chest in chronic bronchitis, also in various scaly eruptions and glandular enlargements. Used as an abortifacient it has frequently caused death, preceded by symptoms of narcotic and irritant poisoning. Even in poisonous doses its abortifacient action is very uncertain, so that only the most ignorant criminals employ it with such purpose. 346 SABINA. SABINA, Savine,—the tops of Juniperus Sabina, a small ever- green shrub of the nat. ord. Coniferae, growing in Northern Europe, Asia and America. It closely resembles Red Cedar (_Juniperus virginiana), but is distinguished from the latter by its smaller size and by its larger fruit. It occurs in short, thin branchlets, having oveo-lanceolate leaves in four rows; of peculiar, terebinthinate odor, and nauseous, bitter, resinous taste. It contains a Volatile Oil (which is official), also tannin, resin, extractive matters, chlorophyll, etc. Dose, gr. v-x. Extractum Sabince Fluidum,—Dose, TT^v-xv. Ceratum Sabince,—has of the Fluid Extract 25, Resin Cerate 90 parts, melted and cooled. Oleum Sabince,—a volatile oil distilled from Savine existing in the fresh tops in the proportion of 2]/2 per cent., and in the berries 10 per cent. It is a colorless, or yellowish liquid, isomeric with oil of turpentine, C10H16, having a peculiar, terebinthinate odor, a pungent camphoraceous taste, and neutral reaction, of sp. gr. about o 910 and soluble in an equal weight of alcohol. Dose, try-v. Preparations. Physiological Action. Externally the action of Savine resembles that of Turpentine, except that it is more irritant, the oil producing vesication if applied sufficiently long. Internally a full medicinal dose causes heat sensations, nauseous eructations, flatulence, increased cardiac action, stimulation of the cuta- neous, bronchial and renal secretions, irritation of the kidneys, hyperae- mia of the ovaries and uterus and increased menstrual activity. In large doses it produces hematuria, dysuria, and intense gastro-enteritis, with violent vomiting and purging. It may originate uterine contractions in the pregnant female, but its abortifacient effect can only be produced by a quantity sufficient to endanger life. The oil diffuses into the blood and is excreted by the various excretory channels. Therapeutics. As an emmenagogue Savine is highly esteemed by many authorities, Dr. Phillips considering it “ one of the most certain and powerful ” agents of this class, “with the additional advantage that it can be given with perfect freedom from risk of doing harm.” So irritant an agent, however, requires the exercise of great caution in its use. It has been found extremely efficient in dysmenorrhoea when not due to mechanical causes; also, in menorrhagia and hemorrhage after abortion. In chronic gout and the joint affections of chronic rheumatism, it was formerly much em- ployed. Externally the cerate is used to prolong the discharge from blisters, setons or issues, and to stimulate the healing of indolent ulcers. For these purposes it is considered safer than Cantharides, as its prolonged employment does not bring on strangury or vesical irritation. As a caustic it is efficient for the destruction of warts and other excrescences, and the moistened powder is used as a paste on venereal condylomata, in SACCHARINA SACCHARUM. 347 combination with burnt alum or cupric subacetate. The oil is the most efficient preparation for internal administration. SACCHARINA, Saccharine,—is a recently discovered derivative of a coal-tar product, Toluene, from which it is prepared by a complicated process. It has the chemical title Benzoyl-sulphonic-imide, and the for- mula C6H4(C0)(S02)NH. It occurs as a white amorphous powder, with a very sweet taste, and a faint flavor of bitter almonds, soluble in alcohol and in ether [Sugar is not soluble in ether], sparingly in cold water, more so in hot water. Saccharine is 220 times sweeter than sugar to the taste, and is also an efficient antiseptic. It is not a food, like sugar; and has no injurious action on man. It may prove of use as a substitute for sugar in cases of diabetes, but it has no curative action upon that disease. Physiological Action and Therapeutics. SACCHARUM, Sugar, Cane-Sugar, C12H22On,—is the refined sugar of Saccharum officinarum, or Sugar-cane, a perennial plant of the nat. ord. Graminaceae, indigenous to India and adjoining countries, but cultivated in tropical regions throughout the world. This sugar is also present in several grasses (as Zea Mays, maize, Sorghum saccharatum, etc.), in the juice of various trees (maple, birch, palm, etc.), and in many roots, particularly Beta vulgaris, the sugar-beet, which contains 12 per cent. Cane-sugar occurs in white, dry, hard, crystalline granules, permanent in the air, odor- less, of purely sweet taste and neutral reaction, soluble in 0.5 of water and in 175 of alcohol at 590 F., in 0.2 of boiling water and in 28 of boiling alcohol, insoluble in ether. The aqueous solution, saturated at 590 F.,has the sp. gr. 1.345, and is miscible with alco- hol in all proportions. Its freedom from Grape-sugar (glucose) and from more than a slight quantity of Inverted Sugar (glucose plus levulose) is ascertained by dissolving 1 gram in 10 c.c. of boiling water, then mixing with the solution 4 or 5 drops of test- solution of Silver Nitrate and about 2 c.c. of Aqua Ammonise, and quickly heating to boiling, when not more than a slight coloration, but no black precipitate should appear after standing at rest for 5 minutes. Other Sugars. Saccharum Lactis, Sugar of Milk, Lactose, C12H220n.H20,—described on next page. Glucose, Dextrose, Grape-sugar, Starch-sugar, C6Hl206, or hydrated C6H1206.H20 (Unofficial), also known as liver-sugar, diabetic sugar,—forms yellowish nodules or crys- tals, very soluble in water and in alcohol, has a sweet taste, less marked than that of cane- sugar, may be obtained artificially from cane-sugar or from starch, by boiling with a dilute mineral acid, or by the action of Diastase, a vegetable ferment formed during the germi- nation of grain. Boiling solutions of the alkalies convert it into a brown substance (melassicacid). Levulose, Fruit-sugar, C6Hj206 (Unofficial),—frequently found with grape-sugar in fruits, also in honey. Inosit, Phaseo-mannit, CgHj 206.2PI20 (Unofficial),—exists in the juice of some meats, in asparagus, etc. Is very sweet, but does not undergo alcoholic fermentation. Allied Substances. Tkeriaca, Treacle, Sugar-house Molasses (Unofficial),—is the uncrystallizable residue of the process for refining sugar,—a thick, brown, fermentable syrup, very sweet, and of sp. gr. about 1.40. It is official in the B. P., and is used in making up some of the official pills of that pharmacopoeia. 348 SACCHARUM LACTIS. Amylum, Starch, C6H10O5,—when boiled with dilute mineral acids orwhen subjected to the action of diastase, ptyalin or pancreatin, starch is converted into glucose. (See ante, article Amylum. page 100.) Cellulose, C6H10O5, (Unofficial),—forms the basis of all vegetable'fibre, and is isomeric with starch. It exists almost pure in cotton and in Swedish filter paper. Pyroxylin (see ante, page 229), or gun-cotton, is dinitro-cellulose. Glycogen (Unofficial),—closely resembles starch in its properties, being converted into glucose by the same agents which so act on starch. It exists in the liver of all animals. Dextrin (Unofficial),—is produced by the action of dilute acids on starch, and is an intermediate product in the conversion of starch into glucose. It is a transparent, brittle solid, looking like gum, soluble in water and dilute alcohol, is not fermentable, nor is it colored by Iodine. Preparations. Sugar is an ingredient of Pil. Ferri Carbonatis, Pil. Ferri Iodidi, Ferri Carbonas Saccha- ratus, Mistura Ferri Composita, Pulvis Cretse Compositus, Pulvis Glycyrrhizse Compositus, and the Troches, Syrups, Compound Syrups, etc. Physiological Action and Therapeutics. Sugar is employed in pharmacy and therapeutics chiefly as a vehicle, a corrigent, a preservative and an antiseptic. Syrups protect the active ingredients against putrefaction, but not always against fermentation. They also protect certain ferruginous preparations against oxidation. As an ingredient in troches, powders and extemporaneous mixtures sugar is used to cover the taste or to make insoluble substances more easily mis- cible with water. It increases the solubility of Lime in water. As a food it possesses well-known properties, being a nutrient to adipose tissue and a respiratory fuel, and is decidedly diuretic in its action upon healthy kidneys. SACCHARUM LACTIS, Sugar of Milk, Lactose,— C12H220n.H20,—is one of the constituents of the milk of mammals, and is officially described as a peculiar, crystalline sugar obtained from the whey of cow’s milk by evaporation and purified by re-crystallization'. Occurs in white, hard, crystalline masses, yielding a gritty, white powder, odorless, permanent in the air, of faintly sweet taste and neutral reaction, soluble in 7 of water at 590 F. and in 1 of boiling water, insoluble in alco- hol, ether or chloroform. On adding to a solution of sugar of milk in an equal weight of boiling water some solution of soda, the liquid turns brown- ish, and on further addition of test-solution of Cupric Sulphate a brick- red precipitate separates. Sugar of Milk is the least soluble of all sugars in water and is insoluble in alcohol. It enters into alcoholic fermentation with difficulty. In the presence of decomposing albu- minous matter and under certain other influences, it undergoes the lactic fermentation, which results in the formation of Lactic Acid, Carbon Dioxide and Alcohol. It readily reacts with the reduction tests. Lactose has been shown to act as a powerful diuretic, especially in cardiac dropsy, in which Dr. See considers it “ the best and most certain diuretic we possess, the excretion of urine caused by it being greater than that due to any other drug.” He found that it acts similarly to, though more powerfully than, Caffeine, while possessing none of the SALIX, 349 disadvantages of the latter. Its diuretic action is but very little in cases where extensive renal disease exists, and it has no power over dyspnoea. Sugar of Milk is used in the Triturations, also in the Abstracts, Dover’s Powder, Denarcotized Opium, etc., as a diluent. Being much harder than cane-sugar it is considered a valuable excipient for powders requiring fine trituration and the minute subdivision of their medicinal constituent. It is less sweet than cane-sugar, and being less apt to ferment in the stom- ach and bowels is better than the latter for use with infants’ food. SALIX, Willow ,—is the bark of Salix alba, the common White Willow, and of other species of Salix, trees of the nat. ord. Salicaceae. It occurs in fragments or quills, inodorous, bitter or astringent, and con- tains a large proportion of tannin, besides resin, gum, wax, lignin, etc., and the characteristic constituent Salicin, which is official. Dose of the bark, gr. x~3j, or more, in infusion. Salix Nigra, the Pussy Willow, grows along streams in the Southern States. A fluid extract is on the market, and may be used in doses of 3ss thrice daily, as a sexual sedative. Salicin, C13H1807, is a crystalline glucoside, consisting of Saligenin and glucose ; found in Gaultheria procumbens (Wintergreen), and in the bark of several species of Salix (willow). Salicylic Acid, HC7H503, is a deriva- tive 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 179, ante.) It is obtained, therefore, either synthetically by combining the elements of Carbolic Acid with those of Carbonic Acid, and subse- quent purification,—or from natural salicylates as the oils of wintergreen and sweet-birch,—or from salicin, by heating with caustic potash and treating the mass with hydrochloric acid. The acid prepared from natu- ral sources is purer and more efficient than that prepared artificially, and will often be tolerated by a patient who cannot bear the latter. Preparations. Salicinum, Salicin, C13H1807,—a neutral principle prepared from the bark of Salix Helix and of other species of Salix. White, shiny, silky crystals, odorless, of very bitter taste and neutral reaction;—soluble in 28 of water and in 30 of alcohol at 50° F., in 0.7 of boiling water and in 2 of boiling alcohol; insoluble in ether or chloroform. Dose, gr. x-3 ij. Acidurn Salicylicum, Salicylic Acid, HC7H503,—occurs in fine, white, needle-shaped crystals, of sweetish-acrid taste and acid reaction, soluble in 450 of water and in 2]/2 of alcohol at 590 F.; 100 parts may be dissolved in 100 of water by the aid of 8 parts of Borax. Dose, gr. j. Sodii Salicylas, Salicylate of Sodium, 2NaC7Ii503.H20,—is soluble in i1 parts of water. Dose, gr. v-gj. Lithii Salicylas, Salicylate of Lithium, 2LiC7H603.H20,—is very soluble in water or alcohol. Dose, gr. v-3 j. Physostigmince Salicylas,—is described under Physostigma, ante, page 308. Dose, 1 1 Oleum Gaultherice, Oil of Wintergreen. Doss, (See ante, page 223.) 350 SALIX Unofficial Preparations. Salol, Salicylate of Phenol,—consists of 60 parts by weight of Salicylic Acid and 40 of Carbolic Acid. Is insoluble in water, almost tasteless and odorless. Dose, gr. v- q j, in compressed tablet. Salipyrin, C18lflgN204,—is a combination of Salicylic Acid 57.7 parts, and Antipyrine 42.3 parts; a white, odorless powder, very soluble in alcohol, insoluble in water. Thera- peutically, it is an antipyretic and antirheumatic of considerable value, according to Dr. Guttmann. Dose, gr. x-xx, every two hours. Physiological Actions. Willow-bark is highly astringent and antiperiodic and feebly tonic, but is never employed medicinally, owing to its bulk. Salicin is a bitter tonic, an antiferment, antiseptic, and is highly destructive to low organ- isms. It has slight antiperiodic power and is feebly antipyretic. It pre- vents the reaction between Amygdalin and Emulsin (see page 67), and also thatof Ptyalin, etc., on Starch (see page 100). It seems to be devoid of toxic power on man, and is mainly excreted as Salicylic, Salicyluric and Salicylous acids, being first changed in the bowel into Saligenin and Glucose. Salicin is well borne by the stomach. Salicylic Acid has properties similar to the above, but is much more energetic in its action, being a powerful antipyretic and antiseptic. It is also anhydrotic, checking local perspiration when locally applied. Inhaled it causes irritation of the respiratory passages, producing sneezing and cough. In small doses it stimulates the stomach, heart and respiration, but moderate quantities derange the stomach, causing nausea and vomit- ing, while large doses depress the heart’s action and the respiration after a primary excitation of both, lower the arterial tension, relax the vessels, produce free perspiration, and reduce the temperature in fever. It causes vertigo, dilated pupils, tinnitus aurium, a sensation of tension in the frontal cerebrum, delirium, and may produce bed-sores from depression of the circulation, but does not affect the peripheral nerves as to either motion or sensation. In the blood it is first changed to Salicylate of Sodium, but a portion is again set free and uniting with glycocoll forms Salicyluric Acid (HC9H8N04), coloring the urine green. It is slowly excreted through the secretions generally, especially in the urine, sweat, saliva and bile. It stimulates the kidneys, at the same time disinfecting them and increasing the acidity of the urine, but may so irritate the kid- neys as to produce albuminuria and hematuria. Salicylic Acid is destructive to the torula, prevents alcoholic fermenta- tion, also that caused by the organic ferments, (pepsin, ptyalin, etc.). In solutions containing bacteria, it will prevent their development, if in the proportion of 1 per cent. ; and in that of 1 in 60 it will destroy them when in full activity. Salicylate of Sodium is remarkably antipyretic in doses of gr. xv, given 4 or 5 times in 24 hours. It is a powerful diaphoretic, and an effi- cient cholagogue, and it is supposed to possess the curious property of SALIX, 351 increasing the fluidity of the bile, at the same that it promotes its secretion,—other cholagogues increasing the proportion of solids therein. (Brunton.) It has no antiseptic power unless in association with a strong mineral acid, which will 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 Antipyrine, and it acts with such force as to frequently depress the tem- perature 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 depression 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 rheumatism, to lower temperature, relieve pain, and reduce articular swelling. They are most suitable to strong, vigorous patients, and if not promptly efficient they should be abandoned. The acid is much used as an antipyretic in fevers, especially those ofsepticaemic character. It is a useful local appli- cation in gangrenous wounds, eczema of the hands or feet, cancer, burns, and in fetid perspirations, in the last affection being used in solution with borax. Salicylate of Sodium is more soluble than the acid and less irritant to the stomach, while in doses about 50 per cent, larger it is equally effi- cient. It 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 for phlegmasia alba, it which it is considered very efficient,— also in cases where there is a tendency to the formation of gall-stones. It is considered a very efficient remedy to cut short an attack of ton- sillitis, a “bad cold,” and also other acute affections of the respira- tory mucous membrane. Salicylate of Lithium is also non-irritant and is supposed to act towards uric acid in the same manner as the other salts of this metal. It is expected to be of especial value in acute rheumatism and rheumatic gout. Salol is a most efficient remedy for duodenal catarrh, catarrh of the bile-ducts and catarrhal jaundice; also in the bilious form of sick-head- ache, and in some forms of neuralgia. Its greatest power is manifested over acute rheumatism, 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 blad- der, as its constituents are excreted with the urine, and come in contact with the vesical mucous membrane for a considerable period of time. 352 SALVIA—SAMBUCUS—SANGUINARIA. SALVIA, Sage, —the leaves of Salvia officinalis, the common gar- den sage, a perennial plant of the nat. ord. Labiatae, native in Southern Europe, but cultivated in our gardens for its strong, fragrant odor. The leaves are about 2 inches long, finely crenulate, grayish-green, thick and wrinkled ; soft, hairy and glandular beneath, of aromatic odor and bitter- ish, astringent taste. They contain tannin, resin, etc., and a volatile oil which consists of Salviol (C10H16O), camphor and terpenes. Sage is a constituent of Vinum Aromaticum. There are no official preparations. Dose of the powdered leaves, g. xx-xxx, in infusion. Sage is aromatic, stimulant, tonic, astringent, and a vulnerary. It was highly esteemed in ancient times, and even yet is popular as a domestic cure-all with many people. In an infusion it may be used as a beverage in febrile conditions and to check sweating, also for the night-sweats of phthisis. Like other members of the same class it has a slight influence over enteralgia and flatulence. It makes a good astringent and stimulat- ing gargle. SAMBUCUS, Elder,—the flowers of Sambucus canadensis, the common elder, a shrub of the nat. ord. Caprifoliaceae, from 6 to io feet high, having small white flowers disposed in loose cymes of five divisions, the cream-colored corolla being whorl-shaped with five stamens on the tube. The berries are small, globular, and when ripe of a deep purple color. The plant contains a small quantity of a volatile oil, also a resin and valerianic acid. The common elder of Europe (S. nigra) is more of a tree, and is official in the B. P. There are no official preparations. Dose, gr. xxx-5j, in hot infusion. Elder-flowers are stimulant and diaphoretic, also perhaps diuretic in some degree. The berries are diaphoretic and laxative, while the inner bark is a hydragogue cathartic and in large doses emetic. Formerly the inspissated juice of the berries was employed as an alterative in rheuma- tism and syphilis, but at present the flowers are used only for flavoring purposes. Elder-flower Water (Aqua Sambuci, B. P.) is a nice vehicle for collyria and lotions. SANGUINARIA, Blood-root, —is the rhizome, collected in autumn, of Sanguinaria canadensis, a perennial plant of the nat. ord Papaveraceae, which grows abundantly throughout the U. S., being one of the earliest and most beautiful of the spring flowers. It has a single white flower on an erect stalk, the petals often tinged with rose or purple. Leaf reniform, smooth, deeply lobed, yellow-greenish above, paler beneath, and strongly marked with orange-colored veins. The rhizome is about 2 inches long and J-ths inch thick, cylindrical, horizontal, wrinkled, red- SANGUINARIA. 353 dish-brown, fracture short, waxy, with numerous small red resin-cells, bark thin, odor slight, taste very bitter and acrid. It contains 3 alkaloids, —Sanguinarine, CnH15N04, which is probably identical with Chelery- thrine (see Chelidonium), Porphyroxine, and Puccine, combined with Chelidonic and Sanguinarinic Acids,—also resin, gum, albumen, sugar, etc. The salts of its alkaloids are of brilliant red and orange colors and are all soluble in water. Dose of the powdered root as expectorant, gr. j-v ; as emetic, gr. x-xx, best given in pill. Extractum Sanguinaria Fluidum,—Dose, rr\j-v as expectorant and stimulant; rryx-lx as emetic, cautiously. Tindura Sanguinaria,—strength 15 per cent. Dose, as expectorant, Tipv- g j, as emetic 3 j-iij. Acetum Sanguinaria,—has of Sanguinaria 10, in Diluted Acetic Acid 90. Dose, TT\x -xxx ; as an emetic, g ij- ss. Sanguinarina, Sanguinarine, CnH15N04, (Unofficial),—is the chief alkaloid and probably the active principle of the plant. Dose, as an expectorant, gr. ; as an emetic, gr. l/2 repeated in 10 minutes will produce vomiting after the second or third dose. Preparations. Physiological Action. Sanguinaria is sternutatory, sialagogue, expectorant and emmenagogue, a systemic emetic, a cardiac paralyzer, a violent irritant, an acro-narcotic and an alterative. Its taste is bitter and acrid. It causes violent sneez- ing when inhaled, increases secretion by irritating the secretory organs as it is eliminated, and in full doses produces salivation, catharsis and vomiting with great depression. Overdoses are violently irritant, the heart’s action being at first increased, together with the arterial tension, then markedly depressed, and finally paralyzed by stimulation of its in- hibition. The reflexes are lowered by paralysis of the spinal centres, muscular contractility impaired, the pupils dilated, temperature lowered, cold sweats, great thirst and collapse supervene, and death occurs by paralysis of the cardiac and respiratory centres, often preceded by con- vulsions. Locally used, Sanguinaria is a feeble escharotic. Opium, Amyl Nitrite, Atropine, etc., to antagonize the depression of the circulation and the local irritant action. Incompatibles are alkalies, tannin, and most of the metallic salts. Antagonists and Incompatibles. Therapeutics. As a tonic to the stomach and a stimulant to the liver Sanguinaria or its active principle is well employed in small doses (gtt. iij of the tinc- ture or gr. of the alkaloid) for atonic dyspepsia, duodenal catarrh and catarrh of the biliary ducts with jaundice. Respiratory affections are often remarkably amenable to its influence, particularly chronic nasal catarrh, asthma and acute bronchitis. In these affections expectorant doses are the best, namely, gtt. x of the tincture, and in the former the 354 SANTALUM ALBUM SANTALUM RUBRUM. powder locally as a sternutatory. A decoction is a very efficient gargle in the sore-throat of scarlet fever. Sanguinaria is a very serviceable remedy in chronic bronchitis and in amenorrhoea of functional charac- ter, also in functional impotence from irritability of the organs, with daily losses and relaxation of the genitalia. By many practitioners it is considered a specific emetic in croup, but others look upon it with dis- favor as too uncertain and harsh in its action. It has been thought to have alterative properties, and hence is frequently used with Stillingia and other plants in the treatment of strumous and syphilitic affections. In pneumonia of typhoid type and in pleuro-pneumonia it has undoubtedly been of great service in many cases. Locally, the powdered root is well employed as an application to foul ulcers and fungous granulations, and by insufflation to nasal polypi, and for chronic hypertrophy of the nasal mucous membrane. Sanguinarine has been used with good results in pneumonia, bronchitis and atonic dyspepsia. Doses of gr. yy to are expectorant without irri- tating the stomach ; and still smaller doses (gr. -fa to are stimulating to the gastric and intestinal secretions. SANTALUM ALBUM, White Sandalwood,—is the source of the official Oil of Santal (see below), but is not itself official. It is a tree of the nat. ord. Santalaceae, having its habitat in India but now nearly- exterminated there;—Santalum citrinum, the yellow sandalwood, from the Sandwich and Feejee Islands, is more commonly met with in commerce. • Preparations. Oleum Santali, Oil of Santal, Oil of Sandalwood,—a volatile oil distilled from the wood of Santalum album ; a pale-yellow liquid, of sp. gr. about 0.945, soluble in alcohol, of peculiar and aromatic odor, pungent taste and acid reaction. Dose, nyx-xxx, in emulsion or capsule. Extractum Santali Fluidum (Unofficial),—made with alcohol as a menstruum. Dose, Si-iij- Physiological Action and Therapeutics. Sandalwood is a very agreeable perfume. The Oil is astringent to mucous membranes, producing dryness of the fauces, thirst, colic, and a sense of fulness in the renal regions. In concentrated form it is a local irritant, but the effects of large doses have not been studied. It is exten- sively used in chronic bronchitis and in gonorrhoea, forming the contents of proprietary capsules which are sold for the cure of the latter disease in all drug stores. As found in the shops it is extensively adulterated with Oil of Cedar, and hence is a very unreliable remedy. SANTALUM RUBRUM, Red Saunders,—is the wood of Pterocarpus satitalinus, a tree of the nat. ord. Leguminosse, native in India. It comes as a dark reddish-brown, heavy, coarse wood, in chips SANTONICA. 355 or as a coarse powder, nearly inodorous and tasteless, not imparting any red color to water when macerated in it, but coloring alcohol, ether and alkaline solutions a bright red. The wood has no medicinal properties and is employed solely for the purpose of coloring alcoholic preparations. It is a constituent of Tinctura Lavandulae Compositus. SANTONICA, Levant Wormseed,—the unexpanded flower- heads of Artemisia maritima, var. Stechmamiiana, a small, perennial plant of the nat. ord. Compositae, which grows in Asia Minor, Turkestan, etc., and contains a volatile oil and the peculiar, crystalline principle Santonin (see below). Flowerheads about inch long, pale greenish-brown, smooth, resem- bling seeds in appearance, but consisting of imbricated involucral scales with a green midrib, enclosing 4 or 5 tubular florets; odor strong and peculiar, somewhat camphoraceous, taste aromatic and bitter. Dose, gr. x-lx. Preparations. Santoninum, Santonin, C15H1803,—the neutral principle prepared from Santonica. Occurs in colorless, prismatic crystals, turning yellow on exposure to light, odorless, of bitter after-taste, and neutral reaction, nearly insoluble in cold water, but soluble in 250 of boiling water, in 40 of alcohol, 3 of boiling alcohol, 160 of ether, 4 of chloroform, also in solutions of the alkalies. Dose, gr. j for a child, gr. j-v for an adult, not repeated too soon, as the action of the drug is slow. Sodii Sanloninas, Santoninate of Sodium, 2NaC15H1904.7H20,—colorless, rhombic crystals, turning yellow on exposure to light, slightly efflorescent, of saline taste and slightly alkaline reaction, soluble in 3 of water and in 12 of alcohol at 590 F., in 0.5 of boiling water and in 3.4 of boiling alcohol. Dose, gr. ij-x, as per age. Trochisci Sodii Santoninatis,—each troche contains of the preceding gr. j, with sugar, tragacanth and orange-flower water. Dose, ij-x, as per age. Trochisci Saniortini (Unofficial),—each troche contains gr. ss of Santonin. Dose, j-v, as per age. Santonin and its preparations are sensitive to light and should be kept in amber-colored bottles tightly corked. Physiological Action. Santonin is anthelmintic to the round worm (Ascaris lumbricoides), also but in less degree to the thread-worm (Oxyuris vermicularis). It is taken into the blood as Santoninate of Sodium, and affects the cerebral faculties and the vision, objects appearing at first blue, green or red, then yellow (chromatopsia), often succeeded by blindness for a week or more. Large doses disturb the consciousness of the patient, produce a sort of intoxication, tremors, weakness, with enfeebled respiration and slowing of the pulse, coldness of the surface, vomiting, sweating, mydriasis, con- vulsions and death from failure of respiration. A dose of 2 grains is said to have proved fatal to a feeble child of five years old. It is excreted by the kidneys, coloring the urine if acid a greenish-yellow, if alkaline a red- dish-purple, and produces considerable enuresis. Santoninate of Sodium acts similarly, but being more soluble it is 356 SAPO. more rapidly absorbed and eliminated, and does not produce the consti- tutional symptoms of the drug in so marked a degree. Therapeutics. As an anthelmintic Santonin is the most certain agent against the round- worm, and is best administered in powder with Calomel at bedtime after a day of fasting, a Senna-draught or a dose of Castor Oil being used the following morning. It also acts fairly well in suppository against the thread-worm, but is inoperative against tape-worm. Some observers con- sider that it is more promptly efficient when given in Castor Oil, and that the oil lessens the risk of evil after-effects. It has also been prescribed with great benefit for nocturnal incontinence of urine, and for certain eye affections, particularly amaurosis from atrophic or inflammatory changes in the retina and optic nerve. It should never be given to children during a fever, nor when the bowels are constipated, for fear of toxic results. SAPO, Soap,—is soap prepared from Soda and Olive Oil; a white solid, hard yet easily cut when fresh, of slight, peculiar odor free from ran- cidity, a disagreeable, alkaline taste, and an alkaline reaction, readily solu- ble in water and in alcohol. It is well represented by the best “white Castile soap.” Sapo Viridis, Green Soap,—is soap prepared from Potassa and fixed oils; a soft, greenish-yellow unctuous jelly, having a peculiar odor and an alkaline reaction, soluble in water and in alcohol, does not impart an oily stain to paper. Incinerated it yields an ash which is very deliques- cent. Green Soap is a bad name for it, as its color is usually brown. Saponification is a process of double decomposition between a fat (stearate, palmi- tate or oleate of glyceryl) and an alkali, in which glycerin and the metallic salt of the fatty acid are formed. The glycerin, not being saponifiable, is set free, but the fatty acid (stearic, palmitic or oleic) unites with the salifiable base to form soaps, which are there- fore mixed stearates, oleates and palmitatesof various bases. Nearly all soaps are oleates or palmitates (or both) of sodium or potassium (or both). Hard soaps are soda soaps, soft soaps are potassium soaps. [Compare the articles Oleum Olivae, Adeps, Acidum Oleicum, Glycerinum, etc.] Insoluble Soaps are combinations of the oily acids with earths and metallic oxides. Two of them are official, viz.,—the Soap of the Mon- oxide of Lead (Emplastrum Plumbi) and the Soap of Lime (Linimentum Calcis). Sapo Mollis, Soft Soap,—official in the Br. Phar., is made with Olive Oil and Potash, the solution of the alkali being present in excess. It is often adulterated with starch. Sapo Animalis, Curd Soap,—official in the Br. Phar.,—is made with Soda and a puri- fied animal fat, consisting chiefly of Stearin. Used in pills and suppositories. Sapo Medicatus,—official in the Fr. Codex,—is a Soda soap prepared from expressed Almond Oil. Unofficial Soaps. SARSAPARILLA. 357 Preparations. Emplastrum Saponis, Soap Plaster,—has of Soap io parts, Lead Plaster 90, Water q. s. Linimentum Saponis, Soap Liniment,—has of Soap 10 parts, Camphor 5, Oil of Rose- mary I, Alcohol 70, Water q. s. ad 100 parts. Opodeldoc is a similar preparation. Tinclura Saponis Viridis,—has of Green Soap 65 parts, Oil of Lavender 2, Alcohol q. s. ad 100 parts. For external use. Soap is also an ingredient of Chloroform Liniment and several of the official pills. Physiological Action and Therapeutics. Soap is a laxative, antacid and antilithic; externally it is a stimulating discutient, and is used for cleansing the skin, removing fatty substances and softening the epidermis, but if too long applied it may prove de- cidedly irritant. It is a good antidote in poisoning by acids, and should be administered freely in such cases until more energetic alkalies can be obtained. In aqueous solution it makes a useful enema for constipation, or a plug of soap may be inserted into the rectum. Green Soap is a powerful detergent stimulant and is much employed in skin diseases, especially eczema rubrum, in which the tincture is well rubbed on, the diseased skin well washed and then covered with a bland ointment. The tincture is the most elegant form for use, and may be diluted with three parts of alcohol for shampooing the scalp. The Liniment is used with friction in sprains, bruises and stiff joints, being a little more stimulating than Camphor-liniment. It makes a good basis for extemporaneous liniment prescriptions. SARSAPARILLA ,—is the root of Smilax officinalis, Smilax medica, and of other undetermined species of Smilax, plants of the nat. ord. Smilacese, growing in Mexico, Central America, Brazil, etc. There are six commercial varieties on the market, which are generally put up in differently formed bundles. The roots are about as thick as a goose-quill, reddish-brown, several feet in length, covered with rootlets and folded in bundles about 18 inches long, taste mucilaginous, bitter and acrid. It contains starch, resin, oxalate of calcium, an essential oil, and an acrid neutral principle named Parillin or Smilacin, which when acted on by dilute sulphuric acid affords another principle, Parigenin. Extractum Sarsaparilla Fluidum.—Dose, 5jss—jjj. Ex/. Sarsaparilla Composition Fluidum,—contains Sarsaparilla 75, Glycyrrhiza 12, Sassafras bark 10, Mezereum 3, Glycerin 10, Water and Alcohol up to 100. Dose, 3SS"3F . . Syrupus Sarsaparilla Compositus,—Sarsaparilla 150, Guaiacum Wood 20, Pale Rose 12, Glycyrrhiza 12, Senna 12, Sassafras 6, Anise 6, Gaultheria 6, Sugar 600, Alcohol and Water up to 1000 parts. Dose, A good vehicle for Potassium Iodide. Decoctum Sarsaparilla Compositum,—Sarsaparilla 10, Sassafras 2, Guaiacum Wood 2, Glycyrrhiza 2, Mezereum 1, Water q. s. ad 100 parts. Dose, Jjj-iv. Syrup of Sarsaparilla (Unofficial),—so much used in flavoring soda-water, is a mixture of the oils of sassafras and gaultheria. Prepai'ations. 358 SASSAFRAS. Physiological Action and Therapeutics. Those who believe that Sarsaparilla has any action ascribe to it prop- erties as a diuretic, diaphoretic, tonic and alterative. So far careful physiological experiments with the drug and its principle have given nega- tive results. It has been used as a so-called “blood-purifier ” in scrofula, chronic abscesses, necrosis, old ulcers, many cutaneous diseases, etc., but is generally combined with other agents of undoubted activity. The compound decoction is considered a good agent in tertiary syphilis, espe- cially in debilitated subjects; while the other preparations are commonly employed as vehicles for Iodide of Potassium and Bichloride of Mercury in syphilis of any form. Whenever used, the compound decoction will give the best results, the hot water and its other constituents being each of medicinal value. SASSAFRAS ,—is the root-bark of Sassafras officinalis, a tree of the nat. ord. Lauracete, growing throughout the U. S., and occurs in irregular fragments of a bright, rust-brown color, strongly fragrant, taste sweetish, aromatic and somewhat astringent. The volatile oil is official. Sassafras Medulla, Sassafras Pith,—is the pith of the tree described above. Occurs in slender cylindrical pieces, often curved or coiled, light, spongy, white, inodorous, insipid. Macerated in water it forms a mucilaginous liquid which is not precipitated on the addition of alcohol. Preparations. Mucilago Sassafras Medulla,—has of the pith 2 parts in 100 of water. Dose, indefinite. Oleum Sassafras,—is a volatile oil distilled from Sassafras,—a colorless or yellowish liquid, having the odor of Sassafras, a warm, aromatic taste and a neutral reaction, readily soluble in alcohol. Sp. gr. about 1.090. Treated with cold nitric acid it becomes of a dark-red color, and is finally converted into a red resin. Dose, Ttpj-iv. Infusum Sassafras (Unofficial),—a popular “ tea” which may be drank ad libitum. Sassafras is a constituent of the three compound Sarsaparilla preparations. Physiological Action and Therapeutics. Sassafras is a stimulant diaphoretic when used in quantity of the hot infusion. It enjoys a popular reputation as a “ blood-purifier,” and has a destructive influence on infusoria. It is employed chiefly in combina- tion with Sarsaparilla and Guaiacum in cutaneous disorders and rheumatic and syphilitic affections. The mucilage of the pith is an excellent demul- cent drink in acute gastritis or enteritis, or in poisoning by irritant or corrosive agents. It may also be used in extemporaneous prescriptions to hold insoluble substances in suspension and for flavoring purposes. The oil is chiefly used for flavoring in mixtures and confectionery. The syrup popularly known as ‘‘Sarsaparilla” is composed of Oil of Sassafras and Oil of Gaultheria. SCAMMONIUM SCILLA. 359 SCAMMONIUM, Scammony,—is a resinous exudation from the root of Convolvulus Scatnmonia, a plant of the nat. ord. Convolvulaceae, growing chiefly in Syria and Asia Minor. It occurs in irregular, angular pieces or circular cakes, of a greenish-gray or blackish color, a peculiar, cheese-like odor, and a slightly acrid taste ; easily triturated into a dirty- gray powder, and with water yields a smooth, greenish emulsion. It con- tains about 80 per cent, of Resin, with gum, sugar, starch, etc. The active principle, Jalapin, is probably identical with the Convolvulin of Jalap, and is contained in the root, the resin, etc. Dose, gr. v-x. Preparations. Resina Scatnmonii, Resin of Scammony,—is wholly soluble in ether. Dose, gr. iij-viij. Extractum Colocynlhidis Compositum,—(see ante, page 185) contains 14 percent, of Resin of Scammony, and is an ingredient of the Compound Cathartic Pill. Scammony is an active cathartic, stimulating the liver and the intestinal glands, and causing free purgation in a fevv hours, with considerable griping. Its solution in the bile is necessary to its action, and it combines with the soda in that secretion. Though quite drastic in action it is somewhat uncertain as a purgative and is generally employed in combina- tion with similarly acting agents. It is anthelmintic against the tapeworm, and in overdoses produces a high degree of irritation. It is used as a drastic purgative for children with Calomel or Potassium Sulphate, when an active cathartic is indicated. In the same way it is the appropriate agent on the principle of derivation in dropsies and cerebral affections, also in torpid states of the intestines with much slimy intestinal mucus ; but it is contraindicated in cases attended by irritability of the stomach and bowels. Physiological Action and Therapeutics. SCILLA, Squill ,—is the sliced bulb of Urginea Scilla, or Scilla maritima, a perennial plant of the nat. ord. Liliacese, growing on the shores of the Mediterranean. It comes in narrow segments about two inches long, of yellowish-white or reddish color, slightly translucent, inodorous, mucilaginous, bitter and acrid to the taste. Its active prin- ciple has not yet been definitely isolated, but it is probably the acrid, bitter glucoside Scillitoxin. Other principles have been obtained and named Scillipicrin, Scillitin and Scillin, also Sinistrin, a peculiar carbo- hydrate or mucilage, and the usual constituents of plants. Dose, in powder, gr. j-iij. Preparations. Extractum Scillce Fluidum,—Dose, TT\j-v. Tinctura Scillce,—15 per cent. Dose, rrpv-xxx. Acetum Scillce,—10 per cent. Dose, npx-^j. Syrupus Scillce,—has of the Acetum 40 parts with Sugar 60 and Water. Dose, 3 ss~ij • 360 SCOPARIUS. Syrupus Scillce Compositus,—has of Squill 120, Senega 120, Tartar Emetic 3, Sugar 1200, Calcium Phosphate 9, Diluted Alcohol and Water up to 2000 parts. Is known as Coxe's Hive Mixture, and each fluid ounce contains about gr. of Tartar Emetic. Dose, for children, the latter being an emetic dose; as an expectorant for adults Tr^xx-xxx. Physiological Action. In small doses Squill is expectorant, in larger doses emetic and diuretic, and in overdoses it is a violent irritant poison, producing nausea, vomit- ing, purging, gastro-enteritis, strangury, bloody urine, perhaps suppression of urine, paralysis and convulsions, with death by paralysis of the heart in systole. Medicinal doses slow the heart, making the pulse stronger and slower, raising the arterial tension, and increasing the flow of urine (like Digitalis). Its active constituents diffuse into the blood, and its systemic effects follow on its application to the skin and seem to be exerted upon the mucous membrane of the secretory organs, especially affecting the bronchial, gastro-intestinal and genito-urinary. Squill is employed in medicine for its expectorant and diuretic effects. It is especially applicable in cardiac dropsy, combined with Digitalis or the saline diuretics, and in chronic bronchitis associated with Ipecac or Ammonia, Asafoetida, Benzoin, etc. It is also used in croup, but is usually combined in this affection with some other emetic, as Tartar Emetic in the Compound Syrup, a mixture which may produce very depressing effects and should be used with caution. In whooping-cough and other irritant coughs with tickling sensations in the throat the Syrup or Vinegar of Squill is often of great service. The actions and uses of Squill should be studied in connection with those of Digitalis and Ipecacuanha. Therapeutics. SCOPARIUS, Broom,—the tops of Sarothamnus Scoparius, or Broom-plant, a common garden shrub of the nat. ord. Leguminosse, having small, downy leaves and numerous large golden-yellow flowers. It occurs in thin, flexible twigs, usually free from leaves, nearly smooth, tough, of a peculiar odor when bruised and a disagreeably bitter taste. It contains Scoparin, C21H22O10, a neutral, crystallizable principle; and Sparteine, C15H26N2, a volatile, liquid alkaloid, having no oxygen, but possessing very decided basic qualities and being highly poisonous. There are no official preparations, but a decoction may be prepared in the proportion of 5j to the pint, and administered in doses of 5j every three hours until its diuretic effect is produced. Sparteine Sulphas, Sulphate of Sparteine, Dose, gr. hypo- dermically ;—gr. y2-ij per orem. Small doses, gr. yy—y, every 5 hours, for cardiac action;—larger, gr. j-ij, for diuresis. (Clarke.) Larger doses are necessary, say gr. iss-iij, ter die. (Prior.) SCOPARIUS. 361 Physiological Action. Broom-tops are diuretic and laxative, also emetic and cathartic in large doses. In the form of decoction they have long been a favorite diuretic and vehicle for other diuretics, in the treatment of dropsies both cardiac and renal, but are considered most reliable in the dropsy of renal origin. Sparteine has been thought to resemble Coniine in its action, paraly- zing the end-organs of the motor nerves and vagi, lowering the reflex ex- citability of the cord, and causing death by paralyzing the respiratory centre in the medulla. Recent observations, however, place it in the Digitalis group, and in the front rank among the members thereof. In small doses Sparteine slows and strengthens the heart-beats, and raises arterial tension, at the same time increasing the cutaneous and renal circulation, so that the surface becomes flushed and moist, and in some cases marked diuresis and diaphoresis occur. The respiration, at first quickened, is soon slowed and deepened,—the patient having a sense of increased warmth and well-being, and if suffering from irregular cardiac action, prsecordial distress and dyspnoea, these symptoms are promptly relieved. If the pulse has been abnormally slow Sparteine will quicken it, though its general action is to slow the cardiac rate. An overdose brings on marked palpitation, a small and rapid pulse of very high ten- sion, prsecordial pain and a sense of “ tightness ” about the chest, with anxiety, and a feeling of intense debility, perhaps even muscular tremor. Death occurs by asphyxia from depression of both the centre and the muscles of respiration. The action of Sparteine upon the circulation is manifested quickly as compared with that of other similarly-acting drugs. In y2 hour after its ingestion the pulse is markedly slower,—in another hour the arterial tension rises, and both effects last from 5 to 6 hours. When taken regu- larly for several days or weeks its influence remains for nearly a week after its discontinuance. There is, however, no danger of cumulative action, and though the dosage employed has varied from gr. every 4 hours, to gr. xij in 24 hours, no toxic action was observed, nor was there any evi- dence of accumulation, even when given continuously for 3 to 4 months. (Clarke.) Only from a dose of gr. xxxj were evil effects observed. (Prior.) Its diuretic power on healthy persons is denied by some observers and affirmed by others, though all acknowledge it in disease. It is accompa- nied by increased excretion of urea,—is due to the increase of blood- pressure both behind and in front of the renal circulation,—and is produced only by large doses, gr. ij. Sparteine acts directly on the cardiac muscle, as well as upon the inhib- itory apparatus, thus giving greater force to the cardiac contractions, and regulating (generally slowing) the pulse-rate. It also stimulates the vaso- motor centre to contract the vessels throughout the splanchnic area, thus 362 SCUTELLARIA. increasing the circulation in the skin and kidneys, and raising arterial tension generally. Therapeutics. Broom-tops are a favorite remedy for dropsies of cardiac origin, and for the general anasarca of chronic kidney disease, but are inadmissible in acute renal affections or where there is pulmonary congestion or in- flammation. Sparteine has been employed with very great benefit in cardiac affec- tions requiring stimulation of the heart’s action with the smallest possible increase of arterial tension, relief of dyspnoea, prsecordial pain, palpita- tion and oedema. In such cases small doses, gr. are best, and as the influence of the drug is remarkably sustained, they need not be repeated oftener than once in 5 or 6 hours. It has given the most marked satisfaction in mitral regurgitation, in which it relieves all the symptoms; also in mitral stenosis, when the pulse is small, weak and irregular. In aortic regurgitation, it quiets excited action of the heart, without unduly prolonging the systole, and is of great value. Used in chronic Bright’s disease, with hypertrophy and high arterial tension, it stimulates the heart without increasing the tension. In exophthalmos, it gives remark- able relief to all the symptoms. For cardiac palpitation and arhythmia, small doses are of great service. In asthma it is of signal benefit, cutting short the paroxysms, and rendering their recurrence much less frequent. In the opium-habit it is used at periods of depression during the treatment, to overcome the “plateau” shown in the sphygmograph trace, by stimu- lating the cardiac action. (Jennings.) For this purpose, doses of gr. iss-iij three or four times daily are necessary. (Prior.) SCUTELLARIA, Skull-cap, —is the plant Scutellaria lateriflora, an indigenous, perennial herb of the nat. ord. Labiatse, growing in moist places and along ditches ; having small, pale-blue flowers disposed in long, leafy racemes, of slight odor and bitterish taste. It contains a little vola- tile oil, traces of a bitter principle, besides fat, tannin, sugar, etc. Preparation. Extraction Scutellaria Fluidum,—DoSe, g ss-ij. Physiological Action and Therapeutics. Scutellaria produces no very obvious effects when taken internally. By some practitioners it is said to have tonic, nervine and antispasmodic powers, and it has been used in domestic practice to calm the nervous system in diseases characterized by restlessness, tremors, spasms, twitch- ing of the muscles, hyperaesthesia, etc., as chorea, delirium tremens, nerv- ous exhaustion from fatigue or over-excitement, hydrophobia, hysteria and SENEGA. 363 epilepsy. The Scutellarin of the Eclectics is not a proximate principle, but an extract precipitated by alum from a concentrated aqueous tincture. It is given in dose of from one to four grains. SENEGA ,—is the root of Polygala Senega, an indigenous, perennial plant of the nat. ord. Polygalacese, having small, white flowers in a close spike at the summit of the stem. The root is about 4 inches long, with a knotty crown and tortuous, spreading branches, thick bark inclosing a porous, yellowish wood ; odor slight but unpleasant, taste at first sweetish, afterwards acrid. Its principal constituent is the glucoside Senegin, C32H54018, which is identical with Saponin, and closely allied to Digitonin. It is a white, amorphous powder, readily soluble in alcohol and hot water, forming a soapy emulsion when mixed with boiling water, and decom- posed by HC1 into sugar and Sapogenin, C,4H2202. Abstractum Senega,—Dose, gr. v-x. Extradum Senega Fluidum,—Dose, rtyx-xx. Syrupus Senega,—has of the fluid extract 160, Aqua Ammonise 4, Sugar 600, Water to 1000 parts. Dose, gj-ij. Syrupus Scilla Compositus,—contains 6 per cent, of Senega. (See page 360.) Dose for children, Ttyv- 3 j; for adults as an expectorant, rtyxx- p, ss. Preparations. Senega is a stimulating expectorant, a diuretic and a diaphoretic. It causes irritation of the throat, with some salivation and gastro-intestinal irritation, an inclination to cough, increased bronchial secretion, and perhaps some diuresis and diaphoresis. Inhaled as a snuff it is very irri- tant to the mucous membrane of the nose, causing cough, sneezing and nasal catarrh. Senegin is violently irritant and a powerful depressant to the heart, vessels, nervous and muscular systems. It is excreted by the bronchial mucous membrane, the kidneys and the skin, all of which it stimulates and in large quantity irritates. Physiological Action. Therapeutics. The use of Senega is chiefly that of a stimulating expectorant in chronic bronchitis, the second stage of acute bronchitis, typhoid pneumonia, asthma, croup, and as a diuretic in dropsy due to renal disease. It re- moves the tightness and oppression experienced in subacute chest affec- tions, relieves the cough and rapidly promotes expectoration. When the mucus is tough and scanty this remedy is of no value. It has been used with great benefit in amenorrhoea, given in saturated decoction for two weeks before the expected period. In chronic rheumatism and in rheu- matic paralysis its stimulating and diaphoretic powers have been of great value. Senegin has been successfully used in 2-grain doses as a remedy for uterine hemorrhage. 364 SENNA, SENNA,—the leaflets of Cassia acutifolia (Alexandria Senna), and of Cassia elongata (Indian Senna), shrubs of the nat. ord. Leguminosae, growing in Egypt and India. The leaflets are from 1 to 2 inches long, lanceolate, brittle, dull green, of peculiar odor, and nauseous, bitter taste. They contain an amorphous glucoside, Cathartic Acid, C180H192N2SO82, which forms salts with bases and may be decomposed into glucose and Cathartogenic Acid. Other constituents are Sennapicrm and Sennacrol, both glucosides;—Catharto-mannite, a peculiar unfermentable sugar ; also a coloring matter allied to Chrysarobin (see page 174), and various vege- table salts. Preparations. Extractum Senna Fluidum.—Dose, gj. An excellent preparation. Syrupus Senna,—has of Senna 33 parts, Sugar 60, Alcohol 4, Oil of Coriander and Water to 100 parts. Dose, gss-ij. Confectio Senna,—has of Senna 10, Coriander 6, Cassia Fistula 16, Tamarind 10, Prune 7, Fig 12, Sugar 50, Water 60 parts. Is sold under the titles “ Tamar-Indien,” “ Tropical Fruit Laxative,” etc. Dose, Infusum Senna Compositum, Black Draught,—has of Senna 6, Manna 12, Magnesium Sulphate 12, Fennel 2, Water 100 parts. Dose, Pulvis Glycyrrhiza Compositus, (see ante, page 228),—contains 18 per cent, of Senna. Dose, gr. xx-^j. Syrupus Sarsaparilla Compositus (see ante, page 357),—contains 12 per 1000 of Senna. Dose, g}-iv. Senna is a very efficient and safe cathartic, producing, when taken in- ternally, copious yellow stools in about 4 hours, with considerable griping and flatulence, which may, however, be lessened by combining it with carminatives. Its action is chiefly expended on the small intestine, and it increases both peristalsis and secretion. It has no irritant qualities in ordinary medicinal doses, and does not produce hypercatharsis, nor leave constipation as an after result. Its infusion injected into the veins causes both vomiting and purging; and in large doses per orem it produces nau- sea, vomiting, flatulence, excited pulse, drastic purgation with severe tenes- mus, but its effects are never poisonous. It may produce hemorrhoids and increase the menstrual flow in women. Given to a nursing mother her milk will acquire purgative powers. In some very susceptible per- sons the odor of the leaves or of the infusion will cause an evacuation of the bowels. Its odor and taste are particularly disagreeable, especially when administered in infusion. Physiological Action. Therapeutics. Senna would probably take rank as our best and safest cathartic but for the nauseousness of its smell and taste. It is a favorite laxative in Eng- land for children, and is used with great benefit in habitual constipation or where prompt evacuation of the bowels is required. In hemorrhoids and anal fissures it is employed to produce soft and easy motions; but if a tendency to hemorrhoids exists, the use of this drug in cathartic doses SERPENTARIA. 365 will cause irritation of the part and induce an acute attack. For the same reason it is contraindicated in any such conditions as hemorrhage or inflammation of the intestinal mucous membrane, hemorrhoids, menor- rhagia, abortion, etc. The least disagreeable of its preparations are the Confection of Senna and the Compound Liquorice Powder. SERPENTARIA, Virginia Snake-root,—is the rhizome and rootlets of Aristolochia Serpentaria and of Aristolochia reticulata, indi- genous herbaceous plants of the nat. ord. Aristolochiaceae, growing in rich, shady woods, with purple flowers arising from joints near the root. The rhizome is about an inch long, thin and bent, having on the upper side short stem-remnants, on the lower side numerous thin, branching rootlets ; odor and taste are aromatic and camphoraceous. It contains a volatile oil, a camphor-resin and a bitter principle named Aristolochine, which is soluble in both alcohol and water. All its preparations should be made from the fresh root, as it deteriorates by keeping. Extraction Serpentarice Fluidutn,—Dose, nyx-xxx. Tinctura Serpentarice,—I o per cent. Dose, g ss-ij. Tinctura Cinchonce Composita,—has 2 parts of Serpentaria in ioo. (See ante, page 177). Dose, 3j-ij. Preparations. Physiological Action. Serpentaria is a stimulant expectorant and tonic, also a cardiac stimu- lant, a diaphoretic, diuretic, emmenagogue, aphrodisiac, and somewhat of an antiperiodic. Its taste is warm and pungent, its odor characteris- tic. Small doses promote appetite and digestion, increase the bronchial and intestinal secretions, the action of the heart, the cutaneous circula- tion and the surface temperature, and produce considerable mental exhila- ration. Large doses are irritant, causing nausea and vomiting, vertigo and headache, colic, borborygmi, rectal tenesmus, flatulent distention and frequent but not watery stools. The irritant action seems to produce gas rather than fluid. Pruritus ani and hemorrhoids are occasionally caused by its use. Serpentaria is chiefly employed as a vehicle for other stimulant drugs, but has many uses of its own. In bronchial affections it is extremely valuable as a stimulating expectorant. In typhoid pneumonia it is a good vehicle for carbonate of ammonium, and in the exanthemata is extremely useful when much depression exists. It is indicated in typhoid condi- tions generally, and in the amenorrhoea of anaemia and chlorosis it is an efficient emmenagogue in many cases. It will often restore the waning sexual power in functional impotence, while in bilious vomiting it fre- quently checks the nausea and settles the stomach. It is used as a Therapeutics. 366 SESAMI OLEUM SEVUM—SILICATES. vehicle for Cinchona in remittent fever. In diphtheria, scarlatina, etc., the infusion forms an excellent gargle. Its diaphoretic and diuretic prop- erties, though slight, are sometimes of avail in chronic rheumatism. SESAMI OLEUM, Oil of Sesamum, Benne Oil,—is a fixed oil expressed from the seeds of Sesamum indicum, or Benn6 plant (nat. ord. Pedaliacese), which is a native of India, but is cultivated in the southern portion of the U. S. It is a yellowish or yellow, oily liquid, inodorous or nearly so, having a bland, nut-like taste and a neutral reac- tion. It is a bland fixed oil, very similar in its properties to olive oil, and may be used for the same purposes. It is rich in Olein (76 percent.) and keeps better than olive oil. It is chiefly employed as a hair-oil. SEVUM, Suet, —is the internal fat of the abdomen of Ovis Aries (the Sheep), purified by melting and straining. It should be kept in well-closed vessels and not used after it has become rancid, as it will on exposure to air. It is a white, smooth, solid fat, of bland taste and neu- tral reaction, soluble in 24 of boiling alcohol, 60 of ether, and slowly in 2 of benzin. It consists chiefly of Stearin, but also has Palmitin and Olein, and is a constituent of Unguentum Hydrargyri and Unguentum Picis Liquidse. It is a harder fat than lard and more liable to turn rancid. It is used in ointments and liniments to give them greater consistency, but may be applied alone as a dressing to ulcers. In physiological action and therapeutics it follows the other oils and fats (see ante, pages 282, 290). SILICATES of Sodium (Na2Si03) of Potassium (K2Si03), and of Magnesium (2Mg03Si02) are used in medicine and surgery, a solution of the Silicate of Sodium being official. Liquor Sodii Silicatis, Soluble Glass Solution—is a semi-trans- parent, colorless or yellowish, viscid liquid, odorless, of sharp saline and alkaline taste and alkaline reaction, of sp. gr. 1.300 to 1.400. A small quantity should not produce any caustic effect when applied to the skin. It usually contains about 20 per cent, of Silica and 10 per cent, of Soda, and is used on bandages to make immovable dressings, being lighter than plaster-of-Paris and stronger than starch. Liquor Potassii Silicatis (Unofficial),—also known as Soluble Glass Solution,—is used for immovable dressings in the same manner as the preceding. A mixture of 2 parts of this solution with one of the soda salt solution is said to set more quickly and firmly than either solution separately. Diluted (i to 4) the solution of the Potassium Silicate has been applied locally in erysipelas, gonorrhoea, cystitis, vaginitis, etc., as an antiseptic, and with good results. SINAPIS. 367 Magnesii Silicas Hydratus, Hydrated Silicate of Magnesium, Meerschaum, 2MgO, 3Si02-)-2H20 (Unofficial),—a mineral used for the manufacture of smoking-pipes, and employed in France as a substitute for Bismuth Subnitrate in obstinate choleraic diarrhoea, to protect the intestinal mucous membrane or as an absorbent. It is given in fine powder and in doses of gj-iv per diem. SINAPIS, Mustard ,—is official under the two following titles, but all the pharmacopceial preparations are made from Black Mustard only. Sinapis Alba, White Mustard,—the seed of Sinapis Alba, an annual plant of the nat. ord. Cruciferse, cultivated in our gardens. It has yellow flowers in racemes, and ribbed pods with a long, ensiform beak. The seeds are about y inch in diameter, yellowish, hard, almost globular with a circular hilum; embryo oily, with a curved radicle and two cotyledons, one folded over the other; inodorous, taste pungent and acrid. White Mustard contains Myrosin, a ferment, and Sinalbin, a crystalline substance, which reacting on each other in the presence of water produce Sulpho-cyanate of Acrinyl, a rubefacient principle allied to the volatile oil of black mustard. It also contains Sin- apine, an alkaloid, Erucic or Brassic Acid, and a bland, fixed oil, all three contained also in Black Mustard. Sinapis Nigra, Black Mustard,—is the seed of Sinapis nigra, an annual plant of the nat. ord. Cruciferse, native of Europe but naturalized in the U. S. It has small, yellow flowers standing closely together on peduncles at the end of the branches, also smooth, erect pods with a short beak. The seeds are about one-half the size of those from white mustard, black and hard, almost globular with a circular hilum; embryo as in Sinapis Alba; inodorous when dry, but when moist of a pungent, irritating odor ; taste pungent and acrid. Black Mustard contains Myrosin, a ferment, and Sinigrin (Potassium Myronate), which reacting on each other in the presence of water produce the Sulpho-cyanide of Allyl, or Volatile Oil of Mustard. It also contains Sinapine, an alkaloid, Erucic or Brassic Acid, and a bland, fixed oil; all three of which are contained also in White Mustard. Commercial Flour of Mustard (Unofficial),—is a mixture of white and black mustard seeds ground to a fine powder. It may be employed in lieu of either variety. Dose, as emetic, 3ij-iv. Preparations. Oleum Sinapis Volatile, Sulpho-cyanide of Allyl, C4H5NS,—a colorless or pale yellow liquid, of very pungent and acrid odor and taste and neutral reaction, sp. gr. i.017 to 1.021, almost insoluble in water but freely soluble in alcohol and ether. Dose, Charta Sinapis, Mustard Paper,—consists of Black Mustard, the fixed oil removed by percolation with Benzin, mixed with Solution of Gutta-Percha and spread on paper. Each square inch should contain about gr. vj of Mustard. For local use. Linimentum Sinapis Cotnpositum,—has of the Volatile Oil 3, Extract of Mezereum 2, Camphor 6, Castor Oil 15, Alcohol to 100 parts. For local use. 368 SODIUM. Physiological Action. Locally used, Mustard is rubefacient, counter-irritant, and a nervous stimulant, causing heat, redness and severe burning pain. Its prolonged application produces vesication by inducing local inflammation. Inter- nally it is a local emetic in full doses, in smaller a condiment and carmi- native. Its irritant effect on the gastric mucous membrane is much less powerful than on the skin. Therapeutics. Mustard is commonly used as a local application to relieve local pain, to stimulate the viscera, and to produce counter-irritation. These objects find their application in muscular rheumatism, neuralgia, colic, gastralgia, inflammation of the throat, larynx, bronchi, lungs, pleurae and peri- cardium, also as a derivative in headache, cerebral congestion, and sup- pressed menstruation. It may also be used as a stimulant to the heart, vascular system and respiratory apparatus. When action of a mild cha- racter is desired it may be diluted with flaxseed or flour. Internally it may be employed as an emetic in indigestion or narcotic poisoning. Its use as a condiment is familiar, acting by stimulation of the gastric mucous membrane. In overdoses it may excite severe gastritis. White mustard seed, unground, has been used as a laxative, as it pro- duces no irritation. The Oil is one of the most irritant of the volatile oils, producing severe gastro-enteritis. It is used chiefly as an ingredient of stimulating lini- ments, but may be employed internally in small doses. SODIUM, Natrium, Na.—This metal is not official, but is repre- sented by a number of official salts, which are generally colorless or white, and with very few exceptions are readily soluble in water. Some of them are found native, as the Chloride (in sea-water, salt lakes, salt mines),— the Nitrate (in Peruvian deserts, etc.) and the Borate (in lakes of Persia, California, etc.). The Carbonate is found in the ashes of marine plants. From the Chloride is prepared the Sulphate, from this the Carbonate, and from the latter most of the other salts are prepared. All sodium salts impart a yellow color to flame, which should not appear more than tran- siently red when observed through a blue glass, which cuts off the yellow rays but allows the violet ones of Potassium to be seen. Sodium Compounds and their Preparations. Soda, Sodium Hydrate, Caustic Soda, NaHO,—a white, hard, opaque solid, deliques- cent in moist air, efflorescent in dry air, odorless, of intensely acrid and caustic taste and strongly alkaline reaction, soluble in 1.7 of water at 590 F., and in 0.8 of boiling water, very soluble in alcohol. Is a powerful caustic but milder than Potassa, and should be kept in well-stoppered bottles made of hard glass. Liquor Sodce, Solution of Soda,—contains about 5 per cent, of the hydrate, and is pre pared by dissolving 180 parts of Sodium Carbonate in 400 of boiling Distilled Water, SODIUM. 369 also 60 of Lime in the same quantity of Distilled Water, boiling, mixing the solutions gradually, again boiling and when cold adding water up to iooo parts, straining, settling, and then removing the clear solution. Or, by dissolving 56 of Soda in 944 of Distilled Water. It is a clear, colorless liquid, odorless, of acrid and caustic taste and strongly alkaline. Dose, irpv- g ss, well diluted with water. Sodii Acetas, Acetate of Sodium, NaC2H302.3H20,—large, transparent prisms, efflo- rescent in dry air, odorless, of saline, bitter taste, and a neutral or faintly alkaline reaction, soluble in 3 of water and in 30 of alcohol at 590 F., in 1 of boiling water and in 2 of boiling alcohol. Dose, gr. xx-^j. Sodii Carbonas, Carbonate of Sodium, Na2C03.ioH20,—large, colorless crystals, rapidly efflorescent, with a harsh alkaline taste and strongly alkaline reaction; very solu- ble in water, insoluble in alcohol. By heat it undergoes aqueous fusion and then dries up, losing 63 per cent, of its weight. Of it 20 grains will neutralize 9.7 grains of Citric Acid, or grains of Tartaric Acid. Dose, gr. v-xxx. Sodii Carbonas Exsiccatus, Dried Carbonate of Sodium,—is the Carbonate 200 parts dried at a heat of 113° F., until it is converted into a white powder weighing 100 parts. Is chiefly used for pharmaceutical purposes. Sodii Bicarbonas, Bicarbonate of Sodium, NaHC03,—an opaque, white powder, perma- nent in the air, odorless, of cooling, saline taste, and a slightly alkaline reaction ; soluble in 12 of water at 590 F., insoluble in alcohol, decomposed by hot water. It is distinguished from the Carbonate by its solution in cold water giving a white and not a colored precip- itate with solution of perchloride of mercury. Of it 20 grains neutralize 16.7 grains of Citric Acid, or 17.8 grains of Tartaric Acid. It is a constituent of Mistura Rhei et Sodse (see page 336) and of Pulvis Effervescens Compositus (see page 323). Dose, gr. x-^j. Sodii Bicarbonas Venalis, Commercial Bicarbonate of Sodium,—should contain 95 per cent, of pure bicarbonate, which it resembles in appearance and properties. It is employed solely for external applications. Trochisci Sodii Bicarbonatis,—each troche contains of the Bicarbonate 3 grains, with Sugar, Nutmeg and Mucilage of Tragacanth. Dose, as of the bicarbonate. Sodii Chloras, Chlorate of Sodium, NaC103,—colorless, transparent tetrahedrons of the regular system, permanent in dry air, odorless; of cooling, saline taste and neutral reaction, soluble in 1.1 of water and in 40 of alcohol at 590 F., also in 0.5 of boiling water and in 43 of boiling alcohol. When heated it melts and then gives off a portion of its oxygen, leaving a residue of sodium chloride. Should be kept in well-stoppered bottles, and should not be triturated with readily oxidizable or combustible substances. Dose, gr. v-xx. Sodii Chloridum, Chloride of Sodium, Common Salt, NaCl,—white, hard, cubical crys- tals or a crystalline powder, permanent in the air, odorless, of a purely saline taste and neutral reaction; soluble in 2.8 of water at 59° F., and in 2.5 of boiling water. Almost insoluble in alcohol. Dose, gr. x-^j. Sodii Nitras, Nitrate of Sodium, Cubic Nitre, Chili Nitre, Chili Saltpetre, NaNO.„— colorless, transparent crystals, slightly deliquescent, odorless, of cooling, saline and bitter taste, and neutral reaction ; soluble in 1.3 of water at 590 F., and in 0.6 of boiling water, scarcely soluble in cold alcohol. Dose, !|j-ij. Sodii Sulphas, Sulphate of Sodium, Glauber’s Salt, Na2S04.ioH20,—large, colorless, transparent, monoclinic prisms, rapidly efflorescent in air; of cooling, saline taste and neutral reaction; soluble in 2.8 of water at 590 F., in 0.25 of water at 91.40 F., and in 0.4 of boiling water, insoluble in alcohol. Dose, gr. v-xx; as purgative ss-j or a third of a teaspoonful in a large glass of water. Sodii Ethylas, Ethylate of Sodium, Caustic Alcohol, C2H5NaO (Unofficial),—is a white powder, often having a brownish tinge, dissolving in water with a hissing sound. Upon contact with the smallest quantity of water or moist living tissue it splits into alco- hol and caustic soda. An alcoholic solution is made by dissolving sodium in absolute alcohol, and is used as a caustic. Chloroform decomposes it at once into ether and chlo- ride of sodium. It should be kept in a cool place as it is liable to explode. The Arseniate of Sodium is described under Arsenic, page 116;—the Benzoate under Benzoin, page 129;—the Borate under Ac. Boricum, page 59;—the Bromide under Bromum, page 133 ;—the Solution of Chlorinated Soda under Chlorum, page 172;— the Iodide under Iodum, page 252;—the Hypophosphite, Phosphate and Pyrophosphate under Phosphorus, page 305 ;—the Salicylate under Salicin, page 349;—the Santoni- nate and its Troches under Santonica, page 355;—the Sulphite, Bisulphite and Hyposul- phite under Acidum Sulphurosum, page 73 ; and the Sulpho-carbolate under Carbolic Acid, page 61. 370 sodium. Physiological Action. The action of the Sodium salts is similar to that of the Potassium salts, except that the former are feebler as alkalies, are not so depressant, and are not so poisonous to the cardiac muscle or the nerves. They are dif- fused more slowly, are neither absorbed nor excreted so readily, and have not so marked a diuretic action. Locally applied in large doses to mus- cular and nervous tissue they are paralyzant, but not so powerfully as potassium salts. Urate of Sodium is not soluble like the urates of lithium or potassium, being therefore much less readily excreted, and forming the masses called “chalk-stones” in gouty subjects. Soda is a less active escharotic than potash, having less affinity for water. Liquor renders the blood and secretions more alkaline, but does not alter nutrition to the extent that liquor potassse does. The Acetate is con- verted into the Carbonate in the blood, and is a less active diuretic than the corresponding potassium salt. The Carbonate is chiefly used in the preparation of the other salts. The Bicarbonate is slightly irritant, stimulates the secretion of gastric juice, acts as an antacid and will increase the alkalinity of the blood. The Chloride is a most important food. It exists normally in the blood, where it keeps the fibrin and albumen in solution, and plays an important part in tissue change. In inflammation, being thus needed, it accumulates at the seat of the morbid action, disappearing from the urine; its reappearance therein being a sign of improvement. A solution of 0.65 part to 100 of water does not destroy animal tissues like water alone, and may be mixed with blood without destroying the corpuscles, though strong solutions are intensely irritating. Internally used in quantity it is emetic and hemostatic. As an enema it is destructive to ascarides. Nitrate of Sodium is a mild cathartic, and in solution is a solvent of false membranes. The Sulphate is generally cathartic in action, though in small doses and with little water it may be passed off by the kidneys. It is mixed with the Bicarbonate to imitate the salts obtained by evapora- tion of Carlsbad water. The Ethylate is antiseptic, and a powerful but almost painless caustic. [The actions of the other Sodium salts are respectively described under the titles of their other constituents, to which their effects are mainly referable.] Antagonists and Incompatibles. Poisoning by caustic alkalies is treated by the dilute Vegetable acids, as vinegar, cider, lemon-juice; then demulcent drinks and oils to protect the mucous membrane, and the usual vital supporters. The alkalies and their carbonates are incompatible with the acids and also with metallic salts, and the caustic alkalies decompose most alkaloids. Therapeutics. The Sodium salts treated of in this article are not much used internally, the corresponding Potassium salts being preferred, especially when it is desired to alkalinize the urine or to promote oxidation. In the alkaline SOMNAL. 371 treatment of stomach affections the Sodium salts are the most efficient, especially the Bicarbonate before meals or on an empty stomach to increase the secretion of the gastric juice. This same salt is used in diabetes to lessen the amount of sugar, in frontal headache with constipa- tion, the pain being seated at the junction of the forehead with the hairy scalp,—also as a wash (gr. ij ad 5j) in itching skin-affections and as a lotion in burns and eczema. The Chloride is used internally as an antidote in poisoning by Nitrate of Silver and as an emetic, and will often relieve hemoptysis and migraine. In bilious diarrhoea it is employed in doses of gr. x-5j, thrice daily. Locally in baths it is a good stimu- lant to the skin, and in solution to 1 per cent.) to wash wounds in place of water, to cleanse the nasal cavities, or to destroy ascarides, in which case it is given by enema of the strength of two tablespoonfuls to the pint. The Carbonate may be used in dilute solution locally to pre- vent itching, but is chiefly employed in the preparation of the other salts. The Sulphate is a good purgative, either alone or with the Bicar- bonate in imitation of Carlsbad Salts, for bilious disorders, gouty affec- tions, chronic constipation, obesity and diabetes mellitus. The Chlo- rate has similar uses to those of the Potassium Chlorate, but being more soluble can be used in stronger solutions, but this is of doubtful benefit for internal use as it has all of the irritating power on the kidneys and destructive action on the blood possessed by the other salt. (See ante, page 324.) The Nitrate is employed as a mild cathartic, and in solu- tion by atomization to destroy the false membrane in croup. The Ethylate has been of service as a caustic in cancer, lupus and naevi, for the latter affection being painted over the growth with a glass rod. Caustic Soda is a better caustic than Potassa as it has less affinity for water and hence does not destroy the tissues so deeply, nor has it the same tendency to run over adjacent parts. [The therapeutics of the other Sodium Compounds are described as noted on page 370.] SOMNAL, C7Hi2C1303N, is a new hypnotic, introduced by a German manufacturer, and formed by the union of Chloral, Alcohol and Urethan, the result being a complex body, and not a simple mixture. It is a color- less liquid, resembling chloroform in its behavior with cold water, with which it forms globules and refuses to mix or dissolve. It is soluble in hot water in alcoholic solutions and in alcohol, 3 parts in 1. The ad- vantage claimed for Somnal is that when administered in 20-grain doses it induces within half an hour a quiet sleep lasting from six to eight hours without any inconvenient after- or by-effects. Doses of 45 and even 60 minims produced no depression of the circulation or respira- tion. 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. 372 SPIGELIA STAPHISAGRIA. The effects are much more striking and certain than those of urethane, and far less de- pressing than those of chloral; and there is no vertigo or depression, as may follow the use of Sulphonal. In drachm-doses, this drug is not powerful enough to decidedly con- trol delirium tremens, maniacal delirium or severe pain. (Dr. Gilman Thompson.) SPIGELIA, Pink-root ,—is the rhizome and rootlets of Spigelia marilandica, the Carolina Pink, an herbaceous perennial of the nat. ord. Loganiacese, native of the southern states ; having large, showy flowers, scarlet or crimson externally, yellow within. The rhizome is 2 inches long, y% inch thick, horizontal, bent and branched; having cup-shaped scars above and numerous thin rootlets below. It contains a bitter prin- ciple and a volatile oil, also tannin, wax, resin, lignin and salts. Dose, 3j-ij for an adult, gr. x-xx for a child of 3 years. Preparations. Extractum Spigelice Fluidutn,—Dose for an adult, 3 j-ij; for a child of 3 years, ttyx-xx. Infusum Spigelice Compositum, Worm Tea (Unofficial),—has of Spigelia 15, Senna 10, Fennel 10, Manna 30, Water 500. Dose, J; iss-v. Spigelia is anthelmintic against the round worm (Ascaris lumbricoides), and is in popular use as a vermifuge, administered usually with Senna. In large doses it is an uncertain cathartic, and may produce quite serious symptoms, as vertigo, dimness of vision, dilated pupils, spasms and even convulsions. These effects are most apt to occur when the drug fails to produce purgation, hence it is usually administered with an active cathartic. Spigelia Anthelmia, the Demarara Pink-root, or Worm-grass, pro- duces vomiting, dilated pupils, dyspnoea, convulsions, and death. If eaten by cattle they perish in great agony. It has been used with real benefit in cardiac affections of rheumatic origin, also in rheumatic fever, and in cardiac palpitation with dyspnoea, due to mitral and aortic disease. A tincture (1 to 8) may be used in doses of upv-xx. STAPHISAGRIA, Stavesacre, —is the seed of Delphinium Sia- phisagria, an annual or biennial plant of the nat. ord. Ranunculaceae, a native of Europe, having bluish or purple flowers, in terminal racemes; and seeds in straight, oblong capsules. The seeds contain an alkaloid Delphinine, probably 3 other alkaloids, a bitter principle, a volatile oil and a fixed oil, etc. There are no official preparations. Preparations. Unguentum Staphisagrice (Unofficial),—contains of the powdered seeds 1 part with 2 each of olive oil and lard. Delphinina, Delphinine, C2 2H3 5N06 (Unofficial),—is the active alkaloid, and exists in the fatty oil which is extracted by ether. Dose, gr. Stavesacre is a violent emetic and cathartic, also parasiticide. The alkaloid is irritant to the skin if locally used, producing tingling, burn- ing, and inflammation. Internally, it lowers the activity of the heart stillingia. 373 and respiration and produces a most profound adynamia, and may prove fatal from paralysis of the spinal cord and asphyxia. In many respects its alkaloid resembles Aconitine and Yeratrine. The ointment is often employed as a parasiticide against pediculi and the acarus scabies. The fixed oil is probably equally effective. Delphi- nine has been used internally in asthma, rheumatism and neuralgia, and in the latter affection is well employed as an ointment (gr. xx to Sj), applied over the course of painful superficial nerves. It has been sug- gested as an antipyretic and for dropsy. A tincture or fluid extract is a very efficient application against pediculi. STILLINGIA, Queen’s Root, —is the root of Stillingia sylvatica, or Queen’s Delight, an indigenous, perennial plant of the nat. ord. Euphorbiaceae, with yellow flowers on a spike, and a large, thick and woody root, of peculiar and unpleasant odor, and an acrid, pungent, bitter taste. It contains a resin and a volatile oil, but its active principle has not yet been isolated. The fresh root should be used in making the preparations, as those from the dried root are almost inactive. Dose of the powdered root, gr. x-3j. Extractum Stillingia Flnidum,—Dose, rt^x-gj. Tinctura Stillingia (Unofficial),—Dose, 3ss_'j- Decoctnm Stillingia (Unofficial),— 3 j ad Oj. Dose, 3j-ij. Syrupus Stillingia Compositus (Unofficial),—is composed of Stillingia, Corydalis, Iris, Chimaphila, Coriander, Xanthoxylum, Sambucus, Sugar, Water and Alcohol. For the formula, see U. S. Disp., page 1363. Preparations. Physiological Action. Stillingia in large doses is emetic and cathartic, in smaller doses it is expectorant, diaphoretic, diuretic, sialagogue and cholagogue, possessing the various properties which are considered “alterative.” Its taste is acrid and pungent, and it increases the action of the heart, skin, kidneys, and bronchial mucous membrane; and the gastric, hepatic, intestinal and salivary excretions. Full doses often excite epigastric pain, nausea and vomiting. Therapeutics. Stillingia is much employed with Sarsaparilla and similar acting drugs as an alterative in syphilitic affections, particularly in chronic cases of the tertiary form, in which the system is greatly reduced by the abuse of mercurials and iodides. In these cases it possesses considerable power and frequently cures. It is also valuable in strumous affections, in ascites due to hepatic changes, portal congestions with jaundice following mala- ria, habitual constipation, hemorrhoids from hepatic obstruction, and intermittents. In the latter affection the fluid extract with Quinine or Arsenic is a very useful combination. A strong decoction is used toward off an impending paroxysm of ague. 374 STRAMONIUM. STRAMONIUM, Thornapple. —The plant Datura Stramonium, Jamestown Weed or Thornapple (nat. ord. Solanacese), is official in two forms, the leaves and the seed. It is an annual, of rank and vigorous growth, having a green stem with large white flowers, and numerous seeds in a large, fleshy, four-celled capsule, open at the summit. It grows wild in Southern Russia and the middle United States, and contains an alka- loid, Daturine, which is generally considered identical with Atropine both physiologically and chemically,—also malic acid, albumen, gum, resin, etc. Stramonii Folia,—the leaves of Datura Stramonium, are about 6 inches long, smooth, petiolate, ovate, pointed, unequal at the base, coarsely toothed, of bitter and nauseous taste. Dose, gr. ij-xx. Stramonii Semen,—the seed of Datura Stramonium, is about l/& inch long, reniform, flattened, pitted and wrinkled, the testa blackish and hard, enclosing a curved embryo embedded in whitish, oily albu- men ; of unpleasant odor when bruised and an oily, bitter taste. Dose, gr. j. The official preparations are all made from the seed. Preparations. Extractum Stramonii,—Dose, gr.y^-y^. Extractum Stramonii Fluidum,—Dose, TT\j—v. Tinctura Stramonii,—10 per cent. Dose, Tip v-xxx. Unguentu?n Stramonii,—has of the Extract 10, Water 5, Benzoinated Lard 85 parts. Daturina, Daturine, C17H23N03 (Unofficial),—is the alkaloid found in all parts of the plant, also in Datura Tatula. It is a Tropate of Tropin, isomeric and identical with Atropine. Dose, gr. T^-5V- Physiological Action. The action of Stramonium is similar to that of Belladonna in almost every particular, except that Stramonium is more powerful and chiefly influences the sympathetic nervous system, not affecting the motor or sen- sory nerves. It excites a greater degree of cardiac irregularity and a more furious delirium, and seems to have a special affinity for the gen- erative apparatus, being decidedly aphrodisiac in full doses. [Compare Belladonna, ante, page 126.] As previously stated the alkaloids, Atropine, Daturine, Hyoscyamine, and Duboisine are chemically alike and almost identical physiologically. They all produce dilatation of the pupil, increase the cardiac action, the pulse and respiration rate, and cause delirium. Poisoning by one of them is indistinguishable from that by another. Antagonists and Incompatibles. These are the same as for Belladonna. Poisoning by Stramonium is not uncommon, as children may eat the seeds, which should be evacuated by an emetic. If physiological symptoms follow Opium must be exhibited as the antagonist, but cautiously, lest opium- narcosis be substituted. Therapeutics. Stramonium is chiefly used as an antispasmodic and to relieve pain. In asthma the leaves are smoked with advantage at the commencement of a STROPHANTHUS. 375 paroxysm, the smoke being drawn into the lungs. In other spasmodic affections, as hepatic colic, laryngeal cough, chorea and stammering, it is very beneficial. In dysmenorrhoea and neuralgia it is used in combina- tion with Opium and Hyoscyamus, and in tic douloureux and sciatica it is often very efficient. In nymphomania with great mental depression it is often very effective, and in mania of furious character, particularly the puerperal form with suicidal tendency, it is highly serviceable in 10-20 minim doses of the tincture every 3 or 4 hours. The ointment is much used in irritable ulcers, and as an anodyne application in painful hemor- rhoids and certain cutaneous diseases. STROPHANTHUS,—is the seed of Strophanthus hispidus, an Af- rican climbing plant (nat. ord. Apocynaceae), from which the natives extract a toxic preparation known as the Kombe arrow-poison. It con- tains a crystalline glucoside, named Strophanthin, the active principle, which is bitter, slightly acid, soluble in water and in alcohol, but almost insoluble in ether, chloroform, benzin, etc. It is very plentiful in the seeds (8 to 10 per cent.), and is an agent of great energy, the frog being killed by a solution of 1 in 10,000,000. (Denian.) Preparations. Professor Frazer recommends the tincture. Tinctura Strophanthi (i in 20),—Dose, TT\v-x, or frequently repeated. A stronger tincture (1 in 8) is on the market. Strophanthinum, Strophanthin,—Dose, gr. hypodermically, gr. has been used, the influence of the one injection upon the circulation lasting at least 8 days. Strophanthus acts primarily upon muscular tissue, by direct contact through the blood, and with great energy. It increases the contractile power of all striped muscle, and in poisonous quantity it fixes the muscu- lar contraction into a condition of tetanic permanence, the muscle being unable to resume its normal condition of partial flexibility. As the heart receives much more blood in a given time than any other muscle in the body, it is quickly and markedly affected by the strophanthus-charged fluid, and by regulating the dosage, the cardiac muscle may alone be affected, by a quantity which would not influence the other muscles. Small doses stimulate the cardiac contractions, increasing the force of the ventricular systole, and lowering the rate of the heart-beats. At the same time the general blood-pressure is raised, and diuresis produced, both being due to the vis a tergo,—the direct stimulation of the circulation from behind. Large doses paralyze the heart in systole, and leave the cardiac muscle in a state of contraction resembling cadaveric rigidity. It does not act through the nervous system, but paralyzes muscular tissue, striated and non-striated, by direct contact;—and when contractility has Physiological Action. 376 STYRAX. been once destroyed thereby, no stimulus will re-excite it. It does not affect the vascular system directly. Compared with Digitalis, then, we have in Strophanthus a much more powerful cardiac stimulant, differing from Digitalis in not producing any vaso-motor constriction of the arterioles. It reduces the pulse, lowers body-temperature somewhat, is not cumulative in action, and does not cause any gastro-intestinal disturbance. It is diuretic, by direct stimula- tion of the renal circulation ; and has power over rigors, by its rapid cardiac action, stopping them, and preventing their recurrence. Therapeutics. Strophanthus is the most valuable of the cardiac stimulants, from the rapidity and permanence of its action, as well as its non-interference with the calibre of the peripheral vessels. It relieves cardiac dyspnoea in a few minutes, in less than an hour it modifies the pulse-rate, and the influence of a single dose upon the circulation persists for a very long time. It is certain to replace Digitalis in the treatment of chronic Bright’s disease and valvular lesions of the heart, where it is important that the work of the heart should not be increased by any additional resistance in the arterial system. Strophanthus has been exceedingly useful in the treatment of Bright’s disease, for the dyspnoea, orthopnoea, dropsy and uraemia ; also in mitral insufficiency, with great anasarca and dyspnoea; in palpitation, exagge- rated cardiac action, and in weak heart, and for exophthalmos, with tumultuous action of the heart; also pulmonary oedema, due to valvular lesions, or to pneumonia. It is useful in endocarditis, also in atheroma of the arteries; in reflex palpitation of neurasthenia, hysteria and chlo- rosis, and for rigors due to catheterization, or operations on the urethra. STYRAX, Storax ,—is a balsam prepared from the inner bark of Liquidambar orietitalis, the Oriental Sweet-gum, a tree of the nat. ord. Hamamelaceae, growing in Asia Minor. It is semi-liquid, sticky, opaque and gray-colored, of agreeable odor and balsamic taste, completely soluble (except accidental impurities) in an equal weight of warm alcohol. It consists of a volatile oil named Styrol, C8H8,—a crystalline solid Slyracin, which is a cinnamate of cinnamic ether,—two peculiar resins, one hard, the other soft,—and Cinnamic Acid, C9H902, a colorless, odor- less, crystalline body, closely allied to Benzoic Acid, excreted in the urine partly as Hippuric Acid, and occurs also in the Balsams of Peru and Tolu. Dose of Storax, gr. v-xx. Preparation. Tinctura Benzoini Composita, Friar’s Balsam,—contains 8 per cent, of Storax. (See atite, page 129.) Dose, gss-ij. SUCCINUM SULPHUR AND SULPHIDES. 377 Storax is a stimulant expectorant, an antiseptic and a disinfectant, acting both locally and remotely, like Benzoin and the Balsams of Tolu and Peru. It is used with benefit in chronic bronchitis and other affec- tions of the respiratory organs, also in chronic catarrhs of the genito- urinary passages, in gonorrhoea and in amenorrhoea. Externally it is employed in ointment as a detergent for foul ulcers, and as a parasiticide for scabies and phthiriasis. SUCCINUM, Amber,—the source of the official Oil of Amber, is a fossil resin, occurring in alluvial deposits, chiefly in Prussia, Bohemia, and Courland. It is usually associated with lignite, sometimes encloses insects and parts of vegetables, and consists of a volatile oil, a yellow resin, another resin, succinic acid and a bituminous principle. Its source is thought to be an extinct coniferous tree, the Piniles succinifer, of which amber represents the exudation. Preparation. Oleum Succini, Oil of Amber,—is a volatile oil obtained by the destructive distillation of Amber, and purified by subsequent rectification;—a colorless or pale yellow, thin liquid, of sp. gr. about 0.920, of empyreumatic and balsamic odor, a warm, acrid taste, and a neutral or faintly acid reaction, and readily soluble in alcohol. Dose, gtt. v-x. Oil of Amber is stimulant, antispasmodic and diuretic, when used internally. Externally it is irritant and rubefacient. It has been em- ployed with benefit in epilepsy, hysteria, convulsions, amenorrhcea, whooping-cough, etc. As a liniment it is often used in chronic rheuma- tism, and has been applied along the spine in infantile convulsions, mixed with an equal part of laudanum and diluted with olive oil or brandy. SULPHUR, and SULPHIDES.—The non-metallic element Sul- phur, S, is a brittle solid of a pale yellow color, permanent in the air, of crystalline texture and susceptible of several allotropic states, which are for the most part induced by heat. It is obtained native in several vol- canic districts, or from the native Sulphides of Iron and Copper (iron and copper pyrites) by roasting, as it sublimes at about 238° F. It is official in three forms, viz.: Sulphur Sublimatum, Sublimed Sulphur, S,—is prepared from crude Sulphur by sublimation and condensation. It is a fine citron-yel- low powder, of faintly acid taste and acid reaction, insoluble in water or alcohol. Ignited it burns with a blue flame, forming sulphurous acid gas, and leaving no residue or only a trace. Dose, gr. x-xx-lx. Sulphur Lotum, Washed Sulphur, S,—prepared by digesting sub- limed Sulphur with dilute Water of Ammonia, thoroughly washing with water and passing through a No. 30 sieve. In this process the Ammonia 378 SULPHUR AND SULPHIDES. dissolves out any Sulphide of Arsenic which may be present and neutral- izes any Sulphurous or Sulphuric Acid. [For solubility and dose see S. Pra:cipitatum, below.] Sulphur Praecipitatum, Precipitated Sulphur, Lac Sulphuris, Milk of Sulphur, S,—prepared by boiling sublimed Sulphur with slaked lime and water, thus forming the Sulphide and Hyposulphite of Calcium. These are then decomposed by HC1, and Sulphur is precipitated as a very fine powder which is next washed until the washings are tasteless, and it is dried with a gentle heat. The result is a very fine, yellowish-white, amorphous powder, odorless and almost tasteless, insoluble in water or alcohol, but completely soluble in disulphide of carbon or a boiling solu- tion of soda. By heat it is completely volatilized. Dose, gr. x-5j- Preparations of Sulphur. Unguentum Sulphuris,—has of Sublimed Sulphur 30, Benzoinated Lard Jo parts, rubbed together. Unguentum Sulphuris Alkalinum,—has of Washed Sulphur 20, Potassium Carbonate 10, Water 5, Benzoinated Lard 65 parts, thoroughly rubbed together. Pulvis Glycyrrhizce Compositus (see ante, page 228) contains 8 per cent, of Sulphur Lotum; and E?nplastrum Ammoniaci cum Hydrargyro (see ante, page 93) contains 1 per 1000 of Sulphur Sublimatum. Sulphuric Acid is described under Acidum Sulphuricum, ante, page J2; Sulphurous Acid and the Sulphites under Acidum Sulphurosum, ante, page 73. The Sulphates are noted under the titles of their respective bases. Ichthyol,—is a preparation obtained from a bitumen found in 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. Sulphides and their Preparations. Calcii Sulpkidum, Sulphide of Calcium, CaS (Unofficial),—is the preparation named “ Hepar Sulphuris, Liver of Sulphur,” by the homceopathists, who prepare it by mixing equal parts of powdered oyster-shell and sublimed sulphur, and heating at a white heat in a crucible hermetically sealed. It is a constituent of the following official compound, viz.: Calx Sulphurata, Sulphurated Lime,—is commonly misnamed Sulphide of Calcium. It is a mixture of Calcium Sulphide and Calcium Sulphate, CaS CaS04, in varying pro- portions, but containing not less than 36 per cent, of the former, and is prepared by heat- ing together in a closed crucible Powdered Lime 100 parts and Precipitated Sulphur 90 parts, at a low red heat for one hour. The result, rubbed to powder, is grayish-white, of offensive taste and alkaline reaction, very slightly soluble in water, insoluble in alcohol. Dose> gr- iW- Potassa Sulphurata, Sulphurated Potassa,—formerly called Hepar Sulphuris,—is a mixture of Potassium Trisulphide with small quantities of Potassium Hyposulphite and Sulphate, formed by heating together 1 part of Sublimed Sulphur with 2 of Potassium Carbonate, until meited. Of a liver-brown color gradually changing with age to a greenish- or brownish-yellow, of disagreeable odor, alkaline and repulsive taste and alkaline reaction. Soluble in 2 of water, excepting a small residue, partly soluble in alcohol. Dose, gr. ij-x, in pill or solution. Sulphuris Iodidum, Iodide of Sulphur, Iodine Disulphide, I2S2,—is prepared by fusing together Washed Sulphur 1 part, and Iodine 4. It is a grayish-black crystalline solid, having the odor of iodine, an acrid taste and a faintly acid reaction, insoluble in water, but very soluble in disulphide of carbon and in about 60 of glycerin. Alcohol and ether dissolve out the iodine, leaving the sulphur. Only used as ointment, gr. xxx to the 5. Hydrogen Sulphide, Sulphuretted Hydrogen, H2S (Unofficial),—is used only as a test. It is a colorless gas having the smell of rotten eggs, prepared by the action of dilute Sulphuric Acid on Sulphide of Iron; the gas being passed into water a solution is obtained. SULPHUR AND SULPHIDES. 379 It precipitates most of the metals from acid solutions as sulphides, that with Arsenic being yellow; with Antimony, orange; with Cadmium, yellow; with Copper, Lead, Mercury and Silver, black; with Bismuth, brown; with Gold and Platinum, brownish- black. Bisulphide of Carbon is described under Carbo, ante, page 154 ; Sulphide of Antimony and Sulphurated Antimony under Antimonium, ante, page 102. Physiological Action. Sulphur is a mild laxative and a diaphoretic. In contact with living protoplasm it enters into combination and produces either sulphuretted hydrogen or sulphurous acid; taken into the intestinal canal a large por- tion passes out unchanged, some of it being converted by the alkaline bile into sulphuretted hydrogen and sulphides. The former is excreted by the lungs, giving to the breath the smell of rotten eggs, and by the skin, discoloring silver articles carried about the person by forming a sulphide of silver. The Sulphides are partly absorbed into the blood, and are excreted in the urine, chiefly as sulphates, and in the faeces, which they blacken and render soft. Given in full doses they are irritant to the stomach and intestines, extremely nauseous to the taste and smell, increase the secretions of the intestinal glands, and peristaltic action, and if used for any length of time they impair the blood, causing anaemia, emacia- tion, tremor and great debility. Sulphuretted Hydrogen is very destructive to plant life, and in ani- mals it destroys the tissue functions, decomposing the blood and para- lyzing the nervous and the muscular systems. The symptoms of poisoning are those of asphyxia; muscular tremors occur and are followed by con- vulsions and death. This gas is often found in cesspools in large quantities, but in one case poisoning occurred from its excessive formation in the intestines and subsequent absorption into the blood. Calx Sulphurata and Potassa Sulphurata act like the sulphides as local irritants and in large doses as irritant poisons, producing narcotic symptoms and convulsions. In small doses they act like sulphur and are supposed by many observers to have a peculiar influence on suppuration to limit or prevent it if given in small doses frequently repeated. The Iodide is believed to possess some of the properties of both its elements. It is doubtful whether it is a distinct chemical compound or merely a physical mixture. As a parasiticide it is very efficient, and has been found remarkably alterative in many local affections of chronic char- acter, but may prove very irritant to the skin if improperly prepared. [The actions of Sulphuric Acid, Sulphurous Acid and the Sulphites are respectively described on pages 72 and 73, ante.'] Antagonists and Incompatibles. Solutions of the Sulphides are decomposed by the mineral acids and by solutions of metallic salts. Antidotes are Chlorine-water, Chlorides of Sodium and Potassium, Sul- phate of Iron, etc. Poisoning by Sulphuretted Hydrogen is best treated by artificial respiration. 380 SUMBUL. Therapeutics. Sulphur is chiefly used as a laxative when pultaceous rather than liquid stools are required, as in hemorrhoids, anal fissure, or constipation. Scabies has long been treated by its local and internal use, but sulphur alone does not kill the itch insect. The older sulphur ointments were made with sublimed sulphur, and probably contained a considerable amount of sulphurous acid on which their parasiticide property depended. The recent ointments, made with purified sulphur, all contain an alkaline ingredient and develop sulphides which are powerful insect poisons. Sulphur fumigations are practically applications of volatile sulphurous acid, while most of the sulphur baths and mineral waters are solutions of sulphuretted hydrogen or of the alkaline sulphides. They are of value in lead poisoning to favor the elimination of that metal, in chronic consti- pation, chronic rheumatism and sciatica, and many skin diseases, especially chronic psoriasis, eczema, pityriasis and prurigo. The Ointment and the Alkaline Ointment are both used in scabies. The Iodide has been used internally in scrofula, glanders and cutaneous disorders, but it is chiefly employed as an ointment in lupus and parasitic skin diseases, especially herpes circinatus. Calx Sulphurata is extremely efficient as an internal remedy in crops of boils, scrofulous sores, glandular enlargements, acne, etc., and will prevent or limit suppuration. For these purposes it must be used in small doses (gr. frequently repeated. Potassa Sulphurata is only used externally as baths or ointment in skin diseases and mucous discharges, also in chronic rheumatism. Ichthyol has been introduced by Dr. Unna, of Hamburg, the cele- brated dermatologist, as a promptly efficient remedy in certain chronic skin diseases, particularly eczema and psoriasis. It mixes with vaseline, lard and oils, is soluble in a mixture of ether and alcohol, and is not irri- tant locally, even if covered with oiled silk. In one case of eczema infantile, an ointment was applied containing i part of Ichthyol to 5 of Vaseline, resulting in the child’s sinking into a stupor which lasted for 12 hours. Though recovery was complete, the result of the application shows that care must be used in the employment of the remedy, as it is not devoid of danger (Sinclair). SUMBUL ,—is the root of Ferula Sumbul, a very large plant of the nat. ord. Umbelliferas, which grows to the height of 8 feet in the mountains of Northern Asia. The root occurs in transverse segments of a strong and musk-like odor and a bitter, balsamic taste, and contains Angelic Acid, C5H802, Valerianic Acid, C5H10O2, also a volatile oil, two balsamic resins, a bitter substance, etc. Dose, gr. xxx-5j or more in infusion, decoction, etc. Preparation. Tinctura Sumbul, io per cent. Dose, gj-iv. TABACUM. 381 Sumbul is an efficient nerve tonic, having qualities closely resembling musk and valerian. It is used by the Russian physicians in very many morbid conditions, and seems to be a favorite remedy in that country for almost any disease. It is probably of some value in hysteria and other nervous derangements of delicate females, and may be used as a substitute for musk in typhoid conditions and fevers, asthma, delirium tremens and perhaps in epilepsy. TABACUM, Tobacco,—the commercial, dried leaves of Nicotiana Tabacum, an annual plant of the nat. ord. Solanacese, native of tropical America, but cultivated in several parts of the world, especially in Cuba and Virginia. The leaves are large, as long as 20 inches, mottled-brown, ovate or lanceolate, glandular-hairy; having a heavy, peculiar odor, and a nauseous, bitter and acrid taste. It contains a very powerful and poi- sonous fluid alkaloid named Nicotine, C10H14N2, also a concrete, campho- raceous, volatile oil, Nicotianin, besides alkaline salts (nitrates, phos- phates), and other less important substances. Its combustion gives rise to several empyreumatic products, of which Pyridine, C5H5N, and its com- pounds are the chief, having somewhat the same action as Nicotine, but of less severity. Besides these products, tobacco-smoke contains Creasote, Hydrocyanic and Hydrosulphurous acids, etc., but little or no Nicotine. Unofficial Preparations. Enema Tabaci,—gr. xx infused in Sjviij Boiling Water, and administered as one enema. Vinum Tabaci,— 5 j to the pint. Dose, tt\v-3j. Oleum Tabaci,—is an empyreumatic product, obtained by distillation at a temperature above that of boiling water, and a most virulent poison. Nicotina, Nicotine, Cj0H14N2,—the alkaloid and active principle; a colorless, oily- looking fluid, having the odor of tobacco and an acrid taste ; readily soluble in water, and forming soluble salts with acids. Dose, in strychnine-poisoning, up to nyj in 2 hours. [Other Liquid Alkaloids besides Nicotine are—Coniine, Muscarine, Sparteine, Lobe- line, Lupuline, and Pyridine.] Physiological Action. Tobacco is a very depressant nauseant, an emetic by irritant as well as systemic action, and an antispasmodic ; also sternutatory, diuretic, dia- phoretic, cathartic, sedative and narcotic. It paralyzes the motor nerv- ous system, its action commencing at the periphery and extending to the spinal cord. It increases the salivary and intestinal secretions, and pro- duces diuresis, tremor, clonic spasms and a tetanic stage followed by pa- resis. It contracts the pupils, depresses the heart, lowers arterial tension, reduces body-temperature, and causes profuse sweating, cold and clammy skin, collapse and death usually by paralysis of respiration, sometimes by 382 TAMARINDUS. paralysis of the heart. It does not impair the muscular irritability, nor does it act upon the cerebrum directly. Its empyreumatic products act similarly but less powerfully. Fatal results have followed on the inhalation of its vapor into the lungs. Nicotine is almost as rapidly fatal as Prussic Acid, death having oc- curred from a toxic dose in three minutes, with no symptoms except a wild stare and a deep sigh. The continued use of Tobacco in excess by smoking or chewing pro- duces granular inflammation of the fauces and pharynx, atrophy of the retina, dyspepsia, lowered sexual power, nervous depression, and occa- sionally angina pectoris. Used by the young it hinders the development of the higher nerve centres, and impairs the body nutrition by interfering with the processes of digestion and assimilation. Strychnine is the true physiological antagonist to Nicotine (or Tobacco) and vice versa. Alcohol, Ammonia, Ergot, Digitalis, Belladonna, etc., antagonize its action on the circu- lation. In poisoning by Tobacco the means resorted to are evacuation of the stomach, Tannin, Iodides, and artificial respiration. A curious synergism has been observed by the author between Opium and Tobacco. If a person, habituated to the use of the latter, either by smoking or chewing, begins to use Morphine, the smallest quantity of Tobacco will make him sick, the symptoms being those experienced by a novice in its use. Therapeutics. Tobacco is now but little used in medicine; the dangers attending its employment either internally or externally have caused it to be super- seded by less violently acting agents. The chief indications for its use are to relax spasm and to relieve local pain. It may be employed with advantage in habitual constipation, for the dyspnoea of spasmodic asthma and emphysema, and in nymphomania and chordee. Intestinal affections like impaction of the caecum, intussusception and strangulated hernia may be overcome bya tobacco-enema to relax spasm, but it is a dangerous ex- pedient. In dropsy, especially the renal form, it makes a very efficient diuretic. In tetanus there is no more effective remedy than minim doses of the alkaloid every two hours by the stomach, or npij by the rectum, or better still the wine in io-minim doses repeated for effect. Strych- nine-poisoning is best met by minute doses of Nicotine (gr. hypoder- mically, as a physiological antagonist. The use of Tobacco in moderation, when under excessive exertion, aids in supporting the system and lessening the sense of fatigue. Smokers rarely suffer from constipation, but generally experience an immediate laxative result from their morning cigar. TAMARINDUS, Tamarind,—is the preserved pulp of the fruit of Tamarindus indica, a large tree of the nat. ord. Leguminosge, native in the East and West Indies. It occurs as a reddish-brown, sweet-acid and TANACETUM TARAXACUM. 383 pulpy mass, containing strong, branching fibres and brown, quadrangular seeds, each enclosed in a tough membrane. It contains citric, tartaric and malic acids, sugar, gum, potassium bitartrate, etc. Confectio Sennce (see ante, page 364),—contains Tamarind to the amount of 10 per cent. Dose, jj-ij. Preparation. Tamarind is a laxative and refrigerant fruit. In infusion it may be used by convalescents as a pleasant acidulous drink, or the pulp may be boiled with milk as a whey for the same purpose. As a laxative it is usually prescribed in connection with other agents having the same action. TANACETUM, Tansy ,—the leaves and tops of Tanacetum vul- gare, a perennial, herbaceous plant of the nat. ord. Compositse, having yellow flowers in dense terminal corymbs, indigenous in Europe, but cultivated in our gardens, and growing wild in roads and old fields. It contains a volatile oil, a bitter principle named Tanacetin, a tannic acid, etc. There are no official preparations, but a fluid extract may be pre- pared according to the general rule and administered in doses of Rix-5j. The dose of the volatile oil (Oleum Tanaceti) is i to 3 drops. An infu- sion (Tansy Tea) may be made in the proportion of 5j to the pint, and used in doses of 3j-ij. Physiological Action and Therapeutics. Tansy is emmenagogue, diuretic and anthelmintic, an aromatic bitter and an irritant narcotic. Fatal results have frequently followed upon overdoses of the oil (gss—j), or strong decoctions, preceded by clonic spasms, disturbed respiration and cessation of the heart’s action. It is a useful remedy in amenorrhoea, but is in popular repute as an abortifacient, a virtue which it does not possess except in quantity dangerous to life. TARAXACUM, Dandelion is the root, gathered in autumn, of Taraxacum Dens-leonis, an herbaceous plant of the nat. ord. Compositse, with a perennial fusiform root, long, sinuate-toothed or runcinate leaves, and slender peduncles, each bearing a single head of yellow flowers. All parts of the plant contain a bitter, milky juice, exuding from any break or wound. Its constituents are a bitter amorphous principle named Taraxacin, a crystalline principle Taraxacerin, with potassium and cal- cium salts, inulin, and resinoid bodies, etc. The French name for the plant is “ Pissenlit.” 384 TEREBINTHINA. Preparations. Extradum Taraxaci,—Dose, gr. v-xxx. Extractum Taraxaci Fluidum,—Dose, 3 j — ,5 J • Physiological Action and Therapeutics. Taraxacum is a bitter tonic, a diuretic and an aperient It has been, supposed to act especially on the liver, and is chiefly used in dyspepsia with hepatic torpor. As found in the shops it is usually inert. The ex- tract is probably only of value as an excipient for pills. TEREBINTHINA, Turpentine, —means a vegetable exudation, liquid or concrete, which consists of resin combined with a peculiar essential oil named Oil of Turpentine (C10H16), and generally procured from various species of the nat. ord. Coniferse (cone-bearers). Of the many turpentines two only are official, viz : — Terebinthina, Turpentine,—a concrete oleoresin obtained from Pinus australis, the Yellow Pine, and from other species of Pinus, nat. ord. Coniferse. Occurs in tough, yellowish masses, brittle when cold, crummy- crystalline interiorly, of terebinthinate odor and taste. Dose, gr. v-xxx as a stimulant, antispasmodic or diuretic; 3'j~iv as an anthelmintic. Terebinthina Canadensis, Canada Turpentine, Balsam of Fir,—a liquid oleoresin obtained from Abies balsamea, the Silver Fir, or Balm of Gilead, a tree of the nat. ord. Coniferse. A yellowish, transparent, viscid liquid, of agreeable, terebinthinate odor, and a bitterish and slightly acrid taste, slowly drying on exposure, forming a transparent mass; completely soluble in ether, chloroform or benzol. Dose, gr. x-xxx. [For Pitch and its preparations, see ante, page 315.] Oleum Terebinlhince, Oil of Turpentine, Spirits of Turpentine,—is a volatile oil distilled from Turpentine, any variety furnishing it. Dose, as a stimulant or diuretic, in emulsion, 3 to 6 times daily;—as a cathartic or anthelmintic or more, combined with other cathartics. A little glycerin and oil of gaultheria will disguise the taste. A thin, colorless liquid, of characteristic odor and taste, having the sp. gr. 0.855 0.870, soluble in 6 of alcohol, mixes with other volatile and fixed oils, and dissolves resins, wax, sulphur, phosphorus and iodine. Bromine and powdered Iodine act violently on it, and when brought into contact with a mixture of Nitric and Sulphuric Acids it takes fire. It is isomeric with a number of volatile oils, has the formula C10H16—but constantly absorbs oxygen from the air when exposed, becoming thicker and less active, from forma- tion of resin. It is a mixture of several hydrocarbons, each having the same formula as itself, viz.:—C10H16. Linimentum Tei-ebinthince, Turpentine Liniment,—has 35 parts of the oil with 65 of Resin Cerate. Linimentum Cantharidis, contains the oil in the proportion of 85 per cent., the other 15 being Cantharides; making a very powerful and unmanageable application unless closely watched. See ante, page 151. Preparations. Unofficial Turpentines. Chian Turpentine,—from the Pistacece Terebinthus, a small larch tree growing in the islands of Chio and Cyprus, a thick, tenacious, greenish-yellow liquid, concreting on exposure to the air into a translucent solid. Dose, gr. iij-v in emulsion. TEREBINTHINA. 385 Venice Turpentine,—procured in Switzerland from the Larix Europcea or European Larch;—a viscid liquid of the consistence of honey, does not concrete on exposure, and is entirely soluble in alcohol. The Venice Turpentine of commerce is usually prepared by dissolving Resin in Oil of Turpentine. Thus Americanutn, Common Frankincense, (B. P.),—the concrete turpentine which is scraped off the trunks of Pinus australis and Finns Tceda, Southern States of N. America. An ingredient of the Emplastrum Picis of the B. P. Analogues of Turpentine. Oleum Succini, Oil of Amber,—a volatile oil obtained by the destructive distillation of Amber (Succinum), a fossil resin, occurring in alluvial deposits in Bohemia, etc., and thought to be the exudation of Pinites succinifer, an extinct coniferous tree. Dose, gtt. v-x. See ante, page 377- Oleum Thupe,—a volatile oil, which is given in doses of Tipj-v. A saturated tincture may be used in drachm-doses. Obtained from Thuja occidentalis, the Arbor Vitse, a coniferous tree. See mfra, page 388. 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 See ante, page 334. 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, npv-xx on sugar, or suspended in 5ss of water by the aid of gr. xx of light carbonate of magnesium. Terebinthene, C10H1S,—another isomeric hydrocarbon, obtained by distilling oil of turpentine with an alkali. This by hydration, is con- verted into Terpine, commonly called “Hydrate of Terpine," instead of Hydrate of Terebinthene, a solid, crystalline body, soluble in glycerin. Acting on this by an acid, we get an oily body, named Terpinol, the dose of which is gr. ij-v, while that of Terpine is gr. v-x. None of these bodies are soluble in water, but all are in alcohol. Sanitas,—is a disinfecting solution obtained by the action of water upon oxidized turpentine, its active principle being Peroxide of Hydrogen. It is not poisonous, and does not stain the linen,—two qualities which strongly recommend it. Physiological Action. Turpentines are stimulant, diuretic, anthelmintic, and hemostatic; in large doses laxative and irritant, and externally used are rubefacient and antiseptic. Their virtues depend entirely on the volatile oil. Oil of Turpentine in small doses causes a sense of heat at the epigas- trium, burning in the mouth, and by reflex action salivation. In moderate 386 TEREBINTHINA. doses it at first stimulates the vaso-motor nervous system, afterwards paralyzing these centres, thus causing a rise and then a fall of the arterial tension. It lowers the functions of the brain, spinal cord and medulla in the order stated, causing diminution of voluntary movement and reflex action, dilatation of the vessels, lowered blood-pressure, and slowed respiration, the latter often becoming spasmodic. The pulse is sometimes slowed, some- times quickened. Large doses produce gastro-enteritis, with vomiting and diarrhoea, suppression of urine, pain in the lumbar regions, burning in the urethra, hematuria, and strangury. The muscular power is diminished, coordination impaired, and a state of intoxication induced. Toxic doses cause complete muscular relaxation, profound insensibility, with abolished reflexes, dilated pupils, cyanosed face, labored and stertorous breathing and death by paralysis of respiration. It is excreted by the various organs of excretion, all of which are highly irritated, the kidneys suffering par- ticularly. Its vapor inhaled produces nasal and renal irritation, frontal headache, and frequently strangury and hematuria. Locally to the skin it is rubefacient, and even vesicant if applied for any length of time or if evaporation be prevented. Turpentine-oil when exposed to the air readily absorbs oxygen in the form of ozone, which it retains tenaciously. This Ozonized Oil of Tur- pentine is an antidote to Phosphorus, preventing the formation of phos- phoric acid, and converting the phosphorus into an insoluble substance resembling spermaceti. Worn about the neck in an open vial it is believed to prevent necrosis of the jaw and steatosis of the organs in workmen exposed to phosphorus-fumes. It is also supposed to dissolve gall-stones. Antagonists. In cases of poisoning the stomach should be emptied, anodynes and demulcents admin- istered, elimination favored, and special symptoms met as they arise. Therapeutics. The Oil of Turpentine is employed externally as a rubefacient and counter-irritant in many conditions producing pain and inflammation. Cloths wrung out of hot water and then sprinkled with the oil (turpen- tine stupes), are useful applications in sciatica and other neuralgige, lum- bago, chronic rheumatism, chronic bronchitis, peritonitis with tympanites, pleurisy, renal colic, etc. It is one of the most efficient agents in hos- pital gangrene applied in full strength to the part affected. The liniment is in constant use for sprains, neuralgia, and other slight local affections. Internally it is best employed in ulceration and hemorrhage of the intestines and in hemorrhages of a passive character from other organs. Active bleeding with a plethoric condition and hematuria are states in which it is contraindicated. It is often used with Ether (i to 3) in biliary and flatulent colic, as an anodyne and antispasmodic. As a vermifuge, THEOBROMA oleum. 387 against tape-worm it must be employed in large doses (Sss-ij), with Castor oil to promote its rapid passage through the intestinal canal. The French acid oil, which is old and contains ozone, is used in phosphorus poisoning. It is well employed as a stimulant to the heart and vaso- motor system in puerperal fever, yellow fever, traumatic erysipelas, pneu- monia, capillary bronchitis, etc. It is also useful in chronic bronchial catarrh, chronic cystitis, subacute gonorrhoea and similar affections of the mucous surfaces generally. Inhalations of the vapor or atomized oil are extremely beneficial in chronic affections of the larynx and bronchi. The pure vapor is too irri- tating for inhalation, but it may be diluted with steam from a steam atom- izer. Chian Turpentine is one of the many remedies which have been used for cancer. Terebene has been extensively used by Dr. Murrell, with excellent re- sults, as a remedy for obstinate winter-cough and emphysema of the lungs, in flatulence, and flatulent dyspepsia, also in cystitis and in gleet. He has employed it with benefit as a spray in phthisis and post-nasal catarrh, also with Cocaine in solution as a spray for coryza and hay-fever. Other observers, of several years’ experience with this remedy in England, praise it highly as an inhalant remedy in phthisis, bronchiectasis, chronic bronchitis, and other pulmonary affections characterized by profuse, puru- lent expectoration. Dr. Rieu employs it extensively in bronchitis and bronchorrhoea, in doses internally of gr. xv-xxx per diem,—but says that it does not affect the muco-purulent expectoration of phthisis {Bull. Gen. de Therap., April 30, 1886). It probably has no superior efficacy to Creasote, Venice Turpentine, etc., except that it is without much odor, and has no taste. Terpine Hydrate is praised very highly in chronic and recurrent bronchitis, night-cough from habit, cold, catarrhs and kindred affections. In fact, all acute and many chronic affections of the respiratory passages form the field for the therapeutical action of this preparation. THEOBROM/E OLEUM, Oil of Theobroma, Cacao-but- ter,—is a fixed oil expressed from the seed of Theobroma Cacao, the Chocolate-tree, nat. ord. Sterculiacese, growing in Mexico, the West Indies and South America. The oil is a yellowish-white solid, of faint odor, bland taste and neutral reaction, and melting at 86° to 950 F. The seeds are oval, about the size of almonds, and consist of shells and kernels, in both of which is found the alkaloid Theobromine C7H8N402, which closely resembles Caffeine, the latter being its methyl derivative. Chocolate is prepared by roasting the seeds, removing the shells, then crushing or grinding the kernels to a smooth paste, which is cast in molds. Cacao-butter consists chiefly of Stearin with a little Olein. Its action 388 THUJA is demulcent, and it does not become rancid on exposure to the air. Its chief use is as a basis for making suppositories. A cerate is prepared by melting together Cacao-butter 35, White Wax 35, Oil of Almond 30, adding a drop of Oil of Rose and coloring with a minute quantity of Carmine previously triturated with a drop of Water of Ammonia. This is known as Red Lip-salve. Theobromine has the same action and uses as Caffeine. (See ante, page 140.) THUJA, Arbor Vitae, —the fresh tops of Thuja occidentals, a tree of the nat. ord. Coniferae, commonly though incorrectly called White Cedar, and growing in swampy ground in Canada and the northern U. S. Its twigs are flattish and two-edged, with scale-like leaves appressed and closely imbricate in four rows, rhombic-ovate, obtusely pointed, having a roundish gland upon the back; of a balsamic, somewhat terebinthinate odor, and a pungently aromatic, camphoraceous and bitter taste. They contain a volatile oil, tannin, wax, resin, etc. ; also Pinipicrin, C22H18On, a bitter principle, and Thujin, C20H22O12, a yellow, astringent and crystal- lizable coloring principle, which is separable into glucose and Thujetin, c14h14o8. Preparations. There are none official. The dose of a saturated, fresh tincture or fluid extract is 3 j 3_6 times daily. The Volatile Oil may be given in doses of TT\j-v. Physiological Action. Thuja resembles Savine in action very closely. It is stimulant, irritant, astringent, also aromatic, diuretic and emmenagogue. The oil is a gastro-intestinal irritant, and produces epileptiform convulsions in warm- blooded animals, and paralysis in cold-blooded ones. It causes rhythmi- cal contraction and dilatation of the vessels, lowers the temperature, and is anthelmintic. Thuja is indirectly an abortifacient when given in doses sufficient to cause violent gastro-enteritis, and is reported to have pro- duced an acute urethritis resembling gonorrhoea. Therapeutics. Thuja in decoction has been usefully employed in coughs, rheumatic and arthritic pains, dropsy and amenorrhoea. It has also been given with benefit in intermittent fever and as an alterative blennorrhetic in chronic catarrh and bronchorrhoea. It is highly praised by Dr. Phillips for the cure of warts with narrow base and pendulous body, a strong tincture being applied locally and given internally at the same time in 5-minim doses twice daily. Dr. Piffard speaks strongly in its favor as a valuable agent for non-syphilitic warts (condylomata acuminata) of the penis and THYMI OLEUM. vulva, for papillomatous growths in general, and for gleets dependent on granular urethritis. It has been used in chronic gonorrhoea and pros- tatitis with asserted success, and is said to have cured epithelioma. The oil has been employed as a vermifuge. THYMI OLEUM, Oil of Thyme,—is a volatile oil distilled from Thymus vulgaris, Garden Thyme, a common shrub of the nat. ord. Labiatse, indigenous in France but cultivated in our gardens. The oil is a pale yellow or colorless, thin liquid, having a strong odor of thyme, a warm, pungent and afterward cooling taste, and a neutral reaction, of sp. gr. about 0.880, and readily soluble in alcohol. It consists of two por- tions, the more volatile being a mixture of the hydrocarbons Cymene and Thymene, the less volatile being chiefly Thymol, which is official. Thymol, C10H13HO,—is a stearoptene contained in Oil of Thyme and in the volatile oils of several other plants. It occurs in large, colorless, hexagonal crystals, of aromatic odor, pungent taste and neutral reaction ; soluble in 1200 of water, 900 of boiling water, and in 1 of alcohol at 590 F., freely in fats and oils, solutions of chloral and alkalies, ether, chloro- form, etc. It liquefies with camphor. Dose, gr. ss-ij. Unofficial Preparations. Thymol Solution,—for antiseptic spray, 1 in 1000. Thymol Gauze,—contains 1 per cent, of Thymol. Thymol Ointments,—vary from 5 to 30 grains to the . Thymol Inhalation,—Thymol gr. xx, Alcoholis 3 iij, Magnesium Carbonate gr. x, Water to Jjiij. A teaspoonful to a pint of water 150° F. for each inhalation. Volkmann's Antiseptic Fluid,—has of Thymol X, Alcohol io, Glycerin 20, and Water 100 parts. Physiological Action. Oil of Thyme has the same properties as the oils of other mints, and containing a large quantity of Thymol it is similar to the latter in action. Thymol in its action stands between Carbolic Acid and Oil of Tur- pentine. Like the former it is a powerful antiseptic and disinfectant. It is a local irritant and anaesthetic to the skin and mucous .membranes, paralyzing the end-organs of the sensory nerves. When absorbed it para- lyzes the nerve-centres in the spinal cord and in the medulla, lessening reflex action, slowing respiration, lowering the temperature and the arterial tension, and in poisonous doses causing weakness, coma and death. Internally administered in doses of 20 to 30 grains per diem it produces a sensation of epigastric heat, sweating, singing in the ears, deafness, a sense of constriction in the forehead, and increase of the urinary discharge, which assumes a dark, greenish hue. It is eliminated by the respiratory and urinary organs which it irritates considerably during the process of its excretion. As an antiseptic it is much more powerful and permanent than Carbolic Acid and much less poisonous. TIGLII OLEUM. Therapeutics. Thymol is chiefly employed in lieu of Carbolic Acid as an antiseptic for dressing wounds; as a gargle, spray or inhalation in laryngitis and diphtheria; as an ointment in ringworm, eczema and psoriasis, and as an injection in ozaena. A solution of 1 part in 1000 is the strength usually employed. Internally it has been used with success in diphtheria, typhoid fever, and other intestinal affections, diabetes, phthisis and vesical catarrh. Its fragrant odor renders it a very agreeable antiseptic application for ulcerated conditions of the mouth and fauces, but makes it very attractive to flies; which fact, together with its high price, will prevent it becoming a favorite in hospital practice. A solution, used as a mouth-wash, is very efficient in removing the odor of tobacco from the breath. TIGLII OLEUM, Croton Oil, —is a fixed oil expressed from the seed of Croton Tiglium, a small tree of the nat. ord. Euphorbiacese, a native of India. The oil is of a pale or brownish-yellow color, somewhat viscid and slightly fluorescent, of fatty odor, acrid taste and slightly acid reaction; sp. gr. 0.940 to 0.955, soluble in 60 of alcohol, freely in ether, chloroform, or carbon disulphide. Its composition is very complex and has not been thoroughly made out, but it is known to contain the gly- cerides of several fatty acids, also a peculiar acid named Tiglinic Acid, C5H802, which is isomeric with Angelic Acid. Dose of the oil, in pill, emulsion or tincture. Physiological Action. Externally Croton Oil is highly irritant, producing a pustular eruption which heals by scabbing and may leave unsightly cicatrices. Internally it is a powerful drastic cathartic, producing in one or two hours copious watery stools, in overdoses causing great congestion of the intestinal canal and perhaps death from gastro-enteritis. Vomiting usually occurs after large doses, so that the irritant hyper-catharsis is not always observed. It is absorbed into the blood, and produces glandular hypersemia as well as direct inflammation of the intestinal mucous membrane, together with in- creased peristaltic action. Its cathartic power is increased by the addi- tion of an alkali, and is manifested, though in less degree, when applied to the integument. Therapeutics. Croton Oil is used as a hydragogue carthartic when a speedy and com- plete evacuation of the bowels, diminution of arterial pressure and prompt derivative action are desired, as in apoplexy, impaction of the intestines, dropsy, lead constipation, paralysis, etc. It is contraindicated where there is debility, organic obstruction, and inflammatory conditions of the TONGA TRAGACANTHA. 391 stomach and bowels. The smallness of the dose makes it a very easily administered and manageable purgative. A considerable fraction of a drop is absorbed by a pellet of sugar, and may be given thus in repeated doses until the desired effect is obtained. It has been used as a vermi- fuge against tapeworm. Externally it is used as a counter-irritant in pvaritis, bronchitis, pleu- risy, rheumatism, neuralgia, glandular swellings, and in laryngeal and pulmonary diseases. The Linimentum Crotonis of the British Pharma- copoeia contains 1 part of the oil in each of Alcohol and Oil of Caju- put, and is a useful pustulant preparation, being more manageable than the oil itself. TONGA (Unofficial),—is a mixed drug said to be obtained from the Fiji Islands, consisting of thin barks, root-fibres and leaves tied into long bundles. The fibrous material is believed to be derived from Rhaphido- phora vitiensis, a creeping plant of the nat. ord. Aracese, containing starch, potassium chloride and a volatile alkaloid Tongine. The barky portion is referred to Premna tatiensis, a shrub or tree of the nat. ord. Verbenaceae, and contains a little volatile oil, sugar, pectin, etc. A fluid extract is prepared by Parke, Davis & Co. of Detroit, and may be given in doses of nLxxx-3j thrice daily. Tonga was introduced by Drs. Ringer and Murrell as a remedy for neu- ralgia in 1880, stating that they had used it with gratifying results. Since then reports have differed considerably in regard to its efficacy, and from the fact that Dr. Ringer does not mention it in the last edition of his Handbook of Therapeutics, it may be inferred that his further experience with it has not borne out the claims first made. TRAGACANTHA, Tragacanth ,—is a gummy exudation from Astragalus gummifer and from other species of Astragalus, shrubs of the nat. ord. Leguminosse, growing chiefly in the mountainous regions of Asia Minor and Persia. It occurs in shell-like, curved or contorted bands, translucent, faintly yellowish, horn-like, tough, swelling with water to a gelatinous mass, which is tinged blue by test-solution of iodine, and consists of a mixture of Arabin, or gum-arabic, which is soluble in water, and Bassorin, a gum which is insoluble in water but swells up in it, also a little starch. Preparation. Mucilago Tragacanthce,—Tragacanth 6, Glycerin 18, Water to ioo parts. Dose, j or more. Physiological Action and Therapeutics. Tragacanth is demulcent, but in large quantities it may cause indiges- tion. It is chiefly employed to suspend resins and heavy powders in 392 TRITICUM ULMUS—UVA URSI. emulsion. The mucilage may be used as a vehicle for active agents in gargles for pharyngitis, and to cause cohesion in the preparation of pills, troches, etc. It is a constituent of 13 of the 16 official troches, and is a better agent than acacia for making emulsions of cod-liver oil. TRITICUM, Couch-grass,—is the rhizome, gathered in the spring and deprived of its rootlets, of Triticutii repens, the Couch-grass, a peren- nial plant of the nat. ord. Graminaceae, abounding in meadows and cul- tivated grounds, where it ranks as a weed, though of the same genus as wheat. The rhizome is very long, but as met with in the shops is cut into two sections about -|ths inch in length and inch thick, creeping, smooth, hollow in the centre, of straw color, and sweet taste. It contains much sugar and a gum-like principle Triticin. Dose, 5j-3j> in infusion or decoction. Preparation. Extractum Tritici Fluidum,—Dose, well diluted. Couch-grass is demulcent, emollient and a feeble diuretic. It is chiefly used in cystitis and irritable bladder. The infusion is a popular fever- drink in Europe, and has had of old a considerable reputation in dysuria. ULMUS, Elm, Slippery Elm,—is the inner bark of Ulttius fulva, and indigenous tree of the nat. ord. Urticacese, and occurs in flat pieces of various sizes, having a slight, peculiar odor and a mucilaginous, insipid taste. It contains a large quantity of mucilage which it readily parts with to water. Preparation. Mucilago Ulmi,—Elm 6, Boiling Water ioo parts, macerated for two hours and strained. Dose, ad libitum. Slippery-elm bark is demulcent, slightly astringent and somewhat tonic. It is used internally in diarrhoea, dysentery and affections of the urinary passages, and externally in the form of poultice as an emollient applica- tion in cases of inflammation. It is also employed in the dilatation of fistulae, strictures and the os uteri. UVA URSI, Bearberry, —the leaves of Arctostaphylos Uva-ursi, a low, evergreen shrub, of the nat. ord. Ericaceae, inhabiting the northern latitudes and high mountains of Europe, Asia and America. The leaves are small, obovate, nearly sessile, shining, reticulated beneath, of a faint but hay-like odor, and a strongly astringent taste. They contain Tannic VALERIANA. 393 and Gallic Acids and 3 principles, viz.—Arbutin, C24H32014, a bitter glucoside, neutral, crystalline, soluble in warm water and resolvable into glucose and Hydroquinotie, C6H602;—Ericolin, C34H5602, bitter and amorphous;—Ursone, C20H34O2, resinous, neutral, crystalline and tasteless. The Californian Manzanita (Arctostaphylos glauca) is an allied plant and also contains Arbutin and Tannin. Dose of the powdered leaves, gr. x-5j in infusion or decoction. Preparations, Extraction Uva-ursi Fluidum,—Dose, Infusum Uva-ursi (Unofficial),— Dose, §j-ij. Arbutinum, Arbutin (Unofficial),—Dose, gr. iij-v. Physiological Action and Therapeutics. Uva-ursi is astringent, tonic and feebly diuretic. Used in large quan- tity it produces vomiting and purging, and is alleged to have oxytocic power. Arbutin is an efficient diuretic, and is decomposed in the body, yielding Hydroquinone which is excreted by the kidneys as Hydroqui- none-sulphuric Acid. This is non-toxic, imparts a brown color with antiseptic and slightly irritant qualities to the urine. Bear-berry was formerly used in all calculous affections and chronic disorders of the urinary passages. It has some reputation as an antilithic, and is no doubt useful in gravel, chronic nephritis, cystitis, urethritis, and kindred diseases. It relieves incontinence of urine, dysuria and strangury, and has proved serviceable even in uterine hemorrhages. Ar- butin has been successfully employed in cardiac dropsy as a diuretic, also in urethritis. VALERIANA, Valerian, —is the rhizome and rootlets of Valeri- ana officinalis, a large, herbaceous plant of the nat. ord. Valerianacege, having small, white, or rose-colored flowers, and opposite pinnate leaves on an erect, round and channeled stem. The plant is a native of Europe but is cultivated in Vermont and New York. The root is peren- nial, its rhizome about an inch long, upright, truncate at both ends, internally whitish or pale-brownish with a narrow circle of white wood under the thin bark. Odor peculiar, taste camphoraceous and bitter. It contains a complex Volatile Oil, from which are developed by oxidation Valerene C10Hi6, which is a terpene, Valerol or Baldrian Camphor, C12H20O, and Valerianic Acid, C5H10O2, which occurs also in many other plants and in cod-liver oil. The Valerianic Acid of pharmacy is obtained as a product of oxidation of Amylic Alcohol, and from it are formed the various Valerianates. It is, however, not identical with the natural acid. Dose of the powdered root, gr. x-xxx. 394 VALERIANA. Preparations of Valerian. Abstraclum Valeriana,—Dose, gr. v-xx. Extraclum Valeriance Fluidum,—Dose, Ttyx-xxx. Tinctura Valeriance,—Strength 20 per cent. Dose, 3 ss—ij. Tinctura Valeriance Ammoniata,—Valerian 20, Aromatic Spirit of Ammonia to 100 parts. Dose, gss-ij. Oleum Valeriance,—the volatile oil, sp. gr. about 0.950, a greenish or yellowish, thin liquid, having the odor of valerian, an aromatic taste and a slightly acid reaction, readily soluble in alcohol. Dose, Ttyij-v. The Oil is by far the best preparation for use, as the tinctures are extremely nauseous and the fluid extract is too bulky. The taste is best covered by Cinnamon. Ammonii Valerianas, Valerianate of Ammonium, NH4C5H902,—described on page 94. Dose gr. ij-x. Ferri Valerianas, Valerianate of Iron, Fe2(C5H902)6,—described on page 217. Dose, gr- j-iij. Quinince Valerianas, Valerianate of Quinine, C20H24N2O2C5H10O2.H2O,—described on page 177. Dose, gr. j-iij. Zinci Valerianas, Valerianate of Zinc, Zn(C5H902)2.H20,—described on page 404. Dose, gr. iij. The Valerianates 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 pre- pared. Preparations of Valerianic Acid. Physiological Action. Valerian is antispasmodic, and a gentle stimulant to the nervous and circulatory systems. It is sedative to reflex excitability, antagonizing the action of Strychnine, Brucine, Thebaine, etc., and is laxative, diapho- retic and anthelmintic. Its taste and odor are very disagreeable, but cats are extravagantly fond of it. In these animals it greatly excites the sexual appetite, prob- ably from a resemblance between its odor and theirs when under vene- real 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 tempera- ture, in most persons producing exhilaration (in some, slight mental dis- turbance), with formication of the hands and feet. Long used it induces a condition of low melancholy and hysterical depression. Large doses cause hiccough, diarrhoea, nausea and vomiting, frequent micturition with tenesmus of the bladder and lithates in the urine, mental disturb- ance even to delirium, reduced motility and sensibility, and lessened reflex excitability. The oil in large doses is paralyzant to the brain and the spinal cord, lowers the blood-pressure and slows the pulse. The Valerianates follow their bases in general action, but are sup- posed to combine therewith some of the sedative qualities of the acid. Therapeutics. Valerian was formerly much used in epilepsy, but it was probably only useful in the hysterical form of that disease (hystero-epilepsy). It is a valuable remedy in all forms of hysteria, especially when occurring in vanilla—veratrum viride. 395 young and delicate women. It is also useful in flatulence of infants and in that of hypochondriacal and hysterical subjects, and in coughs of nervous type, whooping-cough, diabetes insipidus, convulsions due to worms and in delirium with vital depression. In the coma of typhus fever the oil proved remarkably efficient in a series of 135 cases out of 172 cases treated by it. Valerianate of Ammonium is used in the same class of disorders as is Valerian. It is often a good remedy for nervous headache, administered in 10-grain doses and in an elixir. Valerianate of Zinc has been supposed to combine the antispasmodic power of valerian with the nerve-tonic effect of a zinc salt. It has been used in cholera, epilepsy and neuralgia, frequently with considerable success. The Valerianates of Iron and Quinine are used as the salts of their respective bases. VANILLA ,—is the fruit of Vanillaplanifolia, a perennial, climbing plant of the nat. ord. Orchidacese, a native of the West Indies and trop- ical America, but cultivated in Java, etc. It has dark green, tough leaves, pale greenish-yellow sessile flowers, and long pods (6 to io inches), wrinkled, warty, one-celled, containing a blackish-brown pulp with numerous small seeds and acicular crystals, of peculiar and fragrant odor and taste. Its characteristic odorous principle is Vanillin, or the methyl- ether of protocatechuic aldehyd, which oxidizes slowly in damp air to Vanillic Acid, and may be resolved into methyl chloride and proto- catechuic acid. Vanillin may be made synthetically from Coniferin or from Eugenol. Dose, indefinite. Tinctura Vanilla,—io per cent. Dose, a few drops according to the strength of flavor desired. Trochisci Ferri,—contain about fa per cent, of Vanilla. Preparations. Vanilla is an aromatic stimulant, with considerable influence on the nervous system. It is chiefly employed as a perfume and for flavoring purposes, but has been used in hysteria and low fevers. VERATRUM VIRIDE, American Hellebore,—is the rhizome and rootlets of Veratrum viride, or Indian Poke, Poke-root, Swamp Hellebore, an indigenous plant of the nat. ord. Melanthaceae, having a solid, round stem, furnished with bright green leaves, and terminating in a panicle of greenish-yellow flowers. The root is perennial, upright, 396 VERATRUM VIRIDE. externally blackish-gray, internally grayish-white, 2 to 3 inches long, with numerous, shriveled rootlets, inodorous but sternutatory when powdered, taste bitter and very acrid. It contains several alkaloids, fervine, C26H43N02, Pseudo-jervine, C29H43N07, Cevadine, C32H49N09, a very little Rubijervine, C26H43N02, and traces of Veratrine, C37H53NOu, and Vera- tralbine, C28H43N05. Veratroidine, formerly regarded as one of its alka- loids, is now thought to be Rubijervine and Resin. Veratrum Viride also contains Gallic Acid and Sugar. Allied Plants. Veratrum Album, White Hellebore,—is a native of the mountainous regions of continental Europe, and so closely resembles V. Viride in appearance and characteristics that it may be considered a variety of the same plant. The rhizome was official in the U. S. P. 1870. It con- tains the alkaloids Jervine, Pseudo-jervine, Rubijervine, traces of Cevadine, and another powerful alkaloid Veratralbine, C28H43N05. Veratrum Sabadilla, Cevadilla, Asagrsea officinalis,—is a bulbous plant of the nat. ord. Melanthacese, indigenous in Mexico and Central America. It contains the alkaloids Cevadine (formerly called Veratrine), Cevadilline and Veratrine, with Veratric and Sabadillic or Cevadic Acids. It is the source of the official Veratrine (see below). The seeds are official in the Br. Phar. under the title Sabadilla. Extractum Veratri Viridis Fluidum,—Dose, rry-iv. Tinctura Veratri Viridis,—50 per cent. Dose, tt^ij-x. Norwood's Tincture of Veratrum Viride, has a very high reputation for efficiency,— Dose, rrpv, increased by Tt\j every 3 hours, until pulse is down to 65, when the original dose will hold it there. Veratrina, Veratrine,—is an alkaloid or mixture of alkaloids prepared from the seeds of Asagrcea officinalis (see above). A white, or grayish-white, amorphous powder, highly irritant to the nostrils, of very acrid taste, producing tingling and numbness of the tongue and constriction of the fauces; slightly soluble in cold water, soluble in 3 of alcohol at 590 F., in 6 of ether, 2 of chloroform, 96 of glycerin and in 56 parts of olive oil. Dose, err 1-1 Sr- XT. XT’ Unguentum Veratrince,—Veratrine 4, Alcohol 6, Benzoinated Lard 96 parts. For local use. Oleatum Veratrince,—Veratrine 2, Oleic Acid 98 parts. For local use. Preparations. Physiological Action. Veratrum Viride is in action closely allied to Aconite, being a pow- erful cardiac depressant 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 motor 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. VERATRUM VIRIDE. 397 In small doses Veratrum reduces the force of 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 symp- toms very much, the pulse becoming very rapid and so small as to be almost imperceptible ; the skin is cold and clammy, and constant vomit- ing, extreme debility, giddiness, impaired vision, and partial unconscious- ness 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 irri- tates 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 vomiting 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 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 congener, but it is much more irritant to the gastro-intestinal mucous membrane, causing violent vomiting and purging, intense abdom- inal and oesophageal pain, greatly reduced temperature and pulse, collapse, and death from cardiac and respiratory paralysis. Veratrine is an acrid, intensely irritant powder, probably consisting of a mixture of alkaloids. It causes violent sneezing, a burning sensa- tion, and free salivation. It affects the heart and circulation similarly to the other Veratriae 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. Antagonists and Incompatibles. Alcohol, Opium, Belladonna and Ammonia counteract the cardiac depression. Mor- phine and Atropine should be administered hypodermically, or Laudanum internally with alcoholic stimulants, the recumbent position should be enforced, and dry heat applied to the body. Caustic alkalies are incompatible, as they decompose the alkaloids. VERBASCUM. Therapeutics. Veratrum Yiride is inferior to Aconite in most of the fevers and inflammations, by reason of its lacking power over excretion. It renders good service, however, in the early stages of many parenchymatous and serous inflammations when occurring in sthenic subjects, especially in pneumonia. It is highly esteemed in puerperal fever and in many cardiac disorders, as simple hypertrophy, irritable heart, etc. It has been used with remarkably good results in many cases of acute mania and puerperal convulsions, and it is of service in aneurism to depress the circulation to the lowest point, but in this case the recumbent position must be strictly observed in order to secure safety. It should always be administered in small doses and its effects carefully watched. In puerperal eclampsia large doses have been administered without danger and with decided benefit, as much as 20 drops of Norwood’s tincture having been administered every hour for 5 consecutive days and nights in one case, the patient making a good recovery. The same pre- paration may be given hypodermically, in doses of npij-iv. Veratrum Album is the “ Hellebore ” of the ancient physicians, and was much used by them as a derivative in insanity. It is rarely used at present except by the homoeopathists, who give it in the cold stage of cholera, in colic, in the vomiting and purging of summer diarrhoea, in whooping-cough and asthma. Veratrine is chiefly used externally. The ointment or oleate may be used with benefit in many cases of superficial neuralgia, myalgia and headaches, a small quantity being rubbed in over the seat of the pain. It may be absorbed through an abrasion of the cuticle and give rise to dan- gerous symptoms. Internally it has been employed as a cardiac sedative in fevers and inflammation, also in acute articular rheumatism, dropsies, dysmenorrhoea and various nervous affections, but its uncertainty of action and the dangerous depression which it may produce have caused it to lose favor as an internal remedy. VERBASCUM, Mullein (Unofficial),—the leaves of Verbascum Thaspus, the Mulle'in-weed, a common plant of the nat. ord. Scrophu- lariacse, having large woolly leaves and yellow flowers in dense spikes. Its chief constituent is mucilage, though the flowers contain an essential oil in very small proportion. An infusion of Siv of fresh leaves to the pint of milk is the form in which it has generally been given; this quan- tity to be taken thrice daily. Physiological Action and Therapeutics. Mullein is emollient and demulcent, perhaps also slightly anodyne. It has long been a popular Irish remedy in pulmonary affections, as under VIBURNUM VIOLA TRICOLOR. 399 its use the weight steadily increases in phthisis and other wasting dis- orders, while expectoration is rendered more easy, cough is palliated and the general condition improved. It is also recommended in cystitis, irritable bladder, and diarrhoea, and is employed as an enema in dysen- tery and as a poultice for hemorrhoids. The dried leaves may be smoked with benefit in aphonia from laryngeal irritation. VIBURNUM, Black Haw ,—is the bark of Viburnumprunifolium, an indigenous shrub or small tree of the nat. ord. Caprifoliaceae, having sharply serrulate leaves, and small, white flowers in terminal cymes. The bark occurs in glossy, purplish-brown, thin pieces or quills covered with scattered warts and minute black dots; inner surface whitish and smooth, inodorous, somewhat astringent and bitter. It contains tannic, oxalic, citric and malic acids, sulphates and chlorides ; also two resins, one of which is named Viburnin, and Viburnic Acid, which is identical with Valerianic Acid. Preparation. Extradum Viburni Fluidum,—Dose, 3 ss-ij. Viburnum is considered to possess nervine, antispasmodic, astringent, diuretic and tonic properties, and to be especially useful in preventing abortion in the nervous diseases of pregnancy, and in dysmenorrhoea. It may be administered with cannabis indica, morphine, nerve-sedatives or simple aromatics. No exact observations have been made regarding its action, and its therapeutical claims are denied by many who have used it. It often excites nausea and vomiting. Viburnum Opulus, Cramp-bark, Cranberry-tree,—another shrub of the same genus, is highly valued by many practitioners as a remedy in uterine and other abdominal pains, but is not official. The so-called “ Viburnum Compound of Dr. Hayden,” is stated by its manufacturers to consist of “ the active principles of the Viburnum Opulus, Dioscorea Vil- losa, Scutellaria Lateriflora, and a combination of aromatics, prepared by a process peculiar to ourselves.” This they call publishing the formula of the preparation. Physiological Action and Therapeutics. VIOLA TRICOLOR, Pansy,—is the wild-grown, flowering herb of Viola tricolor, the Heart’s-ease Pansy, a plant of the nat. ord. Violacese, native in Europe, but naturalized in the southern U. S. It has an angu- lar and nearly smooth stem; leaves alternate, petiolate, ovate or oblong and crenate; flowers with an obtuse spur and variegated petals, inodor- ous, taste somewhat bitter and acrid. It contains an active alkaloid 400 VISCUM—VITELLUS. Violine, allied in many respects to Emetine, and poisonous. There are no official preparations. Dose, gr. x-5j, in decoction. Viola is mucilaginous, emollient, expectorant and slightly laxative. Its active principle is emeto-cathartic, but exists in very small quantity in the plant. A decoction of the fresh herb in milk, with a poultice of the same was formerly highly recommended in crusta lactea and impetigo. It is used with benefit in some forms of eczema, especially in that of the head and face, and has had some reputation in bronchitis and constitu- tional syphilis. Viola Cucullata, the common Violet, is used in Pennsylvania with success as an internal antidote against rattlesnake venom. The leaves are eaten, and a poultice of salt and indigo is applied to the wound. Physiological Action and Therapeutics. VISCUM, Mistletoe (Unofficial),—occurs in two species (1) Vis- cum album, the European Mistletoe, a small, parasitic, evergreen shrub, of the nat. ord. Loranthacese, growing chiefly on deciduous-leaved trees, and (2) Viscum flavescens, the American species, growing on oaks, elms, etc. They contain mucilage, starch, fixed oil, resin, salts, etc., and Viscin, or Bird-lime, which occurs also in Ilex aquifolium, Gentiana lutea and other plants. Dose, gr. x~5j in decoction, or npv-xxx of a ten per cent, tincture. The berries of the mistletoes have produced emeto-catharsis, with great thirst, tenesmus, bloody-stools, convulsions and even death in young chil- dren. The leaves and twigs have been used in epilepsy, hysteria, chorea, asthma and other nervous affections. The American plant is asserted to possess qualities similar to those of Digitalis, and to incite uterine con- tractions. It has been used in cardiac affections, dropsies, uterine hemorrhages and amenorrhoea, also as an abortifacient. Physiological Action and Therapeutics. VITELLUS, Yolk of Egg,—is the yolk of the egg of the domes- tic fowl, Gallus Bankiva, var. domesticus. It is a viscid, reddish-yellow, opaque liquid, of bland taste, alkaline reaction, odorless, and may be re- garded as a dense emulsion of oil suspended in water by means of albu- men. It is coagulated by heat or by alcohol and contains Vitellin, which is a proteid related to casein, Cholesterin and Albumin, besides fat, inor- ganic salts, sugar, etc. Preparation. Glyceritum Vitelli, Glycerite of Yolk of Egg, Glyconin,—consists of Vitellus 45, Gly- cerin 55 parts rubbed together until thoroughly mixed. xanthoxylum. 401 Physiological Action and Therapeutics. Yolk of Egg is highly nutritive and forms a useful article of diet in exhausted conditions of the system, but its chief use in medicine is for emulsionizing oils and camphors. The Glycerite has the consistence of honey and forms an opaque emulsion with water. It is a very good vehicle for cod-liver oil (see ante, page 282), and an excellent protective application for burns, erysipelas, fissure of the nipples and many cutane- ous disorders. It is also used as a cosmetic, and may be employed as an aliment. XANTHOXYLUM, Prickly Ash,—is the bark of Xanthoxylum fraxineum, the northern species, and of Xanthoxylum carolinianum, the southern species of an indigenous shrub of the nat. ord. Rutacese, having small, greenish flowers, alternate unequally pinnate leaves, leaflets punc- tate with pellucid dots, stems and leafstalks armed with prickles. The bark of both species comes in curved or quilled fragments, of a brownish- gray color externally with whitish patches, and minute black dots, faintly furrowed, inodorous, bitter and pungent. That of X. fraxineum is about inch thick, has several two-edged spines each inch long, the bark of X. carolinianum is twice as thick as the other and is marked by many conical, corky projections, and by stout brown spines, arising from corky bases. It contains a volatile oil, a fixed oil, resin, gum, coloring matter and an alkaloid, Xanthoxyline, which is identical with Berberine (see ante, page 130). Dose, of the powdered bark, gr. x-xxx. Preparations. Extractum Xanthoxyli Fluidum,—Dose, 3 ss-j. Decoctum Xanthoxyli (Unofficial),— j to the quart. Dose, a pint during 24 hours in divided doses. Physiological Action. Xanthoxylum is a stimulant and aromatic bitter, a local and systemic sialagogue, diaphoretic, diuretic and emmenagogue. Its taste is aromatic, soon becoming acrid and bitter and causing profuse salivation, tingling in the tongue and increased secretion from stomach, intestines, liver and pancreas. It also increases the cardiac action and raises the arterial ten- sion, and is classed among the vegetable alteratives, with Mezereum, Guaiac, Stillingia, etc. Therapeutics. Xanthoxylum has a high reputation in chronic rheumatism, myalgia, lumbago and similar disorders, also in jaundice from catarrh of the bile- ducts, in dropsies, chronic pharyngitis and constitutional syphilis. In old cases of pharyngitis, the mucous membrane being glazed and dry, the decoction should be used as a gargle and of the fluid extract 402 ZEA MAYS. taken internally thrice daily. The bark, used as a masticatory, is a popu- lar remedy for toothache, and has been frequently successful in paralysis of the tongue. ZEA MAYS, Maize, Indian Corn.—This well-known species of the nat. ord. Graminacese, though itself unofficial, is the source of two drugs one of which is official, viz.:— Ustilago, Corn Smut,—Ustilago Maydis, nat. ord. Fungi, grown upon the stems, the pistils and the male inflorescence (tassel) of Zea Mays. It occurs in irregular, globular masses, sometimes 6 inches thick, and con- sisting of a blackish membrane, inclosing numerous globular, minute spores, their surfaces covered with echinulate warts. Its odor and taste are unpleasant, and it contains fixed oil, resin, pectin, gluten, sugar, an acid resembling the Sclerotic Acid of Ergot, and a volatile principle called Secaline, which is supposed to be identical with Trimethylamine. Preparation. Extractum Ustilaginis Fluidum (Unofficial),—may be made according to the general rule. Dose, rr^xv-^j. Stigmata Maydis, Stigmata of Maize, Corn Silk (Unofficial),— should be gathered when the tassel has well shed its pollen. Its active principle is said to be Maizenic Acid. Preparation. Extractum Stigmatarum Maydis Fluidum (Unofficial),—made by the general rule for fluid extracts. Dose, gj-ij. The properties of Ustilago, so far as examined, resemble those of Ergot and Nux-vomica combined. It is a spinal excitant, exalts sensibil- ity and reflex action, producing tonic convulsions on the least irritation of the skin. It slows the heart by stimulation of the pneumogastric, dilates the pupils, causes muscular paresis, and death by tetanus of the respiratory muscles or by exhaustion. Experiments on its reputed oxy- tocic action have not substantiated the claims made for it in this respect, though it is said to have produced abortion in cows and other animals, after they had eaten the diseased grain. As a therapeutic agent Ustilago has been very little used, and when employed it has been as a substitute for Ergot. Stigmata Maydis is a certain but mild diuretic when given in full doses at short intervals. It is by some observers considered demulcent and anodyne, and is generally believed to have a specific or alterative influence over many disorders of the genito-urinary passages and the Physiological Action and Therapeutics. ZINCUM. 403 urinary bladder. It has been used with considerable success in inconti- nence of urine, uric and phosphatic gravel, gout, rheumatism, urethritis, pyelitis, acute and chronic cystitis, cardiac dropsy and obstructive valvu- lar disease of the heart. ZINCUM, Zinc, Zn,—is metallic Zinc, in the form of thin sheets, or irregular, granulated pieces, and is a bluish-white metal, having the sp. gr. 6.9. It occurs native as a Sulphide (Blende), as a Carbonate and a Silicate (Calamine), as a Red Oxide {Zincite), and as a mixture of Zinc Oxide with Oxide of Iron and Manganese (.Franklinite). Zinc is soluble in the weakest acids, and therefore should never be used for culinary ves- sels. Its salts are all more or less active poisons. Metallic Zinc is not employed as a medicine. Zinc Compounds and their Preparations. Zinci Acetas, Acetate of Zinc, Zn(C2H320)2.3H20,—soft, white, micaceous or pearly, six-sided tablets or scales, somewhat efflorescent in dry air, of faintly acetous odor, sharp metallic taste and a slightly acid reaction; soluble in 3 of water and in 30 of alcohol at 590 F., in 1 ]/2 of boiling water and in 3 of boiling alcohol. Used locally as an astrin- gent in solution of gr. j or ij to gj, or internally in doses of gr. ]/z-ij. Zinci Carbonas Prcecipitatus, Precipitated Carbonate of Zinc, (ZnC03)2.3Zn(H0)2,— a white, impalpable powder, permanent in the air, odorless and tasteless, insoluble in water or alcohol, but soluble in acids with copious effervescence. When strongly heated it loses water and carbonic acid gas, leaving a residue of oxide of zinc. Used locally as a protective. Zinci Chloridum, Chloride of Zinc, ZnCl2,—a white, crystalline powder, deliquescent, odorless, of caustic, saline, and metallic taste and acid reaction, very soluble in water and in alcohol, forming a clear or only faintly opalescent solution. Tonic and escharotic. For internal use a solution in Spirit of Ether is the most convenient form, of the strength of of which from 4 to 8 drops maybe given twice daily. Strength of injec- tions and collyria, gr. j-ij ad Jjj. Liquor Zinci Chloridi,—an aqueous solution of Zinc Chloride containing about 50 per cent, of the salt. A clear, colorless, odorless liquid, of a very astringent, sweetish taste and an acid reaction. A powerful disinfectant for sinks, drains, etc. Used also as an injection in gonorrhoea, leucorrhoea, etc., in dilute solution, yz to 1 per cent. Burnett's Disinfecting Fluid is similar to the above but slightly stronger. Zinci Iodidum, Iodide of Zinc, Znl2,—a white, granular powder, very deliquescent, odorless, of sharp, saline and metallic taste and acid reaction, very soluble in water and in alcohol. Dose, gr. ss-ij in syrup. Zinci Oxidum, Oxide of Zinc, ZnO,—a soft, pale-yellowish powder, permanent in the air, odorless and tasteless, insoluble in water or alcohol, but soluble in acids without effer- vescence. Dose, gr. j-x, in pill. Unguentum Zinci Oxidi,—strength 20 per cent., made with Benzoinated Lard, thor- oughly mixed. Zinci Sulphas, Sulphate of Zinc, ZnS047lI20,—small colorless prisms or acicular needles, slowly efflorescing in dry air, odorless, of sharp, saline, nauseous and metallic taste and acid reaction, soluble in 0.6 of water, insoluble in alcohol. Dose, as emetic, gr. x-xxx,—as a tonic and astringent, gr. in pill. For Villate's Solution, see ante, page 195. Zinci Valerianas, Valerianate of Zinc, Zn(C5H902)2.H20,—soft, white, pearly scales, of sweet and styptic taste and acid reaction; soluble in 100 of water and in 40 of alco- hol at 590 F. Dose, gr. in pill. [The Bromide of Zinc is described under Bromum, see page 133, and the Phosphide under Phosphorus, on page 305.] 404 ZINCUM. Physiological Action and Therapeutics. Zinc Salts are astringents, but milder ones than the salts of Lead. Its ' soluble compounds (the Chloride, Iodide, Sulphate and Acetate) are cor- rosive poisons, causing violent gastro-enteritis, and in some cases pro- found nervous depression. The Chloride is a very powerful and pain- ful escharotic or rather mummifier of the tissues, having great affinity for water, coagulating albumen and shrivelling the vessels. It is a very active disinfectant. The Sulphate is also escharotic and a specific emetic, acting promptly by direct irritation of the stomach, and without much depression or after-nausea. In small doses it is tonic and astrin- gent, in larger it would be a severe irritant but for its causing prompt emesis. The Acetate resembles the sulphate in action. The Oxide used externally is a mild, soothing astringent; used internally it enters the blood as a lactate or chloride, and acts as a mild astringent and as a nervous sedative. Being almost insoluble in the stomach, it has but feeble diffusive power and consequently but slight activity. The Carbonate resembles the Oxide in action. The Iodide locally is a powerful eschar- otic and has been supposed to possess some alterative powers when given internally in addition to its astringent qualities as a zinc salt. The Valerianate acts as a nervous sedative, but its properties are in all proba- bility due to its base and not to the acid combined with it. Continued use of zinc salts produces symptoms similar to those of chronic lead-poisoning, but of much less gravity. They manifest much less tendency to accumulate in the system than other metallic salts, and are excreted much more rapidly. Elimination takes place chiefly by the liver and intestinal glands. [The actions of the Bromide and Phosphide are described respectively on pages 134 and 305.] Lime-water, mucilaginous drinks, soap, tannic acid, milk, Potassium and Sodium Car- bonates if given early, are the antidotes in poisoning by the salts of zinc. Incompatibles are—lime-water, alkalies and their carbonates, nitrate of silver, and vegetable astringents. Acetate of Lead produces double decomposition with zinc salts, but it is often used in solution with the sulphate as an injection. Antidotes and Incompatibles. Therapeutics. Zinc salts are chiefly employed in weak solution as mild astringent applications in catarrhs of mucous membranes, such as conjunctivitis, gonorrhoea, etc., and as unguents and lotions in skin-diseases, particularly eczema, impetigo, herpes, and erythema. The Chloride is made into a paste with flour and glycerin for the destruction of lupus, epithelioma and other morbid growths, and for opening abscesses in locations where punc- ture or incision might be dangerous. The cuticle, if unbroken, should be removed by strong water of ammonia before the paste is applied, as it ZINGIBER. 405 will not act through the epidermic tissue. It is a commonly used disin- fectant and deodorant, and in weak solution (npiij-v of the Liquor to 3j of water) makes a good lotion for putrid ulcers, and still weaker (gr. j-ij to the pint), is an excellent injection for gonorrhoea. The Iodide is not em- ployed as an escharotic, nor has it ever been a favorite remedy for internal use. It is chiefly employed in solution as an application to enlarged tonsils, and as an ointment (i part to 8 of lard) for the reduction of glandular enlargements. The Sulphate is used locally as an astringent to mucous surfaces generally, internally as an emetic in narcotic poisoning and croup, and in small doses as a tonic and antispasmodic in convulsive diseases, as chorea, hysteria, epilepsy, angina pectoris, asthma, etc. In diarrhoeas and dysentery it is a good astringent, and is frequently combined with Opium and Ipecac. The Acetate is used for the same purposes as the Sulphate, but is usually preferred for collyria. The Oxide may be used as a dusting powder in intertrigo, and as an ointment in eczema and excoriated surfaces generally. In combination with Bismuth and Pepsin it is an excellent remedy for the summer diarrhoea of children, and with Aromatic Powder and Morphine it is very efficient in gastralgia. It is a good remedy in 3-grain doses for the night-sweats of phthisis, and has been successfully employed in epilepsy and neuralgia, in whooping-cough, hysteria, nervous headache and in bronchorrhoea to check the profuse secretion. It is much employed as an ingredient of cosmetics. The Carbonate is by some preferred to the oxide for local use in skin diseases. Calamine Ointment, which is a mixture of the impure carbonate (cala- mine) with the oxide and an unguent basis, was until recently a favorite application as a soothing protective to abrasions and inflammations of the integument. The Valerianate has been used in chorea, epilepsy, neu- ralgia and various anomalous nervous affections, such as the nervous head- ache of hysterical women, nervous coughs and aphonia due to uterine and ovarian irritation. [The Bromide and Phosphide are used entirely with reference to their respective non-metallic bases, under which titles their therapeutics are described.] ZINGIBER, Ginger, —is the rhizome of Zingiber officinale, a plant of the nat. ord. Zingiberaceae, having dingy-yellow flowers on a leafless flower-stalk, and long, lanceolate leaves on a separate stem. The plant is a native of Hindostan, but is cultivated in Jamaica, Sierra Leone, etc. The rhizome is about f inch broad, flattish, on one side lobed or clavately branched, of a pale-buff color, striate, agreeably aromatic and of a warm, pungent taste. It breaks with a mealy, fibrous fracture showing numerous small resin-cells and fibro-vascular bundles. It contains an aromatic, vola- tile oil and a resin. 406 ZINGIBER. Preparations. Extractum Zingiberis Fluidum,—Dose, 5 ss. Tindura Zingiberis,—20 per cent. Dose, £ ij. Syrupus Zingiberis,—has of the fluid extract 2 per cent, in sugar and water. Dose, 3ss-ij. Trockisci Zingiberis,—each troche contains of the tincture 2 grains, with Tragacanth, Sugar and Syrup of Ginger. Oleoresina Zingiberis,—contains all the virtues of the root, and is extracted by ether. Dose, weU diluted. Ginger is also a constituent of Pulvis Aromaticus, Pulvis Rhei Compositus and Vinum Aloes. Physiological Action and Therapeutics. Ginger is sialagogue when chewed, sternutatory when inhaled, and externally a rubefacient. Internally it is a grateful stimulant and carmina- tive, produces a sensation of warmth at the epigastrium and promotes the expulsion of flatus. It is employed as a carminative in colic, as a masti- catory to increase the secretion of saliva and in relaxed conditions of the throat, also internally in atonic dyspepsia, to relieve flatulence, and as an adjunct to purgative agents to correct their griping properties. The syrup is in common use as a flavoring adjuvant in prescriptions. PART II. PHARMACY AND PRESCRIPTION WRITING. Pharmacy ( oz. gr- I == 16 = 7000 i = 437/4 The Troy ounce contains 42 y2 grains more than the avoirdupois ounce, but the Troy pound contains 1240 grains less than the avoirdupois pound. The grain is the only unit common to both. 436 WEIGHTS AND MEASURES. Table of Apothecaries' or Wine Measure. Gallon. Pint. Fluidounce. Fluidrachm. Minim. Congius. Octarius. Fluiduncia. Fluid rack ma. Minimum. c. 0. 8 = i = 11 II II Wtfg'S ~ II II II W- O l-H II II II "1 61440 7680 480 60 Table of British Imperial or Pharmacopoeial Measure. Gallon. Pint. Fluidounce. Fluidrachm. Minim. Congius. Octarius. Fluiduncia. Fluidrachma. Minimum. c o floz. fldr. min. 1=8 = 160 = 1280 = 76800 i = 20 = l6o = 9600 I = 8 = 480 I = 60 The Metric, or Decimal System of Weights and Measures, is generally used on the continent of Europe, and also by French and German physicians in the United States. Its three standard units are the following, viz.— A Meter, the standard unit of linear measure and also of the whole system, is the ten- millionth part of the quadrant of the earth, i. e., the forty millionth part of the earth’s circumference around the poles. One-tenth of the meter is the Decimeter, one hundredth is the Centimeter, and one-thousandth is the Millimeter. A Liter, the unit of measure of capacity, is the cube of a decimeter. One-thousandth of a liter is the Cubic Centimeter, which measure of pure water at its maximum density weighs one Gramme A Gramme, the unit of weight, is the weight of the one thousandth part of a liter of water at its maximum density. Its tenth is the Decigramme, its hundredth is the Centi- gramme, and its thousandth part is the Milligramme. The metric measures above noted are those used chiefly in pharmaceu- tical practice, but the system embraces many other terms of increase which are set forth in the following table. IOOOO Myriameter. IOOOO Myrialiter. 10000 Myriagramme. IOOO Kilometer. IOOO Kiloliter. IOOO Kilogramme. IOO Hectometer. IOO Hectoliter. IOO Hectogramme. IO Dekameter. 10 Dekaliter. 10 Dekagramme. I Meter. 1 Liter. 1 Gramme. .1 Decimeter. .1 Deciliter. .1 Decigramme. .01 Centimeter. .01 Centiliter. .01 Centigramme. .001 Millimeter. .001 Cubic Centimeter. .001 Milligramme. or Milliliter. The relations between the Metric Weights and Measures and the Apothe- caries’ are as follows, viz.— I meter = 39.370432 inches. 1 liter = 2.113433 pints. I gramme = 15.43234874 grains. 1 grain = 7 06479895 gramme. 1 minim = 0.0161613 cubic centimeter. WEIGHTS AND MEASURES. 437 The Metric System is making way but slowly in this country although its progress is aided by every process of forcing which scientific bodies can bring into action, and it remains to be seen how much its adoption in the last edition of the U. S. Pharmacopaeia will influence the medical profes- sion in its favor. With all the influence brought to bear in its favor it certainly has not yet been adopted by any considerable proportion of native-born and home-educated physicians and pharmaceutists. Its chief disadvantage is one which is inherent to any decimal system, viz.—that the number ten cannot be divided more than once without producing a fraction. This is partly compensated for by the practice of dividing five into the three parts of 2, 2 and 1, and on this principle metric weights are usually con- structed. In writing or reading prescriptions it is sufficiently accurate to consider a gramme as equivalent to 15 Troy grains, and a cubic centi- meter (milliliter) as equivalent to 15 minims, or one-fourth of a flui- drachm. All other terms, units or prefixes belonging to the metric system may be wholly ignored by the physician and the 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 misplacement of a point, the dropping of a spot of ink or the intrusion of a fly-speck. The simplest method of writing a metric prescription for one not practiced in the system is to first write for one dose of the medicine in grains and minims, then by substituting the same number of grammes and cubic centimeters (fluidgrammes) we get fifteen doses in metric terms. Of course when a mixture or solution is desired the proper quantity of vehicle must be added to give the dosage in such measures as may be deemed convenient for administration. For ex- ample,— One dose. 15 doses metric. R. Quininse Sulphatis gr. j, I Strychninse Sulph., gr. or 0.016, 016 Ext. Glycyrrhizae FI TtQvj 4 Syrupi, 60] This gives a two-ounce mixture approximately, of which the dose would be “ a tea- spoonful thrice daily.” One dose. 15 doses metric. R. Quinines Sulphatis, gr. j, 1 Massse Ferri Carb., gr. ij, 2 Ext. Nucis Vomicae, gr. or 0.25, 25. Ft. pil. No. xv. Sig.—One pill thrice daily after meals. 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 considered equivalent to 0.05 cubic centimeter (or gramme), the average teaspoonful to 5 c. c., the tablespoon- 438 WEIGHTS AND MEASURES. ful to 20 c. c., the Troy § to 30 grammes, the fluidounce to 30 c. c., and 8 fluidounces to 250 c. c. In prescribing Syrups or Chloroform, each Troy fluidounce should be reckoned at something more than 30 grammes—say 40; and if this be done, the difficulty of converting one scale into the other will be obviated. As to Syrups, Chloroform, etc., the following table shows the actual weight in grammes of each fluidounce of the substances named : Fluid Oz. Water. (Grammes.) Tinctures. (Grammes.) Syrup. (Grammes.) Chloroform. (Grammes ) Ether. (Grammes.) k »• = 29.52 28.00 38.OO 43-7° 22.14 = S9'°4 56 OO 76.OO 84.40 44.28 = 118.08 112.00 152.OO 174.80 88.56 gviii. = 236.16 224.OO 304.OO 349.60 177.12 A table of equivalents between Apothecaries’ and Metric Weights and Measures will be found in the Appendix. Approximate or Domestic Measures become necessary in appor- tioning doses for a patient, when liquid medicines are used. Of these the measure most commonly employed is the teaspoonful, which is gener- ally taken as equivalent to a fluidrachm, though in most cases as now manufactured the teaspoon contains about 75 minims, or 25 per cent, more than the theoretical quantity. The dessertspoonful is about equal to 2 teaspoon fuls, and the tablespoon ful to about 4 teaspoonfuls or fgss, while the wineglass is supposed to contain about f5ij. The use of gradu- ated medicine glasses is strongly recommended instead of the above approximate measures. They may be obtained at a trifling cost in any well-stocked drug-store. Drops (Guttae) are very variable in size, though popularly supposed to equal minims, the variations in their relative dimensions being due to the viscidity of the liquid, the shape and surface of the orifice from which they escape, and sundry other circumstances. The Syrups and Mucilages produce large drops while Bromine, Chloroform and other heavy mobile liquids produce very small ones. These differences are well illustrated in the following table which gives the number of drops in a fluidrachm of several liquids of certain classes. [See the Appendix fora fuller table.] Syrupus Acacise, 44. Syrupus Scillse, 75. Aqua, 60. Liquor Potassoe, 62. Liquor Hydrargvri Nitrat., 131 Acetum Opii, 90. Vinum Opii, xoo. Tinct. Opii Deodorat., IIO. Tinct. Opii Camph., no. Tinct. Opii, 130. Tinct. Iodi, 148. Tinctura Aconiti, 146. Alcohol Dilutum, 137. Alcohol, 146. Oleum Ricini, 77. Oleum Copaibae, 123. Oleum Juniperi, 148. Spiritus Camphorse, 143. Spiritus Chloroformi, 150. Ext. Digitalis Fluid., 134. Ext. Ipecac. Fluid., 120. Ext. Cinchonse Fluid., 138. Ext. Zingiberis Fluid., 142. Ext. Buchu Fluid., 150. Ext. Hyoscyami Fluid., 160. blither Fortior, 176. Bromum, 250. Chloroform Purif., 250. PRESCRIPTIONS. 439 Specific Gravity is the relative weight of equal bulks of different bodies. The specific gravity of water at a certain temperature (generally 590 F.) is taken as 1, and that of all other substances is expressed in terms of this unit. The Pharmacopoeia gives very complete tables of percentages and specific gravities of Alcohol, Acetic, Hydrobromic, Hydrochloric, Nitric, Sulphuric and Phosphoric Acids, and of aqueous solutions of Po- tassa and Soda. The specific gravity of any substance is expressed by the quotient obtained by dividing the weight of a given measure of the sub- stance by the weight of an equal measure of water. In pharmacy the specific gravity of solids is not of any importance, but that of liquids is a matter of constant value, and is determined in most cases by means of a specific gravity bottle or by a hydrometer, instruments which are described in any standard work on chemistry or physics. Modifications of the hydrometer with scales adapted to particular work are the urinometer, saccharometer, lactometer, etc. Specific Volume is the relative bulks of equal weights of different bodies. In pharmacy it means the volume of the weight of a liquid com- pared with the volume of an equal weight of water at 590 F. The specific volume of a body is therefore inversely as its specific gravity, and is ex- pressed by the quotient obtained by dividing unity by the specific gravity. = Sp. vol. and therefore sp. gr. X sp. vol. = 1. [A table of the specific gravity and specific volume of several liquids will be found in the Appendix.] PRESCRIPTIONS. Extemporaneous Prescriptions are formulae written by the phy- sician 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 designed, and the date on which it is written. Then follows the Latin word Recipe, usually abbreviated to the sign R, and signifying “Take,” or “Take thou;” next the names and quantities of the ingre- dient 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 consists of four parts, viz. :—the Superscription,—consisting of the name of the party, the date and the sign & . Inscription,—the body of the prescription, which may consist of the— Basis,—or chief, active ingredient. Adjuvant—to assist the action of the basis. Corrective,—to correct some injurious quality of the other ingredients. Vehicle or Excipient,—giving it a suitable form. 440 PRESCRIPTIONS. Subscription,—the directions for the compounder, usually expressed in contracted Latin. Signature,—The instructions for the guidance of the one administering the medicine, in English, followed by the signature of the prescriber. A prescription may, however, contain the base alone, or the base with the adjuvant, or the base with a simple vehicle or diluent, etc. A single ingredient may serve a double or treble office, as the Syrupus Rhei Aro- maticus with Quinine, in which case the syrup serves as 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. The basis may not need any aid in doing its work, and may require no correc- tive of its action nor any special vehicle. On the other hand there is no limit to the number of ingredients which may be used, provided the prescriber has a clear idea of something to be accomplished by each one, and also provided that there is no chemical or medicinal incompati- bility between them. In olden times prescriptions were very complex, and contained a great many curious and incongruous ingredients. As Dr. Piffard 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 combinations of medicines will often produce effects for the patient’s good, which could not be obtained from the use of any one remedy. An example will perhaps make the foregoing analysis more comprehen- sive, and at the same time serve to indicate the style of abbreviation usually employed. The following formula is that of the Pharmacopoeia for the Compound Infusion of Senna, or the old-time “Black Draught,” except that approximate weights and measures are substituted for the pharmacopoeial parts :— For Mrs. Steele. July 6th, 1886. Recipe, Take,— • Superscription. Senna;, semiunciam, (Basis.) Of Senna, half an ounce; Magnesii Sulphatis, L Magnesium Sulphate, Mannce, ana unciam unam, Manna, of each an ounce; Fceniculi, drachmam unam, Of Fennel, one drachm; Aquce Bullientis,fluiduncias ocio, - Inscription. (Adjuvant.) (Corrective.) (Vehicle) Of Boiling Water, eight fluid ounces. Macera per horam in vase clauso, deinde cola. - Subscription. Macerate for an hour in a closed vessel, then strain. Signa, Mark, or Write thus—A wineglassful every four hours till it operates. T. F. Wood, M.D. - Signature. Abbreviated in the style usual with physicians the above prescription would read as follows, viz. :— PRESCRIPTIONS. For Airs. Steele. R July 6th, 1886. Sennce, 5 ss Magnes. Sulph., Alannce, j Fccniculi, 3 j Aq. Bull., f p, viij Mac. per hor. in vase clauso, deinde cola. Sig.—A wineglassful every four hours till it operates. Wood. The above is given as an example of an ordinary compound prescrip- tion, but as the result is nearly identical with an official preparation, we might write the prescription simply as follows,— R. Inf us i Sentice Compos. Sviij. and this is the manner of prescribing the official compound preparations. It will be noticed that the term “ basis in the analysis of the formula covers two ingredients ; but either of the two might be considered the principal agent, and the other one classed as an adjuvant. As Pareira says, “ These four parts of a formula are intended to accom- plish the object of Asclepiades, curare cilo, tute et jucunde; in other words to enable the basis to cure quickly, safely and pleasantly. ’ ’ The Principles of Combination are so well laid down by Dr. H. C. Wood, that his words are appended verbatim, as follows,— The art of combining medicines is not a difficult one ; but in practice certain principles should not be lost sight of. Chief of these are, to prescribe as few remedies as possible, and to use no powerful drug without a very distinct idea of what it is intended to do. Whenever it is desired to give a powerful remedy in increasing doses until its physiological effect is produced, it should always be given by itself. Thus, it may be necessary to give arsenic so as to impress the system, at the same time that iron is indicated; but the two remedies should be given separately, so that the dose of either can be increased or dimin- ished independently of the other. The principles of combination formulated below were long ago enunciated by Dr. Paris, but are to-day as imperative as ever. Medicines are combined— First. To augment, correct, or modify the action of a medicine. Thus, purgatives act much more kindly when a number of them are united together. The chief reason of this probably is, that as different remedies affect different portions of the gut, the whole intes- tine is best reached by a union of the diverse substances. It may take an intense irrita- tion of the mucous membrane to purge as actively as does a mild irritation of both the mucous membrane and the muscular coat. In the case of neurotics the principle has a very limited action, because so many of this class of remedies are physiologically more or less antagonistic; yet sometimes the principle can be advantageously applied ; thus, the anaesthesia of Chloroform or Ether may be prolonged by a hypodermic injection of Mor- phia; and Chloral and Morphia certainly make a mixture which is much more powerfully hypnotic than is either of the substances separately. Second. To obtain the joint action of two or more diverse remedies. Thus, in a cough mixture Morphia may be included to quiet the cough, whilst Ipecacuanha and Squill (in accordance with the first principle) are added to affect the mucous membrane. The application of this principle requires caution, or the practitioner will be led into that chief abomination—polypharmacy. It is worse than futile to attempt to prescribe for every symptom. It is the underlying cause of the disorder or the under-stratum of bodily con- dition which must be sought out and prescribed for simply. Third. To obtain a special combination, which is really a new remedy, or which expe- 442 PRESCRIPTIONS. rience has shown acts almost as a new remedy. Thus, when to Iodide of Potassium in solution Corrosive Sublimate is added, a new chemical compound is formed, which expe- rience has shown to be of great value in syphilitic diseases. Griffith’s antihectic mixture is another instance of the use of chemical changes, the Proto-carbonate of Iron being formed out of the Sulphate of the metal and the Carbonate of Potassium. In the famous Dover s powder no chemical change occurs, but the ordinary action of Opium upon the skin is so enhanced that the combination may be looked upon almost as a new remedy. Fourth. To afford a suitable form. Thus, Acacia is added to make an emulsion, or Confection of Rose to make a pill. In the choice of excipients care should be exercised to select a substance free from medical properties, having no chemical incompatibility with the medicinal agent, and of suitable physical character. Bread crumbs often make a good basis for pills; but with Nitrate of Silver they are chemically incompatible, on account of the chlorides in them. When writing a prescription, the utmost care should be taken to use such excipients that the combination should not only be attractive to the eye, but also as little repulsive to the palate as may be. Whenever possible, the pill-form should be employed with bitter or disagreeable medicines. The pill may be readily coated with silver-foil; tonic pills may be coated with Iron by shaking or rolling them in Ferri Pulvis whilst soft and sticky. Sugar-coated pills and “compressed pills” are apt to get so hard and insoluble that their use requires caution. In regard to mixtures, flavoring oils should be freely used, and the power of Glycerin to conceal the disagreeable taste of many sub- stances should be remembered. In Writing an Extemporaneous Prescription, the first step is to put down the superscription, consisting of the name, date and the sign R. Next the name of each ingredient should be written in Latin and in the genitive case, each one on a separate line. Then the quantity of each article sufficient for one dose should be mentally determined and multiplied by the number of doses which the mixture is to contain, and the result set down in signs and Roman numerals. The directions to pharmacist and to patient being added, and the presc.riber’s name or initials affixed, the prescription is completed ; but when very active agents are used, it is a good plan to go over the calculations a second time before letting it leave the hands of the person most responsible for its action. For pills or powders the same process should be employed, slightly varied according to the requirements of each case. Frequently the ingredients and quantities for but one pill, powder or suppository are named, with instructions to make a certain number after the formula. When an unusually large dose of any poisonous drug is prescribed, it is cus- tomary to underline the quantity, so as to call the attention of the compounder to the fact that the prescriber is aware that the dose is above the average. There is no royal road to prescription-writing ; practice, care and knowledge of the whole subject is necessary to enable one to turn out habitually those elegant prescriptions which are properly termed “ magis- tral,” being the work of a magister, or master of his business. A fair knowledge of the Latin language is a sine qua non to every professional man, but especially to the physician. It is pitiable to see a Doctor write ignorantly of even the genitive case-endings of the drug-names which he uses. The teaching of Latin is not within the scope of this work, and PRESCRIPTIONS. 443 hence this part of the subject will be dismissed with the advice to the physician who is ignorant of that language to write his prescriptions wholly in English if he cannot write them in decent Latin. Abbreviations, though very commonly used by physicians in pre- scribing, are a source of much annoyance to the compounder, and fre- quently one of great danger to the patient. Physicians who never knew anything of the Latin grammar, or those who have forgotten its rules, are very apt to use abbreviations to conceal their ignorance of case-end- ings. Many others use them through sheer laziness, and some from force of habit. The educated and conscientious man will take pride in turning out a full and clear prescription, free from cabalistic letters and all ele- ments of uncertainty. In the Appendix will be found a list of the Latin terms used in prescriptions, with the abbreviations in vogue, and the English meaning. Ambiguous contractions may result fatally to the patient, as is readily seen by studying the following list, which gives a few examples of the dangers of careless abbreviation. Acid. Hydroc.—may mean Acidum Hydrochloricum. Acidum Hydrocyanicum. A conit. / Aconitine. Hydrargyrum. \ Aconitum. Hydras. Ammon. f Ammonia. Hydr. Hydriod as. \ Ammoniacum. Hydrochloras. Aq. Chlor. f Aqua Chlori. Hydrocyanas. \ Aqua Chloroformi. Sodium Sulphate. Aq. Fontis. J Might easily be read. Sod. Sulph. Sodium Sulphite. t Aqua Fords. Sodium Sulphide. f Chlorine. Sulphur. Chlor. 4 Chloral. Sulph. Sulphide. [ Chloroform. Sulphate. f Calomel. Sulphite. Hyd. Chlor. -{ Corrosive Sublimate. Zinci Phos. Zinc Phosphate. [ Hydrate of Chloral. Zinc Phosphide. Prescription Blanks. After many years’ experience in prescribing on blanks furnished by druggists, the writer has come to the conclusion that it is much better, for many reasons, for the physician to have his own blanks, without the address of any drug-store thereon. These blanks should be furnished with stubs on which to write the prescription at first in rough, afterwards copying it out cleanly on the main blank. A care- ful prescriber always writes a formula twice before letting it go out of his hands. If he does the first writing on the stub of a book of blanks he will always have a copy of such prescription in his possession, for which he will often be thankful. The blank used by the writer measures inches by joined by a perforated edge to a stub 2>V\ inches by inches. On the main blank the physician’s name and address are printed, together with his office hours, and a place for number and date, also the sign R.,and a line for signature. On the stub there are printed the 444 PRESCRIPTIONS. words, “ Copy of Prescription No . 189 . . For and on the back of the main blank occurs the following printed legend in red ink : A Prescription written on this side OF THE SHEET MUST NOT BE RENEWED UNDER ANY CIRCUMSTANCES WHATEVER, WITHOUT MY ORDER. , M. D. These blanks are bound up in books of ioo each, with a flexible morocco cover, from which the book of stubs may be slipped and a fresh book in- serted as required. The size is ample for all ordinary requirements, and permits of the book being carried in the breast-pocket. Renewals.—It would be advisable for physicians to always write the words “ Non Repetatur," 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 inconvenience to the drug-seller would be more than compensated for in the protection 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. It is doubtless a fact familiar to every observer, that the old-time con- fidential relations between the professions of physician and pharmacist have almost passed into oblivion. In fact, the tendency of pharmacy now-a-days is towards the position of a mere money-making trade, instead of in the exalted direction of a profession. The indiscriminate renewing of prescriptions, the open sale of quack nostrums and homoeopathic pel- lets, the readiness with which counter-prescribing is indulged in, the insinuations too frequently made over the drug-counter in reflection on physicians, and many other similar practices, have caused the non- combatant profession to regard the average druggist with suspicion. If physicians boldly took the dispensing of medicines more into their own hands many of these evils would soon eliminate themselves from the drug- stores. Right here, it may be said that there is nothing unprofessional or derogatory in the dispensing of his own medicines by the physician. In England it has been the universal practice for centuries in all places except the largest cities, and it has only been given up by a part of the medical profession as a matter of convenience, not as a right. The homoeo- paths fought for the reclamation of this practice as a right belonging to the medical profession, and succeeded in its legal establishment, but not from a worthy motive. They dispense their own medicines in order to PRESCRIPTIONS. 445 cover up the many frauds of which they are daily guilty, and to give them the power of administering full doses of powerful drugs in a form which is apparently “homoeopathic,” with no tell-tale prescription on file in a drug-store to give mute but dangerous evidence against their honesty. In this way they administer several grains of Calomel or eighth-grain doses of Morphine, or correspondingly large quantities of active alkaloids, triturated with sugar of milk, or dissolved, as many of the latter may be, in alcohol. Chemistry, by isolating the active principles of plants, and furnishing them to commerce in the form of soluble salts, has enabled the homoeopath to practice this fraudulent method of dispensing drugs, which the innocent and ignorant patient, who believes in the power of the mini- mum dose, supposes to be infinitesimal in amount. But the physician of the regular profession is too apt to think that if he adopts a practice which charlatans have appropriated to themselves, he may be classed with them by his professional competitors. Hence, many regular physicians are absolutely afraid to use such drugs as Aconite, Belladonna, Gelsemium, Arnica, Rhus, etc , all of which are official, and most of which are older than homoeopathy in medicine; and avoid pocket-cases, drachm-vials and triturations, as badges of charlatanism. It is high time that we asserted our independence in all these matters, and made use freely of those means which are recommended by our individual judgments as pro- motive of the best results to our patients and to ourselves. With a small stock of reliable fluid extracts, such as are manufactured by Parke, Davis & Co., of Detroit, or Dr. Edward R. Squibb, of Brooklyn,—an equally moderate supply of gelatin-coated pills and compressed tablets from the best houses, such as McKesson & Robbins, Schieffelin & Co., Warner & Co., Wyeth & Co., physicians could check-mate the unscrupulous prac- tices of many druggists to a great extent, save their patients many dollars, and retain many a dollar for their own pockets, which under the present system goes to their enemies. The homoeopaths understand the money part of the argument well. When their patients’ medicine is exhausted, the doctor must be seen for a fresh supply, meaning of course another consultation about symptoms, a change perhaps from Mercurius Dulcis to Mercurius Vims, and another fee. The expense is nothing, sugar of milk being cheap, and there is no prescription in the patient’s pocket- book, to be renewed scores of times (paying toll however every time to the druggist), and finally to be copied by aunts, mothers and friends, as a sovereign remedy for a cough, or a really wonderful receipt in a case of croup. Filling a Prescription means a combination of operations which requires great care, undivided attention, and a special practical appren- ticeship at the dispensing desk. In the following discussion of extempo- 446 PRESCRIPTIONS. raneous preparations such hints are incorporated as are particularly applicable to the compounding of each article under consideration ; and they may be prefaced by a few general suggestions which will serve to point out the most approved method of dealing with this important part of the druggist’s work. The prescription should first be slowly read over in a critical spirit, but no word or action of unfavorable criticism should reach the ears or eyes of the messenger. To shrug the shoulders while scanning the items, to laugh or even smile at the phraseology, to question the person offering it as to whom it is for, or what complaint it is given for, are instances of such flagrant treason to the prescriber as would justify his kicking the offender with a copper-toed boot. The compounder has no business whatever with the propriety of the recipe for its purpose. It might have been given as a placebo for reasons eminently wise and judicious; or if not so consti- tuted it has at least been ordered by one who is in possession of facts which the druggist knows nothing about, even if by education and experience he were competent to judge in the matter, which he seldom is. His criti- cism should be directed only to the dosage and the pharmaceutical compati- bility of the ingredients. Even in the latter case he must remember that incompatibles are often prescribed with the view of forming another agent from the chemical reaction produced. If he thinks that there is any mis- take, and the drugs ordered are in any degree poisonous, it is his duty to make an excuse for delay to the messenger and at once communicate with the physician. This course, in these days of telephones, is nearly always practicable. After reading the prescription, it is well to number it and write the label. This gives time for the label to dry, and avoids the use of blotting paper, which often mars the writing and renders the directions all but illegible. A clearly defined method should next be decided on by which to compound the prescription. Directions for such plans of procedure will be found in the succeeding pages under the titles of the various prepa- rations. Next, the ingredients should be carefully weighed or measured out, each one being checked off so as to avoid the danger of its being duplicated. In many cases the excipient is not specified, its choice being left to the druggist; but in all such a note should be made on the prescription to show the article used, in order that in the event of a renewal there may be no difference perceptible. No alteration or addi- tion should ever be made which would in any degree affect the medicinal action of the prescription, or interfere with the obvious intention of the prescriber. The labelling of the package and the numbering and filing of the pre- scription are matters of mechanical detail which are best learned at the PRESCRIPTIONS. 447 counter. Various devices for simplifying these operations are in vogue and may be seen in any well-appointed drug-store. Poisonous articles sold by the druggists should always be labelled “ Poison,” and the trans- action entered in a book usually required by law to be kept for that pur- pose ; but in the case of prescriptions the word “Poison” should not appear on the package or label unless so directed by the prescriber. Stock Solutions of the salts most frequently prescribed are kept in many establishments for convenience in dispensing. Those most gener- ally used are the following :— Alum,— ijss in a quart of distilled water. Of this solution each fluidounce represents 3 ss of the salt. Potassium Bicarbonate,— 3 j in f 3 iv of distilled water; of which 3 ss contains 3 j of the salt. Potassium Chlorate,—I in 24 of distilled water, will not crystallize as the temperature changes. Potassium Bromide,—I in 3 of distilled water, makes a very convenient solution for dispensing purposes. Chloral Hydrate,—I in 1 of distilled water: of which each minim contains a grain of chloral. Morphine Sulphate,—gr. xvj in 3j of distilled water, with a grain of Salicylic Acid or 3 drops of Carbolic Acid to prevent change. Of this solution, known as Magendie’s, each minim contains gr. of the salt, and contain gr. A safer solution is the Liquor Morphise Sulphatis of the U. S. P., 1870, which had one grain of the salt in each fluid- ounce. Carbolic Acid,— 3 j in f 3 iv of glycerin, makes a convenient solution which will mix with water in all proportions, rrpivss represent gr. j of the acid. Tannic Acid,— 3j in iv of glycerin, dissolved by the aid of a gentle heat, nyvss represent gr. j of the acid. The following rules for the pharmaceutical student are quoted from the Chemist's and Druggist's Diary for 1885. They are well worth remem- bering. 1. Read through a prescription, rapidly and in a manner suggesting no suspicion or doubt. 2. Write directions invariably before dispensing. Avoid thus the use of blotting- paper ; a good dispenser uses almost none. 3. If a mixture contains readily soluble ingredients, never use a mortar. 4. Avoid effecting solution by heat, for fear of recrystallization. 5. With syrups and also ingredients not water, arrange in dispensing to rinse out the measure and leave it clean; a skilled dispenser shows very little traces of his work. 6. Carefully clean and put away weights and scales after each operation. 7. Hold the scales firmly by the left hand, never lift them high above the counter, and judge of the weight as much by the indicator as by the position of the scale. 8. Select glass pans fbr scales, preferably of heavy make, and discard flimsy brass material, which corrodes speedily and becomes inaccurate. 9. Learn to judge of the quantity to be weighed with tolerable accuracy; train the eye as well as the hand. 10. If in doubt, always begin with that about which you have no doubt. 11. Be rapid in manipulation. Finish wrapping, tying, or sealing quickly. Slow dis- pensing is bad dispensing, and arises either from deficient practice or want of knowledge. 12. Never, when in a shadow of doubt, hesitate to ask advice from a fear of compro- mising your own dignity. 448 INCOMPATIBILITY. INCOMPATIBILITY. Incompatibility may be Chemical, Pharmaceutical or Therapeutical, according to the prescribed combination results in chemical decomposi- tion, physical disassociation or antagonistic action. In the first case the incompatibility may be unintentional or intentional on the part of the prescriber, for in many cases the result of the chemical action affords the substance desired. Instances of intentional incompatibility are the mixtures of Calomel and Corrosive Sub- limate with Limewater, producing the Black and Yellow Oxides of Mercury respectively, and commonly known as “Black Wash” and “Yellow Wash.” Such combination should not be filtered (as a novice might suppose), but should be dispensed with a “ Shake-label,” that the precipitate may be uniformly distributed before using. Chemical Incompatibility generally results from neglect on the part of the prescriber of the most common chemical reactions, such as— 1. Acids tend to combine with bases and to form salts. 2. Weak acids or bases are displaced from their combinations by stronger ones, so that salts in solution when brought together generally exchange their radicles, especially if by doing so an insoluble compound can be formed. 3. A salt in solution is easily decomposed by a strong alkali if the salt is one having a weak or volatile base. 4. A substance in solution may be decomposed by another without pre- cipitation, the product being soluble in the solution. 5. Alkaloidal salts are precipitated from their solutions by the addition of fixed alkalies, their salts or salts which produce insoluble compounds. Oxides of the fixed alkalies decompose salts of the metals proper, and those of the alkaloids, precipitating their bases ; but the base may be soluble in an excess of the alkali. 6. Tannic or Gallic Acids and vegetable substances containing them precipitate albumen, alkaloids and most of the metallic oxides, and form inky solutions when brought into contact with the persalts of Iron. Tannic Acid precipitates gelatin. 7. Glucosides are incompatible with free acids or Emulsin. Examples of the neglect of these principles are seen in the prescribing of Quinine Sul- phate in mixture with Potassium Acetate, resulting in a voluminous precipitate of Quinine Acetate which could not be poured from the bottle;—Vinegars or Syrups containing Acetic Acid (Syr. Allii, Syr. Scilke) added to a solution of alkaline carbonates, causing decomposition of the latter with evolution of C02;—the addition of Liquor Potassae to a solution of Ammonia-alum, setting free gaseous ammonia;—the mixing of Strychnine Sulphate and Potassium Bromide in solution, causing the decomposition of the alkaloid sulphate and precipitation of Strychnine;—preparations of Cinchona with salts of Iron, forming an inky tannate of iron; Elixir of Chloral with alkalies, causing the elimination of Chloroform and its subsequent evaporation, etc., etc. The following table shows the most important instances of solutions- INCOMPATIBILITY. 449 which mutually precipitate each other, the letter P meaning “ forms a precipitate with — Table of some Mutually Pre- cipitant Solutions. Alkaloidal Solutions (generally). Metallic Solutions (generally). Lead Solutions. Silver Solutions. Calcic Solutions. Magnesic Solutions. Albuminous Solutions. | Gelatinous Solutions. Solutions of Alkalies, P P P P P P Tannic Acid, P P P P P P Carbonic Acid and Sol. of Carbonates, . . P P P P P P Sulphuric Acid and Sol. of Sulphates, . . . P P P . Phosph. Acid and Sol. of Phosphates, . . P P P P P P Boric Acid and Sol. of Borates, P P P P Hydrochloric Acid and Sol. of Chlorides, . P P Hydrobroraic Acid and Sol. of Bromides, . P P Hydriodic Acid and Sol. of Iodides, . . . P P P Solutions of Sulphides, P P P Arsenical Solutions, P P P Albumen, P P P 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, Arseniates and Tannates of most earthy and heavy metals and alkaloids, and the metallic Sulphides; the Sulphates of Calcium, and of Lead, and the subsalts of Mercury; the Chlorides, Iodides, and Bromides of Bismuth, Silver, Lead, and subsalts of Mercury; the Iodides of Quinine, Morphine and most alkaloids. Instances are—Limewater or Aromatic Spirit of Ammonia with Tincture of Chloride of Iron, or solutions of Mercury salts, or neutral solutions of Quinine or Morphine salts. Ammonium, Potassium and Sodium carbonates or bi-carbonates with Limewater. Solutions of Magnesium Sulphate, Alum, Zinc Acetate or Sulphate with solutions of salts of Iron, Manganese, Bismuth, Antimony, Lead, and of most alkaloids. Ammonium or Sodium Phosphates with solutions of Iron salts, with Limewater, solu- tion of Magnesium Sulphate, of Alum, etc. Liquor Potassii Arsenitis with Limewater, with solutions of basic salts of Iron, and of neutral salts of Quinine and Morphine, etc. Solutions, Decoctions, Tinctures and Extracts containing Tannic Acid with solutions of salts of Iron, Mercury, Antimony, Lead (as also with solutions containing albuminous substances and Gelatin). Limewater with solutions of Quinine and Morphine Sulphates. Solutions of Lead Acetate with Zinc Sulphate or Alum. Sodium Chloride with Silver Nitrate. Morphine Hydrochlorate with Lead Acetate. Alkaline Iodides or Bromides with Bismuth Carbonate or Sub-nitrate, with Lead Ace- tate, with Sub-chloride of Mercury, or with neutral solutions of Quinine, Morphine and Strychnine salts. Explosive Compounds result from the admixture of powerful oxid- izing agents with substances which are readily oxidizable. The most important members of these two classes are as follows :— 450 INCOMPATIBILITY. 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. Explosions have resulted from mixing Fluid Extract of Uva Ursi with certain samples of Spirit of Nitre, Chromic Acid, with Glycerin, Permanganate of Potassium with Glycerin, Nitric Acid with Glycerin, Nitrate of Silver with Creasote, Oxide of Silver in pill with Extract of Gentian, Potassium Chlorate with Glycerin and Tincture of the Chloride of Iron. Chloride of Lime triturated with Sulphur in a mortar has exploded, so also has Calcium or Sodium Hypophosphite when triturated alone. Tincture of Iodine with Am- monia forms the Iodide of Nitrogen, which is highly explosive, especially if triturated in the presence of water. Catechu and Potassium Chlorate in a dentifrice have exploded in the mouth from the friction produced by a dry tooth-brush. Poisonous Compounds may be formed by the admixture of many substances in solution, such as— Potassium Chlorate with Potassium Iodide, in solution together do not react at ordinary temperatures, but in the system they evolve a poisonous agent, probably the Iodate of Potassium. Potassium Chlorate with Syrup of Iodide of Iron, liberates Iodine from the Iodide in the warm stomach, causing severe gastric irritation, perhaps gastritis of dangerous degree. Dilute Hydrocyanic Acid or Potassium Cyanide, with Calomel, forms the Bichloride and Bicyanide of Mercury, both virulent poisons;—with metallic hydrates, carbonates, sub-nitrates or sub-chlorides, cyanides of the metals are formed which are even more poisonous than the acid itself in its usual diluted form. Pharmaceutical Incompatibility differs from chemical incompati- bility in the absence of chemical action, and is generally produced by adding one substance to another which, through differences in solubility, causes a precipitation of solid matter or a separation of part of the liquid. The constituents separated 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, result- ing 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 prepara- tion, the Chloral separating to the top as an alcoholate, and therefore dangerously in excess for the first few doses;—or the neglect to prescribe Acacia or some other emulsifier in mixtures of an alcoholic fluid extract of a resinous body with an aqueous preparation, which would result in the separation of the resin to the surface and an overdose with the first teaspoonful. When the fluid extracts are diluted with liquids differing in composition from those used in the fluid extracts, the gum, albumen, resin and mucil- age are often separated. In such a case as Fluid Extract of Cannabis INCOMPATIBILITY. 451 Indica the active resin would be thrown out of solution, and floating on top might cause serious symptoms; but in many other instances the pre- cipitate would be inert and filtration would be in order. Water is the solvent for albuminous, gelatinous, gummy, and saccharine bodies and for a large number of inorganic salts ; while Alcohol is the solvent for vola- tile oil and resins, gum-resins, resinoids, balsams, and all drugs contain- ing 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 l|j. 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 Nitric Ether with strong mucilages. Infusions generally with metallic salts. Therapeutical Incompatibility arises when two agents are admin- istered 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 ad- ministration of Morphine guarded by Atropine. The antagonists to each of the active medicinal agents may be found in the section on Materia Medica under their various titles; but they may be well summarized as to the most important ones in the following list. Aconitine,—Atropine, Digitalin, Strychnine. Alcohol,—Strychnine. Ammonium Chloride,—Chloral-hydrate. Atropine,—*Aconitine, *Bromal-hydrate, Chloral-hydrate, Hydrocyanic Acid, Jaborandi, Muscarine, *Morphine, Physostigmine, Phytolacca, Pilocarpine, Quinine. [Those marked * will not prevent death from a lethal dose of Atropine, though the latter will prevent death from a lethal dose of either of them.] Barium,—Sodium Sulphate, Potassium salts. Bromal-hydrate,—Atropine. Brucine,—Chloral-hydrate. Calabarine,—Chloral-hydrate. Carbolic Acid,—Chloral-hydrate. Chloral-hydrate,— Ammonium Chloride, Atropine, Brucine, Calabarine, Carbolic Acid, Codeine, Physostigma, Picrotoxine, Strychnine, Thebaine. Chloroform,—Amyl Nitrite. Cocaine,—Morphine. Codeine,—Chloral-hydrate. Digitalin,—Aconitine, Muscarine, Saponin. Gelsemium,—Opium, Atropine. Physiological Antagonists 452 INCOMPATIBILITY. Morphine,—Atropine, Caffeine, Chloroform, Cocaine, Daturine, Hyoscyamine, Nicotine, Physostigma. Muscarine,—Atropine. Opium,—Atropine, Gelsemium, Veratrum Viride. Physostigma,—Atropine, Chloral, Morphine. Saponin,—Digitalin. Strychnine,—Alcohol, Chloral, Hydrocyanic Acid, Nicotine, Nitrite of Amyl. Thebaine,—Chloral-hydrate. 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. (1) Never use more than one remedy at a time, if one will serve the purpose. (2) 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 com- bine free acids with hydrates or carbonates. (3) Select the simplest solvent, diluent or excipient you know of, re- membering that the solvent power of alcohol and of water for their respective substances decreases in proportion to the quantity of the other added. (4) 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, Arseniates and Tannates of most earthy and heavy metals and alka- loids, 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. (5) Never order a drug in combination with any of its Tests or Anti- dotes. (6) 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. (7) Aconite should be ordered in water alone, 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 decompose it. (8) Iodide of Potassium decomposes most of the metallic salts, and is one of the drugs which are best administered alone. (9) The following named substances are incompatible with so many others that it is best to always prescribe them alone; they are best given in simple solution :— EXTEMPORANEOUS PREPARATIONS. 453 Dilute Hydrocyanic Acid. Dilute Nitro-hydrochloric Acid. Sulphuric Acid. Mercuric Chloride (Corr. Sub.). Iodine and Iodides. Syrup of the Iodide of Iron. Potassium Permanganate. Potassium Acetate. Potassium Bromide Tartar Emetic. Tincture of Guaiac. Morphine Acetate. Morphine Hydrochlorate. Quinine Sulphate. Liquor Calcis. Liquor Potassse. Liquor Potassii Arsenitis. Liquor Ferri Nitratis. Tinct. Ferri Chloridi. Zinc Acetate. Citrate of Iron and Quinine. Free Chlorine in Solution. Tannic and Gallic Acids. (io). Silver Nitrate and the Acetate and Sub-acetate of Lead, though incompatible with almost everything, may be combined with Opium, the latter forming with Opium a compound, which, though insoluble, is thera- peutically active as an astringent and anodyne lotion. Silver Nitrate with Creasote forms an explosive compound. (n). Tannic and Gallic Acids, and substances containing them (as the Astringent 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 ferric salts, as it contains neither tannic nor gallic acids. Tannic Acid precipitates gelatin. (12) Iodine and the soluble Iodides are incompatible with the alkaloids and substances containing them, also with most metallic salts. (13) Alkalies neutralize free acids, and precipitate the alkaloids and the 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. (14) Resinous Tincttires or Fluid Extracts, (, A- Ipecac, et Opii, 2, 3, 5. Morphine Sulphate, Ax, H>'A, A, X- Opium Deodorized, 1. Opium y2. and Lead Acetate iy. Pepsin Sacch., 2, 5. Podophyllin, Ay, ys, y, 1, 2. Potassium Bromide, 5, 10. Chlorate, 5. Iodide, 5. Nitrate, 5. Permanganate, y, 1,2. Quinine Bisulphate, yz, 1,2, 3, 4, 5. Salicylate, 2. Sulphate, y, 1, 2, 3, 4, 5. Quinquinine, 2, 3. Rhubarb 3. Rhei Co. (U. S. P.). Rhei 2, et Magnesi*, 2. Salicin, 2y, 5. Santonin, I. Santonin 1, et Calomel 1. Sodium Bicarbonate, 5. Salicylate, 3, 5. Strychnine, j6, up to Ax- Zinc Phosphide, Ax up to y. The following prescriptions represent the composition of a few unoffi- cial pills in general use. A complete pill formulary is easily obtained, being published annually by each of the principal manufacturers. Pills of Iron. R . Ferri Reducti, gr. 1. Mann*, gr. xv. Glucosi, q. s. Fiat massa, et div. in pil. xxv. Sig.—One after each meal. Astringent Pill. R. Plumbi Acetatis, gr. xvj. Pulv. Camphor*, gr. xij. Pulv. Opii, gr. iij. Bismuthi Subcarb., . . . . gr. xij. Ext. Gentian*, q. s. Fiat mass, et div. in pil. xij. Sig.—One thrice daily. Emmenagogue Pill (Otto). R . Ferri Sulph. Exsic gr. xlviij. Pulv. Aloes, gr. xij. Terebinthin*, gr. xxxij. 01. Terebinth., tt\x. Fiat massa, et div. in pil. xxx. Sig.—Two, three times a day. Astringent Pill. R . Argenti Nitratis, gr. xx. Pulv. Cretse (Gallic*), . . gr. lxxx. Petrolati, q. s. Fiat massa, et div. in pil. xl. Hooper's Female Pills. R. Pulv. Aloes Socot., . . . gr. xlviij. Ferri Sulph. Exsic., . . . gr. xxiv. Ext. Hellebori Nig., Pulv. Myrrh*, Saponis, aa gr. xij. Pulv. Canell* Alb., Pulv. Zingiberis, . . . aa gr. vj. Aqu* vel Syrupi, q. s. Plat massa, et div. in pil., quisque pondo gr. ijss. Sig.—One to three at a dose. Cholagogue Pills [Squibb). R. Resin* Podophylli, . . . . gr. vj. Ext. Belladon. Alcohol, . gr. iij. Pulv. Capsici, Pulv. Sacch. Lactis, . . aa gr. xxiv. Pulv. Acaci*, gr. vj. Glycerini Syrupi, q. s. Fiat massa, et div. in pil. xxiv. Sig.—One or two as required. Aperient Pills. R. Pulv. Aloes Socot., . . . gr. xxiv. Pulv. Rhei gr. xlviij. Hydrarg. Chlor. Mitis, . . gr. iv. Ant. et Potas. Tart., . . . gr. ij. Fiat massa, et div. in pil. xxiv. Sig.—One or two as needed. Anaphrodisiac and Sedative. R . Camphor* gr. xxx. Lupulini, gr. xx. Fiat massa, et div. in pil. xx. Sig.—One thrice daily. EXTEMPORANEOUS PREPARATIONS. 469 Tonic Pill for Women. R. Strychninse Sulph., Ac. Arseniosi, . . . . aa gr. j. Ext. Belladonnce, . . . . gr. v. Quininse Sulph., gr. xxxv. Massse Ferri Carb gr. xc. Fiat massa, et div. in pil. xxxv. Sig.—One three times daily. Anti-bilious Pills. R. Pulv. Scammonii, Pulv. Aloes Socot., Pulv. Gambogiae, Hydrarg. Chlor. Mitis, Potass. Bitart., . . . . aa gr. xx. Ext. Taraxaci, q. s. Fiat massa, et div. in pil. xx. Gelatin Capsules are to be obtained from the drug stores, of various sizes from o to io. They are a convenient means of administering oils or nauseous solids, and when filled may be swallowed as easily as a large pill. By some of the manufacturers Soluble Elastic Capsules are prepared, each containing an ordinary dose of such medicines as Castor Oil, Cod-liver Oil, etc. The largest of these capsules makes a bolus which may be swal- lowed with a little effort, as it is quite compressible and changes its shape to suit the calibre of the passage. The ordinary capsules are easily filled by the aid of a paper funnel, and the end of a pen-holder as a packer; but simple devices (capsule-fillers) may be obtained for the purpose of facilitating the operation. R. Pulv. Opii, gr. x. Pulv Camphorse, . . . . gr. xx. Sacch. Alb., q. s. Trit., et fiant capsulse x. Sig.—One at bedtime for chordee; re- peat in two hours if necessary. R. Copaibse, % iss. Oleo-resinae Cubebse, . . . 3 ss. M., et fiant capsulse xij- Sig.—Two capsules three times daily, soon after meals, for gonorrhoea. Troches (Trochisci),—also named Tablets, Pastilles, Lozenges, etc., and Compressed Pills, are not readily compounded at the dispensing counter, but may be obtained in all first-class shops, being prepared in great variety by the manufacturers. Besides the official Troches (see ante, page 431), those named in the following list are generally for sale :— Troches (Lozenges.) Alum, gr. ij. Alum gr. iy2, Catechu gr. ij. Ammonium Chloride gr. ij, and Cubebs gr-j- Ammon. Chlor. gr. ij, Liquorice gr. viij. Benzoic Acid, gr. ]/%. Borax, gr. iij. Bismuth, gr. ij, and Charcoal, gr. v. Bronchial,—01.-res. Cubebs, gr. i, Tolu, gr. Ol. Sassafras, gr. and Ext. of Liquorice, gr. vij. Brown Mixture. Carbolic Acid, gr. j. Ginger and Sodium Bicarb. Guaiac., gr. ij. Kino, gr. ij. Lettuce, gr. j. Lime-juice. Logwood, gr. ij. Magnesia, gr. iij. Pellitory, gr. j. Pepsin, gr. iij, Charcoal, gr. iij, Magnesia, gr. ij, and Ginger, gr. j. Potassium Bitartrate, gr. iij. Potassium Citrate, gr. iij. Santonin, gr. and Calomel, gr. y^.. 470 EXTEMPORANEOUS PREPARATIONS. Compressed Tablets. Ammonium Chloride, gr. iij. Charcoal, gr. x. Cocaine Hydrochlorate. Dover’s Powder. Mercury, Yellow Oxide, gr. Pepsin and Pancreatin. Potassium Bicarb., gr. v. Potassium Chlorate, aa gr. v. Potas. Chlorate and Borax, gr. 2yz. Potas. Chi. and Ammon. Chloride. Spencer’s Chloramine Pastilles. Sodium Bicarb., gr. iv, Ammon. Carb., gr. 01. Menth. Pip., gtt. Compressed Tablets. Sodium Salicylate, gr. iij. Antiseptic. Hydrarg. Chlor. Corr.,gr. vijss. Fehling’s Test for grape-sugar in the urine. Hypodermic Tablets. Morphine Sulphate, gr. Jj to %. Morph. Sulph. and Atropine Sulph. Atropine Sulphate, gr. Strychnine Sulphate, gr. Apomorphine Muriate, gr. Pilocarpine Muriate, gr. fa, ]/2. (And several others.) Confections (Confectiones), and Electuaries (Electuaria),—are very seldom prescribed, and therefore can have but little place in extem- poraneous pharmacy. They are medicinal powders, etc., beaten up with sugar, honey or molasses, to the consistence of a thick paste, and are administered with a spoon like preserved fruits. The two official con- fections are described on page 431, and a few old formulae for similar preparations are given below as pharmaceutical curios. The first is a meritorious prescription. Electuary for Piles. R. Potassii Bitartratis, Potassii Nitratis, Pulv. Jalapae, . . . . . aa i| ss. Confectio Sennse, . . . 3J. Syrupi Zingiberis, q. s. M. Fiat electuarium. Sig.—A piece the size of a marble to be taken thrice daily. The Chelsea Pensioner. R. Sulphuris Loti, 5 ij. Potassii Bitart., 3j. Pulv. Rhei, 3 ij. Guaiaci Resinae, gj. Mellis Despum., tbj. Myristicam Pulv., . . . . j. M. Fiat electuarium. Sig.—A dessertspoonful twice daily, as a laxative in chronic rheumatism. [An ingredient of Warburg’s Tincture.] Confectio Damocratis, This preparation was official in the London Pharmacopoeia of 1745. It contained 1 grain of Opium in j§ss, and consisted of 45 ingredients, as follows, viz.: Cinnamon, 14 parts; Myrrh, 11 parts;—White Agaric, Spikenard, Ginger, Spanish Saffron, Treacle, Mustard Seed, Frankincense and Chian Turpentine, of each 10 parts;—Camel’s Hay, Costus Arabacus, Zedoary, Indian leaf, Mace, French Lavender, Long Pepper, Seeds of Harwort, Juice of ripe Cistus, strained Storax, Opponex, strained Galbanum, Balsam of Gilead, Oil of Nutmeg, Russian Castor, of each 8 parts;—Water Germunder, Balsam-tree Fruit, Cubeb, White Pepper, Seeds of Cretian Carrot, Poley Mont, strained Bdellium, of each 7 parts;—Gentian-root, Celtic Hard, Leaves of Dittany of Crete, Red Rose, Seeds of Macedonium, Parsley, Sweet Fennel Seeds, Seeds of Lesser Cardamom, Gum Arabic, Opium, of each 5 parts;—Sweet Flag, Wild Valerian, Anise seed, Sagapenum, of each 3 parts; Spigrul, St. John’s Wort, Juice of Acacia, Catechu, Dried Bellies of Skunk, of each parts;—the roots finely powdered and the whole mixed thoroughly into a paste with Clarified Honey. Powders (Pulveres),—as prepared extemporaneously are generally compound, and maybe mixed on a slab with a spatula, but a much better EXTEMPORANEOUS PREPARATIONS. 471 method of mixing them is by trituration in a mortar. The latter should always be employed except in the case of substances which may explode if so treated, as Potassium Chlorate with oxidizable substances. (See ante, page 449.) The Diluent best employed in powders is Sugar of Milk, on account of its hardness, its density and its comparative insolubility. A coloring agent, as Carmine in minute quantity, is a useful ingredient, enabling the eye to judge of the degree of mixing and subdivision ob- tained. Powders containing soluble salts, extracts, volatile oils, camphor, or any other hygroscopic or volatile substances, should be dispensed in waxed paper. For ordinary powders the plain white paper of the drug stores will answer, but a better paper for small powders is one having a high surface finish and made very thin, as the white glazed French demy. Powders are often ordered in Wafers (Cachets), to be swallowed without unfolding. The division of powders into the number of papers (Char- tulce) ordered, and folding them neatly, requires a considerable amount of practice. A small machine is used over which the ends of the papers are bent, in order to have them of the proper size for the box in which they are usually dispensed. If they are to be put into an envelope less exactness of folding is required, and the mechanical contrivance may be dispensed with. Substances suitable to administration in the form of powders are those which are insoluble, those which would be chemically incompatible in fluid form, and certain pulverizable extracts. Those which are unsuited to this form are such as have a very nauseous taste or odor, substances of which the dose is large, those which are deliquescent, efflorescent or very vola- tile, and those which liquefy on mixing. A list of deliquescent and efflo- rescent salts is found on page 466, while the following named, though dry alone, become moist when triturated together, viz:— Sodium Sulphate and Potassium Carbonate. Zinc Sulphate and Lead Acetate. Camphor and Chloral Hydrate. Many substances cannot be powdered without the intervention of another body : thus Opium requires a hard substance like Sugar of Milk or Potas- sium Sulphate, Camphor requires a minute quantity of Alcohol, Myrrh, needs Sugar or Gum, etc. Substances, as the alkaloids and their salts, which are very active and are used in very small doses, require some inert substance to give them bulk enough for division and handling. Sugar of Milk will be found the best agent for this purpose. Prescrip- tions may order the ingredients for a single powder, with directions to dispense a certain number of the same composition ; or they may give the quantities for the whole number of powders ordered, with instructions to divide into a certain number. The dispenser should carefully scan the prescription in order to avoid the multiplication of quantities where divi- 472 EXTEMPORANEOUS PREPARATIONS. sion is intended. The official powders are enumerated on page 431 ; and the following formulae will serve to illustrate those generally prescribed :— Astringent Powder for Infants. R. Plumbi Acetatis, gr. ij. Pulveris Opii gr. ss. Camphorae, gr. j. Sacchari Lactis, gr. iij. Trit. et div. in chartulas xij. Sig.—One every 2 or 3 hours in diar- rhoea of infants. For an adult the above represents one dose. Bismuth and Soda. R. Bismuthi Subnitratis, Sodii Bicarb., aa^ij. Pulv. Zingiberis, gr. xl. M., et div. in chartulas xij. Sig.—One after each meal. Corrective in dyspepsia, acne and eczema. Antipruritic Powder. R. Pulveris Camphorae, . . . gj. Zinci Oxidi, z iv. Pulv. Amyli, M., et fiat pulvis. Sig.—Use locally as a dusting powder to relieve itching. Gastric Sedative. R. Bismuthi Subnitratis, . . . £j. Pulveris Rhei, Pulveris Aromat., . . . aa g ss. M., et div. in chartulas vj. Sig.—One before each meal. Laxative Powder. R. Hydrarg. Chlor. Mitis, . . gr. x. Sacchari Lactis, gr. xx. M., et fiant pulv. x. Sig.—One powder twice daily. Catarrh Powder. R. Bismuthi Subnitratis, . . . % iij. Pulv. Acacise, Pulv. Talc., t^ij. Morphinse Muriatis, . . . gr. j. M. Sig.—Use by insufflation. Compressed Pills are really powders which have been compressed into pill shape by machinery. A little pressure from the blade of a spatula will restore them to powder form. (See ante, page 467.) Triturations (Triturationes),—are powders containing minute doses of very active agents diluted with Sugar of Milk, and possessing a definite relation between the active ingredient and the diluent, namely, i in xo, according to the general formula of the U. S. Pharmacopoeia, which, as well as the one official trituration, is described on page 432. Sugar of Milk is employed as the diluent because of its hardness and its compara- tive insolubility. The first of these qualities secures the fine comminu- tion of the active ingredient whereby the action of the medicine is increased and better distributed. Its insolubility makes it the best diluent for powders or triturations administered from a spoon or glass with fluid, as is so often done, for unlike cane sugar it is not readily dis- solved and does not leave the active substance behind on the surface of the utensil. Triturations are excellent forms for the administration of powerful alkaloids, which may thus be divided with great accuracy into the minute quantities required. Mercury and its salts are especially adapted to this method of preparation, being more uniformly divided and hence more active than when administered in any other form. Triturations of mercury with sugar were commonly used in England a EXTEMPORANEOUS PREPARATIONS. 473 hundred years ago, and triturations of many substances were employed by the Arabian physicians of the 13th century. But the subsequent adoption of these preparations by the homceopathists produced such a prejudice against them in the ranks of the regular profession that until recently any one using them stood in danger of being stigmatized as a homoeopath. Their recent recognition by the U. S. Pharmacopoeia under their proper title does away with any such implication, though it is much to be regretted that the compilers of the last revision of the British Pharmacopoeia should have shown their fear of a name by con- tinuing the title “ Pul vis Elaterini Compositus ” to designate a prepara- tion which in every respect is a trituration. The preparations of Pepsin daily prescribed by physicians all over the country are really sugar-of- milk triturations of that ferment, and not pure Pepsin as many suppose. Prof. H. G. Piffard, Med. Dept. Univ. of the City of New York, in his treatise on the Materia Medica and Therapeutics of the Skin (N. Y., 1881), after detailing several microscopical examinations of pills and triturations, uses the following language :— “ It is to be expected, therefore, that the protoiodide trituration will prove, ceteris paribus, more active than the pill, and such we have found it. . . . Iodides of Mercury .... Since we have used the triturations, however, in preference to the ordinary pills, patients more rarely complain of disagreeable sensations. We have been enabled to materially reduce the size of the dose in order to obtain the desired effect. In other words, a larger proportion of the drug is utilized for specific purposes, while but a small amount remains to give rise to local irritation I have nothing to add to this, except that I continue to use triturations of Mercury and other substances with increasing satisfaction. Beside those mentioned I employ Calomel, Cyanide of Mercury, Black Oxide of Mercury and Corrosive Sublimate in this form.” The following examples will illustrate the mode in which Triturations may be prescribed : — R. Hydrarg. Oxidi Flavi, . . . gr. ss. Sacchari Lactis, gr. 1. Trit., et div. in chartulas xxiv. Sig.—One twice daily. R. Morphinae Sulph., . . . . gr. j. Sacchari Lactis, gr. xvj. Trit., et div. in chartulas, viij. Sig.—One every six hours. R . Hydrarg. Chlor. Mitis, . , gr. x. Sacchari Lactis, q. s. Trit., et div. in chartulas x. Sig.—One powder daily. R. Acidi Arseniosi, . . . . gr. ss. Sacch. Lactis, gr. xl. Trit., et div. in chartulas xx. Sig.—One powder thrice daily. Suppositories (Suppositoria),—are small, conical, medicated bodies intended for introduction into the rectum, uterus, or urethra (bougies) occasionally into the vagina. No official suppositories are enumerated, but a general formula is prescribed by the pharmacopoeia for their prepa- ration (see ante, page 432). The basis is usually Cacao-butter, but for those intended for the urethra or uterus a mixture of Gelatin and Glycerin 474 EXTEMPORANEOUS PREPARATIONS. is considered the best excipient, being firmer and more plastic than cacao-butter, and more easily handled. Hollow cones of cacao butter, or some composition resembling it, are kept in the shops, and will be used by the average druggist in filling prescriptions for rectal supposito- ries unless prohibited, as they save him considerable labor; the active drug being simply placed in the centre of the cone which is then sealed with a plug fitting in its base. These contrivances are by no means so efficient as the regular suppository, in which the medicinal agent is thoroughly incorporated with the excipient, for the former smear the rectum with a quantity of melted grease before the active portion of the preparation is permitted to come in contact with its walls. The agents used in suppositories are chiefly extracts and alkaloids ; some few powders, and a few metallic salts are occasionally employed. Those for the adult rectum should contain from 15 to 30 grains of the excipient, for the vagina a drachm of cacao-butter is the average quantity. Those for the uterus and urethra are made of cylindrical instead of conical form, and about the diameter of a No. 9 catheter. The methods of compounding suppositories are two, viz.:—that by the use of moulds (the official method), and that by hand. The former process is described on page 432, but many prefer the hand method, which is as follows: The medicament is mixed with finely shaved Cacao- butter by the aid of a spatula on a board or tile lightly dusted with Lycopodium or Starch. After a smooth and uniform mixture is thus obtained, the mass may be rolled into cylindrical form, cut into the required sizes and with the spatula given the required shape. When dispensed, they should be placed in a powder-box, between layers of cotton. Bougies or Pencils, as urethral and uterine suppositories are often termed, may be prepared by melting together White Gelatin 3, Glycerin 1, and Distilled Water 1 part by weight, then adding the medicament, and drawing the mass into a glass tube previously oiled inside. When cold the bougie may be pushed out and cut into suitable lengths. The Br. Pharmacopoeia describes 8 official suppositories, as follows, viz.:— Suppositoria Acidi Carbolici cum Sapone,—Carbolic Acid, 12 grains; Curd Soap, in powder, 1S0 grains; Glycerin of Starch, 40 grains; to make 12 suppositories, each containing I grain of Carbolic Acid. Suppositoria Acidi Tannici,—Tannic Acid, 36 grains ; Oil of Theobroma, 144 grains ; to make 12 suppositories, each containing 3 grains of Tannic Acid. Suppositoria Acidi Tannici cum Sapone,—Tannic Acid, 36 grains ; Glycerin of Starch, 30 grains; Curd Soap, in powder, 100 grains: Starch in powder q. s.; to make 12 sup- positories, each containing 3 grains of Tannic Acid. Suppositoria Hydrargyri,—Mercurial Ointment, 60 grains; Oil of Theobroma, 120 grains; to make 12 suppositories, each containing 5 grains of Mercurial Ointment. Suppositoria Iodoformi,—Iodoform, 36 grains; Oil of Theobroma, 144 grains; to make 12 suppositories, each containing 3 grains of Iodoform. EXTEMPORANEOUS PREPARATIONS. 475 Suppositoria Morphince,—Morphine Hydrochlorate, 6 grains; Oil of Theobroma, 174 grains; to make 12 suppositories, each containing grain of the Morphine salt. Suppositoria Morphince cum Sapone,—Morphine Hydrochlorate, 6 grains; Glycerin of Starch, 30 grains; Curd Soap, in powder, 100 grains; Starch, q. s. to make 12 sup- positories, each containing ]/2 grain of the Morphine salt. Suppositoria Plumbi Cotnposita,—Acetate of Lead, 36 grains; Opium, in powder, 12 grains; Oil of Theobroma, 132 grains; to make 12 suppositories, each containing 3 grains of Lead Acetate and 1 grain of Opium. Suppositories and Bougies may be prescribed in the manner illustrated by the following formulae :— Anodyne Suppository. R. Ext. Opii gr. vj. Ext. Belladonnae, gr. ss. Ext. Hyoscyami, gr. ij. Olei Theobromae, q. s. M. Fiant suppositoria vj. Sig.—One into the rectum morning and night. Wade’s Bougies. R. Iodoformi, sjj. Bismuthi Subnitrat., .... gj. Chloralis, gr. viij. Morphinae Sulphat., . . . . gr. iij. 01. Rosae, rtpx. Gelatini, et Glycerini, q. s. M. Fiant bougia xij. Sig.—One into urethra thrice daily. Anthelmintic. R. Santonini, gr. xij. Olei Theobromae, gj. M. Fiant suppositoria vj. Sig.—One into the rectum as directed. Bougie for Gleet. R. Zinci Sulphatis, gr. vj. Ac. Carbolici,. iij - Pulv. Hydrastis, gr. xij. Ext. Belladonnae, gr. xij. Gelatini, et Glycerini, q. s. M. Fiant bougia xij. Sig.—One into urethra night and morn- ing. Quinine Suppository. R. Quininae Sulphatis, . . . . gr. v. Olei T'heobromse, gr. x. Fiat suppositorium unum, mitte tales sex. Ointments (Unguenta)and Cerates (Cerata),—are frequently ordered on extemporaneous formulae, though the 34 official preparations of these classes (see ante, pages 432, 433) would seem to give the physician a sufficiently wide field for selection. The basis used is usually either the official Ceratum or Unguentum, but Petrolatum, Lard, Lead Plaster with a fixed oil, etc., maybe used. Lard is probably the best basis for all oint- ments, as it softens the skin better than any other similar substance. Its disadvantage is that it soon becomes rancid, so that preparations made with it must be quickly used. Cerates only differ from ointments in their firmer consistence, melting at temperatures above 104° F., while the latter melt below the ordinary temperature of the body. Oleates are described fully on page 71. The process of compounding an ointment or a cerate is sufficiently sim- ple, being generally a mere matter of triturating the ingredients together in a mortar, or of their incorporation on a slab by means of a spatula. Rarely will melting be required in the compounding of extemporaneous ointments. When extracts, powders or gritty substances are ordered, the ingredients should be first pulverized into a fine powder, then triturated with a small quantity of the basis into a smooth, impalpable paste; the 476 EXTEMPORANEOUS PREPARATIONS. remainder of the basis being added gradually, until the whole is thoroughly incorporated. A warm mortar may be required for hard extracts. Soluble salts should be triturated with a little water before adding the excipient. Camphor needs a little alcohol to enable it to be pulverized ; and Iodine should be rubbed to a fine powder, then a little alcohol added and finally the excipient by degrees. Iodide of sulphur requires persevering work with a small portion of olive oil. Borax should be triturated with glycerin and Red Oxide of Mercury with distilled water. A bone or horn spatula should be used for all ointments, as steel or iron blades will injure many substances, particularly alkaloids, free acids, tannin or iodine, and several of the mercurial salts. Volatile substances should be added last, and quickly worked in, so that their evaporation may be as slight as possible. Ointments are dispensed usually in amber-colored glass pots with wooden or metallic covers, or in porcelain jars called Gallipots. In hospital and dispensary practice the common chip pill-box is used, but soon becomes excessively dirty and disagreeable to handle. Ung. Iodoformi Compos. R. Iodoformi, . . , . . . . . 5jj. 01 Anisi, rrp xx- Ol. Rosae, 01. Ylang ylang, . . . . aaTtyv. Ung. Aquae Rosae, gj. M. Fiat unguentum. Sig.—Ointment. Unguentum Anti-pruriticum. R. Camphorse, Chloralis Hydrat., aa^j. Tere una ad liquorem, dein adde cum tritu— Unguenti Aquse Rosae M. Fiat unguentum. Sig.—Ointment. Plasters (Emplastra),—are rarely prepared extemporaneously, the official and many other ones being produced on a large scale by the manu- facturers, and kept in stock by all druggists. As a consequence the com- pounding and spreading of a plaster by the pharmaceutist has become a lost art. The official plasters are enumerated and described on page 433, and may be ordered by prescription in the manner illustrated below. Blisters may be produced by the application of any preparation of Can- tharides sufficiently strong for the purpose. Either of the official Cerates of Cantharides (see page 151), may be spread on Adhesive Plaster (Em- plastrum Resinse), making a blistering plaster; or Cantharidal Collodion (see page 151), may be painted over the surface. Plasters are usually ordered by the square inch, but a model of the shape and size may be drawn on paper, and the plaster be directed to conform thereto, as in the first of the following prescriptions. Two of the official Papers (Chartae) are practically plasters, viz.—Charta Cantharidis and Charta Sinapis. Emplastrum Vesicatorium. R • Cerati Cantharidis, q. s. Extende supra Emplastrum Resinse hujus formas et magnitudinis. Sig.—Blistering Plaster, to be applied over the region of the heart. Counter-irritant and Anodyne. R. Chartae Sinapis, Emplas. Belladonnse, aa 3// x 6/r. Sig.—Apply the mustard paper first, to be followed by the plaster when the surface has been well reddened. GASEOUS PREPARATIONS. 477 Poultices (Cataplasmata),—are usually prepared at the residence of the patient, the ingredients only being ordered from the druggist. They are generally employed as a means of applying heat and moisture to a cer- tain portion of the body, but are sometimes medicated with anodyne, counter-irritant or disinfectant agents. Poultices are not official in the U. S. Pharmacopoeia, but are in the British, the following list including all so recognized. Cataplasma Carbonis,—Wood Charcoal 1, Crumb of bread 4, Linseed Meal 3, Boiling Water 20 parts. Cataplasma Conii,—Hemlock-juice 1, evaporated to half its volume, Linseed Meal 4, Boiling Water 10 parts. Cataplasma Fermenti,—Beer Yeast 3, Wheaten Flour 7, Water at lOO° F., 3 parts. Cataplasma Lini,—Linseed Meal 2, Boiling Water 5 parts, mixed with constant stirring. Cataplasma Sitiapis,—Mustard, Linseed Meal, Boiling Water and Water, of each a sufficiency. Cataplasma Soda Chlorinates,—Solution of Chlorinated Soda 1, Linseed Meal 2, Boil- ing Water 4 parts. Paints (Pigmenta),—are preparations for external use, which cannot be classed with the preceding. They are generally prescribed in skin- diseases, for use over inflamed joints, or for application to the throat with a camel’s-hair brush. R. Tinct. Iodi, 3j\ /Etheris Fort., g iij. Tinct. Aconiti, g ss. Ext. Belladon. FI., . . . . 3 iv. Morph. Sulph., gr. ij. Iodi, M. et fiat pigmentum. Sig.— Paint 4 or 5 coats freely over the inflamed and painful parts. R. Alcoholis, Saponis Viridis, Olei Cadini, aa !|j. M. et fiat pigmentum. Sig.—Paint over the part. R. Olei Tiglii, 3]. Hitheris Fort., gij. Tinct. Iodi, M. Sig.—Paint on once in 3 days. Vapors (Vapores) and Inhalations (Inhalationes),—are medicines in the form of a vapor, a gas or an atomized spray, to be inhaled by the patient for their local action on the respiratory tract. The well-known steam-atomizer is the agent by which most of these preparations are administered, though many substances may be inhaled from the surface of hot-water, from a sponge in a bottle surrounded by a hot cloth, or from a heated shovel. They are prescribed in the usual manner, as follows:— GASEOUS PREPARATIONS. Stimulant Inhalation. R. Olei Cubebae, 3 ij. Magnesii Carbonat., . . . %j. Aquae, § iij. M. Sig.—A teaspoon ful in a pint of water at 150° F., for each inhalation. Carbolized Inhalation. R. Acidi Carbolici, rrpxlviij. Aquas, q. s ad% ij. M. Sig.—Use one-half in the cup of a steam-atomizer for each inhalation. 478 GASEOUS PREPARATIONS. Oil of Pine. R. Ol. Pini Sylvestris, . . . . 3 ij. Magnesii Carb., X). Aquse, 3 iij. M. Sig.—A teaspoonful in a pint of hot water for each inhalation. Tar and Turpentine. R. Ol. Picis Liquidse, Ol. Terebinth., . . . . aa^ij. M. Sig.—Pour slowly in a hot shovel in the sick-room, keeping the vapor confined therein. The official Charta Potassii Nitratis, Nitre-paper (see ante, page 323), is a preparation intended for use as an inhalation, its vapors while burning being taken into the lungs. PART III, SPECIAL THERAPEUTICS. Applied Therapeutics may be studied either with the various thera- peutic agents as the objects of chief consideration, as in the first part of this work ; or with the different diseases and morbid conditions forming the objects of study in respect to their modification and treatment by medicines. In the following pages the latter method is followed, the therapeutics of each affection being exhibited in the form of an Analyti- cal Index to the recognized text-books of the day. Every indication for the use of a drug, or statement regarding its value, is followed by the initial (in parentheses) of its author: these references enabling the book to be used as an index to the authorities, for more strict differentiation between indicated remedies,—while the brief analyses given include enough to make each section a complete synopsis of the most advanced therapeutics of the disease forming its title. The principal authors to whom references are made, and the various initials indicating them, are comprised in the following list: (A.) Aitken.—The Science and Practice of Medicine, 7th edition, revised. (Ag.) Agnew.—The Principles and Practice of Surgery, Philadelphia, 1878. (B.) Bartholow.—Materia Medica and Therapeutics, 6th edition. (Br.) Brunton.—Pharmacology, Therapeutics and Materia Medica, 3d ed., 1888. (C.) Carter.—A Practical Treatise on Diseases of the Eye, edited by Green. (Cl.) Clarke.—A Manual of the Practice of Surgery, New York, 1881. (D.) Druitt.—A Manual of Modern Surgery, 12th edition, London, 1882. (E.) Emmet.—Principles and Practice of Gynaecology, 3d edition. (El.) Ellis.—A Practical Manual of Diseases of Children, 3d edition. (F.) Fothergill.—The Practitioner’s Handbook of Treatment, 2d edition. (G.) Goodell.—Lessons in Gynaecology, Philadelphia, 1882. (H.) Hamilton.—Nervous Diseases, their Description, etc., 2d edition. (L.) Leishman.—A System of Midwifery, 3d edition, Philadelphia, 1884. (M. & P.) Meigs and Pepper.—Diseases of Children, 7th edition. (N.) Niemeyer.—A Text-book of Practical Medicine, 9th edition. (P.) Phillips.—Materia Medica and Therapeutics, revised edition, 1886. (Pf.) Piffard.—Materia Medica and Therapeutics of the Skin, N. Y., 1881. (R.) Ringer.—A Handbook of Therapeutics, nth edition, New York, 1886. (Ros.) Rosenthal.—Diseases of the Nervous System, New York, 1884. References and Bibliography. 480 ABDOMINAL PLETHORA ABORTION. (S.) Stillk.—Therapeutics and Materia Medica, 4th edition. (St.) Sturgis.—The Student’s Handbook of Venereal Diseases, 1883. (T.) Tanner.—An Index of Diseases and their Treatment, 2d edition. (Tr.) Trousseau and Pidoux.—A Treatise on Therapeutics, 9th edition. (Tt.) Tait.—Diseases of Women, by Lawson Tait, New York, 1879. (W.) Wood, PI. C.—Therapeutics, Materia Medica, etc., 6th edition. (Wa.) Waring.—Practical Therapeutics, 4th edition, edited by Buxton. Besides the above named, occasional references are made to other works by the same authors. References will also be found, with names in full, to Anstie, Brown-Sequard, Clymer, Cohen, Da Costa, Fordyce-Barker, Gross, Hammond, Hilton, Lister, Mitchell, Nelaton, Noyes, Nussbaum, Ricord, Roosa, Simpson, Thomas, and others. When a statement is not followed by any reference it is to be understood as coming from the writer of this book. Abdominal Plethora. Cathartics. The saline and hydragogue cathartics are of value in,congestion of the portal circulation (B.). Saline Mineral Waters, especially the purgative saline waters, as Vichy and Saratoga, in plethora of the abdominal viscera (B.). Grape-cure has helped many cases, particularly those of hepatic engorgement and sluggish portal circulation ; is best used after a preliminary course of power- ful mineral waters (P.). Aliment is very important. A dry diet is particularly indicated in cases of dyspepsia and hepatic enlargement due to excessive beer- drinking. Avoid much bread, also salted or twice-cooked meats, rich sauces, solid vegetables especially cucumbers, soups and fruits. Biscuits, fresh meat, lemons, fish, fowl and game, may be used. [Compare Hepatic Congestion,. Obesity.] R. Potassii Bicarbonatis, Sodii Sulphatis, aa 3 iv. Dissolve in pint of Water, and add Acidi Tartarici (cryst.), . ... gij. Cork quickly and firmly, to be taken thrice daily. Prescriptions. R. Resinse Podophylli, . . . gr. vj. Ext. Colocynthidis Co., . . gr. xij. Ext. Belladonnse, . . . . gr. iij. Fiat massa, et div. in pil. no. xij. Sig.—One pill every night. Abortion. Opium, cautiously in threatened abortion, is often very valuable (Wa.);—the tincture, rtbxx-xxx by rectum (Parvin);—Opium to check uterine action and Ergot to restrain hemorrhage (B.). Ergot, small tonic doses give excellent results in threatened abortion (P.). Tannin, combined with Opium and Ipecac. (W.). Cimicifuga, to prevent miscarriage when uterus is irritable and prolapsed (R.). Savine, the dried powder of the leaves, gr. xv-xx, thrice daily, one of the most powerful remedies against the hemorrhage indicative of approaching abortion (Wa.);—the tincture in doses of 5 to 10 drops, every to 3 hours, useful against the hemorrhage (P.). Viburnum Prunifolium, in threatened and habitual abortion, has a very high reputation. Aurum Chloride, to avert the tendency to habitual abortion (B.). Iron, with Potassium Chlorate, throughout the pregnancy, when fatty degeneration the cause of habitual abortion (McLane). Tamponade, of the cervix uteri, with cotton or sponge, dipped in vinegar or glycerin, when abortion is inevitable and it is desirable to hasten it and restrain hemorrhage. Empty uterus thoroughly with the finger, placenta-forceps liable to do harm (Barker). Abortifacients see pages 48 and 230. Quinine and Ergotin, of each gr. ij in pill every 3 hours, the routine abortifacient of rAany irregular practitioners. Only by the production of such violent irritation of the abdominal and pelvic organs as generally endangers life, can the pregnant uterus be stimulated to expel its contents (P.). The abortifacient effect of Savine and other drugs cannot be obtained unless by the administration of a quantity sufficient to endanger life (B.). ABSCESS ACIDITY. 481 R. Ext. Ergotae Fluidi, . . . g v. Tinct. Opii Deodorat., . . giij. Syrupi Limonis, 5j. M. Sig.—A teaspoonful thrice daily. Prescriptions. R. Acidi Tannici, gr. xv. Pulv. IpeCacuanhae, . . . gr. xij. Extracti Opii, gr. iij. Ft. pil. xij. Sig.—One every six hours. Abscess. Poultices to check or to assist in maturation, may be smeared with Belladonna or Opium (R). Belladonna, as plaster to subdue (B); painted around areola (Wa.) ; internally often successful in aborting (R.). Sulphide of Calcium, half- grain doses frequently repeated, to abort abscess or to hasten formation of pus (B); gr- ■fo every hour or two, gives striking results in healing large abscesses (R.). Phosphate of Calcium, in large abscesses (R.). Mercury and Morphine, the Oleate locally, diminishes induration due to old abscesses and prevents the formation of new ones (R.). Carbolic Acid, a weak solution as injection after evacuation, also as a dressing (Lister). Silver Nitrate, a strong solution in Nitrous Ether if applied early to adjacent surface will check inflammation (B.). Blisters or Iodine, as around or adjacent to seat of disease (R.). Potassium Permanganate, 3j to the pint of water, to correct fetor (B.). Iodine, the tincture injected after opening large abscesses (R.); especially in scrofulous abscess (Wa.). Salicylic or Boracic Acid, as dressings (B.). Sarsaparilla, a very useful remedy in chronic abscess with profuse discharge (P.). Cod-liver Oil, improves and lessens discharge from scrofulous abscesses (Wa.). Surgical. Opening necessary in all deep abscesses, or when on face, near anus, mammary, or if danger of its opening into an internal cavity. Open with grooved director and forceps (Hilton). Never open a deep abscess with a plunge. Drainage- tube may be required, also irrigation of the cavity and pressure (Agnew). Weaning of child necessary in chronic mammary abscess (Gross). Psoas abscess may result from strain or laceration of muscle, as by heavy lifting, effort to re- cover balance when skating, etc., as well as from spinal disease. Symptoms often obscure and simulating those of chronic malaria. Early opening by lumbar incision necessary ; then tonics, good food, and daily irrigation of the cavity with an antiseptic solution. [Compare Suppuration, Carbuncle.] Prescriptions. R. Syrupi Ferri, Quininse et Strychninse Phosphatum, % vj. Sig.—A teaspoonful in water thrice daily. To repair waste from suppuration. R. Quininse Sulph., gj. Ferri Pyrophosphatis, . . gj. Strychninae Sulph., . . . gr. j. Ac. Phosphor. Dil., . . . Syrupi Zingiberis, . . . . g ij. Aquae, q. s ad § iv. M. ft. mistura. Sig.—A teaspoonful thrice daily. R. Syrupi Hypophosphitum, . 3 vj. Sig.—A dessertspoonful thrice daily. Acidity. Acids, Hydrochloric or Phosphoric before meals ; acid wine, a genuine Rhine wine best; Sulphurous Acid rrpv-xxx well diluted; for acid fermentation of starchy foods (R.); acids after meals for alkaline pyrosis (R.). Tannic Acid, useful in pill, gr. iv with n\J of Glycerin (B.). Carbolic Acid, often arrests eructations (B.). Alkalies, after meals for immediate relief, effects only temporary, bicar- bonate best (R.): frequent use of alkalies enhances the mischief (B.). Nux Vomica, gtt. ij-iij of tincture before meals, excellent in small doses (B.); espe- cially in acidity of pregnancy (R.). Pulsatilla, gtt. v of tincture every 4 hours in acid dyspepsia (P.). Silver Oxide, extremely useful (B.). Manganese Oxide, gr. x-xx of the purified black oxide relieves (B.). Kino, a favorite remedy (B.). ipecacuanha, in acidity of pregnancy (R.). Mercury, gr. ss of gray powder ter in die, when acidity with clayey stools’ (R.). Bismuth, gives excellent results, 482 ACNE combined with Opium or Morphine, sometimes with Magnesia (R.). Diet. Use lemon-juice, aerated or old bread, plain biscuits. Avoid new bread, pastry and vegetables. Prescriptions. R. Bismuthi Subnitrat., . . . 3 iij. Acidi Carbolici, . . . . gr. ij-v. Mucil. Acaciee, % j. Aq. Menth. Pip., . . . . 3 iij. M. Sig.—A teaspoonful 3 or 4 times daily for adults. R. Sodii Bicarb., 3 ij. Spt. Ammoniae Aroxnat., . 2; ij. Tinct. Zingiberis, . . . . 3]. Infus. Gentianae Co. (U. S. P., 1870), q. s. . . .ad 5viij. M. Sig.—A tablespoonful or two. Alkalies, internally yield the best results in a number of cases (Bulkley); alkaline lotions for cases with seborrhcea (B.). Borax, a weak solution in rose- water of great benefit locally in acne simplex (Wa.) Potassium Bromide, in moderate doses has proved curative in some obstinate cases (R.). Sulphur, internally and as a lotion. In severe forms an ointment of the iodide or hypochlorite, 3ij ad (R.). Belladonna locally, is of some service, check- ing the abundant secretion from the sebaceous follicles (R). Arsenic, in old cases, especially in acne indurata, but often disappoints. Given with bromides it prevents the bromic acne (R ). Phosphorus, is an excellent substitute for arsenic (B.); the compound syrup of the hypophosphites in acne indurata (R.). Mercury, in lotion is much employed (B.); a weak lotion of the bichloride to the face two or three times daily (R.). The iodo-chloride (gr. v-xv ad 5) as irritant application (Fox); or ointments containing the bichloride or biniodide may be employed instead of the green soap application (Pf.) Glycerin, internally, has been used with success (B.). Berberis, up v of a fresh tincture thrice daily for the acne of girls at puberty. Bromide of Arsenic is adapted to the majority of cases of acne vulgaris (Pf.). Calcium Sulphide is indicated in cases characterized by a tendency to pustulation (Pf.) Bismuth, locally as a cosmetic (B.). Mag- nesium Sulphate, as a purgative daily before breakfast, in cases of acne vulgaris depending on derangement of stomach and bowels (Duhring); the salt, finely tri- turated, is an excellent dusting-powder for cases of acne rosacea. Water, hot sponging for 15 or 20 minutes several times a day, followed by glycerite of starch to allay irritation (R.); the local use of very hot water is of the greatest benefit in all inflammatory forms of acne (Bulkley). Puncturing each papule with a lancet point, followed by very hot water, and ointments of sulphur iodide, ammoniated mercury, etc., diluted (Pf.). Ergot is well used in acne rosacea and other forms of acne; a good fluid extract with glycerin and water, giving 3ss internally per diem (B.). Diet and Hygiene, require careful attention (B.) ; powerful tonics are often required (Bulkley). Sapo Viridis, as an adtive irritant in subacute cases, applied every night as long as bearable, then emollients until irritation subsides, when the green soap should be removed (Pf.). [Compare Seborrhcea.] Acne. Prescriptions. R. Potassii Acetatis, ss-j Tinct. Nucis Vomicae, . . . Ext. Rumicis Fluidi, .... 3 iv. Misce. Sig.—A teaspoonful, largely di- luted, half an hour before meals. R. Sulphuris, gj. Glycerini, ij. Aquae Rosae, 5 vij. M. Sig.—Lotion. R. Potassii Acetatis, 5j. Spt. Etheris Nitrosi, .... Jjss. Ac. Acetici Dil., j^j. Ext. Taraxaci FL, Misce. Sig.—A teaspoonful, well di- luted, on an empty stomach. R. Hydrarg. Chlor. Corr., . . . . gr. x. Alcoholis, q. s. Aquae Destil., 5ij. M. Fiat. sol. Sig.—A teaspoonful in % pint of water as a lotion, twice daily. addison’s disease—adynamia. 483 R. Magnesii Sulphatis, . . . Ferri Sulphatis, gr.xvj. Acidi Sulphurici, . . . . Aquae, q. s. ad 5 viij. M. Sig.—A tablespoonful in a glass of water before breakfast. R. Liq. Potassae, gj. Aquae Rosae ad M. Sig.—Apply with a soft sponge twice daily. R. Bismuthi Subnit., gj. Ung. Hydr. Ammoniat., . Ung. Aq. Rosae, . . . . ad gj. M. et fiat unguentum. R. Potassii Acetatis, fjiv-^j. Tinct. Nucis Vom., . . . Infusi Quassiae, vel Tinct. Cinchonae Co., . ad Siv- M. Sig.—Teaspoonful in water after meals, as an antacid tonic. R. Hydrarg. Iodo-chlor., . . . gr.v-xv. Adipis, Jj. Fiat unguentum. An irritating applica- tion, requiring care. Addison’s Disease. Arsenic, with cod-liver oil, gives the best results (Da Costa). Iron, and other tonics are useful, especially a combination of the chloride, glycerin and chloro- form (Greenhow). Phosphorus, has seemed to exert a beneficial influence (Wilks). Treatment must be symptomatic, and is of little use, the disease being always fatal (H.). Prescriptions. R. Tinct. Ferri Chloridi, . . . !|j. Spt. Chloroformi, £j. Glycerini, gvj. M. Sig.—A dessertspoonful in water thrice daily. R. Quininae Sulph., gj. Ferri Reducti, gjss. Ac. Arseniosi, Strych. Sulph., .... aa gr. iij. Confect. Rosae, q. s. M. et div. in pilulas lx. Adynamia. Cinchona or Quinine, with arsenic, for pale, badly-fed town-dwellers (R.) ; as a general tonic when flesh flabby, skin perspiring (P.). Arsenic, for swelled feet of old or weakly persons, and breathlessness from weak heart (R.); tonic in continued doses of gr. jfe to (Wa.). Nux Vomica, in adynamia of drunk- ards. R. Tinct. Capsici 3vj ; Tinct. Nucis Vom. 3(j ; gtt. xx in water every four hours (B.). Lime Salts, the phosphate, when from prolonged town-life or overwork, gr. j, with grain j each of Phosphate of Iron and Carbonate of Lime, for a dose (R.); Hypophosphites, of Lime or Soda, in nervous or general debility (R.) Iron, promotes appetite and digestion ; gr. j-iij of the Sulphate, or the official iron and aloes pill, or with manganese (B.) ; anrnmic subjects (R.). Hydrastine, as substitute for Quinine, to promote appetite and digestion and improve assimilation (B.). Digitalis or Eucalyptus, in debility with weak heart- action (B.). Bitters, especially Calumba and Gentian, useful for a short time (B.). Sanguinaria, when stomach needs stimulation (P.). Sarsaparilla, broken- down, syphilitic constitutions (P.). Alcohol is of great value, but has been abused; hurtful when it increases temperature and pulse, dryness of tongue, etc. (B.); a wine with much ether in debility of old age, especially where sleep- lessness, indigestion and stomach cramps (R.). Aliment, sugar and saccharine fruits, vegetables, oil, milk, cod-liver oil, wine of good body and strength (B.). Porter or rum-and-milk for town-living women (R.) Sea-bathing is useful in chronic illness, with much debility (R.). Turkish Baths, when debility is caused by the tropics, but caution necessary, When town-dwellers become stout and flabby, are easily tired, suffer from a lack of energy and from mental depression, a course of baths is beneficial (R.). [Compare Anaemia, Conva- lescence.] 484 AFTER-PAINS AGALACTIA ALBUMINURIA. R. Quininse Sulph., gr. xxx. Ac. Sulph. Dil., q. s. Tinct. terri Chlor., .... Aquae, ad g ij. M. Sig.—A teaspoonful thrice daily. Tonic Prescriptions. R. Quininae Sulph., gj. Strychninae Sulph., . . . . gr. j. Tr. Ferri Chloridi, . . . . 7v. Ac. Phosph. Dil., 3 ij. Syr. Limonis, . . . . ad % vj. M. Sig.—A teaspoonful in water thrice daily, in nervous debility. R. Tinct. Ferri Chlor., . . . . 3 iv. Ac. Phosphor. Dil., . . . . Sp. Limonis, 3 ij. Syrupi q. s. ad M. Sig.—A dessertspoonful in water after each meal. R. Ac. Arseniosi, gr. j. Quininae Sulph., gr. xl. Ferri et Pot. Tart., . . . . gr. lxxx. M. Fiant pil. no. xl. Sig.—One after each meal. After-pains. Opium, more certain in action than any other remedy (Wa.) ; Morphine and Atropine (gr. \ and gr. combined (B.), hypodermically (Wa.). Belladonna, as ointment, much used in France (L.). Camphor, gr. x with gr. y% of mor- phine, an effective remedy (B.); in of mucilage, tablespoonful doses every hour or two (Wa.). Chloral, will stop the pains, but large doses, gr. xx-xl, are necessary (R.). Chloroform, the linimentum chloroformi, gj with linim. Saponis 5yj, applied on flannel to the abdomen (Barker). Quinine, gr. v-x night and morning, with the above chloroform liniment locally, in neuralgic after-pains which do not yield to opiates, the uterus being tender on pressure (Barker). Gelsemium, suspends them, large doses necessary (B.). Cimi- ci.'uga, relieves the pains, and allays general nervous excitement (P.) Ergot, is better than cimicifuga (R.). Poultices, warm, over the hypogastrium, with soothing injections into the vagina (L.). Agalactia. Ricinis Communis, gr. v of extract, or 3j-ij of strong decoction, daily in water; also the leaves, or an infusion, locally to mammae (T.). Gossypium, an emulsion of the seeds has repute in India, as a galactagogue. A wineglass of the decoction every 20 or 30 minutes (P.). Pilocarpus, remarkably increases the secretions (B.). Tea, a good black tea promotes the milk-supply. [Com- pare Lactation.] Albuminuria. Aconite, in incipient, high body temperature (R.). Lead, diminishes the albumen (R.). Turpentine, gtt. ss-j, every 2 to 4 hours, or one to two drop doses night and morning, of great value in chronic albuminuria without marked symptoms of Bright’s disease (P.). Gallic Acid, the most efficient agent in the acute form to restrain loss of albumen (B. P.) See Aitken’s formula below. Cannabis Indica is indicated when bloody urine (R.). Chimaphila, has un- questioned power over albuminuria (P.). Cantharis rqj every three hours, of the tincture, after the subsidence of acute symptoms, especially when bloody urine (R.). Fuchsine, in doses of gr. j-iij, completely arrested albuminuria in many cases with oedema (Bouchut). Alkalies, the citrates and acetates as diuretics (R.); the Buffalo Lithia Water of Virginia, is highly recommended. Nitro-glycerin, n\J of a one per cent, solution to dilate the peripheral vessels, relieving the heart and lessening the renal congestion (B.). Turkish Baths, benefit by relieving the kidneys of work (R.). Milk-cure, with buttermilk, has proved very efficient in many cases (B.). Chalybeate Waters, especially those having purgative qualities, are beneficial (B.). [Compare Bright’s Disease.] ALCOHOLISM. 485 Prescriptions. R. Acidi Gallici, 3j-ij. Ac. Sulphurici Dil., . . . . 3 ss. Tinct. Lupuli, 3j. Infusi Lupuli, ad 3 vj. M. Sig.—Tablesp. thrice daily. R. Mist. Ferri et Ammonii Acetatis (U.S.P.), 5 vj. Sig.—Teasp. to a tablesp. according to age, well diluted, thrice daily. (.Basham.) (Aitken.) Alcoholism. Arsenic, for distressing vomiting, one drop of liquor arsenicalis before break- fast (R.). Capsicum, in dyspepsia of chronic alcoholism, and to induce sleep; also as a substitute for the alcohol. Gr. x, with honey (B.). With bromide 01- arsenic and bitters to assist in overcoming habit, by removing the distress at pit of the stomach. The tinct. in 10-minim doses should be taken shortly before meals, or whenever there is depression or craving for alcohol. It obviates the morning vomiting, and promotes appetite and digestion (R.) Ammonia, a full dose (3ss) of the spirit will often sober a drunkard speedily (R.);—a few drops of liquor ammoniae, diluted, have prompt action (S.);—3j of the aromatic spirit with capsicum, see formula below. Ammonium Chloride, of high value (see ante, page 96). Quinine, especially the cinchona rubra, for gastric catarrh of drunkards (B.) ; gr. ij-vj daily to raise the nervous tone (P.). Nux Vomica, for after stomachal disorders (B.); in tremor of chronic alcoholism, of much value (P.). Strychnine Nitrate, hypodermically ter in die for ten days, an absolute cure for dipsomania {Luton). Bromides, 3j every 4-6 hours in the “ horrors ” (B.). Phosphorus, in chronic alcoholism, recommended by Anstie (R.). Opium, cautiously, if at all (B.);—Morphine with tonics before meals for pain, nausea, and want of appetite (R.). Cocaine, has been pronounced of great benefit, restoring appetite, inducing sleep and promoting digestion, while it soothes the brain and induces a feeling of contentment and calm (R.). Cimici- fuga, is said to be useful in the treatment of the drunkard’s stomach (R.). Chloral, is very successful, gr. xv-xx, but must be cautiously used with old worn-out drunkards (B.) Picrotoxin, small doses for the tremor, gr. repeated (B.). Lupulin, is the best substitute for alcoholic stimulants, and extremely serviceable in delirium tremens (B.). Zinc Oxide, is very useful in chronic alcoholism, to diminish the craving, to relieve the gastric catarrh and lessen the tremor (B.). Acute Alcoholic Poisoning requires an emetic or the stomach-pump, cold douche to the head and breast, warmth to the feet and limbs. Artificial respiration may be required. Milk, mucilaginous drinks, and black coffee, are the principal remedies. A milk diet often creates a disgust for alcohol. [Compare Deli- rium Tremens and Vomiting.] Prescriptions R. Tinct. Capsici, 3 ss. Potass. Bromidi, if ss. Vel Liq. Potass. Arsenit., . lt\J. Vel Tinct. Nucis Vom., . 39. Spt. Ammoniae Aromat., . .5 iij. Syr. Tolutani, ad^\j. M. Fiat mistura. Sig. — A dessert- spoonful in water four or five times daily. R. Zinci Oxidi, 3 j. Piperinse, gr. xx. M. Fiant pil. no. xx. Sig.—One pill thrice daily. R. Ext. Lupulini FI., .... §j. Ext. Aromatici FI., 1 Tinct. Capsici, . >■ . Mucil. Acacise, . J aagvj. Aquae Menth. Viridis, . ad iv. Fiat emulsio. Sig.—A teaspoonful or two as required. R. Tinct. Nucis Vom., . . . 3j. Tinct. Gentianae Co., . . . 3 iij. Spt. Limonis nbvj. Spt. Chloroformi, . . . . 3j. Aquae, q. s. ad£ vj. M. Sig.—One-sixth to be taken 3 or 4 times daily, for insomnia. R. Tinct. Gentianse Co., . . 3 ij. Tinct. Calumbee Co., . . 3 ij. Tinct. Nucis Vom., . . . tiblxxx. M. Sig.—A dessertsp. before each meal, for rum-stomachs. (Loomis,) 486 ALOPECIA—AMAUROSIS—AMENORRHGEA. Alopecia. Cantharides tincture, 1 part to 8 of castor oil, well rubbed into roots of hair, night and morning (Wa.). Arsenic, npv of liq. arsenic, ter die, exercises a more or less powerful influence (Wa.). Nitric Acid, with olive oil, makes a service- able liniment (Wa.). Pilocarpine, has a decided influence on the growth of the hair (B.). Glycerin in combination with the above remedies (Wa.). Sulphur Iodide, has been found very effectual, used internally and externally (Wa.). Frequent shaving may often save the hair in alopecia after illness. Use clean brushes with long bristles, and brush against the natural lay of the hair. [Com- pare Tinea. I Prescriptions. R. 01. Amygdalae Expres., Aq. Ammonias, . . . . aat^j. 01. Rosmarini, g ij. Alcoholis, tij. Aquas Destillat., . . . . 5ij. Mellis Despumat,, . . . <27/3 viij. M. Sig.—Lotion for the hair. (Wilson.) R. Tinct. Cantharidis, . . . . 3 jss Tinct. Capsici tr^xx. Glycerini, sjjss. Spt. Odorat., 222/3 vj. M. Sig.—Hair tonic. (Gross.) R . Pilocarpin. Hydrochlorat., gr. j. Aquas Destillat., . . . . 3j. M. Sig.—Ten to thirty drops twice daily, according to age, to improve the growth of the hair. (Bartholow.) R. Tinct. Macis, 3 jss. Olei Olivse, 222/3 ij. M. Sig.—Lotion for baldness. (.Hebra.) Arnica, has long been a popular remedy for amaurosis in Germany. Man- noir employed it with much success (P., Wa.). Rue, in minim doses night and morning,for dimness of vision from functional amaurotic condition. Elgajaki says it produces dimness of vision, and in smaller doses improves the eyesight (P.). Strychnine, may cure, in functional amaurosis from lead, tobacco and alcohol (B.). Gr. hypodermically (Nagel). Hypodermically in tobacco and trau- matic amaurosis, and in progressive nerve atrophy not dependent on inter-cra- nial disease (R.). Guaiac, is advised for cases of amaurosis occurring in persons of a rheumatic diathesis (Wa.). Santonin, has given very satisfactory results in amaurosis (Wa.). Veratrine, as lotion brushed over eyelids, brows and temples once a day, is often useful, but should not be permitted to touch the conjunctiva, or great pain will result. See formula below (Wa.). Potassium Iodide, in amblyopia from lead-poisoning (Wa.). Seton, a small seton in the temple kept open for along period, has been found effectual when other reme- dies failed (Wa.). Amaurosis and Amblyopia are names formerly much used to denote the various conditions of blindness, before ocular diagnosis became as exact as it now is. Amblyopia is still used to designate certain impairments of vision not accounted for by any organic changes visible (Roosa). Amaurosis and Amblyopia. Prescriptions. R . Veratrinas, gr. x. 3 ij. Alcoholis, 3j. M. Sig.—Use with a brush once a day over eyelids, eyebrows and temples. R. Strychninas Sulphatis, . . gr. j. Alcoholis, 3 j. Aquas Destillatse, . . . ad^'w. M. Fiat solutio. Sig.—A teaspoonful thrice daily before meals, when not used hypodermically. Amenorrhcea. Aconite, sudden suppression from cold or wet feet (B., R., P.). Pulsatilla, in sudden suppression, also aconite (B.); often of the greatest value in functional AM ENORRHCEA. 487 form (P.). Iron, when from anaemia, the most frequent cause. Small doses preferred. Solution of acetate, or ferri et ammonii citras (gr. ij), or ferri et strychnine citras (gr. j), also chalybeate waters. Caution.—Careful diagnosis before giving iron (B.). Aloes, when dependent on anaemia (B.); at the pe- riods, with hot pediluvia, friction, etc. (R., P.). Potassium Permanganate, gr. j thrice daily increased to gr. ij, is the best of all remedies for bringing back the menses, having specific action on the uterine tissue (R.);—excellent in amen- orrhcea from cold feet, and is by far the best emmenagogue. In pill it may explode ; best in capsule with powdered elm or liquorice (Parvin). Manganese Biniodide, in pill, gr. ij thrice daily, is a very efficient emmenagogue. Mercury. The Biniodide is a certain and safe emmenagogue, gr. )/% in pill, four times daily. Oxalic Acid, is highly praised, gr. in mixture, every hour (Poulet). Apiol, when from functional inactivity. First give iron for the blood; next aloettc purgatives, then apiol (gr. xv) just preceding the period ; or a daily dose for a week, or several days before (13.). The best emmenagogue next to Potass. Permang. (Parvin). Senega, a saturated decoction of the root, to extent of a pint in 24 hours, during preceding two weeks, advantageous (P.). Polygo- num, has given excellent results when used in gss doses four times daily for a week (B.). Cimicifuga, has been recommended (R.); is of very great value (P.). Arsenic, combined with iron, when from functional inactivity of ovaries (B.) Aurum Salts from torpor of ovaries (B.). Ignatia, in suppression of hys- teria (P.). Cinnamon, causes a flow of blood to the womb (Goodell). Indigo, is considered very efficient, in doses of from oj to 3iv. Larger doses produce nausea and vomiting. Nux Vomica, small doses of the extract, of benefit in some obstinate cases (Wa.). Silver Nitrate, in substance lightly to the os uteri, at time of expected discharge (Wa.). Colocynth, in chlorotic amenorrhoea (P.). Ergot, has cured when due to plethora (B.); when anaemia after use of iron (R.); in chlorotic (P.); Tty every }£ hour for 5 or 6 hours the day before and that of the expected flow, is very efficient when the cessation is not due to anaemia (A. A. Smith). Senecio Aureus, seems to have a well-founded reputa- tion. Rue, in functional inactivity. 01. rutae, ttpj-v (B., P.). Sanguinaria, functional amenorrhoea, in absence of plethora (B., P.). Savine, general atony. Extractum sabinae, fl., rrpv-x (B., R., P.). Serpentaria, with anaemia or chlorosis (B.). Ammonium Chloride, for headache (R.). Sitz-baths, hot, for six days before period ; mustard may be added at period. Often effectual in sudden suppression (B.). Spinal-ice-bag, to lower dorsal and lumbar vertebrae ; or cold sponging useful (R.). Electricity, in atony of uterus and ovaries (B.). [Compare Anaemia, Chlorosis.] R. Olei Sabinse, %j. Olei Rutse, 7,). Tinct. Polygon. Hydropip., . . 53. Ol. Amygdalae Expres., Mucil Acaciae, Aquae Menthae Pip., . . . . && gij. Fiat mistura. Sig.—A teaspoonful two or three times daily. (Bartholow.) Prescriptions, R. Tinct. Ferri Chloridi, . . . 3 iij. Tinct. Cantharidis, .... %]. Tinct. Guaiaci Ammon., . . Jjss. Tinct. Aloes, % ss. Syrupi, q. s. ad% vj. Fiat mistura. Sig.—A tablespoonful thrice daily, in simple atonic amenorrhoea. (//. C. Wood. Dewees.) R. Quininse Sulphat., .^jss. Extr. Nucis Vom., gr. xij. Olei Sabinse, % ss. Aloes Socotrin., gr. viij. Cantharidis gr. xxiv. Fiant pilule xlviij. Sig.—One pill thrice daily. R. Extr. Aloes Aquosi, 7,}. Ferri Sulph. Exsic., 3 ij. Asafcetidae, 3 iv. Fiant pilulae 100. Sig.—One pill after each meal, gradually increased to three. {Goodell.') 488 ANASMIA. Anaemia. Nux Vomica, stimulates blood-making organs, and is used as an adjunct to restorative remedies (B.). Iron, its chief value is to improve digestion ; also furnishes haematin to the blood. The most astringent preparation is the best, and should be used after meals. Also chalybeate waters (B.). Some stomachs, with irritable mucous membrane, require bland preparations. A pale, flabby tongue indicates large doses of the perchloride or sulphate (R.). Arsenic, as adjunct to iron, and where iron cannot be borne, or fails (B.). Quinine, for badly-fed town dwellers (R.). Hypophosphites, are useful, but should not be given with iron, cod-liver oil, or stimulants (R.). Phosphate of Calcium, in anaemia of growing persons, and of women weakened by rapid child-bearing or excessive menstruation (R-). Lacto-phosphate of Calcium, for nursing mothers, or in waste from suppuration (B.). Acids, added to purgative salts as tonics to the mucous membrane (R.). Pepsin, is recommended by Hollmann (B.). Manganese, alone not of much use ; is best combined with iron (B.). Is not, like iron, found in the faeces, nor does it cause constipation (Wa.). Gal- vanization, as aid to remedies (B.). Cold Sponging, needs great caution, or may lower tone by minute degrees (R-). Diet and Hygiene, of prime import- ance. Nourishing, digestible food, in as large quantities as can be assimilated —milk, eggs, animal broths; afterwards, fish, poultry, game, mutton, etc. Moderate daily out-of-door exercise, in pure air, is indispensable. Bathing, especially sea-bathing, aids restoration. Wines, often useful. Red wines are the best. Tonic Prescriptions. R. Tinct. Ferri Chloridi, . . . . giv. Ac. Phosphorici Dil., . . . . gvj. Spt. Limonis 3ij. Syrupi, q. s. ad vj. Misce. Sig.—A dessertspoonful in water after meals. To the above may be added gij of the Liquor Strychninae Hydrochlo- ratis of the B. P. {Goodell.) R. Quininse Sulphatis, gr. xx. Ferri Sulph. Exsic., gr. xl. Strychninse Sulph., gr. ss. Fiant piluke xx. Sig.—One pill thrice daily. (Bartholow.) R. Ferri Sulph. Exsiccat., Potass. Carbonatis, . . aa . . spj. Syrupi, q. s. Fiant pilulse no. xlviij. Sig.—One pill after each meal, gradually increased to three. \Blaud.) R. Hydrarg. Chlor. Corr., . . . gr. j—ij. Liq. Acidi Arseniosi, . . . . 3). Tinct. Ferri Chlor., 3 iv. Ac. Hydrochlor. Dil., ... 3 iv. Syrupi, I iij. Aquae, q. s. ad 3 vj. Misce. Sig.—A dessertspoonful in a wineglassful of water after each meal, as an alterative tonic. (A. H. Smith.) R. Acidi Arseniosi, gr. j. Quininaa Sulphat., gj. Ferri et Potass Tart., . . . . 3: ij. M. Ft. pil. no. xxx. Sig.—One pill after each meal. R. Pil. Ferri Comp. (U.S.), . . . xlviij. Sig.—One to three after meals. R. Tinct. Nucis Vom., .... 3 ijss. Tinct. Cinchonae, . . . . ad 3 iv. M. Sig.—A teaspoonful after each meal. R. Pil. Ferri Iodidi (U.S.), . . . xlviij. Sig.—One to three after meals. R. Tinct. Ferri Chloridi, .... iij. Potassii Chloratis, gj. Liq. Strychnines (B. P.), . . gj. Syr. Simplicis, g iv. Aquas Cinnamomi, ad 3 iv. Misce. Sig.—One or two teaspoonfuls after each meal. R. Massae Ferri Carbonat., . . . 3 j. Acidi Arseniosi, gr. j. Quininae Sulphatis, gr. xl. Fiat massa, et div. in pilulas xl. Sig.—One or two thrice daily. ANAESTHESIA ANEURISM ANGINA PECTORIS. 489 Anaesthesia. Morphine, subcutaneously before inhalation, diminishes the danger, and lessens the after-pain if an operation is to be performed (Nussbaum); Morphine gr. and Atropine gr. hypodermically, after emergence from anaesthesia, will relieve the nausea and vomiting. A preliminary injection of Morphine lessens the stage of rigidity and spasm, enables a smaller quantity of the anaesthetic to be used with full effect, prolongs the stage of insensibility, prevents shock, and antagonizes the cardiac and respiratory depression (B.). Atropine, is decidedly the best antagonist to the respiratory paralysis of Ether, and should be given hypodermically (gr. as soon as alarming symptoms manifest themselves (Amidon). The writer of this book has saved at least four subjects of chloroform-narcosis by the hypodermic use of Atropine after both heart and respiration had apparently failed. Alcohol, of whiskey or brandy, before inhalation, to sustain the heart and prolong narcosis (B.). [Compare pages 80 and 171, ante, for the general subject of Anaesthesia, and page 25 for a list of Local Anaesthetics. See also the article Erythroxy- lon, ante, page 209, for the use of Cocaine as a local anaesthetic.] Aneurism. Potassium Iodide, in large doses (gr. xv-gss), 3 or 4 times a day, gives great relief, and has cured (B.); combined with recumbent position and restricted diet (R.). Veratrum Viride, aids surgical expedients ; also in large internal aneurisms, with absolute recumbence and a little Opium to relieve pain, vomiting to be avoided (B.). Ergot, with recumbent position ; favors coagula- tion of the blood in sac (B.) ; Ergotin (P.). Gallic Acid and Iron, internally, have cured cases of aortic aneurism (Speer). Chloroform, inhalation, great dyspnoea (R.). Plumbic Acetate, a valuable auxiliary to the more important items of rest, diet and mechanical appliances, gr. iij-v ter die (Wa.); its use limited to the sacculated form (S.). Electrolysis, galvano-puncture in deep aneurisms; not very successful (B.). The object sought is the coagulation of blood within the aneurismal sac. Cures have not been attained by this treat- ment, but in many it has produced great amelioration of the most distressing symptoms (Petit). Aliment, milk regimen, for denutrition (B.) ; a low diet, with absolute rest; Ergotin and Iodide of Potass, for deep aneurisms beyond reach of surgical treatment (B.). Rest, in recumbent posture, and light, unstimulating diet, are primary and essential elements in treatment of aneu- risms. Surgical Treatment includes ligation of the vessels, also pressure by a tourniquet or bags of shot, the operator’s fingers, etc., applied to the main artery above the tumor, and the introduction of fine wire into the sac to favor coagulation. Prescriptions. R. Potassii Iodidi, gj. Tinct. Veratri Viridis, . . gjss> Tr. Cinchonse Co., . . . x\. Tr. Cardamomi Co., . . 5 jss. Tr. Gentianse Co., . . . ss. Syrupi Simplicis, Alcoholis, aa 5 iv. Aquae, q. s. ad 3 xvj. Misce. Sig.— |jss thrice daily. Each dose has gr. xv of Pot. Iod. R. Acidi Gallici, gj. Ext. Ergotse, gr. xx. Digitalis, gr. xx. Fiat massa, et div. in pil. xx. Sig.—One every two hours. R. Plumbi Acetatis, gr. xxxvj. Extracti Opii, gr. iv. Confectionis Rosse, q. s. Ft. pil. xij. One every four hours. Angina Pectoris. Aconite, believed by Gubler to be appropriate, and by Fleming to have been curative in many severe cases resisting other remedies (P.). In cardiac disease its action is uncertain (Br.). Arsenic, lessens or prevents paroxysms, if used in the intervals (B., R., Anstie). Amyl Nitrite, as inhalation, affords signal relief ANUS, FISSURED APHONIA. (R., B.); unsafe in advanced degeneration of cerebral vessels and fatty degeneration of heart (B.); gives great relief during paroxysms (Br.). Nitrite of Sodium, is less rapid in action than Nitrite of Amyl, but is more efficient in preventing return of symptoms (Br.). Laurocerasus, as anodyne (P.). Strych- nine, in the milder forms ; very small doses, gr. to (P.). Glonoinum, doses of have been used with success (Pf., R.). Chamomile, in pseudo- spasms of hysterical persons (P.). Ether, aborts a mild attack (B.); Sulphuric Ether, in nervous form ; a spoonful immediately on commencement of attack will greatly mitigate it (Anstie). Phosphorus, often serviceable (R.). Morphine, hypodermically, especially in cardiac dyspnoea; strengthens the heart (R.). Turpentine, applications, hot, over chest, to mitigate severity of the paroxysms, especially in the aged (Wa.). Quinine, when intermittent (Wa.) or when any malarial taint (Br.). Brandy, in frequent small doses, with hot bran poultice over heart, and warmth to extremities. Cocaine, in doses of gr. to ]/2 thrice daily for two days, proved curative in four very severe cases (Laskevitch). Hydrastis, locally, promotes healing (B.). Rhatany, as injection, night and morning, after enema in the morning to move the bowels (Pf., Tr.). Iodoform, improves and relieves pain (B.). Iodo-tannin, well applied effective (B.). Belladonna, locally, of great service for painful spasms of sphincter (P.). Opium, with gall-ointment for fissures of anus; mild purgatives should be simultaneously employed (R.). Sulphur, as a mild purgative, to cause soft motions (R.). Tannin, 3j-glycerin 3ij; introduced on a tent, night and morning, with great advantage (Wa.). Collodion, as protective covering (P.) Potassic Bromide, with 5 parts glycerin, as local application (R.). Castor Oil, as a mild purgative (R.) ; to keep motions soft (Br.). Surgical Means, the most efficient; forcible dilatation of sphincter, or partial division in severe cases, through the mucous membrane, and a few fibres of sphincter. Anus, Fissured. Prescriptions. R. Tinct. Krameriae, . . . . 3 j. Ext. Kramerke gij. Aquae, viij. M. Sig.—One-fourth as injection, night and morning, after using enema. R. Sulphuris, j. Pulveris Aromat., . . . . sjij. Confec. Rosse, . 3 ij. Misce. Sig.—One-third to be taken at bedtime as a laxative. Ignatia, in hysterical women (P.). Atropine, in hysterical aphonia, and for fatigue of vocal chords, gr. to morning and evening (B.). Nitric Acid, rt\,v-x of the dilute acid, for hoarseness of singers, in fatigue of vocal cords, and when stomachal (B.). Benzoin, the tincture by inhalation in laryngeal catarrh (Br.). Oil of Rue, as inhalation in chronic catarrh (Br.). Nitrate of Uranium, as spray in very chronic catarrh (Br.). Alum, gr. aq., as spray, in chronic coughs and hoarseness (R.). Borax, a piece the size of a pea allowed to dissolve in the mouth (R.). Glycerin of Tannin, locally in chronic inflammation of the throat (R.). Sulphurous Acid, by inhalation, spray or fumigation, in clergyman’s aphonia (R.). Ipecacuanha, wine, as spray, when congestion of vocal cords (R.); in laryngeal catarrh (Br.). Ammonium Chloride, vapor inhaled, of great value in catarrhal aphonia (Wa.). Turkish Bath, at commencement of a feverish cold (R.); in acute laryngeal catarrh (Br.). Galvanism, localized, the best means for hysterical aphonia. Aphonia. Prescriptions. R. Liq. Ammonias, gj- Aquae, j. M. Sig.—A teaspoonful in a pint of hot water for each inhalation. R. Acidi Nitrici Dil., . . . . .gij. Tinct. Calumbas, .... |jj. Aquae, ad 3 iv. M. Sig.—A dessertsp. in a winegl. of water thrice daily. APHTHAE APOPLEXY APPETITE. 491 Aphthae. Potassium Chlorate, the best remedy. Solution of gr. x to the 3, as wash, alone or with borax (Br.), and gr. x to xx by the stomach (B.). Borax, with honey, or as glycerin of borax, frequently used (R.) ; crystals allowed to dissolve in the mouth (W.). Sulphurous Acid, as solution, strong or diluted, locally (R.). dilute as spray (B.). Mineral Acids, formerly much used (B.). Mercury, Hydr. cum creta in small doses to remove the indigestion on which aphthae often depends (B.), borax being used locally, when aphthae exist in the mouth (Wa.). Copper Sulphate, a weak solution painted over mucous membrane (R.). Potas- sium Iodide, gr. j-v-jfj aquae, locally (B). Salicylic Acid, one part (dissolved in alcohol) to 250 of water (R.). Quinine, gr. j every 2 or 3 hours, in infants (B.), especially when consequent on diarrhoea (Br.). Coptis, the infusion has repute in New England (B.). Bismuth, freely to parts (B.) ; as a local applica- tion (Br.). Glycerin, will sometimes cure (R.). Rhubarb the compound powder of rhubarb, to remove indigestion (Br.) ;—is highly useful in small doses (Wa.). Prescriptions. R. Ac. Sulphurosi, sjij. Aquae, (id 3 ij. M. Sig.—Mouth-wash, or use as a spray. R. Pulv. Rhei Co., gij. Sacch. Lactis, q. s. Triturat. et div. in pulv. xij. Sig.—One thrice daily. Apoplexy. Aconite, full strong pulse ; hot, dry skin, plethoric cases. The best remedy (P.);—to lower blood-pressure and prevent further hemorrhage, where the pulse is strong and the arterial tension high (Br.). Elaterium, as a purgative ; a large dose (gr. ij) in suppository with soap; or as an injection into large bowel (P.). Croton Oil as purgative, a drop may be put on the back of the tongue (Br.) ;—FiX or X each hour (R.). Colocynth, as a derivative purgative (Br.); appears to act well (P). Cold Water, often harmful, though frequently used. Injurious when face pale, surface cool, circulation depressed (B.). Electricity. Very mild galvanic currents to promote absorption. Caution necessary, espe- cially if much headache and vertigo (B.). Diet and Hygiene, of great import- ance in patients subject to apoplexy. Avoid stimulating food and drink (especially beer), overeating, excitement, haste, exposure to hot sun, heated rooms, etc. At no subsequent period should a full animal diet or the use of undiluted wanes be indulged in (A.). Diagnosis. Should be carefully differ- entiated from drunkenness, with which it is often confounded. [Compare Cerebral Congestion.] R. Tinct. Aconiti, rryc. Aquae Cinnamomi, . . ad% ij. M. S'g.—A teasp. every hour for 2 hours, then every half-hour. Prescriptions. R. Ext. Colocynthidis Co., . . gr. xx. Olei Tiglii, Ttyj. Fiat massa, et div. in pil. iv. Sig.—One pill as required, until free purgation ensues. Appetite. Ignatia, will correct diseased appetite (P.); especially in hysterical subjects (Br.). Anthemis, will stimulate the appetite. Bitters, to stimulate the appe- tite (R.). Food should be savory and well cooked. Habits require examining into, when lost appetite complained of. Fluorides of Sodium or Potassium will produce almost total anorexia, and may be employed with advantage in bulimia (Da Costa). [Compare Dyspepsia.] 492 ASCITES ASTHENOPIA ASTHMA. Prescriptions. R. Gentianse, Quassise, Cinnamomi, aa 3 ij. Sig.—Put into a pint of boiling water, and when cold, strain; take a winegl. thrice daily as an appetizer. R. Anthemidis, Quassise, aa gj. Sig.—Put in a pint of boiling water, and when cold, strain; take a winegl. thrice daily before meals as an appetizer. Ascites. Digitalis of the greatest service, except where aortic regurgitation and car- diac hypertrophy (P.) ; fresh infusion best (R.) ;—its action increased by com- bination with squill and pil. hydrargyri (Br.). Arsenic, when from feeble heart, and in old age (B.). Apocynum Can., an active diuretic (P.). Copaiba, excel- lent in hepatic dropsy (Br.). Jaborandi, has given good results (B.). Stillingia, in ascites due to hepatic changes (B.). Jalap, the compound powder, with podophyllum, the most generally approved hydragogue purgative (B.). Ela- terium, to produce free watery evacuations. Cautiously in debilitated subjects. Contraindicated when gastro-intestinal irritation or inflammation. Is depres- sant (B.). Milk-diet, successful; an ancient practice; causes profuse alvine and urinary discharges (B.);—sometimes very useful when the kidney action is inadequate (Br.). [Compare Dropsy.] R. Resinse Copaibas, . . . . Alcoholis, 3 v. Spt. Chloroformi gj. Mucil. Acacise, . . . . . f, ij. Aquae, q. s. xij. M. Sig.—A tablesp. thrice daily. Prescriptions, R. Hydrarg. Chlor. Mitis, Pulv. Digitalis, Pulv. Scilloe, aa gr. vj. Fiat massa, et div. in pil. vj. Sig.—One pill thrice daily, in ascites from hepatic changes. Asthenopia. The proper glasses; cold douche; rest of eyes. Atropine, systematically instilled, to prevent strain, and control spasm of the accommodation (C.). [Compare Myopia.] Aconite, in spasmodic (P.); often averts the attack, if given at commence- ment ; useful also in the asthma following coryza and sneezing in children. (R.). Ipecacuanha, the wine as spray to the fauces, sometimes useful in severe bronchial asthma, but not of much service in genuine asthma (R.); nauseating and emetic doses in spasmodic form (B.). Lobelia, gtt. x of the tincture every X hour during paroxysm; ter die, with additional doses at night, in bron- chitic asthma when worse at night. Cautiously if heart disease (R.). Often gives permanent relief (B.) Arsenic, as cigarettes as well as by internal admin- istration (B.). One drop of liquor arsenicalis ter die, in attacks from bronchitis, local irritation, etc., allied to hay fever (R.). Belladonna, relieves paroxysm when expectoration abundant, skin cool and moist (B.). Internally in large doses, also in cigarettes (Br.). Atropine hypodermically is more efficient, gr. at bedtime to abort morning paroxysm (B.). Large doses required, but very satisfactory (R.). Was much valued by Dr. Salter and M. See (P.). Potassium Iodide, when from acute bronchial catarrh, gr. xv-xx each 2, 3, or 4 hours (B., R.). The best medicament to suppress the asthmatic attack, in bronchial asthma, is iodide of potassium and chloral (Lazarus). Is the specific in asthma, if any drug can be so called ; should be given with Lactucarium (See). Cocaine, hypo- dermically, is used with the best results, even where other remedies failed to relieve (Mosler). The leaves of the coca-plant make the best cigarettes for asthma (Nachtigal). Pilocarpine Hydrochlorate, gr. in water, at bedtime, Asthma. ASTHMA. 493 promptly and effectively relieves, in cases of bronchitic asthma with hypertro- phic rhinitis. In some of nine years’ standing it gave permanent relief appa- rently (Wyss). Nux Vomica, in nervous subjects (B) ; in spasmodic asthma, often of great benefit (P.). Chloral, may arrest paroxysm (B., R.). Chloroform, inhaled from warm water. Anaesthetics relieve, but increasing doses required, leading to habit (B., R.). Ether, full dose, may avert a mild attack (B.). Amyl Nitrite, inhaled, quickly checks spasmodic asthma (B., R.) Antimony, in an affection of children like asthma. Dissolve a grain of tartar-emetic in half a pint of water, and give a teaspoonful of this every X hour for the first hour, then hourly. If vomiting induced, lessen the dose (R.) Coffee, a small cup of very strong coffee often useful in a paroxysm (R.). Asthmatics should not use it as a beverage (P.). Stramonium, twenty grains of the dried leaves or ten of the powdered root may be smoked. Datura tatula sometimes better. Stramo- nium preparations often bad. Asthmatics advised to grow the drug themselves (R.). Grindelia, gives relief in spasmodic form (B.); three grains of extract thrice daily, to prevent attacks, or rrpxx-xxx of liquid extract every half-hour or hourly from onset of paroxysm (R.). Ethyl Iodide, very valuable in spasmodic form, and lessens liability to subsequent attacks, rrp v-xx thrice daily by inha- lation (B.). Cannabis Indica, has been useful (R.). Sulphurous Acid, by inha- lation, spray, or fumigation (R.). Morphine, hypodermically, quickly cuts short a paroxysm (B.); in some cases morphine will induce a paroxysm (R.). Apo- morphine, gr. TX hypodermically, has been found effective ; or gr. every 3 or 4 hours in camphor water, with or without morphine or ipecacuanha. Tobacco, smoking sometimes relieves (R., P.). Asafcetida, has been recommended (R.) ; palliative only (P.). Colchicum,in gouty subjects (R.). Bromides, relieve but soon lose effect (B., R.). Eucalyptus, smoked with stramonium, belladonna, tobacco (B.). Quinine, after acute symptoms subside, as antipyretic to succeed- ing fever and restorative tonic (B.). Potassium Nitrate, the inhalation of fumes of burnt nitre paper will sometimes avert a paroxysm. Different methods of preparation useful for different cases (R ). Oxygen, when no heart disease (R.). Silver Nitrate, sometimes injected into trachea (R.). Chamomile Oil, has been found very serviceable (P.). Sanguinaria, is very useful in humid asthma, and occasionally so in the spasmodic form (R.). Galvanism, of pneumogastric often relieves ; + pole beneath mastoid process ; — pole to epigastrium. Farad- ism of no use (B.). Prophylaxis, avoidance of exciting causes, especially indi- gestible food, wet, damp, and sudden changes of temperature. Attention to the stomach will do most for many asthmatic patients. An important point is to take the heaviest meal early in the day, and very solid food after 2 p.m. Shower-bath and out-of-door exercise, not, however, to a fatiguing extent (R.). In special cases operative treatment of the nose and naso-pharynx is required (Lazarus). Prescriptions. Arsenical Cigarettes. R . Sodii Arseniatis, 3 ss-j. Aquae Destillatae, . . . . 3J. Moisten unsized white paper, and roll into cigarettes, each containing gr. X to gr. j of the salt. Two or three of these to be inhaled daily. (.Bartholow.) R. Belladonnse Foh, gj. Stramonii Fol., Hyoscyami, aa gss. Extracti Opii, gr. iij. Aquae Lauro-cerasi, q. s. Dissolve the opium in the water, and moisten the leaves therewith. When dry, roll into twelve cigarettes. Smoke two to four daily. (Trousseau.) R . Ext. Grindelise Fluidi, . . 3; ss. Ext. Lobelias FI., . . . . gij. Ext. Belladonnas FI., . . . g). Potassii Iodidi, .^iij. Glycerini iij. M. Sig.—A dessertspoonful as required. R. Tinct. Sanguinarise, Tinct. Lobelise, Ammonii Iodidi, . . . aa sjj. Syr. Tolutani, g vj. M. Sig.—A teaspoonful every 2, 3 or 4 hours, in humid asthma. (B.) 494 ASTIGMATISM—ATHEROMA ATROPHY BALANITIS. R. Chart. Potass. Nitratis, . . . j. Burn in a close room and inhale the fumes. R. Tinct. Lobeliae, gj. Ammonii Iodidi, . . . . g ij. Ammonii Bromidi, . . . giij. Syrupi Tolutani, . . . . M. Sig.—A teaspoonful every i, 2, 3 or 4 hours. (B.) R. Ammonii Bromidi, . . . . gr. clx. Ammonii Chloridi, . . . . gr. xc. Tinct. Lobeliae, z iij. Spt. Etheris Comp., . . . gj. Syrupi Acaciae ad M. Sig.— \ dessertspoonful in water, every hour or two, for the paroxysm. (.Pepper.) R. Spt. Etheris. Compos., Liq. Morph. Sulph. (gr-j ad Ei)> • • • • aa gj. M. Sig.—A teaspoonful every half-hour or hour in the paroxysm. R. Potassii Bromidi, . . , . gj. Potasii Iodidi, g ss. Aquae Cinnampmi, . . . . g iv. M. Sig.—A teaspoonful in water every half-hour or hour. (B.) R. Spt. Etheris Comp., . . . . g j. Tinct. Belladonnse, . . . . g). M. Sig.—A teaspoonful ter in die. Astigmatism Atropine, a weak solution to aid examination of eye by dilating pupil, and paralyzing accommodation (B.). Duboisine, as substitute for atropine, has more rapid action, with shorter duration of effects, and less conjunctival irritation. Glasses, of suitable form, cylindrical in simple astigmatism, bi-cylindrical in mixed astigmatism. Pray’s Test Letters, to determine degree and direction of the defect (C.). Phosphorus, in minute doses, for atheroma, with cod-liver oil (B.). Arsenic, often of great value in atheroma, especially where imperfect action of kidneys (Br.); indicated when there are puffy eyes, drowsiness, intellectual torpor (B.). Quinine, gr. iij-x daily, in atheroma, with advantage (B.). Ammonium Bro- mide, in atheroma, to promote absorption of deposit (Wa.). Digitalis, may be useful in general capillary atheroma; cautiously! (W.). Cod-liver Oil, with phosphates, hypophosphites, or the lacto-phosphate of lime, in combination (B.). ( Compare Aneurism.] Atheroma. Cod-liver Oil, has proved beneficial (Wa.). Olive Oil, by inunction, every 12, 6, or 4 hours, successfully employed (Wa.) Arsenic, has had remarkable success in muscular atrophy (Tr.). Electricity, in progressive muscular atrophy, the induced current very strong at first, then weaker as improvement; interrupted currents from vertebral column and plexuses to nerves of affected muscles; in more extended forms, the constant current to the nerves, the induced to the muscles (Ros.). Massage, removes the waste products and restores the muscular power (Br.). [Compare Emaciation, Locomotor Ataxia.] Atrophy. Balanitis. Mercury, Hydr. Chlor. Corr. gr. j to gjss aquae calcis, as lotion, if not much inflammation (Br.). Oil, on linen, to inflamed part, beneath foreskin, which must be again drawn forward; strict cleanliness. Astringent Lotions, Alum, Sulphate of Zinc, with warm water injections (Br.). Lime-water, the best lotion if much inflammation (D.). Tannin, in alcohol, equal parts, as dressing after washing with a weak solution of common salt. Carbolic Acid, a 5 per cent, solution, on cotton rag after washing, thrice daily, is generally sufficient. [Com- pare Phimosis, Gonorrhoea.] BED-SORES BILIOUSNESS. 495 Bed-sores. Alcohol, Brandy, or eau-de-cologne, to harden skin of parts exposed to pres- sure (R); as wash to parts threatened (B.). Glycerin, or glycerin-cream, rubbed over the parts exposed to pressure, after washing, morning and even- ing, is one of the best preventives (R.). Alum, gss, whites of four eggs, Tinct. Camphorse, gij, an excellent application (B.). Charcoal, sprinkled over the black slough, which is then covered with poultice (R.). Galvanic Couplet, of zinc and silver, connected by a copper wire; one element on sore, the other on adjacent part (B.). Silver Nitrate, a solution (gr. xx-gj) to be painted on the threatened but unbroken skin, as soon as it becomes red, will prevent sores; if Nitrous Ether solution be used, 5 grs. to the oz. is enough (R.). Iodoform, dusted over sores (R.). Linen, air-dried better than that which is ironed or mangled, by reason of its greater softness. Podophyllum, acts as a cathartic (B.); corrects deficient secretion of bile, espe- cially in children and infants; gr. -fo to every six hours, to correct white or clayey stools ; also in general hepatic derangement (P.). Aconite, in occa- sional doses, improves the effect of Podophyllum (R.). Mercurial Cathartics, act only as purgatives, Calomel gr. j-x, or Pil. Hydrarg. gr. v-x ; Mercury as purgative restricted to cases where there is excess or deficiency of bile (B.). Frequent small doses of gray powder for deficiency (R.); Calomel, gr. iij, fol- lowed by 3ij each of Rochelle and Epsom Salts, when the tongue is heavily coated and furred (Gross). Yellow Oxide of Mercury, in doses of gr. to -fo, in trituration with sugar of milk, exceedingly efficient in many disordered con- ditions of the alimentary canal and its appendages (Schaffer). Bryonia, is worthy of commendation in the ordinary bilious headache with vomiting, and in general hepatic derangement known as sluggish liver (P.). Hydrastis, gtt. v-xv fl. ext. daily before meals, when with chronic gastric catarrh and dys- pepsia (B.). Mineral Acids, before meals, Hydrochloric Acid and Pepsin after meals, in atonic dyspepsia (B.). Stillingia, when deficient biliary secretion (B.); may be used in place of Mercury (Br.) Ammonium Iodide, gr. j-iij in water each 2, 3, or 4 hours, when catarrh of duodenum and biliary ducts (B.). Ammonium Chloride, is much employed in Germany for hepatic derangements, and with good success. Euonymus, is considered very efficient by many practitioners in cases of hepatic dyspepsia, or “bilious attacks,” so-called. Manganese, gouty subjects. Rhubarb, as a cholagogue. Aloes, with constipation. Angos- tura, is suitable to worst forms of bilious fevers (P.). Calumba, is of benefit in many forms (P.). Alkalies, and their laxative salts, when bilious state, with uric acid diathesis (B.). Milk-cure, in obstinate cases ; buttermilk or skimmed milk often agrees best (B.). [Compare Dyspepsia, Hepatic Congestion, Duodenal Catarrh.] Biliousness. Prescriptions. Be. Ext. Stillingise FI., 3 v. Tinct. Aloes, 3 ij. Tinct. Nucis Vom., 3_j. M. Sig.—Twenty drops in water thrice daily. (B.) R. Hydrarg. Oxidi Flavi, . . . . gr. j. Sacch. Lactis, q. s. Triturat. et div. in chart, xlviij. Sig.—One powder dry on the tongue twice daily. Be. Ext. Euonymi, 3 ss. Ext. Hyoscyami, gr. xv. Ext. Gentianae, gr. vj. Fiat massa, et div. in pil. xij. Sig.—One pill every other day. R. Masses Hydrargyri, Ext. Colocynthidis Co., aa gr. iij. M. et div. in pil. ij. Sig.—Take at once, and follow in a few hours with a saline cathartic. 496 BLADDER BLEPHARITIS—BOILS. Bladder, Irritable. Belladonna, in nocturnal incontinence, due to relaxation of sphincter, or irri- table mucous membrane (B.); gtt. v-xx of tinct. every 3 or 4 hours give gradual but sure relief (P.). Cantharis, in women, without acute inflammation (B.); on coughing (R.). Benzoic Acid, when from enlarged prostate, removes fetor of urine; also renders phosphatic or alkaline urine acid (P.). Ammonium Ben- zoate, may be used instead of Benzoic Acid (Br.) Gelsemium, the best remedy for irritable bladder of women of hysterical type, with constant desire to urinate (B.). Cubebs, is often successful in women, but Cantharides generally better (B.); is of especial value when vesical catarrh present (P.). Aqua-puncture, strange to say, has been used with considerable success (B.). Cannabis Indica, in spasm of the bladder, and in irritable conditions of that organ is generally useful. Eucalyptol, is often very efficient, but frequently fails, rqjj on sugar two or three times a day. [Compare Cystitis, Dysuria, Enuresis, Lithiasis, Calculi, Urinary Disorders.] R. Tinct. Gelsemii g ss. Sodii Bromidi, giij. Ext. Tritici Fluidi, 5 iss. Prescription. Sig.—A teaspoonful in water every four hours, for irritable bladder. Bladder, Paralysis of, Cannabis Indica, in retention from spinal disease (R.). Ergot, in paralytic dysuria, especially when sensation of bladder being only partially emptied (P.); when incontinence from paralytic sphincter, and in paralysis from over distention (B., Wa.). Arnica, has proved curative (P.). Strychnine, useful (B.). Cantharides, often given with excellent effect, when bladder atonic (Wa.). Galvanism, may greatly benefit (B.); electro-magnetic current from the bladder to the spine, of great use (Wa.). Blepharitis. Pulsatilla, internally and externally (P., B.). Mercury, after detaching crusts, rub in brown citrine ointment (B.); should be diluted with vaseline or simple ointment (Br.). Tannin, powdered, or tannic acid solution, gr. j-x to the 5 (B.). Alum, after acute symptoms subside (B.).; a solution, gr. viij-gj aquae, every % or yi. hour, an excellent application (R.). Hydrastis, as lotion, very serviceable (P.). Bismuth, equal parts of the subnitrate and glycerin to the inflamed surface, in ciliary and glandular blepharitis (Wa.). Ergot, the fluid extract locally, gives excellent results (B.). Prescriptions. R. Aluminis, gr. x. Aquae Rosae, § ij. M. Sig.—Lotion for the eyelids. (B.) R. Unguent. Hydrarg. Nitrat., % j. Vaselinae Albae, tjiij. M. Sig.—Ointment for the margins of l the eyelids. Boils. Belladonna, as plaster, to subdue inflammation, or use’lint wetted with Atro- pine, gr. iv, Aquas Rosas, ,5j (B.); with Glycerin locally, to allay pain ; inter- nally often successful (R., Wa.). Sulphides, in small doses (gr. to ]/z of Calx Sulphurata) every hour or two, or Sulphurous Mineral Waters will abort or mature, and aid to expel pus (B., R.); of no use in the boils of diabetes (R.). Aromatic Sulphuric Acid, for the tendency, gtt. x-xv, in plenty of water thrice daily. Silver Nitrate, gr. v-xx-Sj of nitrous ether, painted over adjacent part, to abort; specific if used early (B., R.). Arsenic, long-continued for succes- BONE BREATH—BRIGHT’S DISEASE. 497 sion of boils (B.); to lessen tendency to recurrence (Br.). Opium, a thick extract locally (R.). Camphorated Alcohol, smeared over boils in the earliest stage, then, when skin dry, smear with camphorated oil, to abort (R.). Sodium Phosphate, the best remedy for the systemic condition which produces boils (R.). Carbolic Acid, undiluted, on a thread passed through centre of boil while recent, will abort it. Counter-irritation, by blisters or Iodine around the boil (R.). Collodion, at papular or pustular stage (R.). Salicylic Acid, locally to destroy the parasitic organism (staphylococcus pyogenes), on which boils de- pend. See formula below. (Heitzmann.) Hydrarg. Biniodide, the oint. locally, with Calcium Sulphide, gr. j daily in divided doses internally, leaves little to be desired so far as treatment is concerned. Poultices to assist matu- ration and allay pain, may be smeared over with Belladonna or Opium (R.). [Compare Acne, Carbuncle.] Prescriptions. R. Calcis Sulphurat., . . . . gr. iij. Sacch. Lactis, q. s. Triturat et. div. in chartas xxx. Sig.—One powder every 2 hours. R. Acidi Salicylici, g ij. Emplast. Saponat., . . . . Emplast. Diachyl., . . . . gj. Sig.—Ointment. (Heitzmann.) Iodine, in scrofulous affections of bones, should be used locally, with the iodide of iron or cod liver oil internally, nutritious diet, wine, out-door exercise (Wa.). Cod-liver Oil, in scrofulous affections, may be relied on if perseveringly used, and accompanied by good hygienic conditions (Wa.). [Compare Caries, Exostosis, Nodes, Periostitis, Rachitis, Spina Bifida, etc.] Bone, Diseases of. Potass. Permang., gr. j-§j aquae rosae, as a wash for the mouth (B.). Chlo- rine, as solution of chlorinated lime, to remove fetor (B.). Carbolic Acid, a dilute solution, as wash for mouth (W.). Camphor, is used as a corrective (R.). Look for bad teeth, disordered digestion; in very offensive cases, gangrenous lungs, cleanliness of teeth and mouth are essential. Thymol, in solution, as a mouth-wash, is very efficient in removing the odor of tobacco from the breath. Breath, Fetid. R. Calcis Chlorat., giij. Aquae Destillatee, Alcoholis, aa t^ij. Olei Rosae, rrpiv. M. Sig.—A teaspoonful in a glassful of water as a lotion for the mouth. (B.) Prescriptions. R. Acidi Salicylici, zj. Liq. Ammonii Acet., . . . iij. Glycerini, Aquae, q. s ad 5 vj. M. Sig.—A tablespoonful every six hours. (Robinson.) Aconite, should be given immediately on the appearance of the nephritis in scarlatina (R.); as a diuretic, advocated (P.). Cantharis, after subsidence of the acute stage, one-minim dose every 3 hours will stop the hematuria (R., B.). Digitalis, (infusion the best remedy in renal dropsy from acute desquamative nephritis (B.); only diuretic as long as dropsy lasts (R.). Can- nabis Indica, as diuretic; is especially useful when bloody urine (R-). Eu- calyptus, sometimes effective; cautiously, or it will aggravate symptoms (B.). Hyoscyamus, in irritable kidneys (P.); may be substituted for Belladonna (Wa.). Jaborandi, is much used (Da Costa) ; large doses very depressant to the heart, but trpv-x of the fluid extract every half-hour or hour will produce sweating. It may be combined with tinct. of Digitalis (A. A. Smith); or the Nitrate of Pilocarpine, to excite skin when symptoms urgent, gr. to x/% for Bright’s Disease, Acute. 498 bright’s disease, chronic. adult (B.). Turpentine, in drop or half-drop doses every 2 to 4 hours, controls the dropsy in a remarkable manner (P.); hot turpentine epithems are service- able, but may increase the action of the kidneys (Wa.). Belladonna, has often proved useful (P.); may be used with benefit (Wa.). Jalap, the com- pound powder is the most generally useful purgative, used in the early morn- ing, to produce free watery evacuations, when uraemic symptoms supervene (B.). Gallic Acid, checks albuminuria (B.). [See Albuminuria, for formula.] Juniper, as diuretic; often aggravates (P.). Poultices, large, of linseed meal, made light and soft as possible, beneficial (Wa.). Cupping, in lumbar region, ameliorates acute desq. nephritis, and congestion of the kidney (B.); cupping or leeches over the loins, with opiates freely, diluents, and demulcents, with rest and an antiphlogistic regimen, often suffice (Wa.). Vapor-bath or Warm Pack, to increase the action of the skin (B.). Diluents, as mdk, and cream-of- tartar in solution, should be used freely to relieve the congestion and remove obstructions from the tubules (B.). Iron, after the acute symptoms have sub- sided, as a tonic, the most suitable preparation being Basham’s mixture, the now official Mist. Ferri et Ammonii Acetatis, in 5SS doses thrice daily. (Da Costa). [Compare Albuminuria, Hematuria, Ur/Emia.] Prescriptions. R. Potassii Acetatis, . % ijss. Infusi Digitalis, . . . . § lij. Infusi Juniperi, .... Sjiij. M. Sig.—A tablesp. every 2 to 4 hours as a diuretic. R . Mist. Ferri et Ammonii Ace- tatis, £ viij. Sig.—A tablesp. thrice daily, as soon as hematuria disappears. R. Ext. Pilocarpi FI., . . . gss. Vini Ipecac., gjss. Mucil. Acacise, 3 j. Aq. Cinnamomi, . . . ad 3 ij. M. Sig.—A teasp. every four hours until free diaphoresis. R. Pulv. Jalapse Comp., . . g iv. Div. in chartulas no. iv. Sig.—One in water before breakfast. Bright’s Disease, Chronic. Milk-cure, has been very successful; skim-milk alone for some time, then gradual addition of other diet (B.). Water, in large draughts, as diuretic, when excretion of solids is deficient (Br.); hot fomentations to lumbar region (B.). Lead, diminishes the albumen (R.). Gallic Acid, to lessen the albu- minuria. See under Albuminuria for formula (A.). Hydrastis, lessens excre- tion of albumen (B.). Potassium Bitartrate, to prevent dangerous accumula- tions in cellular tissue or important cavities, also to draw off effete matters; care must be used as it is a brisk purgative, and is weakening (R.); in form of “ cream-of-tartar lemonade,” an agreeable diuretic (B.). Jalap, the compound powder occasionally, as derivative cathartic, to relieve the kidneys (Da Costa.) Nitro-glycerin, TtL to dilate peripheral vessels, relieves the heart and the renal congestion, and diminishes albumen (B.). Fuchsin, in doses of gr. vij-xv daily, used with considerable success in different stages of the disorder, and was well borne (Riess). Oleum Erigerontis, lessens albumen, lowers vascular ten- sion, improves general condition, and favorably influences the headache, nausea, and other uraemic symptoms (B.). Tartrates, excellent diuretics (R.). Cod- liver Oil, is very useful (R.). Baths, warm and Turkish, when uraemic symp- toms and dropsy; discretion needful, as baths may weaken (R.). Cannabis Indica, as diuretic when bloody urine (R.). Turpentine, sometimes given in very small doses as a diuretic, and to check hematuria (R.); half-drop or drop doses every 2 to 4 hours very successful in dropsy with albuminous urine de- pending on non-desquamative disease of the kidneys. Jaborandi, in uraemia is very satisfactory (B.); large doses very depressant to the heart (A. A. Smith); of the fluid extract ter in die if the urine decreases much (Da Costa). BRONCHIECTASIS—BRONCHITIS, ACUTE. 499 Iron, to improve digestion and correct anaemia ; the tinct. of the chloride or tinct. ferri acetatis preferred (B.) ; in chronic tubular nephritis with cardiac hypertrophy the mist, ferri et ammonii acetatis, gss ter in die, with an occa- sional vapor-bath (DaCosta). Chimaphila, has power over various forms of nephritic disease, especially when albuminuria present (P.). Eucalyptus, in chronic desquamative nephritis, cautiously used will cause improvement (B.). Elaterium, for the dropsy, as a derivative cathartic: must be cautiously used (R.). Bromides, are useful in the convulsions (R.). See Uraemia. Potassium Iodide, has improved'some cases, which were possibly due to syphilis (R.). Aurum, the chloride in pill, gr. to ter in die, persistently, in the chronic interstitial nephritis, to arrest hyperplasia of the connective tissue ; may be combined with Arsenic, which has a similar influence (B.). Mercuric Chloride, acts in the same manner, gr. bis die (DaCosta). Food, should be nourish- ing, particularly suitable are milk, eggs and rare beef (Da Costa). Buffalo Lithia Water, of Virginia, has many advocates. [Compare Dropsy, Uraemia.] (Compare those under Bright’s Disease, Acute.) Prescriptions. R. Strychninae Sulphatis, . . . . gr. l/r. Tinct. Ferri Chloridi, . . . . g ss. Acidi Acetici, Curagooe, Liq. Ammonii Acetat., . .ad §vj. M. Sig.—A tablesp. every 6 hours, fol- lowed by a glass of water. For the anaemia. R. Tinct. Nitro-glycerini, . . . gj. Sig.—One drop, gradually increased to five, four times daily on sugar. (B.) R . Auri et Sodii Chlor., . . . . gr. jss. Aquae Destillatae Solve. Sig.—A teasp. ter in die. Bronchiectasis. Quinine, the most useful remedy as a tonic (B.). Phosphates, are undoubt- edly useful, so also are the Hypophosphites, (B.). Chlorine, in solution as a stimulant and deodorizer, or as inhalation to lessen fetor (Br.). Palliation of the cough and expectoration, with care of the general health of the patient, is all that can be accomplished. [Compare Emphysema.] Aconite, gtt. ss-j every hour (B.); in catarrh and bronchitis of measles (R.). Tartar Emetic, first stage, gr. to TX especially if cough is violent (B.) ;— gr. j to a quart of water, a teasp. of this every hour for the wheezing and cough of slight bronchitis in children (A. A. Smith) ;—gr. X tc> X every 2 or 3 hours (R.). Ipecacuanha, as wine, when expectoration profuse and difficult to expel (R.) ; dry stage (P.) ; Ipecac, when secretion is scanty and dry; Squill, when the secretion, though copious, is difficult to expel (Brunton). Lobelia, as expectorant (B.) ; for paroxysmal dyspnoea (R.). Sanguinaria, after subsi- dence of acute symptoms, as expectorant (B.) ; very successful (P.). Quinine, to reduce temperature (R.). Colchicum, useful when gouty diathesis (P.). Opium. Morphine and quinine combined, or Dover’s powder, to abort an attack ; also with expectorants to allay cough (B.). Frequent and violent coughs, without obstructed oxidation; also to check excessive secretion (R.). As sudorific very useful, grs. x of Dover’s powder (P.). Carbolic Acid, as spray, a 5 per cent, solution with steam atomizer, prompt and efficient. Apo- morphine, the hydrochlorate in doses of gr. every 3 hours, the best of all expectorants. Cimicifuga, an excellent expectorant, and useful when acute symptoms have subsided (B.). Nitric Acid, tipx of dilute acid relieve (B.). Asafcetida or Ammoniacum, the last best, in bronchitis with wheezing of old people (R.). Asafcetida, is an excellent stimulant of respiration, especially when the capillaries have become clogged with the products of inflammation, and suffocation seems imminent. Here also the Cold Bath is a means of enabling the patient to expel the mucus, the equal of which has not been yet Bronchitis, Acute. 500 BRONCHITIS, CAPILLARY. advanced. The cold bath may be used for even very young infants, and should be but momentary (W.). Ammonium Carbonate, when the expectora- tion is profuse, and the condition low (R.). Ammonium Acetate, from its sudor- ific action is always indicated, especially in children (Dessau). See formula below. Cubebs, very useful, especially when secretion copious and system relaxed (P.). Copaiba, after subsidence of the fever, the most serviceable ex- pectorant, but nauseous (B.). Counter-irritants, mustard as poultice (large), with linseed or oatmeal, or both, very useful (R.). Iron, Lead, Zinc Oxide, to check profuse secretion (R.). Heat to chest by linseed poultices, of great service. Diet, should be light and in liquid form. Temperature of atmosphere in room about 8o° F., and the air moistened by steam. [Compare Cough.] R. Antim. et Pot. Tart., . . . . gr. ij. Liq. Ammonii Acet., . . . . 5iv. Spt. Etheris Nitrosi, . . . . %). Tinct. Aconiti, g ss. Syr. Simplicis, . . . q.s. ad M. Sig.—A teaspoonful every 2 or 3 hours. In first stage. Prescriptions. R. Ext. Cimicifugae Fh, . . . . j|ss. Tinct. Opii Deodorat., .... j^j. Syr. Tolutani, ad g ij M. Sig.—A teaspoonful every 4 hours. (B.) R. Tinct. Sanguinariae, Tinct. Lobeliae, aa 3 j. Vini Ipecac., gi). Syrupi Tolutani, . . . q. s. ad g iv. M. Sig.—A teasp. every 3 hours. (B.) R. Liq. Ammon. Acetat., . . . g iv. RjflpSpt Etberis Nitrosi, Syr. Ipecac., aa g iss. Syr. Senegas, gj. Syr. Limonis, 3 j. M. Sig.—A teaspoonful every 3 hours for children. (Dessau.) R. Apomorph. Hydrochlor., . . gr. Ac. Hydrochlor. Dil., . . . rqhj. Sy'rupi Senegae g\. Aquae Destillat., M. Sig.—A teaspoonful every 2 hours. For a child of 3 years as expectorant. Should be put up in a blue bottle. R . Tinct. Aconiti, rqviij. Aquae Cinnamomi, g). M. Sig.—A teaspoonful every y2 hour for 2 hours, then every hour. In acute in- flammatory form. R. Vini Ipecac., g ij. , Liq. Potassii Citratis, . . . . g iv. Tinct. Opii Camphorat., Syr. Acacias, aa M. Sig.—Tablesp. ter die. In first stage of ordinary acute bronchitis. (Da Costa.) R. Ext. Eriodyctii FI. gv). Ext. Senegas FI., 5 iv. Syr.Pruni Virginian., . . . . ,5 ij. Aquae, q. s. ad 3 iv. M. Sig.—Teaspoonful every 3 hours. Bronchitis, Capillary Ipecacuhana, as emetic, preferred to tartar emetic in capillary bronchitis of very young or very old (B.); as wine, when expectoration profuse and difficult to expel (R.). In very young infants should be used in place of antimony (M. & P.). Squill, as expectorant, may be used with benefit (Wa.). Antimony, sulphurated, gr. in combination with Dover’s powder, every 2 or 3 hours, when the temperature very high, and pulse full and strong. Must be stopped as soon as nausea and vomiting begin (M. & P.). Lobelia, for paroxysmal dysp- noea (R.). Ammonium Carbonate, when expectoration profuse and strength diminishing ; in severe bronchitis or broncho-pneumonia of children, especially when prostrate and livid (R.); has probably a specific action on the diseased tissue and its products (Clymer.). Ammonium Iodide, in small, rapid doses, often gives great relief to the catarrhal process (Da Costa); often gives the most astonishing relief (B.). Ammonium Muriate, gr. ij every 2 hours, either alone or with potassic chlorate (Clymer). Serpentaria, in capillary bronchitis of children gives excellent results (B.). Turpentine, one of the best stimulants when vital powers are depressed and peripheral circulation feeble (B.). Cam- BRONCHITIS, CHRONIC. 501 phor, to allay cough and promote expectoration (B.). Hydrocyanic Acid, for cough and tendency to spasm. Hydrarg. Subsulph. effective as emetic (B.). Mustard, as poultice or bath, useful (R.) the most important part of the treat- ment (M. & P.). Poultices, to encircle the whole chest in children (R.). A jacket of cotton-wool around the chest. Steam, by inhalation, may be impreg- nated with sedatives, or with carbolic acid ;—is of great importance (M. & P.). Quinine, in that form of capillary bronchitis occurring in tropical climates, and where marked debility (M. & P.). Stimulants, are often necessary, especially in the suffocative form, and where marked prostration (M. & P.). Emetics are necessary when suffocative symptoms become prominent. [Compare Cough.] Prescriptions. R. Ext. Serpentaria FI., . . . g ss. Ammonii Carb., tjij. Syr. Tolutani, jsjjss. M. Sig.—A teasp. every 2, 3 or 4 hours. (B.) R. Liq. Ammonii Acet., . . . gss. Syr. Ipecac., gj. Liq. Morp. Sulph. (gr-j ad §j) Tt\xl. Syr. Acaciae, j. Aquae, gjss. M. Sig.—A teasp. every 2 hours for a child 2 years old. When surface pale and expression languid, skin cool. (M. & P.) R. Quininae Sulph., gr. vj. Ac. Sulph. Dil., rt^xij. Syr. Simplicis, Aquae, 3 ijss. M. Sig.—A teasp. every 2 hours to child of 2 or 3 years; older children require more quinine. (M. & P.) R. Ammonii Iodidi, .... J?j-ij. Ammonii Carb., zij-iij. Syr. Glycyrrhizae, . . . . ipj. Syr. Tolutani, ij. M. Sig.—A teasp. every 2 or 3 hours. Bronchitis, Chronic. Antimony, when expectoration copious and difficult to expel (R.). Arsenic, where emphysema, in cigarettes (B.). [See ante, Asthma, for formula.] Sul- phur, gr. v-x, in severe cases, with abundant discharge, especially where con- stitutional debility (R.). Sulphurous Acid Gas, inhalations, or the acid in form of spray, sometimes beneficial (B., R.). Lobelia, for paroxysmal dyspnoea (R.). Ammonium Chloride, combined with stimulating expectorants, such as Serpen- taria, Sanguinaria, or Eucalyptus (B.);—when secretion is thick and abundant, may be applied by an atomizer (R.). Carbolic Acid as inhalation of spray, x part to ioo of water; may be combined with tincture iodine (B. R.). A 5 per cent, solution in steam atomizer as inhalation. Hydrastis, fluid extract, locally and internally (B.) ; of great value internally and externally in chronic coryza (P.). Senega, especially in the aged (R.). Iodine, by inhalation, sometimes used (R.) ;—the Iodides, especially the iodide of ammonium, are very service- able in combination with expectorants (B.). Colchicum, in gouty subjects (R.). Balsams of Peru, and Tolu, when copious secretion of pus (R.). Ammonia, inhalation, to lessen expectoration (R.). Oleum Anthemidis, in pulmonary catarrh with excessive secretion and difficult expectoration, a very useful remedy, trpij-iv (P.). Ammoniacum, the mistura, with chloride or carbonate of ammonium, efficient in the bronchitis of old people, with wheezing and abund- ant secretion (R.). [See Bronchorrhcea, for formula.] Benzoin, 3j of the compound tincture to boiling water, as inhalation ; eases cough and lessens expectoration (R.). Sometimes used by atomization (B.). Phosphates, for the resulting cachexia (B.). Phosphate of lime (R.). Serpentaria, as stimulant. Alum, powdered, dusted over surface (B.). Silver Nitrate, locally (gr. on sponge probang (B.). Camphor, to allay cough and promote expectora- tion (B.). Sumbul, has decided efficacy (P.). Opium, with expectorants, to allay cough (B.). When frequent and violent cough, without any signs of ob- structed oxidation ; also to check excessive secretion (R.). Codeine, gr. l/e 502 BRONCHORRHCEA. every 3 to 6 hours, when other opiates are not well borne (P.). Ethyl Iodide, by inhalation, is very valuable by reason of its local influence, iTv-xx thrice daily (B.). Grindelia, an excellent expectorant, and especially when cough is troublesome (B.). Strychnine, as a respiratory stimulant and to check the re- flex vomiting (B.). The syrup of the phosphates of iron, quinine and strych- nine. Squill, in chronic forms with tenacious sputa, but not when fever or acute inflammation (R.). The Pil. Ipecac, cum Scilla, of the Br. Ph. in 10- grain doses night and morning, is a most useful remedy (Br.). Tar, diminishes the secretion and allays the cough (P.); gr. ij in pill every 3 or 4 hours in chronic paroxysmal winter cough (R.). Digitalis, when interstitial pneumonia and general anasarca (B.). Eucalyptus, valuable in chronic cases of broncho- pulmonary catarrh (B.). Gallic Acid, useful in some forms of chronic broncho- pulmonary catarrh (B.). Iron, with free expectoration, mistura ferri composita; or better, the phosphate of iron, quinine, and strychnine (B.). To check pro- fuse bronchial secretion (R.). Myrtol, in fetid bronchitis, of great value (Gubler). Copaiba, when purulent secretion (R.);—for profuse secretion, the best of all expectorants, but nauseous (B.). Cubebs, when profuse expectora- tion, has similar remedial influence (B.). [See Bronchorrhcea, for formula.] Terpine Hydrate, gave immediate and curative results in cases of long-stand- ing and obstinate bronchitis, which had resisted all other treatment; gr. xlviij, in Glycerin, q. s. ut. ft. solutio, Syr. Lactucarii, q. s. ad 3ij, of which a teasp. every three hours (Boyland). Terebene is proving very valuable ; requires an equal weight of light carbonate of magnesium to suspend it. Koomiss-cure, possesses great value (B.). Cod-liver Oil, a teaspoonful ter die after meals, of great service, if continued (B.); to control expectoration (R.). Poultices, made large, of hot linseed meal to cover the chest, when congestion of lungs. Olive Oil, inunctions to chest, has soothing and strengthening effects. Diet, nutri- tious, and stimulants necessary when great prostration. Koomiss is an excel- lent article of diet. [Compare Cough, Emphysema.] Prescriptions. R. Ext. Eucalypti FI %j. Ammonii Chloridi, . . . . gij. Ext. Glycyrrhizae, . . . . z ij. Syrupi Tolutani, j iij. M. Sig.—A teasp. 4 to 6 times daily. R. Syrupi Scillse, § ss. Tinct. Opii Camph., . . . gij. Ammoniaci, g ss. Syrupi Tolutani gx. M. Sig.—A teasp. p. r. n. R. Ammonii Carbonat., . . . gr. xl. Infusi Serpentariae, . . . g iv. M. Sig.—A tablesp. every 3 hours. R. Tinct. Sanguinariae, . . . gj. Ammonii Chloridi, . . . . gj. Syrupi Tolutani, gij. Spt. Etheris Nitrosi, . . . 5 ss. Aquae, jfiijss. M. Sig.—Tablesp. p. r. n. R. Ammonii Chloridi., . . . g iij. Syrupi Picis Liquidae, . . g vj. M. Sig.—Tablesp. 4 times daily. Bronchorrhoea. Ammonium Iodide, often improves the condition, especially if used with arsenic (B.). Oil of Eucalyptus, of great utility (B.); n\,ij ter die on sugar, or see formula above. Sulphurous Acid Gas, as inhalations, or the sulphurous acid as spray, sometimes improve (B.). Lead Acetate, as astringent to restrain secretion (B.) ; gr. j-ij every 2 hours. Petroleum, crude, in capsules, has been administered with rapid amelioration as the result (Blache). Grindelia, an efficient remedy (B.). Iodine, as liniment, over front and back of chest (R.). Spinal Ice-bag, to restrain excessive secretion (R.). Quinine, and the Phos- BRUISES BUBO. 503 phates, also Cod-liver Oil, as restoratives (Wa.). Copaiba, the most serviceable expectorant, but nauseous (B.) ; when copious secretion of pus (R.). Cubebs, has remedial effect in chronic bronchial affections with profuse expectoration (B.). Asafetida, is of great benefit (B.). Turpentine, an excellent remedy when fetid expectoration ; may be used internally (rq,v) or by inhalation from atomizer. Terpine Hydrate, seems to be even more efficient than turpentine, in doses of gr. x-xx daily. Carbolic Acid, internally (rr\j), and by spray (gr. v ad aquae), often of great utility (Da Costa). Benzoin, by inhalation, for its local influence. Myrtol, is largely eliminated by the lungs, and is a most valu- able agent in bronchorrhcea and fetid bronchitis, acting as a stimulant and antiseptic (Gubler) ; dose Tqjj in capsules (Br.). [Compare Cough.] R. Copaibae, Syrupi Tolutani, . . . . aa i|ss. Spt. Etheris Nitrosi, . . . . 3j. Aquae Menth. Pip., . . . . 5; ij. M. Sig.—A teasp. every 4 hours. Prescriptions. R. Ammonii Chloridi, zj. Mist. Asafoetidae, 3 iv. Misce. Sig.—Tablesp. as required. R. Potassii Iodidi, 3 j. Ac. Nitrici Di]., Tinct. Belladonnse, . . . . gj. Ac. Salicylici, zj. Aquae Camphorse, . . . ad 3 iv. M. Sig.—Dessertsp. in water 3 or 4 times daily, for fetid bronchitis. R. Copaibae Bals. Tolutan., Pulv. Acaciae, aa 3 ss. Ac. Sulph. Aromat., . . . . 3 ss. Aquae Destillat., 3 vj. M. Sig.—Tablesp. bis vel ter in die. Arnica, the infusion very useful as an external application for bruises and cuts ; also an excellent internal remedy for internal bruises, shake, falls, blows, or shock ; every 2 or 3 hours (P.); in bruises, sprains, etc. (Wa.). Aconite, the liniment locally to painful sprains and bruises (Wa.). Capsicum, a strong tinct. applied with gum, said to act like a charm on discolored bruises (R.). Sulphurous Acid, a solution constantly applied (R.). Oil of Bay, as stimu- lating liniment (P.). Opium, the tincture with linimentum saponis (gj to §j) diligently rubbed in two or three times a day, affords great relief (Wa.). Bruises. Bubo. Mercury, necessary in the indurated buboes diagnostic of syphilis (Ricord): the powder of calomel locally applied for indolent buboes refusing to heal after opening (H.). Nitric Acid, indolent and broken bubo (R.). Sulphides, are less useful in maturating than in the case of ordinary boils or abscesses (R.); to check suppuration (St.). Iodoform, locally, has proved useful (Wa.). Iodine, applied to produce vesication around a bubo, relieves inflammation (R.); freely every day, with rest and compression, to cause absorption (St.). Silver Nitrate, lightly to surface, to stimulate indolent buboes (Wa.). Potassio-tartrate of Iron, 30 parts to 250 aquae destil., three tablesp. daily ; also as lotion to sore (Ricord); phagedena (St.). Tartar Emetic, gr. j every two hours reduces inflammation in many cases (Wa.). Ice, greatly relieves (B.). Surgical.—Open freely with a bistoury when suppurating; if pus is virulent, the open bubo is a chancroid, and must be treated as such (Keyes). Pressure, by compressed sponge under a spica bandage, or a shot bag, the best local treatment for indolent bubo (Keyes); in all cases cleanliness, rest in recumbent posture, emollient poul- ices. Diet, should be generous, with cod-liver oil, in phagedenic bubo. The treatment of Syphilitic Bubo is that of general syphilis, local measures are use- less, and no treatment called for until a general eruption appears (Keyes). [Compare Chancroid, Syphilis.] 504 BUNION BURNS—BURSITIS—CACHEXIA. Bunion. Iodine paint, or Emplastrum Hydrargyri, for indolent form, thick but not tender (D.). Rest, fomentations, and anti-arthritic remedies for thickened bunion ; burst it by pressure if recent and sac thin (D.). [Compare Bursitis,] Burns and Scalds. Carbolic Acid, 1 part to 30 of lin. calcis, or 1 part to 6 of olive oil; the latter speedily relieves pain, and promotes healing without suppuration (Wa.); 1 part to 10 of olive oil, applied on layers of cotton batting, the best application for burns of all degrees. Boracic Acid, a saturated watery solution, used with great success by Lister (B.). Lead Carbonate, white lead paint, an excellent application to burns of small extent (B.). Salicylic Acid, ol. olivae is an efficient local application (B.). Collodion, flexible, to burns of first degree (B., R., P.). Phytolacca, relieves pain (B.). Lime, as lime-water and oil, equal parts (R.); or lime-water with linseed oil, a favorite application (P.). Rhus Toxicoden., externally o to the pint, in superficial but extensive burns (P.). Cantharis, the tincture diluted with 40 parts of water and applied on rags, is a most excellent application. Sodium Carbonate, in solution as lotion, immedi- ately relieves pain and promotes rapid healing. Turpentine, in dangerous cases, where great constitutional depression (P.); as wash to severe burns, then locally basilicon ointment mixed with turpentine (B.). Cotton-wool, to allay pain and exclude air (P.). Warm Bath, immerse for some days (R.); exclu- sion of air the main indication (H.) Pinus Canadensis, the concentrated extract, painted on freely, relieves the pain effectually. Lime and Linseed. Prescriptions, R. Iodoformi, %]. Cetacei, !|j. Ext. Conii Alcohol., . . . . gr. xl. Acidi Carbolici, gtt. x. M. Sig.—Spread on lint and cover the parts therewith. R. Olei Lini, Svij. Aquae Calcis, viij. M. Sig.—Apply on sheet lint, and cover with oiled silk. R. Sodii Carbonatis 3 vj. Aquae, Oiij. M. Sig.—Apply freely for 3 days on old cloths or lint. R. Pulv. Carbonis Ligni, . . . % viij. Sig.—To be dusted thickly over the burned parts. Bursitis Iodine, painted on outside, after removal of fluid with aspirator (D.) ; after blistering (Wa.) Blisters, in rheumatic enlargement of bursa, are almost indispensable for a rapid cure (Wa.), Fomentations, with rest, to relieve pain and swelling. If unavailing, a crucial incision into the bursa, care being taken not to open the capsule of the knee (D.). Excision, when chronic, tumor hard, resisting other measures (C.). Cachexiae. Lime, the phosphate, in scrofulous affections and anaemia (Wa.); in phthisis, and affections marked by mal-nutrition (B.). Iron, in splenic, syphilitic, and strumous, and especially in all anaemic states ; also in the malarial and phthis- ical; chalybeate waters (B.). The ammonio-citrate the best tonic in the ca- chexia of gastric ulcers, especially in chlorotic females (Wa,). Arsenic, a prompt remedy in the malarial cachexia; also in cancerous of real value (Wa.). Hydrastine, in paludal and splenic cachexia, stands in high esteem (B.). Nitric Acid, is adapted to the cachexia following acute disease or intem- CALCULI. 505 perance ; also as alterative after long course of mercury (Wa.). Potassium Iodide, in constitutional syphilis, and resulting affections of bones and skin (Wa.). Mercury, in the syphilitic ; but its utility much questioned (Wa.). Aurum, in cancerous, mercurial, and syphilitic cachexiae, especially when bones, glands, and oculo-nasal mucous membrane affected. Phosphates, in bone diseases, wasting, bronchitic, leucorrhceic, etc. (B.). Arnica, in very developed cachexias, has excitant action on the nervous system (Wa.). Euca- lyptus, a serviceable tonic and stimulant in cachectic states generally (B.). Manganese, the syrup of the iodine of iron and manganese in anaemic, syphi- litic, strumous, malarial, cancerous, etc. (B.). Grape-cure, often modifies most happily many conditions (P.). Air, in good condition, an important element (B.). Water, the Turkish bath and wet pack as aids to remedial action, in plumbic, mercurial and paludal (B.). Oils and Fats, to promote constructive metamorphosis in many cachexiae, especially cod-liver oil (B.); the latter a most valuable remedy in scrofula, phthisis, atrophy, tubercular and jail ca- chexiae, anaemia, etc. (Wa.). Massage, has been productive of remarkable results in many forms of cachexiae (B.). Aliment, of prime importance (B.). [Compare the various titles, Anuemia, Scrofula, Syphilis, etc., and the formulae for tonics, on pages 484 and 488, ante.\ Calculi, Biliary. Chloroform, is supposed by some to act as a solvent in 20 to 6o-drop doses every 3 or 4 hours ; it cannot act as a solvent, but undoubtedly affords some relief (B.); as an inhalation it may be used to relieve the pain of the paroxysm (Br.). Ether and Turpentine, equal parts of each, 3j once daily for a year, is Durande’s solvent remedy ; is not solvent, and as an anodyne inferior to mor- phine or chloral (B ). Morphine, gr. % with Atropine gr. hypodermically, the best anodyne for the pain and vomiting during the paroxysm (Br.). Chloral, sometime relieves the pain (R.). Counter-irritants, as mustard poultices to relieve the pain during the paroxysm (Br.). Olive Oil, gij at night, followed next morning by 3 or 4 seidlitz powders an hour apart, efficient in facilitating the expulsion of accumulated gall-stones. Nitro-muriatic Acid, as bath, found useful in India to relieve the pain and promote expulsion of the calculus, §iij of the acid to a gallon of water (Scott.). Sodium Phosphate, in Z doses before each meal for several months, to prevent recurrence (B.); should be given in plenty of water (Br.). Sodium Salicylate, increases the secretion of bile and renders it more watery. It is therefore indicated in cases where there is a tendency to the formation of gall-stones (Br.). Succinite of the Peroxide of Iron, hydrated, contains a large proportion of nascent oxygen, and is given in teaspoonful doses after meals for several months, and resumed at intervals afterwards to prevent reformation of the calculi (Buckler). Diet, is import- ant; withhold all starches, sugars and fats, also malt liquors and spirits ; mod- erate exercise out of doors, lean meats, eggs, fish, fruits and succulent vegetables to be used freely. Mineral Waters, the alkaline are useful, especially Vichy, which is deemed of great benefit. [Compare Colic, Jaundice.] Prescriptions. . Succinat. Hydrat. Ferri Per- oxidi, 3 jss. Aquae, 5 vjss. M. Sig.—Teasp. after each meal for several months. R. Spt. Etheris Comp., . . . gij. Liquor. Magendie, .... n\pcxx. Syr. Zingiberis, .... ad M. Sig.—Teasp. doses, an hour apart, until pain is relieved. Alkalies, especially potassium salts, if long continued will effect solution of uric acid calculi (R.) ; sodium salts should not be used (B.). Potassium Citrate, in large doses for bloody urine containing uric acid crystals (R.); the citrate Calculi, Renal and Vesical. 506 CANCER. and carbonate of potassium are the most desirable solvents for uric acid gravel (Sir H. Thompson). Potassium Tartra-borate, if long used, is very efficient as a solvent for uric acid calculi (B.). Potassium salts are much more efficient than those of Lithium as solvents for uric acid (Prof. Rogers). Alka- line Mineral Waters, those rich in potassium preferred, especially Vichy (B.). Ammonium Benzoate, long-continued, will dissolve phosphatic calculi (B.). Ammonium Biborate, will prevent attacks of colic where uric-acid calculi, in 20-grain doses every two hours until free urination, then gr. 15 thrice daily in a glass of flaxseed tea. Magnesium Boro-citrate, is a good solvent of uric acid calculi (Madsen). Lithium Citrate, to promote oxidation (Da Costa). Hy- drangea, in decoction, used by the Cherokees in all calculous affections with uniform success (Butler). Lead Acetate, gr. '/% to the 3 of distilled water, in- jected into the bladder to prevent formation of phosphatic calculi, or a solu- tion of Dilute HC1 Acid, h\, ij-iij to the 3 (Sir H. Thompson). Nitric Acid, very dilute, as injection for phosphatic calculi (R.); gtt. j to the 3, as injection into the bladder in chronic cystitis and phosphatic deposits (B.). Cotton-root, in decoction, as a demulcent for strangury and gravel (P.). Castor Oil, of value as a purgative (P.). Calumba, to relieve the vomiting (P.). Counter-irritants, as mustard-poultices, or turpentine stupes, to relieve pain of the paroxysm (R.). Anaesthetics, for the same purpose (B.). Morphine, hypodermically, as an ano- dyne and to relieve the vomiting (B.). Hot Fomentations, to alleviate spasm and pain while calculus is passing. Diet. Restrict the use of sugar in any form or combination, also fats and alcoholic beverages. Fresh, green vege- tables may be used freely, also skimmed milk or buttermilk. Mineral waters, preferably Vichy, Friedrichshall and Carlsbad. Frequent abstinence from animal food. Lemon-juice and soft water in large draughts, are useful. Sur- gical Measures.—Lithotomy or Lithotrity for removal of stone from bladder. Solvents are of no use except for a very small calculus, and even then a con- siderable time must be occupied in the process. No operation in surgery more certainly safe, rapid and successful than lithotrity (Sir H. Thompson.) [Com- pare Colic, Lithiasis, Oxaluria, etc.] Prescriptions. Magnesium Boro-citrate. R. Magnesii Carbonat., . . . gj. Sodii Biborat., Acidi Citrici, aa g ij. Aquae Bullientis, .... 5 viij. M. Sig.—Tablespoonful 3 or 4 times daily. (B.) Potassium Tartra-b orate. R . Potassii Bitartratis, .... partes iv. Ac. Borici, partem j. Aquae, partes x. By heating the above together, the salt is obtained as a white powder, of which gr. xx in a large draught of water 3 or 4 times daily. Cancer. Arsenic, in cancer of the stomach, diminishes pain and checks vomiting; also in scirrhus of stomach and epithelioma; is believed to retard the growth of uterine cancer (Br.). Arsenious acid, pure or with starch, as a caustic; enough should be used to set up active inflammation (R.). Belladonna, locally and internally (n\, v-x), of great benefit as palliative in severe pains of cancer (P.). Conium, as poultice, and internally to relieve pain (R.). Is particularly applicable to pain of cancer (P.). As palliative (Wa.). Hydrastis, has a renewed interest (Pf.) Carbolic Acid, undiluted, to sore, and injected beneath it, limits and retards (B.); pure, as anaesthetic, before applying caustics; with glycerin, as application to fetid cancers (R.). Mercuric Chloride, in small doses, long-continued, will retard the growth of gastric cancer (Da Costa.). Citric Acid, 3j-3viij aquae, useful in allaying pain of cancerous ulcerations (Wa.). Acetic Acid, i to 3 aquae; ttl xxx injected into the tumors, has been used with varying success-(Wa.). Chloral, in gr. x doses, 3 times a day, has relieved most severe pain of cancer (R.). Chloroform, as vapor to raw surface CANCRUM ORIS CARBUNCLE. 507 (R.). Pyoctanine, or Methyl Violet, in solution, by injection into the neoplasm, to bring about the shrivelling up and final disappearance of carcinoma (von Mosetig). Hyoscyamus, bruised leaves, locally (P.). Bismuth, relieves pain and vomiting of gastric cancer (B.). Glycerin of Tannin, with glycerin of car- bolic acid, checks discharge and stench of uterine cancer (R.). Carbonic Acid, injected up vagina in cancer of uterus, to relieve pain (R.). Iodoform, applied to diseased surface, relieves pain and removes fetid odor (B., P.). Resorcin, 15 parts to 20 of Vaseline as an ointment twice daily after washing with a solution of pot. permanganate has successfully stopped epithelioma (Antonio). Potassium Chlorate, in impalpable powder, dusted on epithelioma, said to be curative (B.). Pepsin, injections into tumor (B.). Salicylic Acid, pure, applied in powder (B.). Zinc Chloride, the most efficient and safe escharotic. Parts j-ij-v flour, or “caustic arrows” inserted at base of tumor (B ). Potassa Fusa, as escharotic (B.). Opium, to cancerous sores. Mor- phine, dissolved in glycerin, and spread on lint, very useful where there is much pain. Opium is also used in cancer of the stomach (R.). Codeine (gr. TV to a good hypnotic (P.). Zinc Sulphate, dusted over, dry. An excellent caustic. Remove the eschar by poultice (B.) Bromine, for destruc- tion of uterine cancer, is preferred by some (B.). Chromic Acid, a power- ful escharotic (B.). Carbonate of Lime, as calcined oyster-shell, very efficient in arresting growth of cancerous tumors, and in alleviating the pain thereof (Hood). Rumex Acetosa, an excellent local application; has a popular reputation. Iron and Manganese, the syrup of the iodide, for resulting cachectic state (B.). Poultices, of starch, applied cold (R.); or poultices of bread, sprinkled with charcoal or freshly ground coffee, as deodorizers to open cancers. Water Enemata, to relieve pain and straining in intestinal cancer (R.). Prescriptions. R . Bismuthi Subnit., 3 ij. Morphinse Sulph., . . . . gr. j. Fiant pulv. vj. Sig.—One thrice daily in milk, when gastric pain and vomiting. (B.) R. Acidi Arseniosi, gij. Mucil. Acacise, g;j. As paste on cancerous sore, followed after 2 or 3 days by bread poultices until slough separates. Cancrum Oris. Arsenic, in medicinal doses (R.). Nitric Acid, to surface (R.); strong nitric acid the best caustic for worse forms of the disease (Wa.). Potassic Chlorate, gr. xx-xl in 24 hours, has been strongly recommended (D.). Quinine, made into a syrup, or as enema, to support the strength (Wa.). [Compare Aphthae, Stomatitis.) Carbuncle. Belladonna, with glycerin, as local application to relieve pain (R., P., Wa.). Ammonium Acetate, to support the system (Cezard). Carbolic Acid, on lint, with glycerin or oil, into discharging sinuses (R.); or hypodermically into the sloughing tissues. Iodine, to produce vesication around carbuncle ; reduces inflammation (R.); part j of the tincture to iij aquae, locally, has most striking effect (Wa.); may be used with benefit internally or hypodermically (Cezard). Calcium Sulphide, gr. hourly, or every two hours, of great service (R;). Opium, a thick extract, locally (R.). Potassium Chlorate, highly recommended, also Quinine and Iron, freely to support the system and counteract the carbun- cular poison. Poultices, the inflamed surface having been previously smeared with belladonna and glycerin (R.). Long-continued poulticing thought to create tendency to a fresh crop. Strapping, with plaster, concentrically from border inwards, leaving the centre free, will sometimes arrest extension (R.). Collodion, as protective covering (P.); as zone around base, leaving the centre exposed (Wa.). Collodium cum cantharide in a broad zone painted around the carbuncle, to relieve the tension (Ag.). Ice, or Ice-bags or iced-water on cloths in early stage, changing to warm fomentations as soon as suppuration has begun (Hebra). Galbanum and Opium as plaster to relieve pain, the separa- 508 CARIES CATALEPSY—CATARACT. tion of the core then proceeding painlessly (Hill). Crucial Incisions are not so frequently made now as formerly; they relieve tension but often give rise to severe hemorrhage. Diet should be very supporting, and stimulants may be used freely when the patient is debilitated. Saline purges occasionally (Hill). Cauterization, with fuming nitric or carbolic acid, on top of a free crucial incision, followed by dressing with carbolized oil, is the course to pursue in malignant pustule. Caustic Potash, applied before an opening occurs, or small pieces inserted into openings made by scalpel, to cause the rapid separa- tion of the slough. The resulting ulcer should be treated on general principles. [Compare Boils.1 R . Calcis Sulphurat., . . . gr. iij. Sacchari Lactis, . . . . q. s. Triturat. et div. in chart, xxx. Sig.—One powder every 2 hours, to be taken dry on the tongue. Prescriptions. R • Tinct. Ferri Chloridi, . . . if j. Potass. Chlorat., giij. Liq. Ammonii Acetat., . . Syrupi et Aquae . . q. s. ad ijviij. M. Sig.—Dessertsp. every 2 hours. Caries. Aurum, in syphiloma of bones (B.). Calcium Chloride, where strumous cachexia (B.). Phosphoric Acid, with 8 parts water, locally applied, has been of benefit (Wa.). Phosphates, best is syrup of lacto-phosphate of lime, or Parrish’s plios. (B., R.). Villate’s Solution, to dissolve the carious bone, has cured many cases (B.); see formula below. Sarsaparilla, a very useful medi- cine (P.). Iodine, locally, with iron or cod-liver oil internally (Wa.) ; see Bone. Potassic Iodide, in syphilitic caries, holds the first place (Wa.). Cod- liver Oil, to promote constructive metamorphosis (B., R.). Mechanical Contri- vances, necessary in most cases; Sayre’s plaster jacket, Agnew’s jacket of leather and steel, Taylor’s apparatus, etc., are used in spinal caries to separate the diseased bones, and extend the spinal column. [Compare Necrosis.] Vitiate's Solution. Prescriptions. R. Cupri Sulphat., Zinci Sulphat., aa partes xv. Liq. Plumbi Subacetat., p. xxx. Aceti, p. cc. To be injected through the sinuses. R. Syrupi Calcii Lacto-phos- phatis (U. S. P.), . . . j|viij. Sig.—A dessertsp. to a tablesp. 3 or 4 times daily. Catalepsy. Turpentine, in enemas, and embrocations along the spine, affords the best chance of stopping the paroxysms (Wa.). Treatment must be essentially tonic and restorative (H.). No constant line can be stated (A.); external stimulation to arouse consciousness, by Ammonia, cold douches, Faradism, etc. Apomor- phine, gr. fa to fa, in the paroxysm ; with the onset of nausea, consciousness returns and spasm ceases; in the intervals between the attacks the treatment should be that of hysteria (Gowers). Cataract. Phosphorus, with oil, by frictions to the forehead, and instillation of the same into the eye, may cause absorption of the lens or capsule (Wa.). Codeine, in diabetic cases (Br.). Sodium Sulphate, a solution suggested as injection into anterior chamber, in hope to dissolve the nebula (Wa.), Galvanism, has been successfully employed in incipient stage (Wa.). Mydriatics, Atropine, Duboi- sine, etc., to secure full dilatation of pupil, as a means of ascertaining when the operation should be made, which is when the cataract is mature, there being CATARRH, ACUTE NASAL. 509 no vision even with dilated pupil (Wa). Diet and Regimen, may do much to retard degeneration of the lens, in cases due to diabetes, or malassimilation in gouty or rheumatic persons (C.). Iridectomy, made earlv and effectually may postpone the progress of lenticular opacity, if due to increased intraocular tension (C.). In partial cataracts, which have become stationary, iridectomy for artificial pupil may be done to expose clear portion of lens (Roosa). Medi- cine accomplishes nothing except to improve general health and so delay the progress of the opacity. Removal may be performed by one of several opera- tions (Roosa). Catarrh, Acute Nasal. Sodium Salicylate, to abort a cold (see ante page 351). Aconite, in severe coryza with much chilliness, aching limbs, hot and dry skin, and quick pulse ; also in catarrhs of children and that accompanying measles (R.); in acute coryza (P.); with Belladonna in ordinary colds with sore throat and high fever (B.); in doses of up every X hour, very useful for a commencing cold in the head (A. A. Smith). Belladonna, in acute nasal catarrh with profuse watery secretion, tincture, then rtp j each hour (B.). Nux Vomica, has great effect upon a dry cold in the head (P.) Euphrasia, is of decided utility in coryza (P.). Pulsatilla, a warm lotion, 3j-ij in giv aquae, syringed into the nasal passages in subacute coryza with muco-purulent secretion (P.) ; acts simi- larly to Aconite, but is contraindicated if much gastric or intestinal irritation exists (B.). Iodine, by inhalation in daily attacks with itching nose (R.); Sij of the tincture with 3j of carbolic acid inhaled from a sponge in the bottom of a wide-mouthed bottle placed in hot water (B.). Iodides, are unquestionably serviceable, their action being local and substitutive; Ammonium Iodide, gr. j every two hours, the best mode of using them (B.). Sodium Iodide, gr. x ter die, with Pil. Ferri Iodidi, in catarrhs of specific origin (B.). Potassium Iodide, gr. x at bedtime at the onset, to cut short an acute cold in the head; also useful in chronic colds (R.). Quinine and Morphine, gr. x with gr. jf, at incipiency, will often abort (B.). Opium, at night, if taken early, will often abort an attack of coryza; a glass of hot grog assists its action (R.); Dover’s powder, in a full dose at the onset may abort (B.). Codeine, is useful in common colds, as a palliative (B.). Ammonia, may be inhaled in the early stage (R.). Potas- sium Chlorate, 8 or 10 lozenges a day will abort many a cold (R.). Cam- phor, as inhalation, the spirit in form of vapor (R.); with Opium and ammonium carbonate as powder (see formula below), to break up or modify a cold (Beard). Tartar Emetic, gr. to in the first stage (B.) ; in acute catarrh of children often accompanied by vomiting and diarrhoea (R.). Arsenic, when sneezing, itching of nostrils, frontal headache (R.); as cigarettes (B.) ; see under Asthma, for formula. Veratrum Viride, if arsenic fails (R.). Ipecacuanha, for acute nasal and bronchial catarrh, and ordinary colds in children (B.). Cimicifuga, when headache, stiff muscles, dull aches, bone-pains, etc. (R.) ; an excellent expectorant (B.) ; rheumatic colds, neuralgic pains in jaw (P.). Jaborandi, the fluid extract in doses of rrpx to xxx, every half-hour until profuse diaphoresis sets in, is one of the best modes of aborting a cold ; or Pilocarpine Hydro- chlorate, gr. l/e in water at bed-time, will give prompt relief, and cure in a few days (Wyss). Cocaine, a 4 or 5 per cent, solution locally as spray, to empty the engorged venous sinuses of the nasal mucous membrane, by their contraction, which it induces. The fluid extract of Erythroxylon diluted with water is equally efficient if enough be used (Cohen). Resorcin, the best of all applications (see Catarrh, Chronic). Cubeb, or Ammonium Chloride, in the dry, congestive stage of a cold in the head; Cubeb cigarettes may be smoked as a temporary palliative with great relief. Sulphurous Acid, in coryza, by inhalation, spray or fumigation, is very efficient (R.). Oil Inunctions, daily to the whole body, in cases of undue susceptibility to taking cold, will prevent the frequency of the attacks (B.). Baths, a warm foot-bath before going to bed; Turkish bath, at onset in coryza, may prove abortive; also useful later on. Cold sponge bath, in cases of extreme susceptibility, supplemented by occa- sional Turkish baths (R.). [Compare Cough, Hay-Fever, Influenza".] 510 CATARRH, CHRONIC NASAL. Prescriptions. R. Quininae Sulph., gr. xviij. Liq. Arsenicalis (B. P.), . rq, xij. Liq. Atropinae (B. P.) . . nqj. Ext. Gentianae gr. xx. Pulv. Acaciae, q. s. Ft. pil. no. xij. Sig.—One every 3, 4 or six hours, for acute colds. ( Whalen.) R • Morph. Acetat., gr. iv. Bism. Subnitrat., Pulv. Talc., aagj. Ft. Chartulas, No. xxx. Sig.—Use as snuff in acute rhinitis. (Sajous). R. Codeinae, gr. ij. Syrupi Tolutani, Syr. Scillae Comp., . . . . aa !|j. M. Sig.—Teaspoonful occasionally for a common cold. (B.) R. Camphorae, gr. 1. ZEtheris q. s. Dissolve to creamy consistence, then add— Ammonii Carbonat., . . . gr. xl. Pulv. Opii, gr. x. Divide into thirty papers. One or two powders, according to age, twice or thrice daily. [Beard.) R. Tinct. Aconiti, x. Tinct. Belladonnas, . . . Syrupi Zingiberis, . . . adgij. M. Sig.—Half to one teasp. according to age, every hour. R. Acidi Carbolici, gr. Ixxx. Alcoholis, §ss. Aq. Ammonise, rrplxxx. Aquae, 3 ijss- M. Sig.—A few drops as an inhalation from a cone of blotting paper. (Brand.) Perrier’s Snuff. R. Morph. Hydrochlor., . . . gr. ij. Bismuthi Subnit., . . . . 3 vj. Pulv. Acacias, ...... 5jij. M. Sig.—Use as snuff, % to ]/2 the above in 24 hours. Catarrh, Chronic Nasal. Sanguinaria, the tincture in io-drop doses thrice daily, or gr. of the alka- loid, internally, and the powder in small quantity locally to the mucous mem- brane, is successful treatment for chronic nasal catarrh (B.). Hydrastis is of value in chronic coryza, also in ulceration of the septum or any other part of the nasal fossse, gtt. v of the tincture thrice daily internally, and 3j to of water locally with syringe (P). Pulsatilla, is excellent in subacute inflamma- tion of nasal passages, with offensive muco-purulent discharge, 3j-ij ad Hjiv of water, as wash (P.). Potassium Bichromate, is an excellent local application in a solution of gr. j-x to jjjiv water (B.). Iodoform and Tannin, x of the former to 2 or 3 of the latter, carefully triturated, and applied by an insufflator every other day only, is the very best of all applications (B.). Sodium Chloride or Phosphate, a teasp. to the pint of warm water as cleansing solution, or the Bicarbonate in the same proportion. A sea-water gargle in the naso pharyn- geal space, has been used with success (Mosler). Wei de Meyer’s Catarrh Cure is simply bicarbonate of sodium and a little pink coloring matter (Robin- son). Potassium Permanganate, gr. j-x to the pint of warm water, as a deodo- rant solution when necessary. Ammonia, by inhalation, when painful inflam- mation of nasal mucous membrane and frontal bones (R.). Carbolic Acid, a 1 per cent, solution as spray, or inhalations of the vapor with that of iodine from a bottle in hot water, or vaporized by the warmth of the hand (B.). Sali- cylic Acid, in weak solution, 1 to 500 of water, as a disinfectant and astringent injection, used with a retro-pharyngeal syringe, and followed by applications of powdered Calomel, through a speculum, upon the ulcerated parts of the mucous membrane (Massei). Cubebs, finely powdered and blown into the nares by an insufflator (B.), have proven very useful (P.); may be smoked, and administered internally in teasp. doses (Wa.); in freshly ground powder, as a confection (see below for formula), very efficient in follicular disease of the naso-pharyngeal space (Robinson). Ammoniacum, in the same condition, verv small doses, gr. j-iij, with ipecac, or carbonate of ammonium, will greatly lessen the amount of secretion (Robinson). Bismuth, in powder, with gum acacias, as CATARRH, CHRONIC NASAL. 511 in Ferrier’s snuff (see above for formula), or with tannin, calomel, iodoform, etc., used by insufflation, daily (Robinson). Aurum Chloride, in mercurialized and syphilitic subjects, with offensive discharge, depressed spirits and soreness of the nasal bones Iodides, of iron and sodium, in catarrh of specific origin (B.). Silver Nitrate, in powder, as alterative application, gr. x-xv to the 3 of menstruum, is often a useful adjunct to treatment, used once every 4 or 5 days (Robinson). Cod-liver Oil, should be used in strumous subjects (R.). Alum, in powder, dusted over the affected surface, is a useful application (B.). Resor- cin, the best of all applications, in acute and chronic catarrh. After cleansing the nose with a Boracic Acid solution, or Dobell’s, use a 2 to 10 per cent, oint- ment (vaseline), also a spray every other day, of 2 to 4 per cent, solution. It gives the same results as Cocaine, but is slower in action and more lasting, and does not suppress the normal function of the mucous membrane, as Cocaine does. Eucalyptus, has been employed with benefit (Wa.). Bromine, the vapor may greatly benefit, but must be used with caution (B.). Senega has been found serviceable (Wa.). Douche is dangerous, being likely to cause extension of the catarrh to the Eustachian tube and the middle ear. It has been very generally abandoned. Sprays by hand-ball atomizers, or com- pressed air apparatus, of warm watery solutions, vaseline, etc., are used with considerable success (Cohen). The Hank’s atomizing tubes, with a 2-ball rubber syringe, are very serviceable for office use, and for the application of Rumbold’s hot vaseline spray. (See formula below.) Sulphur Waters, inter- nally, of great benefit in follicular disease (Robinson). [Compare Oz^ena.] R . Acidi Carbolici, npx. Glycerini, gij. Vaselini, 3 ij. M. Sig.—Warm and use as a spray every 4 hours. {Rumbold.) Prescriptions, R . Acidi Carbolici, n\xl. Sodii Boratis, Sodii Bicarbonat., . . . aagij. Glycerini, gvij. Aquae, q. s. adgviij. M. Sig.—Use daily as spray. {Dobell.) R. Pulv. Argenti Nitrat., . . . gr. vij. Pulv. Acaciae gj. Bismuthi Subnitrat., . . . 3 iij. Triturat. Sig. — Apply with insufflator once in 4 or 5 days. {Robinson.) R. Sodii Boro benzoatis, . . . 5j. Ext. Hydrastis FI., . . . §j. Glycerini, 3 j. Ac. Carbolici, ir^xx. Aquae Camphorae, . . . . j|vj. Aquae, q. s. ad J xij. M. Sig.—Use with syringe or atomizer thrice daily. (Chamberlain.) R. Bismuthi Subcarb., . . . . gvj. Morph. Muriatis, . . . . gr. ij. Pulv. Amyli, 3 ij- Triturat. Sig.—Burness’ modification of P'errier’s snuff. R . Bismuthi Subcarb., Pulv. Acaciae, . . . . . aa 3 ss. Zinci Sulphat., gr. x. Morph. Sulphat., . . . . gr. ij. M. Sig.—Snuff, to be used thrice daily. {Sajous.) R. Sodii Iodidi, jfss. Syrupi Picis Liq., . . . .%'/)■ M. Sig. — Dessertsp. thrice daily with Pil. Ferri Iodidi (U. S.) one thrice daily, in chronic nasal catarrh of specific origin. (B.) R • Pulv. Cubebae, .1 ij. Syr. Aurantii ,5 iij. Aq. Menth. Pip., . . . . 3 ij- Aquae, q. s. ad\ viij. Ft. mistura. Sig.—A teaspoonful every 3 or 4 hours. {Robinson.) R. Ext. Pini Canad., .... ttpxx. Glycerini, Ttpxxx. Aquae, Oj. M. Sig.—Use with post-nasal syringe. 512 CEREBRAL ANAEMIA CEREBRAL SOFTENING. R. Acidi Carbol., gtt. xv. Extr. Hydrastis FL, . . . gj. Sodii Bicarb., Sodii Biborat., .... aa^j. Glycerini, ij. Aquae Camphoras, . . . adg viij. M. Sig. — Use with posterior nasal sprayer. R . Sodii Salicylatis, 55 ij. Sodii Boratis, g »j- Glycerini, Aquas, q. s. ad M. Sig.—Of this put a dessertspoonful into a pint of warm water, and snuff it from the hollow of the hand thrice daily. (Sajous.) Cerebral Anaemia. Iron, the tincture of the chloride, or mild chalybeate waters, in chronic cases from general anaemia (B.). Amyl Nitrite, in vaso-motor spasm; affords relief in sudden attack (B.). Chloral, in small doses with stimulants, warm baths (Ros.). Camphor, or other cerebral excitants, as asafoetida, valerian, serpentaria (B.). The mono-bromide of camphor in one to five-grain doses (Hammond). Glonoinum, rt\j of 1 per cent, solution (P.). Phosphorus, sup- plies the needed material for healthy brain-action (B.). Strychnine, stimu- lates the circulation generally ; as a tonic with iron preparations. Galvanism, a mild current transversely through the head, gives excellent results in the confusion of mind, vertigo, etc., due to imperfect nutrition of the brain from atheroma of the cerebral vessels (B.). Arsenic, is highly efficient in some hypochondriacal cases (B.). Aurum, is of great utility in vertigo, melan- cholia, etc., whenMue to or accompanied by cerebral anaemia (B.). (Compare Insomnia.] Arnica, when from a fall, cannot be too highly spoken of (P.). Warmth, to extremities, rest, expectant treatment, will suffice in mild cases (Ag.). The indications are: (1) to recover from insensibility and collapse; (2) to prevent inflammation; (3) to restore impaired faculties (D.). Stimulants or Venesec- tion, cannot be too strongly reprobated (Ag.). Cerebral Concussion. Cerebral Congestion. Aconite, in active form, renders important service (B.). Is much the best remedy in this condition (P.). Belladonna, one of the best remedies, in all hypersemic conditions of the brain or spinal cord (P.). Gelsemium, n\,v of the fluid extract every 2 hours, very useful (B.). Bromides, are very useful (B.) ; must be used in full doses. Colocynth, as counter-irritant, appears to act well (P.). Cathartics, lessen blood-pressure (B.). Colchicum, in plethoric subjects (B.). Galvanism, of brain and cervical sympathetics (B.). Chloral, when tem- perature high (B.). Arsenic, sluggish venous circulation, torpor (B.). Hydro- cyanic Acid, n\jj-v of Scheele’s dilute acid (B.). Venesection, will prevent injury to brain. Not to be adopted as a matter of course. It is contraindicated when anaemia, aortic valvular disease, or in cases commencing with syncope (A.). Water, cold douche to head, feet in warm water; ice and hot watdr alternately to head and nape of neck, often more effective than ice alone (B.). Hot water to head on flannels; mustard and hot-water packing for 20 to 30 minutes, around legs, when active congestion. Protect bowels well (R.). Diet, should be low, but not too low, until all fear of relapse past. Full animal diet should be avoided, also undiluted wines (A.). [Compare Apoplexy, Coma.] Cerebral Softening. Venesection, and antiphlogistic treatment generally, most beneficial in red softening, result of inflammation. Require wise discretion, and should be used early. Not to be thought of in the yellow form, from want of nutrition; where restoratives and food, perhaps wine (A.). Phosphorus, in threatened softening of the brain; is the only drug which affects the nerve-centres (W.). CHANCRE CHAPPED HANDS CHEST-PAINS. 513 Chancre. Mercury, small doses steadily, ptyalism must not be induced. Black-wash (calomel gr. viij, aq. calcis g]), or yellow-wash (hydr. chlor. corr. gr. j, aq. calcis on lint, to erosions and ulcerated indurations (B.). Calomel alone as dry dressing. Internal use of mercury best postponed until secondary symptoms appear (St.). Carbolic Acid, as wet dressing, gr. ij of crystals to Jiv aquae ter die (St.). Iodoform, heads the list of dry dressings ; with lyco- podium, equal parts, or 1 to 2 zinci oxidi ; 2 to 1 hydr. chlor. mite (St.). Hy- drogen Peroxide, said to destroy the specific character. Wash lesions ter die, and apply lint soaked in it (R.). Caustics, should never be used unless chan- cre attacked by phagedena (St.). Caustic Alkalies, to hard edges (R.). Bro- mine, Chromic Acid, best escharotics (B.). Dressings, are effective as far as the local trouble is concerned in the majority of cases; sometimes a piece of lint on the erosion will suffice. Never cauterize an initial lesion unless it is attacked by phagedena (St.). Cleanliness, of great importance; tepid water locally frequently suffices for the outward treatment of infecting chancre. [Compare Syphilis.] Mercury, the acid nitrate one of the best caustics ; apply with a glass rod (B.). Nitric Acid, fuming, as caustic (B., R.) ; gj to aquae is an excel - lent dressing (St.). Carbolic Acid, injected into sore (B.) ; 3ij-v to Oj aquae locally in phagedena (St.). Ferri et Potas. Tartras, the “born enemy of phagedena” (Ricord); gj to gvj aquae, internally, teasp. doses thrice daily; also locally (St.). Ferric Iodide, in sloughing phagedena, or simple c. in de- bilitated constitutions (B.). Iodoform, powdered and dusted over the sore, allays pain, changes morbid action, and is antiseptic (B., R.); 1 part to 2 of lycopodium, or one of tannic acid; as stimulant and alterative (St.). Does no good except to relieve pain (Gross). Potassium Chlorate, in impalpable powder, is better than Iodoform (B.). Chloral, gr. iij ad g] aquae, the best local application to relieve pain (Gross). Caustics, in severe cases, the white iron strong sulphuric acid, pure nitric acid, pure carbolic acid, are effective in the order named (St.). [Compare Bubo.] Chancroid. Sulphurous Acid, as solution, or by fumigation, will speedily cure (R.) Glycerin, diluted, or better still, glycerin of starch, or with the quantity of eau de cologne (R.). Benzoin, the comp, tinct., 1 part to 4 of glycerin ; an admira- ble application (P.). Hydrastis, on compress as lotion (P.). Collodion, is usefully employed (P.). Carbolic Acid, X to 2 of glycerin, locally; one appli- cation is generally sufficient. Unguentum Aquae Rosae alone, is often efficient; may be combined with oxide of zinc. Chapped Hands and Lips. R. Resinse, Cerae Albae, 3ij. Adipis, § ij. Zinci Oxidi, 3 vij. Prescriptions. R. Cetacei, 3_j. Glycerini, 3 ij. CeraeAlbse, • • . . . . gr. xv. Ol. Amygd. Amarse, . . . rr\,iij. Chest-pains Belladonna, as ointment, when tenderness is in skin (pleurodynia) (R.). Iodine, oint.; pain in muscles (myalgia) of chest, they being tender on pressure, while the skin may be pinched without pain (R.). Strychnine, affords relief in functional irritability of the nervous system, manifested by wandering neural- gic pains (B.). Arnica, for a “stitch” in the side. Bryonia, when painful catching of breath. Cimicifuga, for intercostal rheumatism and pains under the breasts in women. CHICKEN-POX—CHILBLAINS—CHLOROSIS. Chicken-pox. Aconite, is of great value (B.) Water, hot and cold baths and packs are of great utility ; cold, if hyperpyrexia ; cold compress if sore-throat; hot or warm pack when free diaphoresis required (B.). Treatment, precautionary only required. Avoid exposure to cold and wet; maintain the action of skin and bowels (H.). Acetate of Ammonium, in diaphoretic and antifebrile mixture. See Fever, Simple, for formula. Inunction, with camphorated oil, or thin starch, to relieve itching and allay inflammation (P.). Chilblains. Arnica, a useful application (Wa.). Iodine, ointment, the best application (R.). Carbolic Acid, an efficient application is an ointment of carbolic acid and iodine (B.). Benzoin, the tincture in glycerin, applied after thorough washing in soap and water and drying, the best application. Sulphurous Acid, an effi- cient application ; 3hj_3j each of water and glycerin (B.); as solution or fumi- gation (D.). Balsam of Peru, in ointment for broken chilblains (R.). Capsi- cum, tinct. painted over unbroken chilblains (R.). Cajuput Oil, applied locally (R.). Turpentine, as wash, then apply basilicon ointment mixed with turpentine (B.). R. Acidi Carbolici, . . . . g j. Tinct. Iodi, g ij. Ac. Tannici, ij. Cerati Simplicis, . . . M. Sig.—Ointment. (B.). Prescriptions. R. Tinct. Benzoini, . . . . gi). Olei Lini, g iv. Cerae Flavae g ij. Glycerini, q. s. M. Sig.—Ointment. (Reveil.) Chlorosis. Iron, combined with arsenic or strychnine. Occasional purgation and active exercise. Also chalybeate waters for blood deficiencies (B., R.); is not a specific in chlorosis, and acts best in the purest types (Tr.); the iodide, when much torpor of the system, is often speedily efficacious (Wa.). Arsenic, if iron fails, or disagrees (B.). Ergot, in chlorotic amenorrhoea (P.). Manganese, the sac- charated carbonate of manganese and iron (B ). Nux Vomica, stimulates the blood-making organs, and may be combined with iron. A very generally useful preparation is the syrup or elixir of iron, quinine and strychnine (B.). Cocculus Indicus, with amenorrhoea and exhausting leucorrhoea (P.). Hypophosphites, of lime or sodium (R.). Benzoin, has been used with advantage (P.). Pepsin, benefits, especially where digestive derangement (B.). Sulphur, of great benefit in cases where iron is of no effect; also to prepare the system for benefit from iron (Schulz). Purgation, is very important, to prevent auto-infection from putrid intestinal decomposition, which is the true cause of this disease (Duclos) ; absorption of such products tending to impoverish the blood, and produce a “fecal anaemia” (Sir A. Clark). Oils and Fats, as inunctions after baths, of great benefit (B.). Galvanization, central: will aid the action of the remedies (B.). [Compare Anaemia, Amenorrhoea.J Prescriptions, R. Ferri Arseniatis, . . . gr. ij. Extracti Cinchonae, . . gr. xij. Fiant pil. xij. Sig.—One after each meal. (B.) R. Ferri Sulph. Exsiccat., . gr. xl. Quininse Sulphatis, . . gr. xx. Strychninae Sulphat., . gr. ss. Ft. pil. xx. Sig.—One thrice daily. R. Pulv. Aloes Socot., . . . gr. v. Ferri Sulph. Exsiccat., . gr. xv. Ol. Tanaceti vel Ol. Sabinas, gtt. xxx. Myrrhae, Croci, Cantharidis, . . . . aa gr. xxx. Ft. pil. lx. Sig.—Two thrice daily gradually increased to four. ( Wallace.) CHOKING CHOLERA. 515 Choking. Potassic Bromide, benefits a curious affection, sometimes found in children who from their birth can swallow solids with ease but choke at drinks (B.). Oil of Cajuput, in one case of persistent “ choking” sensation in the throat, a few doses removed the symptoms which had lasted several weeks (Hale). Cholera Asiatica. Camphor, a drop or two of the saturated tincture, or v-x drops of the spirits with a little opium every half-hour (B.); gtt. iv-vj of strong spirits every ten minutes until symptoms abate, then hourly (R.). Arsenic, in epidemic cholera ; some cases of arsenic poisoning not distinguishable from cholera (B.); for the vomiting and in collapse (R.). Copper salts have been given (R.). Turpen- tine, npx-xx every two hours promises to be a remedy of value (Wa.). Chloral, as injection, the most efficient treatment, especially when morphine and atropine are given coincidently (B.). Chloroform, a few drops frequently repeated, or x-xxx drops of chlorodyne, of great value (B.). Opium, to gr. morph, hypodermically in preliminary diarrhoea (B., P.); y% to y gr. of the greatest value even in collapse (R.); dangerous if kidney complications exist (P.). Lead, the acetate in early stages (R.). Carbolic Acid, with iodine, has given good results (B.). Sulphuric Acid, the aromatic, with opium, is very effective (B.); two parts of the former with one of laudanum, of this 5 to 30 drops as per age, is one of the best prophylactics (McClellan). Strychnine, as prophylactic during the pre- liminary diarrhoea, and in epidemic when nearing collapse (B.). Alcohol, small doses of iced brandy for vomiting (B.). Spinal Ice-bag, for cramps (R.). Saline Injections, into the veins, have been successful in the collapse (B.). Transfusion, of milk, in collapse (B.). Absolute Rest, recumbent posture, no food, ice ad libitum ; enemata of warm milk ; fresh air, friction, and heat to abdomen, legs and feet; stimulants worse than useless. Prescriptions. R. Acidi Carbolici, gr. iv. Tinct. Iodi, gtt. xvj. Aq. Menth. Pip., 3 iv. M. Sig.—A tablesp. every hour or oft- ener. (B.) R . Chloralis Hydrat., .... 3 iij. Morphinae Sulph., .... gr. iv. Aquae Laurocerasi, . . . 3 j. M. Sig.—Fifteen to twenty drops as in- jection hypodermically. (B.) R. Chloroformi, 3 ij. Tinct. Opii, Spt. Camphorae, Tinct. Capsici, . . . . aa X vss. Alcoholis, gj. M. Sig.—30 to 60 drops in water. (Squibb's Cholera Mixture.) R. Acidi Carbolici, gr. viij. Bismuthi Subnit., 3 ij. Mucil. Acaciae, Aquae Laurocerasi, . . . aa !|j. M. Sig.—Teasp. every hour or two for vomiting and diarrhoea. Ipecacuanha, greenish stools with mucus and often blood (B.). Arsenic, for vomiting and collapse (R.). Mercury, gr. of gray powder hourly of great service in infantile cholera with incessant sickness, profuse almost continuous diarrhoea, offensive and nearly colorless stools. A starch injection, with a minute quantity of laudanum, assists the gray powder, and should be given in urgent cases (R.). Zinc Oxide, with bismuth and pepsin, is very useful (B.). Camphor, 3j-giv of milk, very serviceable (B.); an admirable remedy for summer and choleraic diarrhoea (R). Opium, generally necessary. Enemata of starch and laudanum (see above under Mercury). Morphine, hypoder- mically, in doses of gr. to according to age, the latter dose for a child of Cholera Infantum 516 CHOLERA SIMPLEX. one year, with 5 or 6 drops of ether, to be repeated in an hour, the most effi- cient treatment (E. Smith). Copper Sulphate, often very successful (B.). Car- bolic Acid, with Bismuth, may arrest the disorder promptly (Br.). Lead Ace- tate, is one of the most useful astringents in this complaint (Br.). Potassium Bromide, when due to nervous irritation or cerebral congestion (B.). Silver Nitrate, is beneficial after the acute symptoms have passed (B.). Caffeine, when due to nervous irritation (R.). Coto Bark, the tinct. gtt. j-iij is highly recommended by Rohrer for choleraic diarrhoeas in children. Alcohol, in grave cases, with tendency to collapse, gtt. x-xx of brandy with milk every 30 to 60 minutes. Diet. Farinaceous food a common cause. Cow’s milk 0% with sacch. lactis §j to 0% aquae-bul., or cold milk with lime-water (R.) ; milk, ani- mal broths; no starches or fats (B.). Drinks, as water, weak tea, etc., freely, to keep vessels filled and prevent paralysis of the heart (Meinert). Spice Poul- tice, to abdomen, composed of cloves, ginger and cinnamon, mixed with brandy or whiskey. Mustard Bath, in stage of collapse, with mustard over the heart, and ether hypodermically (Smith). Lactic Acid, a 2 per cent, solution in drachm doses, 5 to 8 times in 24 hours, in epidemic diarrhoea of infants with green discharges, with local antisepsis as to linen and diapers, on the theory of a bacillary origin for the disease (Hayem). Prescriptions. R. Acidi Carbolici, gr. iv. Bismuthi Subnit., . . . . gij. Mucil Acacias, ijj. Aquae Menth. Pip., . . . Jjiij. M. Sig.—Teasp. every 2, 3, or 4 hours. (B.) R. Cupri Sulphat., gr. j. Tinct. Opii Deod., .... gtt. viij. Aquae Destil., M. Sig.—Teasp. every 2, 3, or 4 hours for a child of one to two years old. (B.) R. Acidi Carbolici, gr. xxiv. Spt. Vini Gallici, .... gtt. xxiv. Aquas Menth. Pip., . . . Mucil. Acaciae, gvj. Syr. Papaveris, gvj. Tinct. Opii Deod., . . . gtt. x. M. Sig.—A teasp. every 2 hours. R. Plumbi Acetat., gr. xxiv. Pulv. Opii, gr. xij. Pulv. Camphoras . . . . 3 ss. Sacch. Lactis., q. s. Triturat. et div. in chart, xij. Sig.—One every hour. (B.) R. Hydrarg. Chlor. Mitis, . . gr. yL. Bismuthi Subnitrat., . . . gr. ij-v. In powder every half-hour for the vomit- ing and purging. R. Hydrarg. Chlor. Mitis, . . gr. jf. Plumbi Acetatis, . . . . gr. i. Opii, . . gr. | to XV Ft. pulv. no. j. Repeat every half-hour or hour for the acute gastric symptoms. Cholera Simplex Camphor, an admirable remedy (R., B.). Veratrum Album, for the vomiting (R.). Copper Salts, have been given (R.). Arsenic, for vomiting; also for col- lapse in latter stages (R.). Chloral, by injection, the most efficient treatment (B.). [See C. Asiatica for formula.] For the cramps, Chloral 5j, in Lin. Saponis applied with friction to the abdomen (Da Costa). Carbolic Acid, with bismuth, very effective (B.). [See above, C. Infantum.] Lead, the acetate, in early stages (R.). Opium, gr. %~y2 morphine, hypodermically; very useful (B.). Gr. jl, or opii, every 2, 4, or 6 hours in early stage (P.). Calumba, as anti-emetic, of great value (P.). Ipecacuanha, has been used with much advantage (Wa.). Sumbul, said to have proved successful (P.). Mustard, as an emetic in collapse, to stimulate a failing heart (P.). Cajuput Oil, much used in India for choleraic affections (P.). Alcohol. Iced brandy in small doses for vomiting (B.). The value of stimulants justly doubted; if given, should be largely diluted (Wa.). [Compare Cholera Asiatica and Infantum, above.] CHORDEE CHOREA. 517 Chordee. Aconite, gtt. j hourly, will relieve (R. P.). Belladonna, combined with cam- phor or opium, gives the best results of remedies administered internally (St.). Camphor, Sj doses of the spirits will relieve (R.). Cantharis, gtt. j ter die, will prevent (B., R.). Cannabis Indica or Cannabis Sativa (P.). Lupulin, valu- able (P.); said to prevent (B.). Morphine, hypodermically, the one sure remedy ; should be injected into the perineum at bedtime (St.). Cocaine, a few drops of a 4 per cent, solution, locally to the glans ; or injected into urethra, promptly relieves chordee. Diet should be plain, even low, no stimulants ; copious draughts of barley-water, or linseed tea. Prescriptions. R. Liq. Morph. Magendie, . giv. Atropinae Sulphat., . . . . gr. j. Acidi Acetici, q. s. Aquae Destillat., . . . ad g j. M. Sig.—rn v-viij hypodermically at bedtime. (St.) R. Pulv. Opii, . gr. xij. Pul. Camphorae, gr. xxiv. Sacch. Alb., q. s. Fiant capsulae xij. Sig.—One at bedtime, to be repeated in 2 hours if required. (St.) Cimicifuga, in cases due to menstrual derangement, is very useful (B., P.); when rheumatic history (R.); a very valuable remedy (P.). Strychnine, in doses gradually increasing to toxic (Tr.) ; minute doses (gr. to ) have been of much use when from fright or commencing puberty (B.); Arsenic, large doses required up v ter die, when non-ansemic (B.); very successful in uncomplicated cases (R.). Zinc, the Sulphate, has similar action to Arsenic, but is inferior (B.). In large and increasing doses it is very useful (R.). Iron, large doses of the Subcarbonate in anaemic cases, about the time of puberty (B.) Chalybeate waters often relieve or cure. Arsenic generally better, unless anaemia coexists (R.). Hyoscyamine, gr. ter die, gradually increased, has cured cases which resisted all other remedies (Da Costa). The mydriatics are very suitable in nervous, delicate children. Copper. Cupr. Ammoniatum has been used successfully (B.). Veratrum Viride, has been employed (R.). Coc- culus, picrotoxine, large doses (B., P.). Conium, in large doses, to quiet mus- cular agitation (B.); is only palliative (R.); evidence contradictory as to its value (P.). Valerian, said to restrain the movements (R.). Useful when from worms (P.). Chloral, contributes to a cure by inducing quiet sleep (B., R.). Chloro- form, inhalations, often of great service in severe cases (R.). Morphine, with Chloral, hypodermically in large doses for severe cases (Tr.) ; when the move- ments prevent sleep (R.). Physostigma, is recommended (R.) ;—of doubtful benefit (B.). Musk, has been given (R.). Cod-liver Oil, in low nutrition (B., R.). Water. Cold affusion to head and spine, and cold-baths, important (B.); not to be used if rheumatism, fever, or pain in joints. Tepid water first (R.). Galvanism, the constant current, used by Benedict in twenty cases, all recov- ering. Galvanic chain around neck and down the back. Chorea. R. Tinct. Ferri Cbloridi, . . §)• Liq. Acidi Arseniosi, . . . x, ij. Syr. Limonis, § ss. Syr. Simplicis, Aquae, . . . . aa q. s. | iv. M. Sig.—Half a teaspoonful thrice daily, after meals, gradually increased, and effects carefully watched. Prescriptions. R. Chloralis Hydrat., . . . . X iv. Tinct. Hyoscyami, . . . . S j. Syr. Limonis, §). Aquas Cinnamomi, . , . . % iv. M. Sig.—A teasp. 3 or 4 times daily, according to age. 518 CHOROIDITIS COLIC, INTESTINAL. Choroiditis. Mercury, as in iritis; cannot be borne to the same extent as in latter dis- ease (A.). Opiates, necessary externally and internally to overcome pain (A.). Treatment, is generally the same as in corresponding forms of iritis, but when atrophic spots appear on the choroid, no treatment can repair the damage (A.). Rest of eyes and protection from light by blue glasses. In suppurative form (panophthalmitis) use Atropine in strong solution, with ice compresses and leeches in early stage. Paracentesis repeatedly to relieve tension and give exit to pus. Canthoplasty of outer canthus to relieve the pressure of the lids (Roosa). Climacteric Disorders. Aconite, for nervous palpitations, and restlessness or “fidgets;” gtt. j hourly (R.). Cimicifuga, for distressing headache (R.). Nitrite of Amyl, in small doses when the “ heats” predominate, followed by cold, clammy, pale skin (R.). Ergot, for the flooding, gr. ij of Squibb’s extract, in fresh pill every hour until relieved. Cannabis Indica may be well combined with it. Cannabis Indica, is used in the headaches of the menopause with uniformly good results. [See Headache, for formula.] Nux Vomica, Opium, and Belladonna, when symptoms described under Iron are limited to head and face (R.) Iron, for flutterings of the heart, with fullness of head, heat and weight on the vertex, frequent flushings, and hot and cold perspirations. Large doses of Sesqui- chloride ter die (R.). Ammonia, Raspail’s sedative lotion to painful part of head, in headaches (R.) Potassium Bromide, for despondency, with sleep- lessness and irritability, often also with heats, flushings, perspirations (R.). Physostigma, the extract, gr. every hour for 7 or 8 doses for flatulence and a sensation of fluttering at the pit of the stomach (A. A. Smith). Cam- phor, for drowsiness and headache. Eau-de-cologne saturated with camphor rubbed to head (R.). Zinc Valerianate, hysterical symptoms (R.). Change of air and scene, where other treatment only partially successful (R.). Warm Bath, to promote free perspiration. 90° to 950 Fah. for an hour once a week, will obviate many of the symptoms (R.). [Compare Metrorrhagia.] Coccyodynia. Chloroform, injected as deeply as possible about seat of greatest pain (B.). Electricity, has cured one severe case of 12 years’ standing, and helped others. Surgical treatment the only resource in rebellious and painful cases (Ros.). Nott extirpated the coccyx; Simpson performed subcutaneous section of mus- cles and ligaments. Goodell removes the bone, after first treating the case as a local expression of a general neurosis. Strychnine, for cold hands and feet (R.). Cold Baths, with friction to the skin, nightly for cold feet (R.). Spinal Ice-bag, is often efficiently employed in general coldness of the surface, and persistent coldness of the hands and feet (R.). Coldness. Colic, Intestinal. Nux Vomica, quickly subdues abdominal cramps and spasms (P.) Bella- donna, especially in children (R.). Chamomile Oil, iv-vj, in colicky attacks of hysterical women (P.). Cocculus, of great value, especially during pregnancy (P.). Chloral, sometimes relieves (R.). Chloroform, effective in flatulent colic ; also useful in hepatic and saturnine (B.). Often used combined with Opium (D.). Potassium Bromide, in a peculiar form in young children (R.). Given in anise or peppermint water is of greater efficacy for the colic of infants than the opium preparations in general use, and perfectly safe (B.). COLIC, LEAD. 519 Asafcetida, no better remedy in flatulent colic of infants. Teasp. doses of the mistura asafcetidae (B.). Morphine, gr. hypodermically, repeated in 15 minutes, gives more relief than any other remedy, in all forms of colic (B.). Frequent small doses (R., P.). Arsenic, will cure in a surprising manner when enteralgia is idiopathic (B.). Essential Oils, especially those of Cloves and Cinnamon (R.), Anise, Cardamom, etc. Oil of Rue in flatulent colic of children (P.). Magnesia, the carbonate with Opium and Asafetida, as in Dewees’s Carminative, now official as Mistura Magnesiae et Asafcetidm, the dose being npxx for an infant of 2 to 4 weeks old. Tobacco, as enema ; dangerous ! (B.) ; as clyster, or by stomach (R.). Ammonia, in spasm of intestinal canai and in colic of children or infants from bad feeding (R.) Lime Water, for young children who eject milk in lumpy masses, with colic and flatulence (R.). Water. Hot fomentations to ease pain (R.). A copious enema of warm water often gives immediate relief. Prescriptions. R. Spiritus Chloroformi, Tinct. Cardamomi Co., . ij. M. Sig.—Teasp. in water every y2 hour. (B.) R. Ext. Gentianae, Pulv. Rhei, aagj. Ft. pil. xx. Sig.—One or two thrice daily for tendency to colic. R. Atropinse Sulph gr. j. Zinci Sulphatis, gr. xxx. Aquas Destil., 3 j. M. Sig.—3 to 5 drops 2 or 3 times daily. (B.) R. Pulv. Camphorae, Pulv. Capsici, Pulv. Zingiberis, . . . aa gr. ij. Ft. pil. ij. Sig.—One as required. Alum, singularly, is the best remedy (B.); gr. x hourly (R.); converts the poisonous salt of lead in the system into a comparatively innocuous sulphate ; 3jss-ij daily with TTpxl-l Tinct. Opii, and an occasional dose of castor or croton oil to procure one or two motions daily (Wa.). Opium, gives more relief than any other remedy, gr. yi to y. of morphine hypodermically (B.) ; gr. ij-iv of opium, with a moderate dose of castor oil (P.). Sulphuric Acid, diluted well, as a prophylactic, and is useful in the treatment of the disease (B.) ; con- sidered remarkably efficient when used in association with repeated sulphur baths (Wa.). Calomel, a full dose, with or without opium, followed in a few hours by castor oil and a turpentine enema, often affords speedy and marked relief (Wa.). Tobacco, may control, but is dangerous (B.). Croton Oil, in half-drop doses, with sufficient opium to relieve the pain, repeated every 3 or 4 hours until free evacuations are produced; proves effectual when other remedies fail (Wa.). Magnesium Sulphate, for the constipation, and to remove the poison from the system; should be combined with Iodide of Potassium, Z] of the former given ter in die and about two hours after gr. v-x of the iodide. This treatment dissolves the lead in the tissues, causes its elimination by the intestinal mucus, renders it insoluble after it has entered the intestinal canal, and quickly removes it from the body (Br.). [Compare the treatment of Lead-poisoning, ante, page 319.] Colic, Lead. Prescriptions. R. Aluminis, 3 ij. Ac. Sulph. Dil., X). Syr. Limonis, Aquae, £ lij. M. Sig.—Tablsp. every hour or two for colic. (B.) R. Magnesii Sulphatis, Ac. Sulph. Dil., xj.. Aquae, 5 iv. M. Sig.—Tablesp. every 3 hours (B.); or thrice daily, each time preceded by a 5 to 10 grain dose of Potassium Iodide. (Br.) 520 COLIC—COMA CONJUNCTIVITIS. Colic, Renal and Hepatic. Ether, inhaled in paroxysms of hepatic colic (R.). Chloroform, inhalation in renal and biliary colic, inferior only to morphia injection, superior to opium, warm baths, etc.; two or three administrations may be required (R.). [See also Colic, Intestinal.] Counter-irritation, flying blisters for renal colic (R.). Opium, small doses with spt. chloroform, every five or ten minutes until the pain gives way, or morphia hypoderm. (R.). Turpentine, has been given with benefit in biliary colic (R.). Dioscorea, is used successfully in so-called bilious colic, of the fluid extract. Water, warm baths to ease the pain (R.). Aliment. Withhold all starches and fats. Alkaline mineral waters are useful (B.). [Compare Calculi.] Coma. Blisters, in a comatose condition, large blisters or mustard poultices should be applied in quick succession to different parts of the body—chest, abdomen, thighs and calves; often very valuable in the critical condition near the end of an acute illness (R.). Cold Douche, for stupor of drunkenness or of opium poisoning. May have to be repeated if relapses occur. It should be kept up for a long time if pulse and breathing improve, or no worse (R.). Croton Oil, as purgative, tt\, % or every hour (R.). Potassium Bitartrate, as purgative when blood is poisoned (R.). Mustard, as poultice to the feet and ankles in the coma of narcotic poisoning (P.). Exercise. In coma from poisoning the patient should be persistently walked about. [Compare Cerebral Conges- tion, Uraemia, and the treatment of Narcotic Poisoning, ante, page 297.J Nitric Acid, §j to Oj aquae, as wash, frequently used (B., R.). Thuja, locally a strong tinct. with gtt. v in water, night and morning, internally, for warts with narrow base and pendulous body. Warts about anus or pudenda of either sex, whether syphilitic or not, often rapidly cured by Thuja (P.). In non- syphilitic warts of penis or vulva, I have employed it with satisfaction (Pf.). Mercury, Calomel dusted over, after washing with a solution of chlorinated soda (Ricord, R., B.); the nitrate locally or a 20 per cent, oleate (R.). Zinc, the chloride, iodide or nitrate as local applications (R.). Arsenic, arsenious acid as a caustic (R.). Carbolic Acid, as a mild escharotic (B.). Chromic Acid, gr. c-gj aquae dest.; a good local application (B.). [Compare Syphilis, Warts.] Condylomata. Conjunctivitis, Catarrhal. Zinc, a weak solution of the sulphate or acetate as astringent collyrium (B.); gr. ij ad jjj aquae destil. as mild astringent lotion every few hours, with ice locally in the earlier stage (Roosa). Borate of Sodium, gr. v ad §j aquae dest. a good and mild astringent for ordinary cases. Boric Acid, gr. vj ad gj each of aq. camph. and aq. destil., as collyrium (Fox). Boro-glyceride 3 ss ad of aq., camph. and aq. dest. a very efficient application. See ante, page 59. Carbolic Acid, a 5 per cent, solution applied every two hours by spray of steam atomizer, which dilutes it one-half, an extremely efficient application, relieving the pain and contracting the vessels. Cocaine, the hydrochlorate in 3 to 5 per cent, solu- tion or oleate, applied to the palpebral conjunctiva, is a very efficient palliative, especially where much pain and photophobia (Koller). Alum, potassa alum after acute symptoms subside (Br.); gr. iij-v ad 59 aq. destil. brushed over the conjunctiva twice daily. Pulsatilla, 3j-ij of tincture to aquae as wash sev- eral times daily, also n\j-x internally every 3 or 4 hours (P.). Opium, the wine dropped into the eye relieves pain and improves the condition of the conjunc- tiva (R.); Morphine, gr. j-ij ad 3j, is often used in collyria with zinc salts or alum. Mercury, Calomel dusted over the palpebral conjunctiva, in severe cases ; should be finely levigated and dusted from a camel’s-hair brush (B.) ; the CONJUNCTIVITIS. 521 oleateof mercury and morphine to the outside of the lids in palpebral conjunc- tivitis (R.); the red oxide as ointment, gr. x ad gj vaseline (Bader); the yellow oxide, gr. viij—x ad 3j vaseline (Seely). Cadmium, as collyrium gr. ij of the sulphate to gj aquae rosse (B.). Tannin, in glycerin, gj ad gj, every second day in chronic catarrhal conjunctivitis, presenting diffused injection of vessels with oedema (Hansell). Silver Nitrate, solutions of strength gr. j-iv ad §j applied by physician to conjunctiva (R.); should not be given to patient. Zinc and copper salts are preferred (B.). Copper, the sulphate crystal in chronic cases where great swelling or hypertrophy of the papillary layer. Is too irritating to be entrusted to the patient. Lead salts should never be used lest deposits occur in slight abrasions or ulcerations of the cornea. Sulphates, of zinc, copper and iron with alum, aa gr. j to 5j of aq. destil. as collyrium, extremely effi- cient; in severe cases may be used in saturated solution by the physician (Holmes). Castor Oil, a drop placed in the eye often allays the pain and pho- tophobia caused by an irritant (R.). Belladonna, locally and internally (B.). Atropine in strong solution, gr. iv to jfj, is one of the best local applications where mydriasis is not objectionable. Euphrasia, as a mild astringent (P.). Blisters, behind the ears in bad cases (R.). Ergot, the fluid extract locally gives excellent results in acute conjunctivitis (B.). Staphisagria, especially in tarsal ophthalmia (P.). Colchicum, when gouty diathesis (A.). Spigelia, in rheumatic form (P.). Prescriptions, R. Zinci Sulphatis, gr. ij. Morphinae Sulph., gr. ij. Atropinae Sulph., gr. ss. Aquae Rosae, gj. M. Sig.—Eye-water. (B.) R. Hydrarg. Oxidi Rub., . . . gr. x. Atropinae Sulph., gr. j. Vaselini, gj. M. Sig.—A minute portion as an oint- ment for the eye. (Bader.) R. Liq. Plumbi Subacetat., . . . g). Aquae Destillatae g iij. M. Sig.—For local use. To be brushed over conjunctiva of everted lids by the sur- geon and washed off with water. (Buller.) R . Ung. Hydrarg. Nitrat gr. xx. Cocaince Hydrochlorat., . . gr. v. Vaselini Albi, gij. Use a fresh ointment, triturate thor- oughly, and label “ Ointment for the eye.” Conjunctivitis, Diphtheritic. Zinc Chloride, gr. ij-iv ad §j, as collyrium, has succeeded admirably (Wa.). Atropine, locally, throughout the disease. Treatment not very effectual (Roosa); is, for severe cases, powerless ; cornea sure to be attacked and liable to slough (Noyes). Boric Acid, 4 per cent, solution, as antiseptic, the best application, with Quinine, internally in full doses (Noyes). Iron, the pyro- phosphate for children, 3j in giij of simple syrup, of which a teasp. thrice daily after meals, with quinine in 1 to 3-grain doses thrice daily, and good food (Derby). Cold by compresses, as in purulent ophthalmia, in early stages. Silver Nitrate in solution locally, a 10-grain solution or the mitigated stick in the second stage. Tannin, gr. xx to the 5 of glycerin, later on, applied every day, with hot water lotions if corneal complications. Conjunctivitis, Gonorrhoeal. Zinc Chloride, gr. j-ij ad gj aquse, as collyrium, with marked benefit (Wa.). Silver Nitrate, a 2-gr. to the g solution, after syringing out the eye with warm water, followed by ice compresses, in hope to abort the attack, if seen early (Roosa). Cold, by ice or wet compresses, essential in the early stage (C.). Atropine, nrav be used from the beginning, as corneal complications begin very early. Treatment, generally the same as for Purulent Conjunctivitis. Isolation and cleanliness are of prime importance. 522 CONJUNCTIVITIS. Conjunctivitis, Granular. Silver Nitrate, the diluted stick (see page 113) applied lightly and quickly (C.) ; strong solutions to granular lids, gr. xx ad cautiously when corneal ulcers exist (B.); mild solutions better, gr. v ad daily in the papillary form ; in miliary trachoma it should not be stronger than gr. ij ad (Noyes). Applications lose their effect after a time, and should be changed (Roosa). Copper Sulphate, the solid crystal lightly touched to the membrane once a day, the favorite astringent and caustic in all forms of trachoma (Roosa); when membrane torpid to other stimulation and when lymphoid substance is pre- dominant. As ointment gr. v-x ad §j vaseline, when for use by patient (Noyes). Alum, a smooth crystal is a useful daily application (Noyes). Tannin, gr. x-xxx ad glycerini an application to change to from others (Roosa). Bismuth is one of the numerous applications in chronic conjuncti- vitis and granular lids (B.). Phytolacca internally, is undoubtedly efficient in granular conjunctivitis (W.). Jequirity, to excite substitutive inflammation. See ante, page 55. Atropine, gr. ij ad J;j aquae, thrice daily, is often advisable, where moderate irritation and haziness of the cornea (Noyes). Hygienic Meas- ures, of great value. Protection by blue or smoked glasses. Rest of eyes, best secured by using atropine collyria. Hot or cold water as local bath frequently. Tobacco must be avoided, also all locations contaminated by impure air. Canthoplasty of outer commissure when lids press on globe. Conjunctivitis, Phlyctenular. Mercury. Calomel finely levigated and dusted from a camel’s-hair pencil over the membrane in phlyctenular ophthalmia, an excellent local applica- tion ; which should never be used when iodine is being taken. In more obsti- nate cases a small bit of Pagenstecker’s ointment, the size of a pin-head (Hy- drarg. Ox. Flav. gr. j-iij, Vaselini 3j), placed between the lids (Noyes). Ergot, the fluid extract, applied undiluted, gives excellent results in the phlyctenular ophthalmia of children (B.). Antimony. Tartar emetic gr. to 3 or 4 times daily in strumous ophthalmia, with sharp purgation at the outset (R.). Belladonna, or Atropine, locally in strumous ophthalmia, of great service in relieving pain ; constitutional treatment also required (Wa.). Arsenic, invalu- able in inveterate cases of strumous ophthalmia, especially when complicated with cutaneous eruptions (Wa.). Tannin, finely powdered and dusted over the everted lid, gives remarkably good results in this and other forms of conjunc- tivitis, causing very little pain and no inflammatory reaction (B.). Carbonic Acid Gas, applied to the eye is said to relieve the pain and photophobia of strumous ophthalmia (R.). Hydrastis, as lotion, is serviceable when Meibo- mian follicles are implicated, causing adhesion of lids in the morning (P.). Eserine, locally, to reduce the pupil and shut out the light (P.). Iodine, is em- ployed locally in strumous ophthalmia, for its alterative stimulation (W.). Zinc Chloride, gr. ij-iv ad %j, as collyrium, has succeeded admirably in pustular ophthalmia (Wa.). Zinc Sulphate, gr. j-iv ad 3 j, is very serviceable; the addi- tion of liquor plumbi improves its efficacy (Wa.). Rhubarb, the mistura rhei et sodas where much disturbance of digestion present. Tonics, may be given later, preparations of Cinchona and Iron. Cod-liver Oil, in strumous subjects, tends to remove the manifestations of the disease (R.). Conjunctivitis, Purulent. Alum, gr. ij ad aquas, a sufficient astringent application in ophthalmia neonatorum (Roosa); gr. viij ad aquas, applied every or hour in the purulent ophthalmia of children, its success depending on the frequency of the application (R.). Copper Sulphate, gr. j ad 3j aquae camph. as collyrium in purulent ophthalmia of infants (YVa.). Silver Nitrate, gr. iij-x ad aquae destil., rarely so strong as gr. x, once daily applied by brush to everted lids in purulent CONSTIPATION. 523 ophthalmia of infants (Noyes); solution gr. % ad twice daily under lids (Meigs)—by many it is considered needless and injurious (Roosa). * Boric Acid, a 4 per cent, solution, as antiseptic, is all that is necessary in mild cases; in others it is the proper fluid for cleansing the eye (Noyes). Atropine, when the cornea becomes invaded, and shows haziness, a solution gr. ij ad must be instilled every 3 hours (R.) Cold, by ice or wet compresses, essential in the early stages of acute purulent ophthalmia (C.). Cleanliness, a matter of great importance. As the discharge is infectious the patient should be isolated and care taken to prevent inoculation of the other eye therewith. Prescriptions. R. Sodii Boratis, gr. xij. Zinci Sulphatis, gr. j. Aquae Camph., £j. Aquae Destillat., j$j. M. Sig.—Apply to lids 2 or 3 times daily in oph. neonatorum, with solution of Silver Nitrate, gr. ad injected under lids twice daily. (Meigs.) R. Sodii Boratis, gr. iij. Aquae Rosae, Aquae aa %j. M. Sig.—Apply beneath lids three or four times daily after cleansing. R. Atropinae Sulph., gr. j. Glycerini, gss. Aquae, . . . M. Sig.—Two drops into the eye. Nux Vomica, gtt. j-ij of tincture bis vel ter in die (R.) ; gtt. v-x in a glass of cold water before breakfast and dinner, often overcomes the most obstinate constipation (P.) ; especially useful when great fecal accumulations from torpor of bowel (B.). Sulphur, gr. x with confectio sennae, often succeeds after other remedies fail (R.). Sulphurous mineral waters (B.); or sulphates in purgative waters; frequent small doses (R.). Podophyllum, the most generally used cathartic when deficient secretion (B.). Gr. to % night and morning when constipation with nervous and bilious headaches (P.). Senna, as in the pulvis glycyrrhizae compos. U. S., which may be taken in doses of a teasp. to a tablesp. as required, and kept up for months (Goodell). Mercury, Calomel or gray powder as cathartic (R.). Hydrastis, very valuable, when constipation refer- able to a sluggish liver (P.). Magnesium, the bi-carbonate, a useful and mild aperient (R.) Alum, cheap and serviceable laxative (B.). Aloes, in minute doses, in pill with Sulphate of Iron, as the official Pil. Aloes et Ferri, is one of the best agents in the management of chronic cases:—purgation should not be aimed at. Ipecacuanha, gr. j every morning, fasting, when great torpor of bowel (R.). Cocculus, flatus, hard lumpy motions (P.). Turpentine, in purely atonic constipation, with gaseous distention of colon, has triumphed when all other remedies failed (P.). Physostigma, very effective in intestinal torpor (B.). Stillingia, tt\,x of fluid extract in habitual constipation (B.). Castor Oil, a mild, efficient cathartic (B.). Ammonium Chloride, in the so-called bilious state, with constipation (B.). Arsenic, small doses (rr\jj) of Fowler’s solution often over- come constipation (R.). Belladonna, gr. y2 of the extract at night, in habitual constipation (B.) ; gr. )/(>-% once a day, especially when dyspepsia (R.). Acts directly on the bowel as a stimulant (P.). Croton Oil, the most efficient ca- thartic, when simple impaction without inflammation. Gtt. j-ij (B.) ; when evacuation of blackened feces (R.). Cascara Sagrada, the fluid extract in doses of 3j, produces large, soft evacuations without griping, and leaves behind it a laxative influence. Frangula, in similar doses, is equally efficient, but if from a fresh bark may produce griping. Cathartics, especially confectio sennae, pil. rhei compos., pil. aloes, the comp, cathartic pill, as well as those above (B.). Purgation as usually practiced denounced by editor of the Lancet, Octo- ber i, 1870. Saline Waters, are useful (B.). Pullna, Friedrichshall, or Hun- yadi; the first two with milk, are good for children (R.). Enemata, of soap- suds and salt, or a pint of cold water (B.); or turpentine, castor oil, aa £ss, to Oss-j of gruel (P.). The habitual use of warm enemata increases torpor of the Constipation. 524 CONVALESCENCE—CONVULSIONS. bowels (R.). Tamar-Indien, a favorite mild aperient, is proprietary, and sup- posed to contain cocculus, Glauber’s salts, etc. Aliment, important in habitual constipation ; corn bread, cracked wheat, oatmeal, bread of unbolted flour, fruits, green corn, tomatoes, and celery. dozen each of almonds and rai- sins daily. A glass of cold water before breakfast may overcome habitual constipation (B.). An orange or a smoke after breakfast (R.). Tobacco habitues rarely suffer from constipation. [Compare Intestinal Obstruc- tion.] R. Ext. Colocynth. Co., . . . gr. xij. Ext. Belladonnae, . . . . gr. ij. Ext. Gentianae, gr. vj. Olei Cari, gtt. iij. Ft. pil. vj. Sig.—One pill at bedtime. (Goodell.) Prescriptions. Castor Oil Emulsion. R. 01. Ricini, Glycerini aa Tinct. Aurantii n^xx. Tinct. Senegae, rr^v. Aq. Cinnamomi, . . . ad ss. M. ft. emulsio. Sig.—One dose. R. Podophylli Resinae, . . . . gr. ij. Quininse Sulphatis, Ext. Aloes Aquosi, . . aa gr. viij. Fellis Bovini gr. xvj. Ft. pil. no. xvj. Sig.—One or two at bedtime. (Goodell.) Artificial Hunyadi Water. R. Magnesii Sulph., Sodii Sulph aa 5 ss. Potas. Sulph., gr. ij. Sodii Bicarb., gr. viij. Sodii Chloridi, gr. xx. Aquae, q. s. ad 3 viij. M. Sig.—A winegl. before breakfast. R. Ext. Cascarae Sag. FL, . . Jjj. Ext. Belladonnae FI., . . . gj. Tinct. Nucis Vom., . . . . 3 ij. Syrupi et Aquae, . . aa ad £ iv. M. Sig.—Teasp. thrice daily in obsti- nate constipation. (Clarke.) Convalescence Lime, as lime-water, or the carbonate, in convalescence from serious dis- ease (R.). Quinine or Hydrastine, to promote digestion and appetite (B.). Fats, especially cod-liver oil (R.). Alcohol, before or during meals (R.). Koumiss, possesses great value (B.). Bitters, especially gentian and calumba (B.); the latter especially when stomach weak (R.). Eucalyptus, a serviceable tonic (B.). Coca, 3ss-ij of the fluid extract as a dose (B.). Guarana, gr. xv- 3j may be given (B.). Opium, as laudanum, injected per rectum, for insomnia of convalescents (R ). Sea-Baths, valuable in many cases (R.). Diet, requires the most careful attention ; the prevalent error of giving food of difficult diges- tion too early must be guarded against, especially in intestinal and gastric dis- orders. The strictest moderation should be enjoined. The symptoms must be watched closely, and combated by appropriate medication. [Compare Adynamia for Tonic Prescriptions.] General Directions.—In all cases, horizontal posture, fresh air, loosen the clothing ; insert a plug of soft wood, or a cork, between the teeth, to prevent biting the tongue; sprinkle the face and chest with cold water. Epileptic.— The general directions above will usually suffice. [See also Epilepsy.] Hys- terical.—The diagnostic peculiarities are : pupils not dilated, but are sensitive to light; no wounding of tongue ; face not livid ; pulse usually normal. [See also Hysteria.] Infantile.—Administer some anti-spasmodic, as Ether, alone or combined with Musk or Belladonna; then search for any mechanical cause, as a pin in the dress, etc. Lance gums if dentition the cause (A.). [See Con- vulsions, Infantile.] Uraemic.—[See Uraemia ; Puerperal Convulsions.] Convulsions. CONVULSIONS—CORNEAL OPACITIES CORNS. 525 Convulsions, Infantile. Belladonna is of the highest value in certain congestive forms, as in fits due to the irritation of teething, or those referable to whooping cough (P.). Ignatia, is efficient in convulsions of children from intestinal irritation, no cerebral con- gestion being present (P.). Valerian, has been successfully used when from worms, to which parasites it is fatal (P.). Potassium Bromide in all forms of convulsions in children (R.) ; children bear it in large doses, gr. v thrice daily or oftener for a child a year old in convulsions from teething (Br.). Chloral, in large doses, gr. v, by mouth or rectum (Br.); best used as a suppository rather than by liquid injection, and often very useful (R.). It gives better results than any other agent. Chloroform, inhalations of great service (R.) ; useful in all forms (B.); should be used to arrest the convulsion and prevent recurrence (A. A. Smith). Alcohol, has remarkable power in arresting convulsions of den- tition ; small doses of wine or brandy (Wa.). Asafetida, in the convulsions of teething, a small portion in enema, appears to mitigate them (Wa.). Opium, efficient, but dangerous in young children. Veratrum Viride, has been em- ployed successfully (R.). Amyl Nitrite, gtt. v with gr. % of morphine used in one case as a last resort, after five hours’ convulsions in a child of 18 months, which resulted in producing quiet sleep (Engel). Hot Baths, are important, with cold affusions or ice to the head (B.). Spinal Ice-bag, may be very effi- cient (R.). Prescriptions, R. Chloralis Hydratis, . . . gr. v. Lactis, M. Sig.—As rectal injection. Or the dose may be made into a suppository with cacao-butter and inserted well up into the rectum. R. Sodii Bromidi, Chloralis Hydratis, Sodii Bicarb., aa gr. viij. Aquse, gj. M. Sig.—A teaspoonful every hour to a child under four months old. Corneal Opacities. Cadmium, is said to promote their absorption; gr. ij of the sulphate to §j of rose-water as collyrium (R., Wa.). Mercury, Calomel by insufflation, or the red iodide gr. ij, cerate gr. xl, oil gtt. xx, as ointment, successfully used (Wa.); weak solutions of the bichloride, or ointments of the oxides, gr. ad gj, as remedies, among many others to hasten their absorption in recent cases (Arlt). Oils, eel-liver and cod-liver oils, ox-gall, juniper oil, oil of turpentine combined with olive oil, and others, dropped into the eye once or twice daily for the same purpose (Arlt). Opium, the wine at first, then insufflations of calomel and red precipitate or yellow oxide of mercury ointment, most frequently used by me in recent cases (Arlt). Potassium Iodide, as ointment with carbonate of potassium after cod-liver oil or oil of turpentine with olive oil, in cases of longer standing (Arlt). Silver Nitrate, gr. v-x ad §j aquas, as lotion (C.). Iodine, internally and as collyria, has been efficacious, especially in strumous cases (Wa.). Sodium Chloride, gr. x ad aquae destil., of which rtbv-x injected subcon- junctivally, to hasten disappearance of turbidity (C.). Operative Measures, only in case of incrustations, as of lead and lime, situated superficially by removal of epithelium and anterior elastic layer. Deeper interference may lead to suppurative keratitis. Excision of opaque cornea and transplanting of one from an animal’s or a recently enucleated human eye (keratoplasty), has always failed. Artificial pupil by iridectomy, for central opacities which are unre- movable. Tattooing to relieve deformity of disfiguring leucomata (Arlt). Pannus and leucoma are best let alone (D.). Stenopaic Spectacles, for semi-transparent opacities in pupillary region (Donders). [Compare Keratitis.] Corns. Silver Nitrate, solid, after soaking and paring (Wa.); the best application for soft corns, and very irritable ones (D.). Acetic Acid, strong, to remove corns (Wa.). Mercury, corrosive sublimate in alcoholic solution locally to remove corns (Wa.). Iodine, gr. xl ad §j alcoholis, locally (Wa.). Poultices are useful; or a plaster 526 COUGH of soft material with hole in centre (D.). Water, hot and cold, alternately applied to inflamed corns. Keep a corn thin by frequent washing and paring. In performing the latter operation, the knife should work downwards to the apex of the corn, so as to remove pressure from its centre. Prescription. R • Acidi Salicylici, . . . . gr. xv. Extract. Cannabis Ind., . gr. vijss. Alcoholis, 90°, np xv. yEtheris, 62°, rr^xxxvij. Collodii Flexilis, .... nplxxv. Mix, and keep in closely-corked vial. Paint the corn every other day for a week, then it can be easily squeezed out. ( Vigier.) Cough. Opium, in some form, is much used in cough-mixtures; morphine and gly- cerin to fauces (B.); moderate doses only are useful in irritative affections of the air-passages, to allay irritation and hypersecretion, but it may do even fatal mischief in cases where secretion is copious and expulsory power feeble (P.); opiates inadmissible when with copious expectoration there is any indication of bronchial congestion (Wa.); very useful in violent and frequent cough with little rhonchus and no signs of obstructed oxidation ; also, when cough is due to red, inflamed and ulcerated throat; opium or morphine given so as to cling for some time in contact with the pharyngeal structures (R.). Codeine is often effi- cient in cough when morphine cannot be borne (Br.). Apomorphine Hydro- chlorate, very valuable in cough where a persistent hacking without expectora- tion, or with difficult expectoration. The dose is only gr. to in the 24 hours. The solution rapidly alters unless a few drops of hydrochloric acid are added (Stocquardt). Terpine Hydrate, in bronchial cough, and night-cough from habit, is very efficient in a 2-grain dose at bed-time, repeated early in the morning (Boyland). See under Bronchitis, Chronic, for formula. Aconite, irritable, tickling throat-cough; short, dry cough of asthmatics, with anxious look, full, strong pulse (P.). Belladonna, often useful. No indications (R.). Internally and externally as plaster to the chest, very serviceable in spasmodic and nervous coughs (Wa.). Hyoscyamus, very useful in spasmodic, tickling night coughs (P.). Hydrocyanic Acid, for nervous, irritable cough, and cough of phthisis and mother’s sympathetic cough (B.); no more certain palliative for simple, nervous cough due to irritable state of the system (Stille); a valuable adjunct to ordinary remedies in cough of phthisis (Wa.). Potassium Cyanide,, is equally useful, gr. iij with each of Ext. Grindeliae FI., Syr. Scillae and Syr. Tolutan., makes a good non-opiate cough mixture, of which the dose is 3j every 4 hours (Waugh). Prunus Virginiana, has some influence due to its hydrocyanic acid ; is much used in cough-mixtures (B., P.). Laurocerasus, used as substitute for hydrocyanic acid in spasmodic coughs (B.). Conium, supposed to be useful (R.); is very useful in spasmodic cough (Wa ). Ipecacuanha, the fl. ext. for troublesome night-cough (B.); in obstinate winter-cough, with wheezing, the wine as spray to fauces efficacious (R.); in coughs of childhood ipecac is one of the most generally serviceable expectorants we can use (Wa.). Lobelia, dry cough, continued tickling sensation, even in sleep (P.). Sanguinaria, combined with hyoscyamus, in nervous, spasmodic cough (P.). Senega, as a stimulant expectorant in the cough of chronic bronchitis and subacute chest affections. Gelsemium, excessive irritability of the respiratory centre (R.); often remarkably relieves convulsive or spasmodic, reflex, nervous coughs (B.). Nux Vomica, has specific action on the pneumogastric, and is one of the most efficient reme- dies in cough of any kind, whether from bronchitis, pneumonia, phthisis or emphysema, but especially in nervous coughs and periodic coughs which come on in evening and stay all night. (Jour, de Med.) Pulsatilla, as anemonine, Y gr. and gr. doses, very useful in irritative cough, asthma, whooping-cough (P.). Iodine, by inhalation for children in hoarse, hollow cough, wheezing (R.). Alum, internally in spasmodic cough, gr. x to gj aq. as spray, in chronic cough also (R). Drosera Rotundifolia, the fluid extract in teaspoonful dose to an adult every 2 or 3 hours, of high value when spasm predominates. See ante COXALGIA. 527 page 202. Potassium Bromide, serviceable in various reflex coughs (uterine, renal, etc.), and in cough of phthisis occasionally ameliorative as a gargle (B.) Cubebs, 3ss-j of the tinct. in half-glass of linseed tea thrice daily, often cures like a charm the coughs of chronic catarrh, of emphysema, or acute catarrh, or following an attack of influenza (R.). Asafcetida, Garrod ascribes its value to the sulphur in it (P.). Very serviceable in after-cough from habit, and in mother’s sympathetic whooping-cough (B.). Carbolic Acid, as spray, a 5 per cent, solution in a steam atomizer will often prevent as well as cure a cough from cold. Valerian, in asthmatical and hysterical coughs (P.). Chloroform, with morphine and molasses in paroxysmal dry cough. May be painted on throat also (R.) ; in irritable reflex cough the vapor of a teaspoonful of the spirit may be inhaled from the surface of hot water and repeated every five minutes for four or five times (B.). Chloral, in convulsive coughs, ameliorates symptoms after hypnotic effect (Wa.). Camphor, equal parts of camphor and chloral triturated together are said to allay spasmodic cough when painted over larynx (B.). Glycerin of Tannin, applied to throat when chronically inflamed and so producing cough ; often the case with children (R.). Grindelia, used in cough of habit and spasmodic cough (B.). Squill, in catarrhal cough, should not be employed until active inflammation has subsided (Wa.), the syrup or vinegar of squill is the best preparation for cough with tickling in the throat (P.). Cod-liver Oil, in chronic coughs (R., Wa.). Lactucarium, the syrup as vehicle in cough-mix- tures (B.). Chamomile Oil, gtt. ij-viij, in coughs due to heightened reflex irritability, especially in hysterical women (P.). Pix, Tar-water, in winter cough, especially when paroxysmal (R.). Allays the cough of bronchitis and phthisis (P.). Emplastrum Picis, as rubefacient and counter-irritant in chronic coughs (Wa.). The frequency and violence of nervous coughs may be controlled by a determined effort of the patient’s will. [Compare Bronchitis, Pertussis, Phthisis.] Prescriptions for Cough Mixtures. A dulls. R. Spiritus Etheris Nitrosi, . . gij. Vini Ipecac., gss. Tinct. Opii Deodorat., . . gj. Syrupi Tolutani, . . . ad$ ij M. Sig.—A teaspoonful twice or thrice daily. (.Bowditch.) Children. R. Mist. Glycyrrh. Co., . . . ij. Syr. I’runi Virginian., Syr. Tolutan., aa^j. M. Sig.—Half teaspoonful 3 or 4 times daily for infants, teaspoonful doses at 1 to 2 years, larger doses for older children. (Potter.) R. Liq. Morph. (Magendie), . gj. Syr. Scillse Comp., Syr. Tolutani, aagj. Syr. Ipecac. Spt. Lavand. Co aagss. Spt. Limonis, gj. Syr. Pruni Virgin., . . . adj. M. Sig.—A teasp. as required. Each dose has of Morph, gr. R. Tinct. Opii Deodorat., Vini Antimonii, aagss. Ext. Valerianae FI., Syr. Simplicis, aa g ij. Aquae, gjss. M. Sig.—A teaspoonful every hour or two until cough controlled. For those 4 years and upward. (Meigs dr5 Pepper.) Barium Chloride, in considerable doses (gr. j—ij) persevered in for a month, thought to be a most valuable remedy in scrofulous diseases of joints (Wa.). Sulphuric Acid, 3j ad gj adipis, as ointment, persevered in, has resulted in great benefit. A powerful irritant (Wa.), Counter-irritation, by blisters around the hip, with perfect rest in the straight posture, cod-liver oil, etc. (D.). Iodide of Iron, in scrofulous disease of the joints, with cod-liver oil and nutri- tious diet (Wa.). Iodoform, very successfully used by many continental prac- titioners in scrofulous diseases of the joints (Wa.). Cod-liver Oil, the remedy on which most reliance is to be placed (R-). [Compare Abscess, Caries, Sup- puration, Synovitis.] Coxalgia 528 CROUP, Croup, Catarrhal. Aconite, valuable (R., Wa.); has been employed with the best results (P.); from gtt. to j every half-hour, until an impression is made on the fever- movement, then every hour or two (B.). Hot Water, applications beneath the chin and along the whole course of the larynx (Wa.). Hot fomentations or turpentine stupe to throat (El.); hot bath (g5°-io2°) in the paroxysm a good method (M. & P.). Potassium Bromide, locally, a solution by atomization has proved highly efficient in spasmodic croup (Wa.). Lobelia, has been used with occasional success (P.). Ipecacuanha, the syrup or fluid extract as an emetic at the outset (EL); is a slower emetic than tartar emetic (P.); the syrup to vomiting during the paroxysm, and rrpv-x every 2 or 3 hours next day (M. & P.). [Compare Laryngismus Stridulus.] Prescriptions. R. Potassii Citratis, gj. Syr. Ipecac, . . . . . . 3 ij. Tr. Opii Deodorat., . . . gtt. xij. Syr. Simplicis, ij. Aquae, 3 jss. M. Sig.—Teaspoonful every two hours at 2 years of age. In severe form of spas- modic laryngitis. (M. & P.) li • Tinct. Belladon gtt. iv. Tinct. Opii Camph., . . . gtt. 1. Pulv. Aluminis, gr. vj. Syr. Acacia;, S ss. Aquae, . . • * gjss. M. Sig.—Teaspoonful every 2 or 3 hours at 6 months old whtn cough frequent and harassing. (M.. & P.) Croup, Membranous. Mercury, a remedy of established value, gr. ss-j of calomel, with gr. ]/%-% of ipecac, according to age, every 2 hours, with local and other general meas- ures, especially the use of a hot (7o°-75°) and moist atmosphere (Wa.). The sub-sulphate, given early, is the best emetic, gr. iij-v; calomel is strongly urged as a laryngeal sedative and aplastic agent, allaying laryngeal spasm and preventing formation of membrane (B.). Alum, one of the best emetics in this disease, a teasp. in honey or syrup, repeated every 10 or 15 minutes until it operates (M. & P.); a very useful and non-depressant emetic (B.). Sanguinaria, by many considered specific, is undoubtedly the best emetic for this disease (P.); is too harsh and too uncertain in action (B.). Tartar Emetic, as an emetic, has established value in croup (Wa.). Is injurious; too depressant (B.). Potas- sium Chlorate, as alkali, after emetics, the most reliable internal remedy, gr. ij-iij every 2 hours to a child of 4 years (M. & P.). Chloride of Iron, may be combined with the preceding, in doses of 3-5 drops of the tincture, at the same age (M. & P.). Emetics, besides the above: Copper Sulphate, in small frequent doses (R.). Ipecacuanha, inferior to mercury (B.). In severe cases, vomiting should be caused 3 or 4 times a day, and should be commenced early (R.). Apomorphine, effective, but highly dangerous (B.). Senega, is considered a valuable auxiliary (P.), has been employed (R.). Quinine, in full doses is highly useful (B.). Sulphurous Acid, as spray, hourly or more frequently (R.). Tannin, a 5 per cent, spray, several times a day for 15 or 20 minutes (R.). Lactic Acid, as solvent of membrane (B.). Iodine, the tincture, externally, affords great relief, and tends to prevent formation of false membranes (Wa.). Water.— Warm bath, hot fomentations or compress to throat. Watery vapor in room. Steam inhalations, with a few drops of Iodine or Bromine. Diet.—Water only in small quantities during attack. Supporting diet may be required afterwards. Lime-water, by vaporization, or inhalations of the vapor of slaking lime for a few minutes in every hour, or some other alkaline solution during the whole treatment (M. & P.). Tracheotomy fully justifiable, per cent., recovered, out of 1024 operations ; should be done when paroxysms become very frequent, and dyspnoea is rather persistent than paroxysmal (M. & P.). [Compare Laryngitis, Diphtheria.] CYANOSIS—CYSTITIS. 529 Prescriptions. R. Pulv. Sanguinariae, . . . gr. xx. Pulv. Ipecac., gr. v. Syr. Ipecac., g ij. M. Sig.—A teasp. every % hour until emesis, then teasp. every hour. (P.) &. Acidi Lactici, g iijss. Aq. Destillat., x. M. Sig.—To be used as a spray, or ap- plied by a mop. (.London Throat Hospital.) Amyl Nitrite, by inhalation, often gives marked relief (P.). Quebracho, in that from asthmatic attacks of consumptives, lessened the cyanosis or entirely relieved it (Rohrer). Leeching is of service, in a manner not easily understood (P.). Treatment must depend on the nature of the lesion or disease giving rise to the cyanotic condition (A.). Cyanosis. Belladonna, is a good remedy in almost every form of vesical irritation (G.); when the vesical mucous membrane is irritable (B.) ; very useful in recent catarrh from chill, wfith pain (P.). Cantharis, in large doses causes inflamma- tion of the urinary tract, but gtt. j of the tincture every hour will often relieve vesical catarrh (A. A. Smith); in small doses continued, very efficient (B.); gtt. j-v of the tincture thrice daily, when bladder is irritable, its sphincter weak, and pain along the urethra (P.) ; may be employed in cystitis with benefit (R.) ; the best remedy in small doses for acute cystitis. Aconite, for febrile symptoms (R., P.). Quinine, often useful for acute symptoms (B.). Iodoform, in sup- pository for painful cystitis (R.). Opium, a rectal injection of starch and lau- danum will subdue pain and prevent the frequent micturition (R.) ; opium is dangerous if kidneys are diseased (P.) Alkalies, the citrates and bicarbonates if urine is highly acid ; stop when it becomes alkaline (R.) Liquor Potasste in barley-water or in a decoction of Triticum repens, preferred to all other alka- lies ; urine must be maintained at a neutral or very slightly acid reaction (Thompson). Cannabis Indica, an excellent anodyne in all bladder cases, having specific effect on that organ. Rest in horizontal posture, mucilaginous drinks, hot fomentations and hip-baths, from ioo° to no°, laxatives for the bowels, light food. Milk-diet often necessary, especially in children. [Com- pare Bladder Irritable, Calculus, Dysuria, Enuresis, Hematuria.] Cystitis, Acute. Prescriptions. R. Atropinse Sulphatis, . . . gr.j. Acidi Acetici, gtt. xx. Alcoholis, Aquae, aa M. Sig.—Four drops in a winegl. of water before each meal. (G.) R. Pulv. Opii, gr. xij., Camphorm, gr. xxx. Ext. Belladon., gr. iij. 01. Theobrom., q. s. M. et div. in supposit. no vj. Sig.—One at bed-time. Cystitis, Chronic. Benzoic Acid, and the benzoates, in chronic cystitis, from any cause, when urine is alkaline (B.); has some balsamic character, and is useful in some cases of chronic cystitis; gr. xxiv at least in the day, in pills made with glycerin (Thompson). Sodii Benzoas £>j in Tinct. Gelsemii Jij-iij and water to §vj makes an excellent wash for painful cystitis of old men with enlarged prostate. A fluid ounce should be warmed and injected, and retained 20 to 30 minutes (Copeland). Alkalies, when urine is acid ; the liquor potassae, with hyoscyamus as an anodyne, preferred notwithstanding its chemical incompatibility, to con- trol painful and frequent micturition (Thompson); bicarbonates or citrates better, as the strong reaction of liq. potassae unfits it to be given in doses suf- ficiently large to affect in any great degree the reaction of the urine (R.). 530 CYSTITIS, CHRONIC. Triticum, is very efficient as an internal remedy, gij-iv of the rhizome boiled in a quart of water until reduced to a pint, this strained to be taken in four doses in the 24 hours (Thompson); a very useful remedy (Pancoast). Buchu, is probably the most efficient of the urino-genital remedies, the fluid extract in doses of trLx-3j (B.); the best drug in chronic cystitis, especially when the catarrh implicates the ureters or the kidneys themselves, producing consider- able muco-purulent discharge (P.) Uva Ursi, is decidedly effective (P.); is less so than Buchu (B.). Stigmata Maydis, an infusion, £ij ad Oj, wineglassful every 3 or 4 hours, has been used internally with considerable success (Des- sein). Pareira, considered superior to Uva-Ursi (Brodie); often very successful (P.). Chimaphila, is often very efficient, but is more actively diuretic than the preceding named remedies (B.); by many practitioners it is considered the best remedy for chronic cystitis. Copaiba, is very useful by virtue of its local action on the mucous membrane, but objectionable for its nauseous taste and resulting gastric disturbance (B.). Cubeb, is often useful from its stimulating effect (P.). Turpentine, has been useful in many cases (R., P.); when cystitis due to urethral inflammation or prostatic disease (B.). Juniper, the oil is indicated under the same conditions as is turpentine (B.). Eucalyptus, there is no more efficient remedy in chronic cystitis than this (B.); the oxygenated oil of Merck is best in doses of 3 drops on sugar every 6 or 8 hours. Salicylic Acid, in large doses, either internally or by injection into the bladder, is most efficient (B.); the acid or salicylates often useful to prevent decomposition (P.) Carbolic Acid, and sulpho-carbolates to preserve the urine sweet (R.) Sulphites will accom- plish the same object (B.). Silver Nitrate, by intra-vesical injection, gr. j ad §iv to begin with, increased gradually to gr. % ad §j at most (Thompson). Stronger solutions are advocated by Professor Richardson of New Orleans, and Prof. Gardner of McGill College, Montreal. In the writer’s experience a 5 gr.1° §j solution, used as a vesical wash, has been promptly efficient in curing many cases which resisted other treatment for months. It sometimes produces serious symptoms, and it is therefore well to have a neutralizing solution of sodium chloride on hand for use if required. Other Injections which may be used to wash out the bladder, are—Lead Acetate, gr. j to 3iv of warm water, once daily : Nitric Acid, dilute, ttp j-ij to the §j of water : Tannic Acid, gr. j to §j : Borax, §j in jfij of glycerin and of water, of which to £iv of warm water for one injection ; Quinine, gr.j-ij to the 5 of water, with a drop of acetic acid. All injections must be used with great care, not more than Jij forced in at once and that very slowly. Use flexible catheter, warm solutions, and a rubber-injecting bottle with a long nozzle and stop-cock (Thompson). Washing the bladder is of great value (R.). Evacuation of the urine, some of which is often retained in the bladder, is a matter of great importance. Ergotin, hypo- dermically, increases the contractile power of the bladder, and enables it to empty itself more perfectly (Langenbeck). Pichi, the fluid extract, n\,xx to xxx four times daily, gave excellent results in bad cases of long standing, urine being alkaline, ammoniacal, ropy and purulent (Delamere). [Compare Blad- der Irritable, Calculus, Dysuria, Enuresis, Hematuria.] R. Uvae Ursae Fob, Pareirae Radicis, . . . aa j—ij • Sig.—Boil in 3 pints of water until re- duced to a quart, then strain, and take 1 or 2 wineglassfuls 3 or 4 times daily. {Thompson.) Prescriptions. R. Quininse Sulphatis, . . . . 5 ss. Acaciae, 3 ij. Morphinae Sulphatis, . . . gr. jss. Aquae, q. s. ad 3 iij. M. Sig.—A tablesp. to ounces of warm water, which inject in 3 parts, daily. R. Ext. Tritici Fluidi, . . . . .^ij. Syr. Amygdalae, 3 ij. M. Sig.—A dessertsp. in water 5 or 6 times daily. {Pancoast.) R. Sodii Boratis, Glycerini, Aquae, aa 3 ij. M. Sig.—Tablesp. in four ounces of warm water as an injection. CYSTS—DEAFNESS DELIRIUM TREMENS. R. 01. Terebinth., Camphorae, gr. xv. Ext. Hyoscyami, ... • gr. ss. Fiat massa. Sig.—Take a piece the size of a cherry-stone morning and evening. (Chauvel.') R • Argenti Nitratis, gr. vij. Aquas Destillat., . % iijss. M. Sig.—Injection every third or fourth day after washing the bladder out with warm water. (Ricord.) Cysts. Iodine, injection very effective in cysts of neck, and sometimes in unilocular ovarian (B.) ; §x after tapping (R.). Silver Nitrate, gtt. v-x of solution, t)j-ij as injection, will cure after setting up inflammation (B.). Galvano-puncUire, will permanently occlude cysts of neck (B.). Aurum Chloride, may sometimes cure ovarian dropsy (B.). Remedies internally have all been proved worth- less (E.). Deafness. Quinine, cures some forms, and often causes deafness (Brown-Sequard). Glycerin, for dryness of meatus ; also to form a film to ruptured tympanum (R.); either alone or in combination with olive oil (P.) ; effects are temporary (Wa.). Tannin, the glycerite as application for throat deafness (R., Wa.). Colchicum, when from gout in ear (A.). Cantharides, as ointment; gr. xxx ad §j adipis, below and behind the ear bis die, with alterative mercurial treat- ment, in deafness from thickened tympanum (Wa.). Gargles, in throat-deaf- ness, are of great value ; potassium nitrate, borax, etc., in sthenic ; tincture of capsicum added in nervous forms; hydrargyrum perchloride, when from secondary syphilis (Wa.). Water, washing in warm water, in deafness from general debility (Toynbee). Faradization, of the ear in nervous deafness, in which slight results only to be expected from the treatment (R.). Demands the utmost caution (Wa.). Collodion, contractile, applied to the membrana tympani, in deafness from relaxation of the membrane, has exerted a perma- nently beneficial influence, even in cases of long standing (Wa.). Turpentine, gtt. xl in 3SS glycerin, a few drops into the meatus, in deafness depending on deficient secretion of cerumen, results in much benefit (Wa.). Morphine, gr. ss sprinkled on surface behind the ear denuded by a small blister, has proved curative in chronic deafness, after all other remedies had failed (Wa.). Delirium. Belladonna, delirium of typhus and other fevers (R.); severe forms of de- lirium (P.). Hyoscyamus, delirium of typhus ; mild, less inflammatory form, hallucinations, nervous excitement, little cerebral congestion (P.) Stramo- nium, in wild and furious delirium of puerperal mania, with general restless- ness and suicidal or destructive tendency (Wa.); no drug deserving of more confidence in the greater number of maniacal cases (Cullen). Opium, in traumatic delirium, as a rectal injection, combined with tartar emetic in fevers, or, better still, morphine hypoder. Laudanum in low, muttering delirium (R.). is regarded with suspicion (P.). Cannabis Indica, the extract in doses of gr. %-]/-! in nocturnal delirium occurring in softening of the brain (Wa.). Potas- sium Bromide, in delirium resembling delirium tremens (R.). Camphor Mono- bromide, useful in rambling delirium (Wa.). Camphor, in 20-gr. doses, every 2 or 3 hours, especially in low muttering delirium (R.). Chloral, in violent deli- rium of fevers (R.). Antimony, delirium of fevers (R.). [See Fevers.] Water, the cold douche in maniacal delirium; place patient in warm bath during application (R.). [Compare Cerebral Congestion, Fever, Mania.] Delirium Tremens. Belladonna, of proven efficacy when congestion of the brain (P.); useful for the insomnia when coma vigil, cold surface, cyanosis (B.). Stramonium can do all that Bell, can do, and is more powerful (Tr.). Hyoscyamus, in 532 DEMENTIA AND INSANITY. some forms admirable (P.). Opium, cautiously, if at all (B.); as rectal injec- tion, hypodermically, or with spirits. If patient strong, delirium boisterous, and pulse full, add Tartar Emetic or Aconite (R.). Bromides in the “hor- rors” preceding the delirium, 3j every 4 to 6 hours. Are of less value in the delirium and in subsequent attacks (B., R.). Ammonium Bromide has been used with very good results (Wa.). Chloral, at outset (R.) ; very successful, but dangerous to old drunkards, or when heart disease exists (B.). If long continued to produce sleep chloral will produce a condition of insomnia. Chloroform, inhalations to procure sleep (R.). Anaesthetics dangerous (B.). Cannabis Indica, gr. ss-j of extract, one of the least dangerous and most use- ful hypnotics (P.). Tartar Emetic, as hypnotic (B.) ; combined with opium to control mania and insomnia (R.). Capsicum, to induce sleep in early stages, gr. xx-xxx in a bolus with honey, repeated after three hours (R.). In 20-30 gr. doses has remarkable success (P.). The tincture in 3ss-doses every three hours of great benefit (Wa.). Nux Vomica, or Strychnine, should be more freely used than it is in alcoholism, and in delirium tremens may be used hypo- dermically almost to the commencement of tetanic action (Luton). Arnica, the tincture is exceptionally serviceable in cases where there is depression (B.). Coffee, often exceedingly useful (P.). Digitalis, Jss of tinct. repeated in 4 to 6 hours (R.); a tablesp. of the infusion every 4 hours in pale subjects, anaemia of brain, with effusion and oedema (B.) has cured many cases promptly with- out producing any unfavorable symptoms. Its safety and efficacy are alike questionable (Wa.). Cimicifuga, an excellent tonic for the nervous system, very successful (P.). Quinine, with a mineral acid to restore digestion, in the “horrors,” and in adynamic states (B.); gr. j two or three times daily as a tonic, the best to produce nervous tranquillity (Anstie). Sumbul, very efficient for insomnia (P.). Zinc Phosphide, gr. jss daily, in divided doses, for many weeks, is used with decided benefit. Zinc Oxide, is of essential benefit as a nerve tonic and sedative, gr. ij-viij, twice daily, gradually increased to the higher dose named (Wa.). Lupulin, the tinct. or oleo-resin, useful in mild cases as stomachic tonic and cerebral sedative (B.). Ammonium Carbonate, when anaemia of brain and feeble heart-action (B.). Conium, combined with opium, useful (P.). Alcohol, of undoubted use where failure of stomach to ap- propriate food (B.). Water, about 60° with ice to head, to reduce temperature in the hyperpyrexia (B., R.). Treatment, should tend to nourishment, and establishing of digestion. Concentrated liquid nourishment, with moderate use of stimulants (H.). Diet and Hygiene. The immediate source of danger is exhaustion, hence animalized and nutritious, digestible diet in fluid form, small quantities frequently repeated ; beef-tea, soups, yolk of eggs, warm milk, cocoa, cayenne pepper or stimulants in soups; coffee, to still nervous excite- ment ; hot baths and wet pack to eliminate the poison. A quiet, dark room, sleep a necessity, often induced by Belladonna. [Compare Alcoholism.] Prescriptions. R. Tinct. Capsici, Ext. Lupulini FI., . . . aa §j. Mucil. Acacias sjss. Aquas Cinnamomi, . £ jss. M. Sig. — Dessertsp. as required for the wakefulness and excitement which pre- cedes an attack. R. Chloralis Hydrat., . . . . Ext. Conii FI., 3 iij. Ext. Hyoscyami FI., . . . Mucil. Acacias, g T Aquae Menth. Virid.,. . ad 5 ij. M. Sig. — Teaspoonful in water after each meal. Dementia and Insanity. Moral or Mental Treatment in recent times, is confided in greatly. With correct management from the start, nearly all cases of insanity unattended by paralysis or physical decay may be cured (Savage). This can be best admin- istered in a well-conducted asylum or hospital for the insane, where security and the prospect of recovery will be better than in the best home. The total DEMENTIA PARALYTICA DENGUE—DENTITION. 533 abolition of any one plan of treatment in favor of another would be a great mistake. More than half of first attacks of insanity are recovered from under good management, which is best attained under the direction of persons trained in this specialty (H.). Recently, efforts have been made at the improvement of the insane condition by requiring them to attend school daily, with remark- ably good results. Tonics and Hypnotics, should be used in cases requiring them. Food, of good quality is at the basis of treatment. Opium, morphine, the best form, especially for melancholics, climacteric and senile cases, which improve under its use; is hurtful in mania. Chloral, does as much harm as good, is best suited to wildly maniacal and erotic patients. Potassium Bromide, is almost discarded, except for epileptic cases. Conium, is useful, sparingly, for noisy patients, so also is Hyoscyamine. Colchicum, for gouty cases, which are numerous. Cure the gout, and you may cure the insanity. Shower-bath, suitable for cases due to self-abuse, and the wet pack in the mania of hystero- epilepsy. Stimulants rank high, next to quiet and absence from home. " Kou- miss, a good food in hysterical dyspepsia and anorexia, being easily digested and preventing waste (Dr. Savage, Bethlehem Asylum). [Compare Delirium, Hypochondriasis, Mania, Melancholia.] Dementia Paralytica. Physostigma, has seemed to retard the progress of the disease in some few cases (B.). Paraldehyde, in one or two drachm doses as a calmative and hyp- notic is as efficient as chloral and without danger (B.). Tonics, may be used, though treatment is only palliative. Lacto-phosphate of Calcium, Cod-liver Oil, etc. No remedies have hitherto been of any avail (B.). Dengue. Emetics and Purgatives are indicated at the outset, also free diaphoresis. Treatment is entirely symptomatic. Quinine, in five-grain doses every four or five hours for the fever (Da Costa); should be given more for its tonic than for its antiperiodic effects (Fayrer). Opium, in some form for the pains and nocturnal restlessness. Salicylic Acid or salicylates for the pains in joints and muscles. Carbolic Acid, as lotion, a 5 per cent, solution, for the itching, or camphorated oil. Belladonna confers great relief in this disease, npx-xv of the tincture may be given every hour for two or three doses (Fayrer). Aconite, with saline sand nitric ether, during the pyrexia, which may be so high that cold sponging or the cold bath may be required. Bitter Tonics, as gentian and calumba, with quinine and a mineral acid or strychnine during convalescence. R • Tinct. Colchici Sem., . . . 3 ij. Spt. Nitrosi, . . . 5J iv. Potassii Nitratis, gr. xl. Aquae, ad § vj. M. Sig.—Tablespoonful well diluted every hour or two until profuse dia- phoresis occurs. For relief of the violent pains. Prescriptions. R. Tinct. Aconiti, rt\,xvj. Morph. Acetatis, . . . . gr. ij. Spt. rEtheris Nitrosi, . . . % iv. Liq. Ammon. Acetat., . . 5 iij. Aquae Camphorae, . . . ad 3 iv. M. Sig.—Teasp. to dessertp. according to age, every hour for three hours, then every two hours. Dentition Belladonna, in convulsions of dentition rarely fail to relieve (P.). Hyoscy- amus, to alleviate pain and subdue irritation ; better than opium for children (P.). Chamomilla, ff\J of the tincture every X hour, an excellent sedative for children (A. A. Smith). Potassium Bromide for irritability and convulsions in teething (R.) Dulcamara, the infusion, in diarrhoea of dentition quickly checks symptoms (P.). Calumba, excellent for the accompanying vomiting and 534 DIABETES INSIPIDUS—DIABETES MELLITUS. diarrhoea (P.). Hypophosphites, of lime or sodium, as a general tonic, are highly recommended (R.). Rhubarb, with soda, internally for the aphthae, with perfect cleanliness of the mouth and a wash of Borax or Potassium Chlorate in glycerin, gr. x ad §j (E. Smith). Castor Oil, for the diarrhoea of dentition to clear out the bowels, then a mixture of Chalk and Catechu, or Oxide of Zinc, gr. j to the dose, with gtt. j of Laudanum if required to reduce peristalsis (E. Smith). Lancing the Gums to relieve tension when gum is actually swollen : should not be indulged in indiscriminately. Prescriptions. R. Potassii Bromidi, .... %]. Olei Anisi, n\jj. Mucil. Acacias, Aq. Menth. Pip., . . . aa gj. M. Sig.—Teasp. every half-hour until relieved. (B.) R. Sodii Bromidi, Sodii Bicarbonat., Chloral is, aa gr. xx. Aq. Menth. Viridis, . . . Jjjss. Syr. Zingiberis, ss. M. Sig.—Half-teasp. to dessertsp. ac- cording to age. Diabetes Insipidus. Opium, large doses necessary, gr. vj-xij a day (B.); combined with gallic acid the most generally useful remedy (W.). Ergot has cured many cases, the fluid extract in doses of 3ss-j thrice daily (Da Costa); one of the most efficient remedies (B.) ; is the most useful remedy (R.). Iron and Strychnine are very useful for tonic effects (Da C.). Valerian restrains the flow of urine but does not cure (B.). Muscarine has been used with apparent success (R.). Potassium Iodide is curative in many cases of syphilitic origin (B.). Alum has produced good results (B.). Jaborandi, used successfully to reduce the quantity of urine (B.) Valerian, large, increasing doses (R.). Krameria lessens the quantity of urine (P.). Diet, a dry diet beneficial (B.). Prescriptions. R. Ext. Ergotas FI., .... % iij. Sig.—Half-teasp. thrice daily, gradually increased to a dessertspoonful. R. Acidi Gallici, Div. in chartulas xij. Sig.—One thrice daily. Diabetes Mellitus. Phosphoric Acid, largely diluted, assuages the inordinate thirst. In one case it seemed to act as a curative agent (Wa.). Arsenic, when from faulty assimi- lation, in diabetes of hepatic origin, and in thin subjects (B.); the Bromide of Arsenic is credited with several cures. The Lithiated Arsenical Water, used in 70 cases with cure of 96 per cent. (Martineau). See infra for formulae. Morphine, is very efficient in reducing sugar when used by mouth, but is of no value when employed sub-cutaneously, even in the same case (Bruce). Opium in large doses (gr. vj-xij a day), ameliorative. Codeine, is especially service- able (B.). Abates thirst and controls appetite (R.) Its value much disputed (P.); is of great value in many cases (W.) Codeine gr. %-%, one of the best remedies (Da Costa). Sodium Salicylate has cured when all other drugs have failed (R.); gr. x-xv in compound spirit of lavender, and water, thrice daily, is my favorite remedy (Da Costa). Ergot is one of the useful drugs (Da C.) ; decreases the quantity of sugar and the volume of urine. Potassium Bromide, gr. xx ter die, cured two cases in six weeks (Begbie, R.); useless (Da C.). Krameria lessens the quantity of urine (P.). Phosphates, to avert failure of nutri- tion (B.) Glycerin has produced good results (B.). Used in place of sugar (W.). Aurum Chloride is one of the promising remedies (B.). Iodoform, in doses of gr. j-ij, rapidly reduced the sugar and caused its disappearance in 4 or 5 days, in five cases, without any change in diet being made (Moleschott); the DIARRHCEA. 535 amount of testimony for its value in this disease is quite considerable (B.). Iodol, can be advantageously substituted for Iodoform in all the diseases to which the latter is applicable (B.). Oxygen, as oxygenated water, instead of carbonated, very successfully used (Le Blond). Uranium Nitrate, gr. i-iij, thrice daily has caused decided improvement in several cases (Hughes). Alka- lies are used on theoretical grounds, but have not produced much benefit. One case apparently cured by the diligent use of Ammonium Carbonate (B.); are serviceable (Da Costa). Alkaline mineral waters for diabetes of hepatic origin and in obese subjects, are extremely useful (B.). Salines, a warm solution of phosphate and chloride of sodium, by intravenous injection, in diabetic coma, produced astonishing results in one case (B.). Aloin, for the accompanying constipation (Da C.). Nux Vomica, or Strychnine, is generally beneficial. Calcium Lactophosphate benefits the thin, nervous type of diabetes remarkably (B.). Aliment. All saccharine and farinaceous foods forbidden. Use fats, animal food, and gluten or almond bread. Milk-cure, buttermilk best, to be the only food until cessation of symptoms. Alkaline Waters, when of hepatic origin and in obese subjects. Tepid drinks in the intense thirst (B.) Diet and Hygiene are of the utmost importance. Avoid amylaceous food, and everything containing sugar, especially ordinary bread. Use fresh, nutritious animal food, with bread of bran or almonds. Warm baths, warm climate, flannel under- clothing. Milk-cure, by skimmed milk, very successful, 6 to io pints daily. No other food for six weeks, then animal food. Caution,—the urine of patients taking salicylic acid gives the reaction of sugar with Trommer’s test (R.). R. Liq. Potassii Arsenitis, . . Tinct. Opii Deodorat., . . % v. Syrupi Zingiberis, . . . . £j. Aquae Cinnamomi, . .ad § iv. M. Sig.—Teasp. thrice daily. Prescriptions, R. Codeinae, gr. viij. Syrupi, et Aquae, £ ij. M. Sig.—Half teasp. thrice daily, grad- ually increased up to two teaspoonfuls. (Pavy.) R . Lithii Carbonat., gr. xl. Sodii Arseniat., gr. j. Ext. Gentianae, gr. xx. Ft. pil. no. xxv. Sig.—One night and morning until sugar disappears from urine. ( Vigier.) More convenient than Marti- neau’s liquid. R . Sodii Arseniat., gr. iij. Aquae, Oj. A tablesp. of this with Lithii Carbonat. gr. iij into a quart siphon filled with car- bonated water, which is to be taken freely, as daily beverage. (.Martineau.) Aconite, when from chill, high fever, cutting abdominal pains (P.). Mercury: Calomel for infantile diarrhoea (ileo-colitis), gr. to T every half-hour (B.). The bichloride, gr. jin §x aquae, a teasp. frequently in acute or chronic diarrhoea of adults or children with slimy, bloody stools, pain and straining. Gr. l/e of gray powder hourly, or gr. of corrosive sublimate every two or three hours (R.); gr. j of the bichloride to the quart of water, of this a teasp. every hour in mucous diarrhoea (A. A. Smith). Camphor, in summer diarrhoea and the preliminary diarrhoea of Asiatic Cholera (B.); when from effluvia of drains or exposure to cold (R.) ; useful in many forms (P.). Ipecacuanha, in summer diarrhoea and dysentery of children with greenish stools (B.); hourly drop- doses of the wine especially if vomiting (R.); when from nervous irritation, especially young children (P.) Dulcamara, in diarrhoea of children from damp, or with dentition (P.). Pulsatilla, dyspeptic diarrhoea, mucous discharges, active piles (P.). Quinine, in periodic diarrhoea, with dysentery and jaundice (B.). Veratrum Album, in the vomiting and purging of summer diarrhoea (R.). Podophyllum, in chronic, with high-colored motions and cutting pains, also, in morning diarrhoea (R.). Gr. to with occasional doses of aconite, for vomiting and diarrhoea of gastro-enteritis and prolapse of rectum (P.). Diarrhoea. 536 DIARRHCEA. Chamomile, an infusion in summer diarrhoea of adults, or in that of dentition (R.). The oil in diarrhoea of children, especially from worms (P.). Arsenic, for evacuation of undigested food (B.); gtt. j of liq. arsen. before meals when diarrhoea excited by food; also in chronic and membranous forms (R.). Nux Vomica, a very useful adjunct to other remedies (B.); often of much service in epidemic diarrhoea (P.) Sulphuric Acid, in summer and choleraic diarrhoea. Small doses in chronic form and in the straining diarrhoea of children (R.). Iron, sol. of pernitrate in army diarrhoea (B.). Lime Carbonate, in later stages, as chalk mixture in diarrhoea of typhoid or phthisis (R.). Zinc Salts, very effi- cient in summer diarrhoea of children (B.). Rhubarb, in early stages to get rid of irritant, afterward to check the diarrhoea (R.); when torrefied it has no pur- gative power, but its astringency is retained. Rumex, in morning diarrhoea (R.). Arnica checks exhausting diarrhoea with great certainty (P.). Silver Nitrate, in diarrhoea of children. White, pasty and offensive stools. Combined with opium the most effective remedy forthat of phthisis and typhoid (B.). Min- eral Acids, in painless, watery stools, light color and alkaline (B.). Alkalies, mistura cretae in sour-smelling stools (B.) Sodium, potassium or magnesium bicarbonates when acid canal (R.). Lead Acetate is excellent in all forms (B.) ; with opium as an injection (R.). Bismuth is effective, requires large doses. Gr. xxx-lx every three or four hours ; is especially indicated when desire for stool is felt immediately after eating (B.). Gr. j hourly with milk, sometimes with gr. Ye gray powder, in various forms of infantile diarrhoea (R.). Opium, com- monly used, but is best in watery evacuations, combined with mineral acids or acetate of lead (B.). An injection with starch in severe cases (R.). Calumba, when not inflammatory (B.). Coto Bark, the fluid ext. or Cotoin is one of the new remedies for atonic diarrhoea. Purgatives, Saline, a teasp. of Epsom salts (magnes. sulph.) in a wineglass of water every three hours when intestinal inflam’n (B.). Copper Sulphate, the most effective astringent in chronic diar- rhoea and that of phthisis (B ). Ergot, in persistent chronic diarrhoea (B.). Iodine, one or two drops of tinct. in diarrhoea from atony of mucous membrane (B.). Tannic Acid, very useful in profuse and chronic diarrhoea. Stille advises tannic acid and milk diet for chronic diarrhoea and dysentery (B.). Thymol, gr. xx to 3ij in 24 hours in divided doses for adults, is a very efficient internal antiseptic in all cases of diarrhoea, especially that of phthisis, teething children, chronic diarrhoea, etc. (Martini). Carbolic Acid, very useful in fermentative diarrhoeas, especially when combined with bismuth in cholera nostras and cholera infantum (B.). Diet. Cool or cold, light, bland food. Gruel, rice, arrow-root, whey, barley-water, in recent cases. In chronic cases the most digestible but nutritious food, as fresh fish, game, raw eggs, rice, mucilaginous drinks. Milk-and-lime-water or soda-water very useful. Also raw meat pulp. Avoid beef, pork, veal, and much starchy food. [Compare Dysentery, Cholera.] R. Bismuthi Subnit., .... 5jj-ij. Pepsini Saccharat., . . . . g ss. Zinci Oxidi, gr. vj-xij. Trit. et div. in chartulas xij. Sig.—One every four hours in summer diarrhoea of children. Prescriptions. R. Tinct. Opii Deod., .... g). Tinct. Calumbae, . . . . ad ij. M. Sig.—Teasp. in a winegl. of water before meals. R. CupriSulphat. gr.j. Morph. Sulphat., gr. ij. Quininae Sulph., gr.xxiv. Fiant pil. no. xij. Sig.—One pill thrice daily. R. Sodii Bromidi, g ss. Mucil. Acacia;, Aquae Purae, . . aa q. s. ad "g ij. M. Sig.—Teasp. every three hours in the diarrhoea of dentition, for child less than a year old. (A. A. Smith.) R. Zinc Oxidi, gr. xvij. Sodii Bicarb., gr. viij. M. et div. in chartulas iv. Sig.—One every 6 hours. DIPHTHERIA 537 R. Zinci Sulphatis, Pulv. Opii, Pulv. Ipecac., . . . , aa gr. xij. M. Fiant pil. no. xij. Sig.—One 3 or 4 times daily in chronic diarrhcea of adults. R. Plumbi Acetat., gr. xx. Pulv. Opii, gr. x. Fiat massa, et div. in pil. x. Sig.—One twice daily. R. Tinct. Opii Camph., Tinct. Catechu, . . . . aa 3 iij. Mist. Cretse, 3 x. M. Sig.—A teasp. four or five times daily for children. R. Ac. Nitrici Diluti, . . . . gij. Tinct. Camphorae, Tinct. Opii, aa 3 j. Syr. Zingiberis, 3 iv. Aq. Menthae Pip., . . . ad gvj. M. Sig.—Tablesp. doses to be used after a cathartic. [Hope's Mixture modified by Thompson.) R . Spt. Attheris Co., Tinct. Opii Camph., . . aa 5). Syr. Simplicis, 3 ij. M. Sig.—Dessertsp. after each move- ment. R. Tinct. Opii Camph., Syr. Rhei Aromat., . . aa 3 ss. Aquas Calcis, ad g ij. M. Sig.—A teasp. for children. Diphtheria Belladonna, an excellent remedy ; if given early will abort the exudation and later is useful to sustain the heart (B.) ; especially when throat and tonsils acutely inflamed and much swollen (R.). Corrosive Sublimate, gr. 2X0-| every 2 or 3 hours, has given me most success, with Thymol or Boric Acid gargle; and Potassium Chlorate, Iron and Quinine together, where the membrane is not spreading (Da Costa): gr. jss in of glycerin and water, of which 3) every hour for 6 doses, then every hour night and day, to a child of 4 years. (Grant-Bey): locally very efficient, gr. ij to Oj of water, applied on a cotton swab, which should be burned after one using ; this hourly night and day (Oat- man). Hydrarg. Cyanide, in solution of gr. to the of which a teasp. every }4 hour day and night to older children and adults, with a gargle of the same solution (Sellden); gr. according to age, every hour or two (Erichsen). Calomel is next in importance to quinine and iron, has proved successful in cases where other means failed, gr. }i-% every 3 hours, with a little Dover’s powder (Da Costa), checks plastic exudation ; its use limited to children of good constitution, with sthenic symptoms. Gr. )4 to j every 2 or 3 hours with or without Dover’s powder (gr. j) or ipecac, (gr. j) till bowels become relaxed, with greenish stools (Wa.). Gr. v. repeated boldly every hour to 3>iv, for a child of 3 years, until the stools appear like polyps in water-troughs, gelatinous, and of a bright, dark-green hue. Then a dose of castor oil if salivation is feared (Reiter’s Monograph). The safest and most efficient germicide with which we can saturate the system ; nothing like it in diphtheria,— gr. ye,-1/} every hour, even gr. j every 2 hours, has no bad effects, no salivation (Fowler). Calcium Chlorate, solution locally as lotion for the mouth. Considered almost specific by some; its chief utility is in removing fetor; may influence germs (R., B.). Potassium Chlorate, grain-doses every % hour (A. A. Smith); is more largely used than any remedy, both internally and locally (B.) ; in full doses with Liq. Cinchonae, seems to be of service in some cases (Wa.). Pilocarpine, used in 80 cases without a single death ; produces free salivary discharge but is depressant to the heart (Guttmann) ; many opinions for and against it. Is decidedly inju- rious in adynamic cases (B.). Quinine, in tonic doses recommended from my experience (Da C) ; when headache with high temperature, vomiting, and symptoms of septic poisoning, then in full doses (Wa.); is most useful after serious symptoms have abated, then with Iron and a mineral acid (Mackenzie). Carbolic acid, in spray, locally to the fauces, to remove fetor and destroy disease- germs (B.). As caustic, the concentrated acid in glycerin on a mop or brush (W.). With iodine to prevent systemic infection (B.). Arsenic, in medicinal doses, when sloughing of throat, or malignant diph. (R.). Salicylic Acid, locally 538 DIPHTHERIA. and internally (gr. x), has produced good results (B.). Sulphurous Acid Gas, recommended by a royal commission in Victoria, as a means of arresting the disease. Crude sulphur burned in the room, all apertures being closed (R.). Sulphurous Acid, in full and frequent doses, causes rapid disappearance of the exudation, and improvement in the general condition, gj every y hour to an adult in severe cases, in ordinary ones every two hours. An 8-ounce mixture should have 2 or 3 ounces of syrup, and should be given in milk to very young children (Snow). Sodium Sulphite, 3j-§j aquae, locally, an easily managed application (B.); an injection for nares in nasal diphtheria (Da C). See for- mula below. Sodium Hyposulphite, in solution of gj tojjij of water, of which hourly doses of gj, to be retained in throat several minutes before being swal- lowed, an excellent local and constitutional remedy, which may also be used by a brush or spray to the throat, and by a syringe to the nares (Fruitnight). Sodium Benzoate, is highly efficient, 75 to 100 grains daily, according to age, also used locally (B.). Sodium Sulpho-Carbolate, has been found useful in lieu of carbolic acid (Wa.). Lime Water, dissolves false membrane. The vapors of slacking lime inhaled; or better, lime water by atomizer to back of fauces while patient respires deeply (W.). Ferric Chloride, as solution painted on or applied by spray to the throat (R.). Of no advantage locally, internally may serve by supporting the organism (B.); the tinct. of the chloride, gtt. xx every 2 or 3 hours; or better the perchloride, gr. y to j every 2 hours in syrup and water, is easier to take and doesn’t hurt the throat (Da C.). Strychnine, hypo- dermically, for the subsequent paralysis (R.). Tartaric Acid, locally, converts membrane into a gelatinous mass, easily expelled (Vidal). Thymol, gr. xx to the § of water, with a little glycerin, is the best gargle ; may need weakening (Da C ). Boracic Acid in solution, is next best as gargle (Da C.). Alum and Sulphur, equal parts, powdered and blown into the throat at moment of deep inspiration, as often as asphyxia is threatened, has been found efficient (Jones). Trypsin, is a good solvent of the false membrane; of all remedies used with the spray-atomizer, it has given me the largest percentage of recoveries (Fruit- night). Chinolin, a 5 per cent, solution painted over the affected parts with great advantage (Seifert) ; the tartrate in 10-grain doses internally (B.). Bro- mine, the vapor by inhalation, is useful (Wa.); a Xw ’n chronic form. [See under Dyspepsia.] Calumba, and other bitters are use- ful (B.). Ammonium Chloride, in high repute in Germany (B.). Caffeine, especially when associated with migraine (B.). Bismuth, is very useful in chronic gastritis, especially that of drunkards, and the chronic gastric catarrh of children with vomiting (R.); invaluable for its sedative, alterative and astringent action ; 10-15-grain doses several hours after meals (Da C.). Lead Acetate, in chronic gastritis with gastralgia and pyrosis, may be combined with morphine beneficially (B.). Alum, when vomiting of glairy mucus (B.). Ali- ment, such as will be digested in the small intestines; requires careful atten- tion. The milk-cure has been very effective in bad cases; malt liquors are harmful (B.). Mineral waters of purgative type, to keep the portal system drained. Exercise is not beneficial; better live quietly, and occasionally spend a day or two in bed (Da C.). Kumyss very agreeable, and tolerant to stomach; the milk-cure and buttermilk have been very efficacious. The farinaceous vegetables, rice, tapioca, arrowroot, aerated bread. [Compare Dyspepsia, Gastralgia.] Prescriptions. R. Sodii Bicarbonat., .... £jss. Tinct. Aurantii Cort., . . . 2ss- Infusi Calumbae, . . q. s. ad 3 viij. M. Sig.—Two tablesp. before each meal. In chronic gastric catarrh. R. Magnesii Sulphatis, . . . jjj-ij. Sodii et Potassii Tart., . . 3 ss-j. Ac. Tartarici, gr. xx. Sig.—Dissolve in a glass of water, and drink, an hour before breakfast. GASTRIC ULCER. 567 R . Aluminis, ....... 3 ij. Ext. Gentianae, 3ss. M. Ft. pil. no. xxx. Sig.—Two twice daily. R. Argenti Oxidi, gr. xij. Ext. Belladonnae, . . . . gr. iij. Olei Caryophylli, .... gtt. xx. M. Ft. pil. no. xxiv. Sig.—One pill twice daily. (Da Costa.) R. Sodii Bicarbonat., . . . . gr. lxxx. Spt. Chloroformi, .... gjss. Tinct. Gentianae, . . . . 3 ss. Tnfusi Rhei, Siv. Aq. Menth. Pip., q. s., ad viij. M. Sig.—A tablesp. or two before each meal. In chronic gastric catarrh, with flat- ulence. Gastric Ulcer. Arsenic, Fowler’s solution in drop doses lessens the pain and relieves the vomiting remarkably (B.); has given relief when commonly-used remedies failed (R.) ; gives good results when used in very small doses (Da Costa). Bismuth relieves pain and vomiting, and contributes to the cure (B.). [See under Gastralgia for formulae.] Silver Nitrate, in solution, to check pain and relieve the vomiting (R.); is next in value to bismuth, promoting cicatriza- tion and easing the pain (B.). Silver Oxide is equally efficient, and is not liable to produce staining (Da C.). Atropine often happily relieves the pain and vomiting, even when given in very small quantity (B.). Morphine, for the pain and vomiting (R.); in full doses if perforation occurs, to localize peritonitis until adhesions take place (Da C.). Ergotin, j to water x, of which gtt. xv hypodermically several times a day for the hemorrhage. Gallic Acid, in 5- grain pill every hour for hemorrhage. Lead Acetate, is sedative and hemo- static ; gr. ss-ij in pill with opium, very useful to check hemorrhage and allay pain (R.). Turpentine, 5 to 10 drops frequently repeated in hemorrhage (R.). Charcoal is said to ease the pain by preventing formation of acid products (R.). Mercury. Corrosive sublimate an effective remedy ; gr. e*0—sty thrice daily before meals (B.). Pepsin, by facilitating digestion, is useful (B.). Iron for the anaemia : the lactate or ammonio-citrate if stomach irritable (Da C.). Ice-bag, to the epigastrium, for pain and vomiting, etc. (R.). Nutrient Enemata, to rest the stomach. [See under Enemata for formula.] Brandy may be added, also laudanum, gtt. x-xx, if the rectum is irritable (B.). Milk-cure, has suc- ceeded admirably (B.); a strictly skimmed milk diet with lime water, 2 parts of milk to 1 of aqua calcis (Da C.). Diet, should be of non-irritating character, which, with cold or hot compresses to the epigastrium, leaves little room for medicine. In bad cases nourish per rectum, so as to give the stomach complete rest. In any case such food as is chiefly digested in the small intestines, e.g., farinaceous vegetables, rice, arrow-root, etc. A nice change from milk diet is a warmed pancreas, chopped up with rare meat, being nutritious and well relished (Da C.). Rest in bed for several months is imperative (Da C.). Defibrinated Blood, by injection into rectum, in doses of from (A. H. Smith). [Compare Hematemesis.] Prescriptions. R. Argenti Oxidi, Ext. Hyoscyami, . . . aa gr.x Ft. pil. no. xx. Sig.—One pill thrice daily before meals. R. Argenti Nitratis, gr. v. Ext. Opii, gr. iij. Ft. pil. no. xx. Sig.—One pill thrice daily. R. Bismuthi Subcarb., ... 3 iij. Morphinae Sulph., . . . . gr. j-ij. Pulv. Aromat., 3j. Ft. pulv. no. xij. Sig.—One powder in milk before each meal. R . Argenti Oxidi, gr. v. vel Zinci Oxidi, 3 ss. Morphinse Sulph gr. j-ij Ft. pil. no. x. Sig.—One pill thrice daily, before meals. 568 GLANDERS—GLEET. Glanders and Farcy. Ammonium Carbonate, in water, hourly, as concentrated as can be swallowed, followed by an opiate, and preceded by an emetic of ipecac, and an incision into each of Wharton’s ducts; proved successful in a case of acute glanders (Wa.). Carbolic Acid, and the' Sulphites, as sodium sulphite, are most worthy of trial. Creasote, or Carbolic Acid, in glycerin, locally (Wa.) ; or dilute chlori- nated soda, and lime-water. Escharotics, to destroy the affected spot, if inocu- lation occurs. Iodine, internally, also Arsenic and Strychnine, have been recommended. Quinine in large doses, and Chloride of Iron, may be useful. No drug yet tried has any marked specific effect on the disease (Durham). Glandular Enlargements. Iodine and Iodides, no remedy more efficient, when simple hypertrophy. Useless (with all other medicines) when caseation or suppuration has set in. Iodine injected-into cystic and glandular growths of neck. Syrup of the Iodide of Iron occupies an important place (B.). The iodide of potassium for mammae and testicles, but especially for thyroid (R.). Iodoform is equal, if not superior to iodine, in enlarged scrofulous glands, and other glandular swellings (Wa,). Iodide of Lead, as an ointment. Ung. Hydrarg. Iodidi Rubri, produces very striking effects in goitre, enlarged spleen, etc. (B.). Sulphides, especially the Blue Lick water, are said to abort or to mature suppuration in glands (R.). Calcium Sulphide, for hard, swollen glands behind the angle of the jaw, with deep-seated suppuration (R.). Calcium Chloride, highly useful in strumous inflammation and suppuration (B.). Pilocarpus, is curative in acute affections of parotid and submaxillary glands (B.). Mercury, useful in acute inflamma- tory states, tonsillitis, parotitis, etc. Hydr. chlor. corr. gr. or hydr. cum creta, gr. J, every 2 hours (B.). The oleateof mercury and morphine in obstinate and painful tonsillitis, and inflammation of lymphatic glands (R.). Belladonna, especially in tonsillitis (P.). Valerian with Guaiacum, in strumous enlarge- ment (P.). Hydrastis, frequently controls (P.). Carbolic Acid Injections, a 2 per cent, solution injected into substance of gland (B.). [Compare Bubo, Goitre, Tabes Mesenterica, Parotitis, Tonsillitis, etc.] Glaucoma. Atropine, gr. hypodermically beneficial (Anstie) ; imprudently used has caused the disease (Von Graefe, Soelberg Wells). Eserine, lowers intra-ocular tension, and is indicated with Quinine in all cases of threatened glaucoma, to preserve the eye from the risk of consecutive glaucoma, and after iridectomy or sclerotomy (De Wecker). Iridectomy, the only remedy for the disease, medicine being worse than useless. The operation should be performed as soon as a state exists which can be called glaucomatous. Even when vision is lost, the operation will best relieve the pain (C.). Almost a certain cure in early stages; in later, nearly always palliative; often curative. Drainage of Eye, by gold wire or catgut, has had success (De Wecker). Gleet. Cantharides, in drop doses, when frequent desire and pain in region of prostate (R.); of benefit in subjects of relaxed fibre and feeble circulation (B.). Blisters, to the perinasum, of undoubted benefit (B., R.). Piper Me- thysticum, has cured obstinate gleet (Switzer). Bismuth, i, glycerin x, water 6 parts, as an injection, often useful in gleet (R ). Eucalyptol, is used with benefit in chronic catarrh of the genito-urinary tract (R.). Iron, the tincture of the chloride, gss in Oss of water with 3j of laudanum, makes a good injection for gleet (R.); internally for anaemic subjects (St.). Mercury, ]/2 grain of cor- rosive sublimate in 3yj of water, is a good injection in gleet, used every 2, 3 GLOSSITIS GOITRE. 569 or 4 hours (R.). Zinc Salts, the sulphate or chloride, gr. ij of the latter to a pint of water, as injection every hour (R.). Bougies, of gelatin, medicated with astringents, are extremely efficient.' Turpentine, in moderate doses, when due to relaxed condition (B., R.). Copper Sulphate, a solution as injection (R.). Astringent injections may be used with benefit (Wa.). Copaiba, smeared on a bougie, and introduced into the urethra, will sometimes cause gleet to yield (Wa.). Oil of Sandalwood, n\,xv ter die (R.). Glycerite of Tannin, with equal quantity of olive oil or mucilage, as injection, 3>j enough. Per- severe 8 or 10 days after discharge ceased, and do not use at bedtime (R.). Balsams of Peru and Tolu, Buchu, Canada Balsam, Copaiba, Mastic, and Tannin, are used with advantage (P., R.). Often kept up by over-treatment. Will some time or other come to an end (St.). Diet and Habits important. Stimulants, both solid and' liquid, should be rigidly avoided, also coffee. Fre- quent ablutions, fresh air, good nourishment. [Compare Gonorrhoea.] R. Tinct. Ferri Chlor., . . . 3 vj. Tinct. Cantharidis, . . . . 3 ij. M. Sig.—15 drops in water three times daily. Prescriptions. R. Pulv. Cantharidis, . . . . gr. iij. Ol. Terebinth., :jj. M. Ft. pil. no. xij. Sig.—One thrice daily in obstinate gleet. If strangury occur, stop for a day or two. R. Zinci Sulphatis, gr. iij. Ac. Carbol., - Ext. Hydrastis, Ext. Belladonnae, . . . aagr. vj. Gelatini, q. s. M. Ft. bougia no. vj. Sig.—One in urethra at bedtime. R. Ac. Tannici, gr. x. Bismuthi Subnit., . . . . ij. Aq. Rosse, 3 vj • M. Sig.—Shake and use as an injection thrice daily. [Maury.) Glossitis. Bismuth, gr. xx of subnit., with §j of glycerin and of water, as lotion, for erythematous inflammation of tongue (A.). Purgatives, with gargles, leeches, antiphlogistic regimen generally (D.). Quinine and Iron, should be given internally, with dilute acid washes, and free purgation (Cl.). Alum, dry, powdered, may be dusted on tongue (CL). Leeches, applied beneath the jaw, if symptoms are urgent (CL). Abscess, should be opened, if any form. In- cisions, along superior surface, followed by vapor of hot water, may instantly relieve congestion (A.). Tracheotomy, or Laryngotomy, if suffocation is immi- nent (A.). Glottis, CEdema of. Emetics, non-depressing when oedema slight (A.). Inhalations, of steam with benzoin, or conium, of great service (A.); or of tannin, gr. viij or x to 5j of water; or alum, gr. x to the 5, or a saturated solution of potassium chlorate, all as spray (Walker). Ethyl Iodide, by inhalation, proved curative in one case in which it was repeated twelve times (See). Scarification, by laryngeal lancet, of paramount value (A.). Tracheotomy, if the above fail (A.). O’Dwyer’s laryngeal tubation promises well. [Compare Croup, Laryn- gitis.] Goitre. Iodine, is curative in simple hypertrophy (ordinary goitre), used both inter- nally and externally. Deep injection of the tincture is very successful in cystic degeneration of the gland (B.); also in the fibrous and fibro-cystic varieties, if injection be made into the tumor; dangerous, if into a vein or into the surrounding areolar tissue (Wa.). Mercuric Iodide, as oint. assisted by the sun’s rays, a piece the size of a large pea rubbed in daily, very successfully used in India for simple hypertrophy (R.); the official unguent, hydrarg. iodidi rubri, i in io daily (B.); is too strong (Gross); gr. xv to the strong enough for the worst cases (Wa.). Potassium Iodide, internally, also externally as ointment, 570 GONORRHOEA. in simple hypertrophy of the gland (R.). Strychnine, gr. thrice daily, has been successful in several cases (Holmes). Chloride of Iron, injections of the solution used in thirty-eight cases with curative results (Mackenzie). Ergotin, injected with benefit into the parenchyma of the goitre (P.); also used hypo- dermically with good results (Wa.). Ammonium Chloride, as an internal remedy, has proved curative (Stevens). Electrolysis, has sometimes cured in cases of simple hypertrophy and cystic gland (B.). Spongia Usta, was formerly considered a sovereign remedy (Wa.). Seton has cured. Fluoric Acid, in doses of rr\,xv to 3] thrice daily, largely diluted, cured seventeen cases out of twenty (Woakes). Excision, is a very difficult operation, only to be considered in extreme cases; it has been performed successfully by Desault, Harris, Hedenus, Billroth and Greene. [Compare Exophthalmos.] Prescriptions. R. Ung. Hydrarg. Iodidi Ru- bri> 3i\. Vaselini, g vij. M. Sig.—Use as directed. [Gross.) R. Ammonii Chloridi, . . . g vss. Syrupi Simplicis, . . . . g ss. Aq. Cinnamomi, . . . . £ iv. M. Sig.—Teasp. thrice daily. Gonorrhoea. Aconite, a drop of tinct. each hour in the acute stage (R.); when inflam- mation (Pf., St.). Gelsemium, serviceable, acute stage (Pf.). Cannabis Sativa, after acute symptoms subside, a few drops 3 or 4 times a day, is fully as effect- ual as copaiba or sandal, and infinitely more pleasant to take (Pf.). Canna- bis Indica, relieves pain, diminishes discharge (P.); occasionally useful (R.). Mercury, excellent results from corrosive sublimate (Pf.); gr. to 5yiij aquas destill, in subacute and chronic stages, as injection thrice daily; may have gr. ss-j of zinc chloride added with benefit. Often effectual (Wa.j. See page 462 for formula. Hydrastis, the infusion best for injection, 3j of root to aquas (Pf.); the fluid extract is one of the best injections, properly diluted ; or the muriate of berberine (hydrastin) 3) to §iv of mucil. acacias (B.). Col- chicum, the wine of the seed has frequently cured gonorrhoea, and was used in thirty-minim doses nightly for the relief of chordee by Brodie (B.). Chlo- ride of Iron, when acute stage has passed and the discharge is degenerating into gleet, few remedies are more useful than this tincture, in doses of xx thrice daily (Wa.). See Erysipelas for formula. Alkalies, citrates or bicarbonates to render the urine alkaline (R.); Lithium Carbonate in five-grain doses thrice daily for the same purpose. Alkalies are the chief factor in Otis’s treatment; Potassium Bicarb., gr. x in a tumbler of water, or in flaxseed tea, or infusion of triticum, with gr. xv of Potass. Bromide, if great pain present. Vichy Water (Celestin’s) freely (Otis.). Turpentine, in chronic stage, when parts are relaxed, moderate doses are of great benefit (B.). Can- tharides, drop-doses may be used (R.) ; in the chronic stage (B.). Pulsatilla, in subacute and gonorrhoeal ophthalmia (P.). Copaiba, especially adapted to gonorrhoea (B.); pour it upon a half a wineglassful of water to which add some bitter tincture (Chapman); if given too early in the disease it will aggravate the symptoms (P.); should not be used until pain in urinating is nearly gone, chordee ceased, and the discharge is diminishing and of yellow color (Wa.); is no good, but rather injurious, and prolongs the disease (Otis). See page 459 for formula. Sandalwood Oil, valuable in subacute (P.) ; a good quality difficult to obtain (Pf.). Best internal remedy ; Copaiba next (St.). Silver Nitrate, a weak solution (gr. as injection. In vaginal gonorrhoea a strong solution (3)~§j) through speculum to every part of canal (B.). As abortive injection is useless and dangerous (St.). Cubeba, unlike copaiba, given with good effect in acute stage; best results from mixture of both as in electu- ary. See formula below. Is not irritating to the stomach, and agrees with some patients better than copaiba (Wa.). Zinc Salts, a weak injection of the chlo- ride, gr. j to or viij of rose-water; or the sulphate gr. j to the frequently repeated, is probably the best treatment (B.). The best injections are those of GONORRHCEA. 571 the sulphate or acetate, gr. vj-xij to giv aquae, after the acute inflammation subsides (St.). Bismuth, the oleate, smeared on a sound, and inserted for 5 minutes (Shoemaker); with mucilage as an injection, excellent in chronic gon- orrhoea (Hill). Lead Acetate, the dilute solution of the subacetate, as injection, may be employed at any stage (B.). Chloral, a week solution, gr. j-iv to the a very good injection (Hill). Resorcin, a 1 per cent, solution makes a use- ful injection (Wa.). Injections, of tannin, copper sulphate, iron, cadmium, port- wine, brandy-and-water, and 1000 other agents (R.). Injections are very bad, especially in the acute stage; should never be used until the 5th week and then only if the case is not progressing (Otis). True gonorrhoea is never cured in less than four weeks (Van Buren and Keyes); urethritis is a different disease entirely (Otis). Balsams of Peru and Tolu, also Buchu, Uva Ursi, Chi- maphila, Pareira, etc., are among the numerous remedies used for gonorrhoea (R.). Alcohol, as a beverage, or any other stimulant, must be avoided entirely (R.). Soluble Bougies made of iodoform, eucalyptus and cacao-butter, are highly recommended to cut the disease short (Wa.); a series of similar prepa- rations, having a basis of gelatin and glycerin, medicated with the usual astrin- gent and sedative drugs, is manufactured by C. L. Mitchell of Philadelphia, and may be obtained of the drug trade. Wrappings of several folds of cotton are heating and uncomfortable, also dirty and productive of balanitis, etc. Pin a false front to shirt for covering (St.). Rest in bed is an absolute desideratum, especially during the inflammatory stage. Hot water, ioo° F., to the penis during urination, extreme cleanliness, milk diet; water freely as a beverage; flavored with a few drops of oil of gaultheria, or flaxseed tea, or infusion of triti- cum with potassium bicarbonate. Sexual thoughts to be entirely avoided (Otis). [Compare Chordee, Gleet,Orchitis, Rheumatism Gonorrhceal, Urethri- tis, Urethral Stricture, Vaginitis.] For Internal Use. R. Potassii Citratis, Spt. Limonis, gss. Syr. Simplicis, 3 ij. Aquae, $)■ M. Sig.—Dessertsp. largely diluted, 3 or 4 times daily. As alkali for the increas- ing stage. (Otis.) Prescriptions. For Local Use. R. Resorcini 3 j. Ac. Borici, gr. xx. Zinci Acetatis, gr-}(-/4- Aquae Destil., M. Sig.—Dessertsp. as injection. R. Pulv. Iodoformi, . . . . ss. Ac. Carbolici, zij. Glycerini, 5 ij. Aquae Destil., . ... ad 3 viij. M. Sig.—Teasp. as injection. The Black Paste. R . Pulv. Cubebae, % iij. Copaibae, i|jss. Aluminis, 3 ij. Sacchari Albi, ijj. Magnesiae, Olei Cubebae, gj. Olei Gaultheriae, . . . , 3j. M. fiat elactuarium. Sig.—A piece the size of a walnut after each meal. (Otis.) R. Zinci Sulphatis, gr. vj. Plumbi Acetatis gr. viij. Ammonii Chloridi, . . . . gr. iv. Aluminis, gr. v. Aquae Rosse, gj. M. Sig.—Injection, to be used after acute symptoms subside. R. Oleoresinae Cubebae, ... 3 iv. Potassii Bromidi, . . . . 5 j. Olei Sassafras, fr^x. Syr. Acaciae, 5ij. Aquae, q. s. ad 3 vj. M. Sig.—Dessertsp. 3 or 4 times daily. (/. Wm. White.) R. Zinci Sulphatis, gr. viij. Liq. Plumbi Subacet. Dil., j|iv. M. Sig.—Use as an injection. R. Zinci Chloridi, gr. j. Aquae Rosae, g vj-viij. M. Sig.—Use as injection. [For Alkaline Emulsion of Copaiba see ante, page 459.] [For Injection Brou and others, see ante, page 462.] 572 GOUT. Gout. Morphine, hypodermically, as close to the affected joint as possible outside of the red areola, is miraculous in giving immediate relief. Antipyrine, remarkably efficient for relieving the pain as well as prophylactic against future attacks (Marshall). Aconite, may certainly relieve pain (P.). Belladonna, the best remedy to effectually and speedily soothe pain ; also in gout of the stomach, 5-Tfo doses efficacious (P.). Potassium Iodide, especially when pain is worse at night (R.). Colchicum is merely palliative; a large dose (3j) of the wine often removes the severest pain in an hour or two, and soon after the swell- ing and heat subside (R.); it is especially useful in acute and rheumatic gout (B.); is not specific, nor a lasting or final remedy for gout, but acts very directly on the pain and inflammation of acute attacks. Laville’s tincture is a colchicum preparation, though colocynth is also a constituent (P.): is useful in the bron- chitis, asthma, dyspepsia, urticaria, etc., of gouty subjects (R.). Veratrine, as ointment to painful joints (R.). Sulphides, as baths in chronic gout, or fumi- gation with sulphurous acid, and bed-clothes exposed to strong fumes (R.); sul- phur waters certainly benefit (B.). Iodine, painted round joints in chronic (R.). Strychnine, hypodermically for later stage of gout paralysis (R.). Arsenic, very serviceable in a form of chronic arthritis allied to neuralgia (B.). Lithium, the bromide internally and a strong solution of lithia to the joints (B.): the bro- mide is the most efficient agent in combating the disease (Aulde) : the carbo- nate (gr. v to the 3) on lint around gouty enlargements, joints, etc. (R.). Sodium Salicylate, gr. x internally every 2 hours, also 3(j to §vij water warmed, as lotion on lint covered with oiled silk. Guaiacum has long had high repute, and may be given for a long time without injury (Wa.). Rhubarb with an alkali, regularly during intervals, very serviceable (Halford). Manganese, syrup, ferri et mang. iodidi (n\, x-gss) for the cachectic state (B.). Alkalies, to relieve indigestion, especially lithium salts. Alkaline mineral waters have long had a deserved reputation (B.): Magnesia and its carbonates often of great service; the latter dissolved in excess of C02 an elegant form of administra- tion (Wa.). Alkaline Poultice, 9 of linseed meal to one of sodium bicarb, is a useful application (R.). Turkish Baths, are useful in chronic gout (B., R.). Aliment. Farinaceous vegetables and acid fruits. Avoid animal or saccha- rine food. Milk-cure has improved cases, and apparently removed the diathe- sis (B.). Cod-liver oil in chronic gout (B., R.). Entire abstinence from alcoholic beverages is best; the worst wines are port, sherry and madeira. Local Measures. The affected limb should be raised, and surrounded with hot, moist flannels. Wrap the hands in flannel dripping with water, and cover with water-proof bag, to dissolve gouty deposits. [Compare Rheumatic Arthritis, LlTHyEMIA.] Scudamore's Mixture (Modified). R. Vini Colchici Radicis, . . 5j. Magnesii Sulphatis, . . . S). MagnesiaeOptimae, . . . . 3 ij. Aquae Menth. Pip., . . . . 3 x. M. Sig.—Tablesp. every hour until it operates. Prescriptions. Lallemand's Specific. R. Ext. Colchici Acet. (B. P.), Ext. Opii Aquosi, . . . aa gr. xv. Potass. Iodidi, 3 iv. Potass. Acetatis 3 ij. Aquae Destill j^iijss. Vini Albi 3 ss. M. Sig.—20 drops thrice daily. R. Colchicinae, gr. j. Ext. Colocynthidis Co., . . 3 ss. Quininae Sulphat., .... 3 iij. Ft. pil. no. lx. Sig.—One every four hours. (B.) R. Lithii Citratis, Magnesii Carbonat., . . aa Jj. M. et div. in pulv. no. 1. Sig.—One in water thrice daily. In chronic gout. R. Vini Colchici Sem., . . . 3 ss. Tinct. Digitalis, Liq. Potassii Citratis, . . . ijss. M. Sig.—A teasp. in water every six hours. R. Lithii Bromidi, Liq. Potas. Citrat., . . . . ,^iv. Syr. Tolutan., j|ij. M. Sig.—A teasp. in plenty of water after each meal. (Aulde.) GUMS—HAIR HAY-FEVER. 573 Gums. Myrrh, the tincture for spongy and ulcerated gums (P.); iv in Jjivof water or infusion of cinchona, is highly serviceable as a gargle or mouth-wash (Wa.). Alum, for spongy and ill-conditioned gums, tending to recede from the teeth, whether of mercurial or scorbutic origin (Wa.). Catechu, a piece dis- solved slowly in the mouth is often of service in similar conditions (Wa.). Rhatany, the powder as a dentifrice, keeps gums in good order (P.). Potassium Chlorate, gr. ij every four hours for a child of one year, for inflammation of gums in teething (Wa.). Carbolic Acid, gr. iij ad 3j aquae, as lotion in diseases of the gums (Hilditch). Pomegranate, the bark an excellent basis for gargles in relaxed gums (P.). Potassium Iodide, gr. x thrice daily, for periostitis of alveolar processes, marked by looseness of teeth, pain and swelling of gums (Graves). Iodine, gr. j ad §j aquae, applied by a camel’s-hair brush, after each meal, for retraction of gums with loosening of the teeth (Stille). Tannin, the glycerite, for spongy and bleeding gums (B.). Carbolate of Iodine, when fetor, (B.). Benzoin, the tincture a good application (B.). [Compare Scurvy, Teeth.] Prescriptions. &. Aluminis, . . . . . . . 3 ss. Tinct. Myrrhae, . . . . £j. Tinct. Cinchonae, . . . . X iv. Mel. Rosae, 3j. Vini Albi, M. Sig.—Mouth-wash. R . Tinct. Orris, Spt. Rosae, Alcoholis, aa 3 iv. 01. Amygd. Amar., . . . gtt. ij. M. Sig.—Violet Mouth-wash. [Piesse.') Hair Rosemary, encourages the growth of hair, mitigates baldness, and is supposed to prevent uncurling in a damp atmosphere (P.). Hydrogen Peroxide, and other preparations of oxygen, are used to “blonde” the hair, for purposes of fashion (Wilson). Hair-dyes, comprise potassium permanganate, pyrogallic acid, black oxide of lead, which are temporary, and the black oxide of silver, which is permanent in its action (Wilson). Depilatories usually consist of powders containing quicklime 3 parts, sodium sulphide 1, and starch 4. A powerful depilatory is barium sulphide made into a thin paste with starch (Wilson). Another contains yellow sulphide of arsenic, gr. xx, quicklime, starch, 3ij. A very effective one is barium sulphide and oxide of zinc (B.). Sarsaparilla is stated by Teste to possess the curious property of changing red hair to a light flaxen color when taken internally for three months. [Compare Alopecia, Syphilis, Tinea Tonsurans, etc.] U. Sodii Boratis, giv. Aq. Ammonise 3j- Spt. Myrciae, 3>j. Aq. Rosae, 3 xiij, M. Sig.—Shampoo Hair Wash. Prescriptions, I&. 01. Ricini, i|jss. Ol. Bergamii, gjss. 01. Cinnamomi, 01. Caryophylli, . . . . aa n^vij. 01. Lavandulae Tl\xl. Tinct. Cantharidis, . . gj. Aq. Ammonise, gij. Alcoholis, . . . . q. s. ad Oj. M. Sig.—Hair Tonic. R . Ac. Salicylici, gr. xl. Tinct. Benzoini, . . . . gss. Alcoholis, Glycerini, . aa 3 viij. M. Sig.—Hair Wash. Arsenic, especially valuable when disease is more of catarrhal than of asth- matic type, 3-minim doses of liquor arsenicalis (Mackenzie); as cigarettes, 2 or 3 daily (see Asthma for formula) (B.). Belladonna, when nasal secretion is Hay-Fever. 574 HAY-FEVER. very profuse (B.). Euphrasia, of decided benefit for the catarrhal symptoms (Pf.). Quinine, very useful after the more acute symptoms have subsided (R.) ; injected into the nares checks catarrhal discharge and spasmodic symptoms (P.); a solution of the hydrochlorate, gr. iv-viij ad §j aquae, applied locally to nasal mucous membrane by a spray-producer or a brush, will arrest the disease if confined to the nares and fauces (B.). Ipecacuanha, in hay-asthma (R.) ; is of great value, though the smallest doses cause similar effects (P.). Aconite is better than arsenic in true hay-fever (R.); has been used with the best results (P.). Grindelia benefits cases of asthmatic type (B.). Iodides are very ser- viceable, locally and internally; large doses until some iodism observed, may be combined with arsenic (B.). Opium, especially as morphine, of great value in any stage, but great danger of the opium-habit (B.); the tincture in doses of Ttpij-iij every 2 hours for three doses, then n\j every 2 hours until the discharge abates, has given excellent results (Wa.). Black Coffee is highly recommended (P.). Cocaine, a 5 to 20 per cent, solution of the hydrochlorate, brushed over the nasal mucous membrane after drying it as far as possible, is the most effi- cient palliative yet obtained (R.): a 4 per cent, solution dropped from a medi- cine-dropper well into anterior nares, the head being thrown well backward, or sprayed up the nostrils from a small atomizer; gives immediate relief, and though not curative it prevents so much suffering and distress that in no case should it be left untried (Da Costa). Ignatia, the tincture has seemed to benefit some cases, and to favorably influence the course of the disorder (Da C.). Lobelia, has been found an efficient remedy (Wa.). Tobacco, smoking helps some and aggravates the symptoms in other instances. Internally ad nauseam it helps, but there are better and safer remedies (Wa.). Removal to the sea- coast, or a barren, mountainous district, gives the only relief to some sub- jects ; though many of the worst cases, hitherto unaffected by medicine, are now relieved by the local application of Cocaine. [Compare Asthma, Catarrh, Conjunctivitis, Influenza.] Prescriptions. For Internal Use. R. Potassii Iodidi, Liq. Potass. Arsenit., . . £j. Aquae Cinnam., M. Sig.—Teasp. every 4 hours. For Local Use. R . Tinct. Iodi gj. Ac. Carbol., gtt. x. Aq. Destill., M. Sig.—For local use with atomizer or post-nasal syringe. R. Ext. Hyoscyami, .... gr. xij. Potassii Iodidi, 3 j. Potassii Bicarb., g ij'. Ext. Glycyrrhizae Pur., . . ziv. Aq. Anisi, 5 ivss. M. Sig.—Dessertsp. every 4 hours until relieved. (Weber.) R. Menthol, Ac. Carbol., g ss. Zinci Oxidi zj. 01. Amygd. Dulcis, . . . Cerati Simplicis, . . . . ij. M. Sig.—Apply thoroughly to the nos- trils every few hours. R. Liq. Potassii Arsenit., . . i|j. Tinct. Belladonnae, . . . jij. M. Sig.—5 to 10 drops after meals, as a prophylactic. R. Quininae Bisulph., . . . . giij. Aquae, 3 iv. M. Sig.—Irrigate the nares, after cleansing with a weak alkaline solution. R. Tinct. Euphrasiae zjss. Aq. Camphorae, . . .ad 3ij. M. Sig.—Teasp. four times daily, for the catarrh. R. Cocainae Hydrochlor., . . gr. vj. Aquae Destill. gij. M. Sig.—5 per cent, solution. A few drops to be instilled into nares while head is lowered. Costa.) HEADACHE. 575 Headache, Bilious-sick. Antipyrine, the most valuable single remedy for headaches; an 8-grain dose in dyspeptic headache, in a little water, at commencement of attack, the patient lying down in a dark room. A second dose one hour after is generally enough, but a third or fourth may be required. Sleep generally follows, and there are no unpleasant after effects. Acetanilide, in 4-gr. dose, equally effec- tive. Nux Vomica, gtt. j of tinct. frequently, when acute gastric catarrh, with headache and nausea (R.); gtt. j every 10 minutes, soon after meals, often gives marked relief in sick-headache not of neurotic origin (A. A. Smith). Strychnine, with aloin and belladonna, in minute granules, for bilious head- ache from obstinate constipation, effective if given several times a day for a week or ten days (Roy). Belladonna, the extract in doses of gr. in similar form. Iris, blinding headache in right supraorbital region, nausea, vomiting, usually the result of hepatic derangement, n\j every half-hour for three doses. Usually relieves promptly (Pf.). Bryonia, ordinary bilious with vomiting (P.). Picrotoxin, gr. -fa by stomach, in periodical form (B.). Cha- momile, a popular remedy (R.). Podophyllum, in sick headache, with dark, bilious diarrhoea, or constipation with dark motions (R.). Sanguinaria, when due to stomach derangement, a few doses relieve (P.). Hydrastis, from con- stipated bowels (P.). Mercury, as “blue pill,” to prevent or mitigate; or, gr. Ytxcy °f bichloride when with light-colored diarrhoea (R.). Ammonium Chloride is an efficient remedy in most forms of headache (Wa.). Sodium Phosphate, a useful laxative in so-called “ bilious-sick-headache ” (B.). Po- tassium Bromide, a large dose in ordinary or sick-headaches (R.). Ginger, in paste, as counter-irritant (P.). Water, as cold or hot affusion, or ice-bag to head ; hot sometimes best. The purgative waters (as Friedrichshall) before breakfast in a cup of hot water (R.) ; a brisk saline purgative, or small doses of Epsom salts thrice daily, very effectual for frontal headache with constipa- tion (Br.). Nitro-muriatic Acid, 10 drops of the dilute acid in a winegl. of water, before each meal, often an effectual remedy (Br.). Charcoal, two tea- spoonfuls stirred in half-glass of water, as a draught, is an efficient remedy for sick-headache with sour stomach and flatulence, etc. [Compare Hemi- CRANIA.] R . Ammonii Chloridi, ... 3 iij. Morphinse Acetatis, . . . gr. j. Caffeinae Citratis, . . . . g ss. Spt. Ammonii Aromat., . . ,qj. Elix. Guaranae, Jiv. Aquae Rosae, M. Sig.—Dessertsp. every quarter-hour until relieved. (Carpenter.) Prescriptions. R. Podophylli Resinse, . . . gr. ij. Tinct. Zingiberis, . . . . ij. Alcoholis, . . . . q. s. ad gj. M. Sig.—Teasp. in a winegl. of water every night at bed-time, or every second, third or fourth night as required. {Dobell.) Aconite, to reduce the circulation (R.). Veratrum Viride, at menstrual periods (R.). Belladonna, relieves cerebral congestion, and distress from light and sound (P.); pain over brows and in eyeballs—often due to stomach or uterine derangements—especially in young women; rr\jij of tinct. every three hours (R.). Potassium Bromide, a large dose (gr. xv-xx) in ordinary or sick- headaches (R.); Bromides are useful when nervous system has been irritated, but when exhausted they do harm (Hammond). Calomel, gr. every hour for ten or twelve doses, will relieve the headache of syphilis occurring at night (Tr.). Cannabis Indica is given with uniformly good results in the headache of the climacteric. Potassium Iodide, throbbing, intolerance of light, pain passing from back of neck over vertex to brow, nocturnal, tender scalp, almost unbearable; ten-grain doses ter die will cure (R.). Hydrastis, when consti- pated bowels (P.). Amyl Nitrite, for headaches with severe flushing heats at menstruation or climacteric, a sufficient dose (R.). Mustard, in hot foot- Headache, Congestive. 576 HEADACHE, NERVOUS. bath, or as poultice to nape of neck in various forms of headache (R.). Water, cold water poured gently over forehead, sometimes warm water better (R.). A very hot foot-bath often effectually relieves (Wa.). Purgatives are often bene- ficial, especially when congestive headache arises from suppression of hemor- rhoidal discharge, or in persons of phlegmatic habit; aloes best (Wa.); or colocynth, as derivative, when cerebral hyperaemia (Da Costa). Prescriptions. R. Ext. Colocynthidis Co., . . gr. xij. Pulv. Capsici, gr. iv. Ext. Gentianae, gr. xxiv. Ft. pil. no. xij. Sig.—One pill thrice daily. Also a 25 grain dose of Sodium Bromide every night at bedtime. [Da Costa.} R. Spt. Ammonias, Sj. Spt. Camphorae, 3 ss. M. Sig.—For a quart of water in which a handful of common salt has been dis- solved. Cork tightly and use locally on lint as an evaporating lotion. Cannabis Indica, ten-minim doses of the tincture thrice daily in the intervals, often curative in bad cases of neuralgic headache; or X t0 %-grain doses of the extract (P.). See under Hemicrania. Belladonna, rqjij of tinct. every 3 hours, when pain over brows and in eyeballs, especially when at men- strual periods ; also when from overstudy or fatigue (R.). Nux Vomica, if with gastric symptoms (R.); is better than strychnine, and should be given in quarter- grain doses of the extract after meals, combined with iron and quinine if patient is chlorotic (Hammond). Bromides, when the nervous system has been irritated are useful, but harmful when it is exhausted (Hammond). Silver Nitrate, half- grain doses with minute doses of pil. coloc. comp., invaluable in headaches of hysterical women, and especially stomach headaches of delicate and literary men (Wa.). Ignatia, removes clavus hystericus (Pf.). Ammonia, the aromatic spirits (3ss-3ij) or the carbonate (gr. v-x) in nervous headache (B.); the hydro- chlorate (gr. x-xx) in bilious and hysterical headaches, especially in hard-worked and delicate young women (Wa.). Amyl Nitrite, inhaled when extreme pallor of face (B.). Arsenic, throbbing supra-orbital (R.) ; as a nerve tonic stands next in value to Zinc (Hammond). Cimicifuga, in nervous or hysterical women, especially at menstrual periods (R.); in rheumatic headaches and menstrual (P.). Coffee and Tea, when from nervousness or exhaustion (R.); coffee espe- cially useful (P.). Guarana, a very effective palliative, gr. xx every half-hour for three doses (P.); ttfxv of the fluid extract every quarter-hour increased to will often relieve periodical headaches not of malarial origin (A. A. Smith). Sodium Salicylate, in small doses, gr. ij-iij every quarter-hour, is very efficient in neuralgic headache (Br.). Caffeine Citrate, two-grain doses, in capsule, every half-hour, a very effectual remedy for nervous and sick-headache, but causes insomnia if used in the evening. Phosphorus, as dilute phosphoric acid, in doses of ttlxxx well diluted, thrice daily; or zinc phosphide, gr. in pill, ter die, very useful in most forms of nervous headache (Hammond). Cajuput Oil, well rubbed in twice daily (P.). Menthol, locally to forehead in frontal head- ache (Wa.). Potassium Cyanide, locally in reflex headaches, as gastric, cardiac, pulmonary, menstrual (B.). Valerian is of great value in excitable persons (P.). Camphor, a saturated solution in eau-de-cologne rubbed on head, when of uterine origin (R.) ; in hysterical females, internally, with magnesium carbonate (P.). Podophyllum, purgative doses often give relief when near menstrual periods, with constipation and dark stools (R.). Zinc Oxide, two- to five-gr. doses useful (R.); a remedy of great value (Hammond). Bismuth, the sub- carbonate, in two-grain doses after each meal, often better than zinc, especially where gastric disturbance (Hammond). Ether Spray, for frontal headache after acute illness or fatigue (R.). Chloroform, Rhxv-xxx of the spirit internally, often effective (Wa.). Galvanism, sometimes valuable; the constant current always, avoiding too great intensity lest amaurosis ensue (Hammond). [Com- pare Hemicrania, Neuralgia.] Headache Nervous. HEART DISEASES, 5 77 Prescriptions. R. Potassii Cyanidi, gr. x-xx. Aquae Laurocerasi, . . . . g iv. M. Sig.—Apply locally on a compress for % to y2 an hour. (B.) R. Extract! Nucis Vom., . . . gr. iij. Ferri Reducti, gr. xij. Quininae Sulphatis, . . . gr. vj. Ft. pil no. xij. Sig.—One after each meal. (Hammond.) R. Zinci Phosphidi, gr. iij. Ext. Nucis Vom., . . . . gr. x. Confect. Rosas, q. s. M. et div. in pil. no xxx. Sig. —One pill after each meal. (.Fordyce Barker.) R. Ext. Cann. Ind. FI., . . . j|ss. Pulv. Acaciae, Zv, Syr. Aurantii Cort., . . . 3 ij. Aquae, q. s. ad gvj. M. Sig.—Teasp. every 3 hours. Heart Diseases Aconite, in the highest degree serviceable to diminish excitement or irrita- bility. It is more a remedy for functional derangement than for organic disease (Wa.). In pericarditis (R.). Nervous palpitations and hypertrophy (P., B.). The heart seldom affected in rheumatic fever if aconite be used from the start (P.). Veratrum Viride, as cardiac depressant (B.); in chronic cardiac diseases where excessive hypertrophy, i. e., when digitalis is contraindicated (W.). Cimi- cifuga, safer than digitalis in fatty heart (B.). Its action is strongly stimulating and tonic ; it relieves excessive dyspnoea when weak heart (P.). Caffeine, an excellent cardiac stimulant, and diuretic, gr. ij-v of the citrate every three hours (Da C.). Arsenic, for dyspnoea from weak heart (R.) ; in all cardiac neuroses it is especially valuable when combined with iron and strychnine, and is regarded as indispensable in all forms of weak heart accompanied by pain (Wa,). Digitalis, acts as a stimulant tonic (P.); small doses for sedative action; tonic or physiological doses to create hypertrophy in dilatation (Tr.); irregularity of pulse is best indication (R.). Irritable heart (Da Costa). The freshly-made infusion the best preparation (B.); especially indicated in weak heart acting rapidly because of its weakness, and in valvular disease (Wa.). Convallaria Majalis, will usually succeed in all cases in which digitalis is useful, acting similarly to that drug, but with less reliability ; is useful in aortic disease and in others where digitalis cannot be used (Wa.); valuable in all forms of heart disease where there is oedema of tissues (See). Strychnine, in medicinal doses, said to strengthen heart-beats (R.). Blisters, flying, over prsecordial region, to stimulate action in extreme weakness (R.). Alcohol, brandy when heart sud- denly enfeebled by fright, loss of blood, etc. (R.). Ether, hypodermically, repeated soon, is a very promptly-acting stimulant in sudden heart-failure. The compound spirit in gj doses for less urgent cases. Morphine, next to Digitalis, is in general the most indispensable remedy in the treatment of severe heart disease, being by far the most efficient agent for the dyspncea (Striimpell), hypodermically, is employed in many cardiac disorders with marked advan- tage, especially in dyspnoea and angina with diseased coronary arteries; mitral regurgitation, with its dyspnoea and insomnia ; aortic disease, etc. Iron, useful in various forms, especially anaemic disorders and palpitation. Also in dilata- tion and fatty heart, and mitral regurgitation (B.). Hyoscyamus, in functional derangement from emotion, is specially indicated ; requires large doses (tipxl- lx), or gr. of hyoscyaminae sulph. hypodermically (Wa.). Amyl Nitrite relieves heart-pains resisting all other treatment (W.). [Compare Angina Pec- toris, Dropsy, Endocarditis, Pericarditis, and the five following articles.] R. Ext. Ergotse FI., iijss. Tinct. Digitalis, ss. M. Sig.—Teasp. thrice daily in enlarged heart without valvular lesion. (B.) Prescriptions. R. Spt. Athens Comp., Liq. Morphinae Sulph. (U. S. P., 1870), . aa g). M. Sig.—Teasp. as required for the dyspnoea. 578 HEART, DILATED—PALPITATION. Heart, Dilated. Digitalis, where much dilatation, and hypertrophy of left ventricle without valvular disease. Is not contraindicated when aortic disease (R.); physiologi- cal doses (Tr.). In simple dilatation gives most favorable results (W.). Very useful in mitral disease, with dilatation of the left ventricle (P.); gives miracu- lous relief, is not sufficiently appreciated, but requires skilful administration. Use the infusion in preference to other preparations, a tablespoonful thrice daily, watching its effects (Da Costa). Scoparius, the infusion (broom-tea), to main- tain the kidney action if digitalis is not sufficient (Da C.). Purgation, brisk, free, watery stools next to digitalis are the best treatment (Da C.). Morphine, hypoderm. gr. two or three times a week in dilated heart with dyspnoea (B.). Amyl Nitrite, dyspnoea from dilatation (R ); is useful when great dysp- noea (cardiac asthma) (P.). Ether, the compound spirit an excellent remedy for the dyspnoea (Da Costa). Mercury, a classical pill and a very efficient one as a diuretic in dropsy from cardiac disease is the combination of gr. j each of Pulv. Digitalis, Pulv. Scillse and Hydrarg. cum Creta (B. Foster). Iron, the tinct. ferri perchlor. in small doses for a long time, has been of remarkable benefit (Wa.). Cimicifuga, safer than digitalis (B.); the latter should not be used (Wa.). Digitalis of no value except for very temporary use and for some special indication (Da Costa). Strychnine, often the first remedy to do good. Unduly pushed will produce nervous worry and be injurious (P.); is the remedy with iron, nourishing but not fat-making diet, and wine to keep up the tone of the blood (Da C.). Ergot, occasional doses have been given with appa- rent benefit (Wa.). Ether, the compound spirit for sudden attacks of pain or dyspnoea (Da C.). Amyl Nitrite, for the same, but chloral must be entirely debarred (Da C.). Stimulants, freely, in an acute attack of any kind, give the only chance (Da C.). Heart, Fatty. Heart, Hypertrophied. Aconite, often better than digitalis (R.); dangerous in hypertrophy of left side, with diseased valves, but useful in simple hypertrophy (P.); for overaction, with hypertrophy (B.); the one remedy which can be depended on. Small doses for months, say gtt. j of a good tincture ter die, to lower the heart gradually and keep it low (Da Costa). Digitalis, very useful in pure hypertrophy due to val- vular disease or excessive muscular exertion (R.). The primary action (small doses) required, as it creates hypertrophy when given in physiological or tonic doses (Tr.). Veratrum Viride, as a cardiac depressant (gtt. v ter die) will relieve in simple hypertrophy, and irritable heart from abuse of tobacco, inad- missible when valvular lesions exist (B.); gives the best results, next after aco- nite (Da C.). Lead Acetate, for violent palpitations, in some instances (Wa.). Amyl Nitrite, in dyspnoea, syncope (R.). Ergot, in enlarged heart without val- vular lesion; may be combined with digitalis (B.). Potassium Iodide, small doses long continued, benefit some cases (Wa.). Camphor, in doses of gr. iij-xij daily for tumultuous palpitations, and dyspnoea of hypertrophy with dilatation (Wa.). Iron is necessary where anaemia exists (Da C.). Quiet Life of great importance, no stair-climbing, no long walks; rest in bed often of service for days at a time, moderate diet, avoiding fattening foods, meat, and stimulants (Da C.). Heart, Palpitation. Aconite, for “fluttering ” of nervous persons, and nervous palpitations (R.); for over-action, with hypertrophy (B.); for palpitation with simple hypertrophy (P.). Hydrocyanic Acid, when from dyspepsia (P.). Iron, when due to anae- mia, a very frequent cause. Other causes are tobacco, coffee, tea, etc., to excess, HEART, VALVULAR DISEASE. 579 dyspepsia, venery, excessive exercise (Da. C.). Spigelia Anthelmia, when due to mitral and aortic disease, with much dyspncea (P.). Digitalis, in small doses as sedative (Tr.); combined with iron in palpitations with valvular disease, or alone in very severe cases (Wa.); suits a large number of cases, especially for temporary purposes (Da C.); the only remedy for positive service for the actual palpitation (Richardson). Camphor, recommended in nervous palpitations (R.). Veratrine, as ointment to chest, when rapid, irregular pulse, hurried breathing, dropsy and lividity, palpitation, inability to lie down (R.). Nux Vomica, of great value in nervous palpitation. Bromides, in “fluttering” heart (B.); are useful when tolerated by the stomach (Da C.). Hyoscyamus, in nervous, and violent palpitations from excited state of the brain (P.); in large doses, for functional disturbance arising from emotion (Wa.). Belladonna, in small doses, may also be applied externally, when irregularity of rhythm (Da C.) Valerian, nervous, with dyspnoea (P.). Eucalyptus, palpitation and weak heart (B.). Galvanization, of cervical sympathetic and pneumogastric, for palpitation (B.). Hot Foot-Bath relieves palpitations (R.). Milk-cure, has been beneficial in irregular action (B.). Ice, to the cardiac region, has benefited many cases ; is of chief value when patient can be kept in bed, which sometimes becomes necessary (Da C.). Prescriptions, B. Pulv. Digitalis, . . . . gr. xx. Pulv. Colchici Sem., . . gr. xl. Sodii Bicarb., gr. lx. M. et div. in pil. no. xl. Sig.—One pill at first 3 or 4 times daily, gradually reduced to one at bedtime. For irregular cardiac action. {Bowditch.') R. Tinct. Digitalis, zij. Spt. Etheris Nitrosi, . . . §j. Liq. Ammonii Acet., . ad M. Sig.—A dessertsp. every 4 hours. If prolonged insomnia with palpitation add of Morph. Sulph. gr. to each dose. (Richardson.) Heart, Valvular Disease. Digitalis, in aortic regurgitation (R.); most effective in mitral insufficiency (P.); in rapid action with low arterial tension ; and in mitral disease. Infusion best; tablesp. doses twice daily (B.); try of tinct. every % hour or hour, often gives more relief than larger doses (A. A. Smith); when heart is weak and struggling (Da Costa). Morphine, hypodermically for dyspnoea, better in mitral than in aortic disease (R.); the agent above all others in aortic insufficiency, combating the two great symptoms therein, the cerebral anaemia and the dysp- noea ; is to aortic regurgitation what digitalis is to mitral (Dujardin-Beau- metz). Aconite, useful for the palpitation, but dangerous in hypertrophy of left side with diseased valves (P.); for cases presenting excessive growth and strong action, diminishes the blood-pressure in the arterial system, and gives great relief (Da C.). Veratrum Viride, has similar applicability, but is more apt to nau- seate. An admirable sedative, and one which does not sicken is a mixture of Tinct.Aconiti,rt\j,Tinct.Verat.Vir.,TTDij,Tinct.Zingib.,rr\,vij(DaC.). Strophan- thus, is a cardiac tonic like Digitalis, but does not contract the vessels nearly as much (Br.). Nitroglycerin, is the best of all remedies when actual cardiac pain ; it lessens blood-pressure and diminishes the resistance the heart has to over- come (Da C.). Caffeine, as a tonic and diuretic, of especial value in cases where urine is scanty, with cardiac pains, headache and dyspnoea, and weak heart; gr. ij of the citrate every three hours (Da C.). Adonidine, in doses of gr. to thrice daily, acts excellently as a cardiac regulator (Da C.). Barium Chlo- ride, gr. in pill three or four times daily, is diuretic, lessens cardiac pain, increases tone in the vessels, and is a good general and cardiac tonic (Da C.). Purging, with Jalap, etc., in engorgement of right side of heart (R.); occasion- ally purging (Da C.). Treatment is directed chiefly to the dilatation or hyper- trophy resulting from the valvular disease. The simplest rule is to use judg- ment as to when the heart needs strengthening by Digitalis or reducing by Aconite or by Veratrum Viride (Da C.). [Compare Endocarditis.] 580 HECTIC FEVER HEMATEMESIS HEMATOCELE. Hectic Fever. Quinine, large doses, gr. xv-xx daily, if stomach and intestines don’t rebel (P.); given before the paroxysm, to limit it (Roberts). Antipyrine, is better than quinine, but must be used in much smaller dosage than ordinarily employed, say gr. iv or v about hour before fever rises, then doses of gr. ij hourly as long as temp, remains above 100.50. This daily, will give excellent results in hectic of phthisis (Pribram). Aconite in small doses, a remedy of much value in the irritative fever of phthisis (Da C.). Morphine and other anodynes, are of especial value, given in full doses toward bed-time (Gross). Prunus Virginiana, the bark has been found useful, especially when irritable cough (P.). Calcium Phosphate, is especially useful (R.). Calumba, excellent for tonic effects (P.). Digitalis, the tincture, combined with tinct. ferri chloridi, abates the tempera- ture and diminishes the sweats (B.). Iron, the mistura ferri composita has obtained great celebrity, especially when much debility and anaemia (Wa.); the sulphate and tincture of the chloride of especial value in the treatment of hectic (Gross). Ipecacuanha. A few grains of Dover’s powder at bed-time, will stop the profuse perspirations (Wa.). Salicin, for profuse perspirations (Wa.); as antipyretic. [Compare Perspiration, Phthisis.] Prescriptions. R. Tinct. Digitalis, g iij. Tinct Ferri Chlor., . . . g v. M. Sig.—15 drops 3 or 4 times a day. (B.) R. Quininae Sulph., gjss. Elix. Taraxaci, giv. M. Sig.—Teaspoonful every hour for six hours. Ipecacuanha, is decidedly effective in small doses, also when hematemesis is vicarious of menstruation (P., Wa.). Hamamelis, Tt\j-ij of tinct. every 2 or 3 hours (R.); effective from its tannin (B.). Alum, serviceable in passive hem- orrhage ; iron better (B.). Turpentine, especially in passive hemorrhage with debility (R.); and in hemorrhagic transudations on the free mucous sur- faces—hematemesis, etc. (B.). Ergot, has often cured when other means failed (P.); most valuable. In urgent cases ergotine in 2- to 5-gr. doses hypodermi- cally (R.). Iron, the subsulphate (Monsel’s solution) or pernitrate, the best remedies ; gtt. j-ij frequently, diluted with ice-water (B.). Lead Acetate, espe- cially in gastric ulcer, gr. ss-gr. v (B.). Tannic Acid, gr. when from gastric ulcer or obstructive disease of liver (B.). Gallic Acid, an extremely useful agent; is best used in combination with dilute sulphuric acid (Wa.). Ice, small pieces swallowed, a most useful agent, with perfect rest for stomach; when hematemesis from that organ, nutrient enemata must be employed. Iced cham- pagne to arrest faintness, if persistent; when moderate need not give cause for alarm. Hematemesis. Prescriptions. R. Olei Terebinth cpij. Ext. Digitalis Fluid., . . . gj. Mucil. Acaciae, g ss. Aq. Menth. Pip. §j. M. Sig.—Teasp. every 3 hours. R. Ac. Gallici, gj. Ext. Ergotae Aquosi, Digitalis aa gr. xx. M. et div. in pil. no. xx. Sig.—One every 4 hours. Opium, or morphine, if needed for pain, with absolute rest in bed, and a moderately tight abdominal bandage (E.). Hemostatics, as gallic acid, lead, turpentine, etc., to arrest the hemorrhage, if it still be going on, combined with opiates, and the use of ice-bags or cold lotions to the abdomen or per vaginam. Tonics, as iron and quinine, while resolution of the extravasation is going on. Hematocele, Pelvic. HEMATURIA—HEMERALOPIA. Bromides and Iodides, to quiet the action of the ovaries, if the hemorrhage recurs at different periods. Potassium Iodide, as an absorbent, may be given with quinine (Braxton Hicks). Iodized Cotton, an excellent application to the cervix uteri in cases of hematocele (Wa.). Leeches, should be applied early in cases of peri-uterine hematocele ; later, except to check inflammation, they are inadmissible (Wa.). Mercury, gr. of the bichloride thrice daily, with iron and ergot, conjoined with vaginal injections of hot water morning and evening ; later in lieu of the mercurial the syrup of the iodide of iron in 20- drop doses thrice daily, was thoroughly efficient treatment in one very bad case of retro-uterine hematocele (Hengst). Surgical interference has many advocates, but is criminal in a large majority of the cases (E.). If the case does not end in resolution it will terminate in pelvic abscess. Prescription. R. lodi., Potassii Iodidi, % ij. Glycerini, 3 viij. Mix and saturate 8 oz. of cotton with the mixture; then carefully dry, and label “ Iodized Cotton.” Hematuria. Turpentine, when with constitutional debility (B.) ; in very small doses (R.) often is very efficacious (P.). [See ante, Hematemesis, for formula.] Hama- melis, has arrested severe cases (R.). Chimaphila, controls hematuria (P.). Gallic Acid, the most uniformly successful remedy (B.); gr. x-xx every hour or two (Da Costa). Sulphuric Acid, alone or with gallic acid, is an efficient remedy (Da C.). Acetic Acid, in a case of alarming hemorrhage from the bladder, which occurred after an operation for vesico-vaginal fistula, and resisted all other means, an injection of apple-vinegar and ice-water, equal parts, succeeded in arresting it (Ghent). Quinine, large doses necessary ; cures when intermittent or from malarial infection (B.); useful in some cases of intermittent hematuria (R.). Iron. Tinctura ferri perchlor., npx-xx several times daily; in this affection the best form of iron for internal use (Wa.), Ipeca- cuanha, exercises a powerful influence (Wa.). [See ante, Hematemesis.] Ergot, by stomach or subcutaneously; may be combined with ipecac, krameria, or other astringents (B.). Ergotine, hypodermically, is far superior for efficacy and rapidity of operation (Wa.). Matico, the infusion, in doses of jfij every 2 or 3 hours, is fully equal to gallic acid, lead, etc. (Thompson). Ammonium Benzoate, in 5-grain doses, for the albuminuria and hematuria of scarlatina (Hillier). Cannabis Indica, is especially indicated in dysuria and strangury when there is bloody urine (R.). Camphor, in 2 to 5-grain doses is said to promptly remove the renal hyperaemia with bloody, coagulable urine, caused by cantharis, turpentine, oil of mustard, copaiba, etc. (R.). Ice in rectum or to perineum, for vesical hemorrhage (Thompson). Prescriptions, R. Acidi Gallici, 3 ss. Ac. Sulphurici Dil., . . . gj. Tr. Opii Deodor., . . . .3 j. Infusi Digitalis, iv. M. Sig.—Tablesp. every 4 hours or oftener. In hematuria, menorrhagia, pur- pura hemorrhagica, and the hemorrhagic diathesis. (D.) R. Ext. Ergotse Fluidi, Tine. Kramerige, . . . aa §j. M. Sig.—A teasp. every hour or two. R. Ext. Ergotse, (Squibb), . . 3j. Aquse, §j. M. Sig.—For hypodermic use; trpx contain gr. j. Strychnine, night-blindness; small doses, gradually increased, of service (Wa,). Mercury, Hydrarg. chlor. corr. gr, ij ad aquae §j, dropped into the eye twice daily, with blister on each temple, and mild aperients, cured hemeralopia Hemeralopia and Nyctalopia 582 HEMICRANIA. (Smith). Quinine, in as large doses as can be borne, after cathartic and emetic, for night and day-blindness (Howard). Blisters, small, 1 y inches in diameter, close to external canthus of the eye (Bampfield). Electricity, occasionally useful (Wa.). Rest, protection of eyes from bright light, constitutional reme- dies, as indicated by state of general health, change of climate, speedily cures hemeralopia. It is sometimes merely a symptom of pigmentary degeneration of the retina, or a feature of scurvy. Hemicrania. Belladonna, when due to vaso-motor spasm, the face being pallid (B.); the tincture in small and repeated doses if the disease be of reflex character (H.). Iris, in blinding form, from hepatic trouble, right supra-orbital region; n\J every half-hour for 3 doses, usually relieves promptly (Pf.). Cannabis Indica, one of the most valuable remedies for megrim or sick headache, apparently acting on the nervous centre whence the disorder springs; is most useful in the intervals to prevent the attacks, and especially when the paroxysms are becoming more frequent; it may be combined in pill with either iron or aloes (K.); in the congestive form of especial value, the tincture in repeated doses until physiological action is induced (H.); gr. y of the extract before each meal, increased gradually to ]/2 or % grain, in the intervals, kept up for 3 months (Seguin); gr. ]/% of the solid extract night and morning, very efficient in migraine, if used continuously for some time (Hare). Camphor, gr. iij-v, with xx or xxx-grain dose of magnesic carbonate, is very useful, especially in hysterical females (P.). Croton-chloral, in milder forms without severe vomit- ing, headache being predominant; the bromides are useful after it (R.); rarely of any use, but if given it should be in 20-grain doses twice daily (H.); Gua- rana, is useful (B.), a very effective palliative; gr. xx every y2 hour, for three hours (P.); efficacy diminishes by degrees, attacks usually become longer (Tr.); 3ij of fluid extract in course of an hour or two; to anticipate the attack when expected (Seguin). Caffeine, in typical migraine; gr. j ad rthxxv-xxx aquae hypodermically (P.); is especially adapted when chronic gastric catarrh, gr. j every x/2-hour (B.). The citrate in grain doses every hour for some time before a paroxysm (Wa.); gr. j every y2- hour often gives marked relief (A. A. Smith). Valerian, of especial value when in excitable temperaments ; after profuse or painful menstruation (P.). Ammonium Chloride, is exceptionally serviceable ; seldom fails to cut short an attack (Austin), x-xv gr. doses (B., R.); as a diffu- sible stimulant is very efficient, gr. xx up to Sj every hour during the attack (H.). Sodium Chloride, in small doses, proved very efficient in six positive cases attended by gastric distress (Rabon). Antipyrine, the most valuable single remedy for headache, especially in migraine and those cases of it for which Ergot and Amyl Nitrite are indicated. 5 grains at beginning of the attack often sufficient (Birdsall); of great value in true migraine, employed in twenty cases with unfailing benefit; less useful in the malarial or dyspeptic forms, and useless in uraemic (Thompson); one dose of gr. xx, or 2 doses of gr. x each, y-hour apart, given in the prodromal period, or at the very beginning of a paroxysm, will invariably cut it short within an hour (Sprimon, Ungar, etc.). Podophyllin or Mercury, bilious origin (R.). Bromides, for true migraine. Ras- pail’s eau sedative locally, gives great relief (B.). When due to uterine disorder (R.). Potassium Bromide, very serviceable in the paroxysm, also in continu- ous form (R.). Eucalyptus, in cerebral anaemia (B.). bigitalin, granules bis die), for congestive hemicrania (B.). Ergot, if due to miliary aneurisms of intercranial arterioles; also in congestive migraine, and in nearly all kinds (B.). Menthol, locally in frontal headache due to migraine, is said to be very efficient (Wa.). [See formula below.] Piscidia, is highly recommended (Wa.) ; efficient in doses of 5>j of the fluid extract (Ford). Arsenic, for cerebral con- gestion and hemicrania (B.); for throbbing pain in one brow (R.); often has the best effect. Watson believed that gtt. iv-vj of liq. arsenic, 3 or 4 times a day, with due attention to the bowels, would cure 9 out of every 10 cases (Wa.). Aconitine or Veratrine, ointment, over brow (R.) ; Aconitine is of great HEMIOPIA HEMIPLEGIA HEMOPTYSIS. service internally (Seguin). Phosphorus, is strongly recommended (R.). Amyl Nitrite, by inhalation, in migraine, with pallor of face (B., R.). Sanguinaria, a few doses very successful, when m. due to stomach derangement (P.). Igna- tia, removes clavus hystericus (Pf.). Nux Vomica, when of gastric origin (R.). Cimicifuga, is strongly recommended (P.). Rubber Bandage, applied tightly from eyes up, protecting the temporal arteries by pads, or a dry muslin band- age wetted after being put on (Weir Mitchell). Acupuncture, the needle run down to the cranium, will give relief to clavus hystericus, when nothing else will do so (Pancoast). Prescriptions. R. Quininse Sulph., . . . . g ss. Pulv. Belladon., gr. x. Ext. Digitalis, gr. xv. Ext. Valerianae, g ss. Mellis, q. s. Ft. pil. no. xl. Sig.—2 to 10 pills daily gradually increased, during 3 or 4 days be- fore the expected attack. R. Ammonii Chloridi, . . . 5jvj. Ammonii Bromidi, . . . Z iv. Spt. Etheris Nitrosi, . . . 2 j. Syr. Pruni Virgin., . . . t±iij. Aquae, q. s. ad 3 vj. M, Sig.—Dessertsp. 3 or 4 times daily, conjoined with the use of Raspail's Eau Sedative (see page 94), locally. R. Mentholi, .gj. Alcoholis, . . . . . . . 01. Caryophylli, 01. Cinnam., .... aa Ttqxx. M. Sig.—Apply with finger over seat of pain. $. Aconitine (Duquesnel), . gr. Alcoholis, Glycerini, aa jj. Aq. Menth. Pip., . q. s. ad £ ij. M. Sig.—Teasp. thrice daily. (Seguin.) Hemiopia. When established, hemiopia offers little hope of cure, though it has no ten- dency to progress. In hemiopia scintillans, Potassium Bromide, gr. xl-lx daily, or band of such metal as idiosyncrasy of the patient may decide, with stimulants to ward off the aura ; Quinine, Iron, Hydropathy, when Potassium Bromide fails (DeWecker). Hemiplegia. Strychnine, is most useful when members are relaxed; hypodermically, when paralysis incomplete, and the muscles flaccid but not wasted (B.). [See Paralysis for formula.] Potassium Iodide, gr. x-xviij daily, occasionally proves effectual (Wa.). Galvanism, constant current to the brain or cord, faradic to the muscles opposite those contracted (Hammond). Physostigma, prevents muscle wasting, and hence is given with benefit to hemiplegics; gr. n\>—'i\j °f the extract repeated frequently (R.). Massage, in hemiplegia and other forms of paralysis due to intercranial lesions, when cold and blue skin, wasting and contracted muscles, ulcerations, etc. (B.). Cocculus, in hysterical, epileptic, and choreic hemiplegia, acts well; also in hemiplegia from cold (P.). [Compare Paralysis, Facial.] Hemoptysis. Gallic Acid, exceedingly effective (P.); may be combined with ergotin and digitalis. [See Hematemesis and Hematuria for formulae.] Acetate of Lead, with opium (B.) ; proves signally useful (Wa.). Ergot, the fluid extract in 30 to 40-minim doses, every 3 or 4 hours, or hourly in severe cases; or Ergotin hypodermically for urgent cases, in 2 to 3-grain doses (R.). Opium, should be freely used for the attendant excitement (W.). Turpentine, drachm- doses every 3 hours, may cause unpleasant symptoms which soon disappear on its discontinuance (R.); has proved very efficient (P.) ; after other hemostatics fail it is worthy of trial (Wa.). Alum is serviceable in purely atonic hemor- rhages (Wa.); in 10-grain doses every 2 hours (B.). Oil of Erigeron, is very 584 HEMORRHAGE. efficient when no fever or other signs of constitutional irritation (Wa.). Hama- melis, rqj-ij of tincture, every 2 or 3 hours (R.); ffbij-x of fresh tincture sev- eral times a day (Pf.). Ipecacuanha, has been highly praised (R.); in emetic doses (Tr.); arrests as emetic (B.) ; arrests, though in poisonous doses pro- ducing hemoptysis (P.). Ferric Acetate, a little added to water so as to taste, this constantly sipped (R.). Iron spray will often arrest (B.). Digitalis, has undoubted power over hemoptysis (B.). Small doses daily (P.). Infusion in large doses (R.). Arnica, of great service, if from violence (P.). Aconite, employed with best results (P.). Sodium Chloride, half a teaspoonful of com- mon salt, taken dry, repeated till nausea (R.). Sulphuric Acid, the dilute acid a useful adjunct to other treatment (Wa.). Spinal Hot-Water Bag, to cervical or upper dorsal vertebrae (R.). Auxiliaries.—Cold externally, acidulated drinks, perfect rest, and antiphlogistic diet (Wa.). R. Ext. Ergotse FI. ifjss. Ext. Ipecac. FI., Tr. Opii Deod., . . . aa M. Sig.—Teasp. every hour. Prescriptions. R. Aluminis, gj. Sacch. Alb., Pulv. Ipecac. Comp., . . . gr. xx. M. ft. pulv. no. vj. Sig.—One every 2 hours. (Skoda.) R. Plumbi Acetat., gr. xx. Pulv. Digitalis, gr. x. Pulv. Opii, gr. v. M. ft. pil. no. x. Sig. — One every 4 hours. (B.) R. Liq. Ferri Subsulph., . . rr^xx. Aquae, =ij. M. Sig.—Use as spray by inhalation for 5 minutes every hour. Acids. Sulphuric sometimes very effective in uterine hemorrhage (B.). Dilute Vinegar to leech-bites, piles, cuts, etc. (R.). Apple-Vinegar as injec- tion for vesical hemorrhage. [See under Hematuria.] Iron, when hemor- rhagic diathesis due to anaemia; the tincture of the chloride preferred (B.). The tincture of ferric perchloride as styptic (Wa.) ; i or 2 teaspoonfuls of the concentrated solution in a glass of water, an excellent hemostatic (Tr.). The acetate, just enough to make water taste, in hemorrhage of lungs and kidneys (R.). Ergot, in uterine hemorrhage of any kind, and many forms of hemor- rhage, ergot or ergotine of great value (P.); not to be relied on alone (B.). Alum, is sanctioned by high authority (B.) ; dusted on in slight cases (R.) ; in uterine and traumatic hemorrhage, when small vessels open (Tr.). Hamamelis, Tt\j-ij of tincture every 2 or 3 hours, effective in many forms (R.). Ipecac- uanha, produces hemorrhage in poisonous doses, yet has great energy in arresting it (P.); exercises a powerful influence on internal hemorrhage gener- ally, and in exhaustion therefrom ; gr. j-ij every % hour (Wa.). In emetic doses serviceable (Tr.). Turpentine, few agents more useful in the passive forms (B.); small doses in hematuria (R.); for serious hemoptysis, and hemor- rhage of typhoid (P.). Belladonna, hemorrhage from rectal ulcers (P.). Digi- talis, in uterine, and many other forms, of great value (P.); with restoratives has undoubted power in the hemorrhagic diathesis (B.). [See Hemoptysis.] Chimaphila, controls hematuria (P.). Gallic and Tannic Acid, in all passive hemorrhages, especially in that of the bladder (P.). Tannic acid for local use, Gallic for systemic effects upon remote parts. When hemorrhage occurs in relaxed and debilitated constitutions, Gallic Acid may be combined with Ergot and Digitalis (B.). Matico, proves useful in many cases, especially menorrhagia, hematuria and hemoptysis (Wa.). Nux Vomica, in hemorrhagic diathesis, especially when occurring in anaemic subjects. Also the syrup of iron, quinine, and strychnine; no prescription more generally useful (B.). Aconite, to reduce the circulation, in epistaxis, hemoptysis, etc. (P.). Cinchona, internally very efficient in some forms of hemorrhage (Tr.). Copper Sulphate, in stick, solution, or ointment, to arrest hemorrhage from small vessels (R.). Hemorrhage, Hemorrhagic Diathesis. HEMORRHAGE, INTESTINAL—POST-PARTUM. 585 Arnica, in hemorrhages (ecchymoses), from mechanical violence (P.). Rhatany, the extract, one of the most powerful hemostatics (Tr.). Grape-cure, as tonic for convalescents (P.). Alcohol, in hemorrhagic diathesis, to elevate the arte- rial tension (B.); brandy, wine, when heart suddenly enfeebled by hemorrhage (R.). Venesection, will promptly arrest pulmonary hemorrhage (B ). Styptics, are either needless or inefficient, hence practically useless in general surgery ; hemorrhage should be controlled by either pressure or ligation (Roberts). Hot Water, sponged over a bleeding surface, the best agent to stop hemorrhage (Gross). Transfusion, when death imminent (B.). Ice, internally in wounds or hemorrhage of lungs, or from stomach ; small pieces frequently (R.). Rest. Perfect rest often indispensable, especially in hematemesis, in which nutrient enemata may be required. [Compare Dysentery, Epistaxis, Hematemesis, Hemoptysis, Hemorrhoids, Hematuria, Hemorrhage, Post-Partum— Intestinal, Menorrhagia, Metrorrhagia, Purpura, Wounds, etc.] Prescriptiofis. Pagliarrs Styptic. R. Tinct. Benzoini, i^viij. Aluminis, lb. j. Aquae, lb. x. Boil 6 hours in a glazed earthenware vessel, adding hot water in lieu of that vaporized, and keeping well stirred; filter, and put up in stoppered bottles. R. Potassii Carbonat., . . . . 3 ij. Saponis gj-ij. Alcoholis, 3 iij. Mix and use as a styptic especially for operations about the face. (/os Pancoast.') Pancoast's Styptic. R. Ext. Ipecac. FI. gij. Ext. Ergotse FI., . . . . 3 iv. Ext. Digitalis FI., . . . . 3 ij. M. Sig.—Half teasp. to a teasp. at a dose, repeated as required. An excellent anti-hemorrhagic combination. (B.) R. Infusi Digitalis, Ext. Ergotse Fluidi, Tinct. Kramerise, . . . aa M. Sig.—A tablesp. as required in hemorrhagic conditions generally. (B.) Hemorrhage, Intestinal. Turpentine, should be used (B.); especially in typhoid (P.). [See Hema- temesis, for formula.] Belladonna, for irritable and bleeding rectal ulcers (P.). Iodine, in passive, gtt. j-ij of tinct. frequently repeated, of great service (B.). Sulphuric Acid, is serviceable (B.). Acetate of Lead, often of great service, especially when used as an enema (Jenner). Tannin, one of the most serviceable remedies for the intestinal hemorrhage of typhoid fever (B.). Hamamelis, very effective in intestinal hemorrhage, owing to its large propor- tion of tannin (B.). Ergot is most valuable; may be given hypodermically in urgent cases (R.). Gallic Acid, gr. xv with gtt. iij-v of laudanum, in a winegl. of iced water, every 2 or 3 hours in the hemorrhage of typhoid (Jenner). Opium, a valuable adjunct to astringents, allaying the nervous excitement (Wa.): is most useful (Da Costa). [Compare Hemorrhoids, Dysentery, Typhoid Fever.] Hemorrhage, Post-Partum. Hamamelis, for persistent oozing (R.). Ipecacuanha, in flooding after de- livery (R.). Iron, Monsel’s solution, j-iij of water, strong enough and safe as injection (B.); the perchloride diluted (R.). Amyl Nitrite, n\,v by inhala- tion, has stopped a hemorrhage promptly and permanently (Kerr). Ergot, a full dose of the fluid extract as soon as birth is completed as a prophylactic (Playfair); hypodermically in urgent cases, gr. ij of Bonjean’s Ergotine deeply into the tissues of the arm (Wa.); 3ss doses of the fluid extract every 4 hours in secondary hemorrhage. Cimicifuga, will check post-partum hemorrhage, especially when tediously prolonged (P.). Digitalis, the infusion best; a tablesp. bis die, or in urgent cases every half hour for 4 doses (B.). Nux Vomica, gtt. xx; ext. ergot, fl. gtt. xxx; each hour for 2 or 3 doses (B.). 586 HEMORRHOIDS. Opium, the tincture 3j, with brandy, in profuse flooding (R.). Vinegar, a handkerchief soaked in vinegar and carried into the uterus, will often check a severe hemorrhage (Landis); is antiseptic, astringent and sufficiently irri- tating to produce contraction, yet not so irritating as to cause subsequent mis- chief, and always acts promptly (Penrose). Tamponade by absorbent cotton, plugs of linen, etc., is indicated in hemorrhage from abortion or placenta praevia (Parvin) ; never tampon after delivery ! you might as well hang the woman by the neck (Wallace). Auxiliary Measures of importance are firm pressure on the uterus, compression of the abdominal aorta, the plug, and if necessary intra-uterine injections (Wa.). Hot Water, no0 to 122° F., injected into uterus, extremely successful in checking post-partum hemorrhage (Att- hill) ; the most prompt and certain method, and the least unpleasant to the patient (Parrish). See also Dr. Cameron in Canada Med. and Surg. Jour., March, 1878, with record of 16 cases so treated. Ice, to abdomen or within the womb (B.); into womb or rectum (R.). As a prophylactic against hem- orrhage and to secure firm contraction of the uterus, a good method is to grasp the womb through the abdominal parietes with a hand kept cold by frequent immersion in a pan of broken ice, while waiting for the expulsion of the placenta. While one hand is kept on the uterus the other may be im- mersed in the ice. Transfusion of milk into veins may be necessary in cases of collapse (Thomas). Hemorrhoids. Galls, as ointment, very useful: the official unguentum gallae, or combined with lead and opium. See formula below (R.). Iron, a solution of the sub- sulphate as wash to bleeding piles, which should then be well oiled (B.); or an ointment of the subsulphate, gr. xv to the locally night and morning, with gr. j of the salt thrice daily by mouth ; gives excellent results. Hama- melis, by mouth, also lotion or injection in bleeding piles (R.); is employed with satisfaction; n\jj-x of tincture several times a day; also enema or suppository (Pf.). Nux Vomica, emphatically beneficial (P.). Sulphur, gr. v-x, with 3j confec. sennas, as laxative (R.). Exercises a most soothing in- fluence (Wa.). Sulphides, especially Blue Lick waters (B.). Podophyllum, as cathartic for hemorrhoids of recent formation, bleeding from stasis in portal circulation (B.). Aloes, causes congestion of pelvic viscera, yet Fordyce Barker shows it to be curative in piles, especially in recent ones, as after de- livery (B.); to greatly relieve bowels (R.); cures by removing constipation (P.). Hydrastis, as lotion or ointment to external piles, of great value ; of tincture ter die internally at same time (P.). Ergot, with or without nux vomica, in dilated hemorrhoidal veins without new tissue, given by the stomach and used locally will often cure (B.). [See Diarrhcea for formula.] Stil- lingia, will remove permanently when due to constipation, and temporarily when from hepatic obstruction (B.). Senna, to procure soft and easy evacu- ations, use the confectio sennae at bedtime, gr. cxx in a bolus (B.). Iodoform, the ointment, and in suppository (B.). Nitric Acid, as caustic, followed by free use of olive oil (B., R.); ad Oss of water as lotion for bleeding piles (R.). Hyoscyamus or Stramonium, leaves bruised, or ointment, locally, for pain (P.). Oleum Lini. Linseed Oil, boiled, in doses of twice daily, has quite a reputation as a remedy for piles (W.). Alum, to painful bleeding piles, a crystal trimmed and passed into rectum, or as an ointment (B.). Ice, to painful, bleeding piles, or cold water injected daily (B.); locally, for pain after operation (R.). Leeches, directly to swollen, irreducible, and painful piles (B.). Alkaline Mineral Waters, excellent (B.). Carbolic Acid, 3 parts to 1 of olive oil, a few drops injected into the tumor. A favorite and successful treatment by itinerants (Andrews); uncertain in all cases and in many fraught with danger (Gross). A good procedure, use 4 drops each of pure carbolic acid and glycerin, and inject one tumor at a time (Hunt). Grape-cure, is used with success (B.). Saline Purgatives, notably Epsom salts, in bleeding piles, combined with sulphuric acid, will often stop the hemorrhage (B.). [See Dys- HEPATALGIA HEPATIC CIRRHOSIS. 587 entery for formula.] Diet, etc. Avoid stimulants, indigestible food and over- eating ; during an attack use little animal food. Petroleum soap when piles protrude, with cold or tepid water ablutions. Injections, Oj cold or tepid water, are very useful. Stool should be at night. Surgical Methods are—the ligature for internal hemorrhoids, excision for external ones. Ligation is the proper treatment for the former, all other methods of operating radically being now discarded as unsurgical, and dangerous to life (Gross). The thermo-cau- tery is used by Smith of London and many other surgeons, but is apt to leave behind fissures and ulcers, which are with difficulty healed. Prevention. Soft seats favor the production of piles, as also of uterine disorders, by pressure on the arteries as they emerge from the pelvis, and so tend to drive the blood into the interior of that cavity (Holden). Prescriptions. R. Pulv. Gallse, gr. xxx. Pulv. Opii, gr. x. Ung. Plumbi Subacet., . . gr. xl. Ung. Simplicis, gj. M. et ft. unguentum. Sig.—Ointment for piles. ( CEsterlen.) R. Iodoformi, g). Balsam. Peruv., g ij. Magnes. Calcin., .... g). Ol. Theobroms, Cers Albs, aa M. et fiant suppositoria xij. Sig.—One twice daily. R. Ext. Colocynth. Co., . . . gr. xx. Ext. Nucis Vom., . . . . gr. vj. Hydr. Chlor. Mitis, Ext. Hyoscyami, . . . aa gr. xij. M. et div. in pil. no. xij. Sig.—One as required for sluggish bowels. [Barker.) R. Pulv. Galls, Pulv. Opii, Plumbi Acetat, . . . . aa gr. xx. Ung. Picis Liquids, Cerati Simplicis, . . . aa § ss. M. et ft. unguentum. Sig.—Apply night and morning after bathing parts with cold water. R . Ac. Carbolici, ij. Ac. Tannici, gj. Alcoholis, g iv. Glycerini, gj. M. Sig.—Hypodermic injection for piles. [Girard.') R . Ext. Opii, gr. x. Pulv. Stramonii, g). Pulv. Tabaci, gss. Ung. Simplicis, gss. M. Sig.—Ointment for piles. (iShoemaker.) Ammonium Chloride, grains xx-xxx, every 4 hours, is highly efficacious (Anstie). Bryonia, worthy of commendation in many liver affections (P.). Nux Vomica, has been found of much benefit. Dose should be small, gr. to -fa twice or three times a day (P.). Quinine, would naturally be thought of in malarial subjects, but does not afford any relief (Anstie). Hepatalgia Hepatic Cirrhosis Nitric Acid, in long-standing diseases, as this, will augment flow of bile after liver has struck work from mercury (R.). The mineral acids do not benefit (B.). Arsenic, small doses perseveringly, give good results in improving the nutrition of the organ (B.) Bryonia, of great value in many liver complaints (P.). Iodides, are the best remedies for the first stage (B.): the potassium iodide is highly recommended by some authorities (Da Costa): the great measures in the treatment of this affection are potassium iodide, hydrotherapy, and a milk diet (Lanceraux). Stillingia and Alkaline Mineral Waters, are important in the first stage (B.); alkalies early, especially Carlsbad water, with total absti- nence from alcoholic beverages (Legg). Mercury. Corrosive sublimate in small doses, gr. thrice daily, for a long time, does benefit the condition, and has possibly cured a few cases (Da C.). Sodium Phosphate is said to produce 588 HEPATIC CONGESTION. good results (Da C.); has power to retard the sclerosis, and may possibly arrest the changes and restore a state of comparatively normal function (B.). Chloride of Gold and Sodium, in doses of gr. as an hepatic alterative, may be used conjointly with phosphate of sodium (B.). Tapping becomes necessary for the dropsy, though purgation and diuresis may help to lessen it (Da C.). Diet, should be easily digested, especially milk, avoiding starches and fats, and quit- ting alcohol (Da C.). Nitric Acid, in chronic congestion, will augment flow of bile after liver has struck work from excessive use of mercury (R.). Nitro-Muriatic Acid, is found useful in India, with the acid bath ad gall, j) to hypochondrium (B.): formerly held high rank but is now superseded by ammonium chloride; the acid baths being now rarely employed (Fayrer). See page 462 for formula. Sulphur. Sulphates in purgative natural waters, small doses often repeated; potassium sulphate is occasionally poisonous (R.). Chelidonium, as deobstruent (P.); energetically affects the liver (Pf.). Iodine, tincture and unguent, locally for hepatic engorgement after malarial attack. The iodide of ammonium in moderate frequent doses in functional derangement, from malarial disease (B.). Sodium Phosphate, 3j-ij, 3 or 4 times daily, in plenty of water, as a purgative (B.). Ammonium Chloride, in passive congestion, and chronic torpidity, is well worthy of attention; gr. xx every 4 hours (Wa.); an excellent remedy (Da Costa). Turpentine, epithems, hot, often found very beneficial (Wa.). Quinine, gr. xv-xx with morphine, gr. i*1 the acute congestion due to climatic or malarial causes, no remedy so efficient (B.). Bryonia, is worthy of commendation in liver affections of various kinds (P.). Iris, really serviceable when stools clay-colored and skin jaundiced (B.); is one of the best aperients in hepatic derangement (P.). Mercury, valuable only as a purgative; its use restricted to cases where there is deficiency or excess of bile (B.); a full calo- mel purgative is of utility in cases of congestion (Wa.). Podophyllum, the resin in congestion of the portal circulation, is especially useful (B.); ]/(,-% gr- doses every six hours will speedily relieve symptoms (P.). Sanguinaria, is useful in hepatic engorgement without organic disease (P.). Colchicum, in hepatic con- gestion and dropsy ; an active remedy in congestion of the liver (B.). Resin- bearing Purgatives, as Rhubarb, Podophyllum, Iris, Euonymus, etc., are all actively cholagogue. (See list on page 39.) Ipecacuanha, decidedly stimulant to the flow of bile (B.); is the Indian treatment now for the local liver, given in large doses for a week or two (Da C.). Taraxacum, has had a reputation, but I cannot recommend it (DaC.). Aliment. No starches or fats. Milk, eggs, oysters, beef broth, whitefish, etc. (B.). Cold Water Belt around the abdomen, covered with oiled silk, gives great comfort in chronic cases (Da C ). [Compare Biliousness, Jaundice, etc.] Hepatic Congestion. Prescriptions. R. Elaterii, gr. j. Spt. Nitrosi, . . . ij. Tinct. Scillae, Tinct. Colchici, . . . . aa S ss. Syrupi Simplicis, . . . . % M. Sig.—Teaspoonful thrice daily. (B.) R . Ext. Taraxaci, gr. Ixxij. Ext. Aloes, gr. xxiv. Ext. Colchici Rad., Pulv. Ipecac aa gr. xij. M. et div. in pil. no. xxiv. Sig.—2 nightly in chronic enlargement and torpidity. (Martin.) R . Hydrarg. Chlor. Mitis, . . gr. vj. Pulv. Ipecac., gr. j. Sodii Bicarb., gr. x. Div. in pulv. no. ij. Sig.—One at bed- time, followed by the following:— R. Ac. Nitro-hydrochlor. Dil., 3 iij. Elix. Taraxaci Co., . . ad £ vj. M. Sig.—Dessertspoonful before meals, and a milk diet. R. Sanguinarise, gr. viij. Podophyllini, gr. iij. Ext. Hyoscyami, . . . . gr. iij. Saponis, gr. viij. M. et div. in pil. no. xx. Sig.—2 to 4 pills daily. In hepatic tor- por without organic disease. (Phillips.) HEPATIC DISEASES. 589 R. Pil. Hydrargyri, . . . Pulv. Aloes Socot., . . aa gr. iv. Pulv. Rhei, Extr. Hyoscyami, . . aa gr. vj. M. et div. in pil. no. vj. Sig.—2 pills every other night. R. Euonymini, gr. xij. Ext. Hyoscyami, . . . . gr. vj. M. et div. in pil. no. vj. Sig.—One at bedtime, followed next morning by a full dose of an aperient min- eral water. R. Cinchonidinae Sulph., Euonymini, Leptandrini, Juglandini, Irisini, aa Podophyllini, Ext. Belladonnse, Ext. Hyoscyami, . . . aa gr. x. M. et div. in pil. no. lx. Sig.—One pill thrice daily. In obstinate hepatic torpor. {Blackwood.) R. Potass. Bicarb., Potass. Citratis, . . . . aa^j. Syrupi Simplicis, ovb M. Sig.—A teaspoonful to a tablesp. with a similar quantity of lemonjuice, in glass of water; the whole to be drank while effervescing. (Wood.) Hepatic Diseases Ammonium Chloride is highly serviceable in all cases of liver disease, whether due to organic changes or to functional derangement; especially indicated after the more acute symptoms have abated (Wa.). Nitro-hydro- chloric Acid formerly held high rank, but is now superseded by ammonium chloride (Wa.); even the acid baths, so long considered of great importance, are now but little, if ever, used in India (Fayrer). Nitric Acid acts in some way beneficially on long-standing liver-diseases, as in chronic congestion and cirrhosis (R.); with vegetable bitters, long continued, useful in waxy liver (Wa.). Podophyllum has a high reputation in a variety of liver diseases (P.); is actively cholagogue (R.). Mercury, mercurial purgatives are used for both deficiency and excess of bile; harmful in many acute forms of hepatic disease, and generally are of doubtful propriety in liver affections (B.); in hepatic con- gestion a full calomel purge is of great benefit (Wa.). Red Iodide of Mercury, as ointment, gr. j to 55 v, gives best results in malarial enlargement of the liver (W.). Calomel is used in inflammatory disorders of the liver, but is less suited to parenchymatous than to serous inflammations (Da Costa). Ipecacuanha promotes the flow of bile (B.); may be used in small doses with great advan- tage in functional derangement of the organ (Wa.). Resinous Purgatives, as Leptandra, Iris, Euonymus, Rheum, etc., are decidedly cholagogue. (B.). Euonymin is of great value in torpid liver and its accompanying headache (W.). Bryonia is worthy of commendation in liver affections of various kinds (P.). Chelidonium powerfully affects the liver (Pf.). Taraxacum is highly recommended in all chronic affections of the liver, especially in indolent enlargement and incipient scirrhus (Watson). Sodium Phosphate is cholagogue, and extremely useful in liver affections, especially the jaundice of children and hepatic calculi (Thudicum). Phosphorus specifically affects the liver, and used early in acute yellow atrophy may have an action of antagonism upon the disease (B.). Potassium Salts, as depuratives, are of decided value, especially the citrate, in hepatic torpor and other affections (W.). See preceding article for formula. Sulphur, the sulphurous mineral waters, prolonged, give excel- lent results in liver disorders (B.). Alkaline Waters are very serviceable (B.) ; especially the sulphur waters. Glauber’s salt in their place (Da Costa). Chlo- rine Water has been employed with benefit in chronic hepatic affections, in doses of in or iv of water (W.). Iron preparations, long continued, in amyloid degeneration (Da C.). Gentian, and other bitter tonics, in func- tional disorder; also Nux Vomica occasionally, but use mercurials and podo- phyllum sparingly (Da C.). Iodine and Iodides in waxy enlargement, simple hypertrophy and chronic congestion, of great value (Wa.); the iodide of potassium alternately with the iodide of iron in waxy liver (Frerichs); a few 590 HEPATITIS HERNIA—HERPES. drops injected into hydatids (B.). Sanguinaria is of great value in hysteria from chronic hepatitis, and in hepatic engorgement without organic disease (P.). See preceding article for formula. Stillingia, for torpid liver and jaun- dice following ague, in the first stage of cirrhosis, and in ascites from hepatic changes (B.). Malt Liquors are harmful in all chronic affections, especially in fatty liver (B.). Galvano-puncture for hydatids, the negative needle into the hydatid (B.). [Compare Lists of Agents acting on the Liver, page 39, ante; also, the articles in this section entitled Biliousness, Calculi, Cancer, Hepatalgia, Hepatic Congestion, Hepatic Cirrhosis, Hepatitis, Jaun- dice.] Hepatitis and Hepatic Abscess. Ammonium Chloride, is almost a specific in hepatitis and abscess of the liver (Stewart); often preventing the latter disorder, and in many instances curing it (Wa.). Quinine, in large doses for the acute parenchymatous inflammation (Da Costa). Tartar Emetic, gr. every two or three hours, with opium or calomel as indicated by symptoms; of especial value early in the acute attack (Wa.). Leeches to margin of the anus in the acute type (B.) ; to unload the portal system (Wa.). Mercury is used, but is better suited to serous inflamma- tions than to parenchymatous ones (W.). Chelidonium has been used with benefit in both acute and chronic hepatitis (P.). Alkalies and Colchicum, when the affection is of a gouty nature (Wa.). Sulphites are recommended in chronic forms (Da Costa). Sinapisms and linseed poultices over the hepatic region in acute hepatitis (Wa.). Saline Purgatives, as the sulphates of sodium or magnesium, to increase the watery exudation from the mucous membrane of the intestines, in acute hepatitis (Wa.). Nitro-Hydrochloric Acid, for some time in chronic form tending to abscess (Da C.). Aspiration, when pus forms; early operation the rule of practice ; has induced many recoveries (Da C.). [Compare Jaundice.] Hernia. Opium, or morphine hypoder. to narcotism, often obviates the necessity of an operation in strangulated hernia (Wa.). Chloroform, of evident benefit (Wa.); inhaled to assist reduction (R.); has superseded the use of tobacco and lobelia in strangulated hernia (P.). Coffee, large doses, has certainly a remark- able influence in aiding or causing reduction of strangulated hernia (Wa.). Oak Bark extract, as-injection into the tissues, for a radical cure by stimulating the occlusion of the rings (Heaton’s radical cure). A similar operation was patented by a Dr. Gage in 1840, the oil of cloves being the injection used. Professor Pancoast injected tincture iodine for the same purpose. Operations for radical cure all satisfactory. A properly adjusted truss (Ag.): is the best remedy for a reducible hernia, answering the purpose of a retentive apparatus, and often permanently curing the disease by the steady, gentle and uniform pressure of its block (Gross). Ice Poultice is of use if no strangulation of gut or omentum (Wa.). Sternutatory, as snuff or ipecac, to cause sneezing while patient lies on his shoulders with elevated hips and legs over the back of a chair, frequently successful after taxis has failed to effect reduction. Herpes. Ferrum Arseniate, in doses of gr. £ daily, will effect the cure of a herpetic affection in the adult, however extensive or long established (Duparc). Mer- cury, calomel ointment, 3j to the 3, is one of the best mercurial preparations (Pereira). Potassium Carbonate, as lotion, gr. xxx to Oj, to allay irritation (Wa.); or as ointment, gr. xx to §j, smeared over eruption at night, and washed off in the morning with a solution, gr. xxx to Oj (Neligan). Glycerin, diluted, is a serviceable application in herpes labialis (Wa.). Ergot, the oil prepared by the action of benzin upon ergot, which, upon evaporation of the solvent, makes a valuable application in herpes genitalium and other skin HERPES ZOSTER—HICCOUGH. 591 affections (Shoemaker). Alum, in herpes praeputialis, a solution of 3j to aquae, applied on lint to the glans penis, is generally effectual (Wa.). Collo- dion, the flexible form, is applicable to various kinds of herpes (Wa.). Mag- nesium Citrate, as a cooling laxative, with soothing and protective lotions and ointments, and the Liquor Picis Alkalinus, diluted 10 to 20 times for the itch- ing (Bulkley). Astringent Lotions, of tannin or zinc sulphate, in herpes prae- putialis, to render the parts less sensitive (Da Costa). [For Herpes Circinatus see Tinea Circinata.] R . Tragacanthae, % ij-iv. Liq. Calcis, |j iv. Glycerini ,3 j. Aquae Rosae, 3 iij. M. Sig.—A soft jelly for local use as ointment. Prescriptions. R. Ac. Carbolici, gtt. v-xv. Pulv. Calaminae Prsep., Zinci Oxidi, aa 3 ss-j. Ung. Aq. Rosae, . . . . M. et ft. unguentum. A soothing and protective application. Herpes Zoster. Rhus Toxicodendron, very readily subdues, especially when burning or itch - ing (P.). Aconite and Opium, locally for pain (Wa.). Morphine, oleate ext*, without friction (R.) ; hypoder. to mitigate the pain (Anstie). Celandine has been recommended (P.). Dulcamara has an old reputation (P.). Silver Ni- trate, painted on the warning patch of erythema, before or as soon as ves icles begin to form (R.). As a local application, reported on favorably (Wa.). Vera- trine, as ointment, in neuralgia following shingles (R.). Zinc Phos- phide, gr. every 3 hours, is said to control the pain and abort the eruption (Hughes). Grindelia is reputed to relieve the pain (Stille). Mercury, the Ung. Hydrarg. Ammoniat. is said to relieve the pain and irritation remarkably (Wa.). Blisters, for subsequent neuralgia (R.). Hot Fomentations will often-disperse (R.). Baths daily, exercise out of doors, abundant nutritious food. Flexible Collodion, constantly reapplied to exclude air (Anstie). Galvanization of the affected intercostal nerves, the positive pole over their points of emergence, the negative brushed over the terminal filaments in the skin (B.). Starch, dusted over the eruption, and on a muslin band sewed tightly around the body to pro- tect it from the friction of the clothes, gives the greatest relief (Bulkley). Rest, absolute, when eruption is extensive (Fournier). Prescriptions. R. Zinci Phospbidi, Ext. Nucis Vomicae, . . aa gr. x. M. et div. in pil. no xxx. Sig.—One every 2 to 4 hours, as a nerve tonic. (Butt ley.) R. Bismuthi Subnit., . . . . g iv. Hydr. Chlor. Mitis, Zinci Oxidi, aa gj. M. ft. pulvis. Sig.—To be dusted on cotton-wool, and applied to the ulcerated vesicles, after washing with the solution of Sodium Hypochlorite. (Fournier). R. Liq. Sodii Hypochlorit., . 5iv. Aquae, M. Sig.—Wash for ulcerated vesicles. (.Fournier.) Hiccough. Nux Vomica, in 5- or io-tt\, doses of tincture, with of dilute nitric acid; a short course frequently curative (P.). Chloroform, combined with opium (R.). Pepper, gr. ij-x, to stop hiccough (P.). Laurel-water, a useful remedy, (P.). Morphine, hypoderm., often arrests (R.). Camphor has been recommended (R.). Mustard, 3j infused in aq. fervid, has cured most obstinate cases (R.). Pilocarpine, gr. of the muriate, has cured bad cases which resisted all other means (Ortille). Ether, as spray to the epigastrium for ten minutes, then the site of the phrenic in the neck (Regoni); or the spirit, tt\,xx-xxx in 592 HYDROCELE HYDROCEPHALUS HYDROPHOBIA. some aromatic water, given internally, will often arrest the spasm immediately (Wa.). Zinc Valerianate, gr. X with a small portion of extr. belladonnae, cured a severe case of fifteen days’ duration (Danet). Nitro-glycerin, sometimes arrests (R.). In mild cases deep inspirations, holding breath as long as pos- sible, or a firm belt around epigastrium (T.). Hydrocele. Iodine, injection of tincture 1, water 2, into the sac to excite obliterative inflammation, the usual procedure for radical cure after tapping the sac (Wa.);. may be used full strength, or with equal part of water; the latter the safest method in ordinary cases, but relapses are not infrequent (Gross). Carbolic Acid, 3ss, with a minute quantity of water or glycerin to render it fluid, injected into sac and manipulated to bring all portions under its action, after which rest in bed and support to scrotum (Levis); a very efficient method for radical cure, but may cause erosion of vessels and hemorrhage into sac (Gross). Am- monium Chloride, as discutient lotion to the scrotum in hydrocele of children (Wa.). Galvano-puncture, a current of 20 to 40 elements, by two needle elec- trodes, will invariably cure (B.). Operations for radical cure include that by iron-wire sutures to excite adhesive inflammation (Simpson); and the incision of the hydrocele under antiseptic precaution (Volkmann); the same end may be obtained by the simpler methods of injection noted above (Gross). [Com- pare Dropsy, Orchitis.] Hydrocephalus, Acute. Iodine, lotions to scalp, or inunction of iodine ointment together with ferric iodide and cod-liver oil internally, offer the best chance of success, although most remedies often fail (Wa.). Tartar Emetic, oint. as counter-irritant to scalp in tubercular meningitis (R.); in large doses internally was formerly employed (Wa.). Croton Oil, is said to have removed the excess of fluid from the ventricles (R.). Mercury, hydrarg. chlor. corr., in doses of gr. to -fa, has proved successful (Wa.). Magnesium Carbonate, 3j-ij saturated with lemon- juice, every 2 or 3 hours, a useful purgative in hydrocephalus (Wa.). Turpen- tine, in doses of with of castor-oil, or terebinthinate enemas, in incipient hydrocephalus (Wa.). Purgatives, in small doses every 4 or 6 hours after having overcome the constipation, to maintain action for some days. A single dose of calomel, followed up by magnesium sulphate at short intervals. Their value can hardly be overrated (Wa.). Leeches, on crown of head rather than on temples, when much febrile action; inadmissible if patient is much debilitated ; sometimes serviceable (Wa.). Hydrocephalus, Chronic. Mercury, holds a high place in the opinion of many. Calomel gr. twice daily, with mercurial inunction to the shaved head, or the latter alone; child to wear a woollen cap. This treatment for 30 or 40 days (Wa.). Ferric Iodide, with cod-liver oil, always gives good results among the poor (Wa.). Iodine, lotions. [See Hydrocephalus, Acute.] Potassium Iodide, may arrest progress (Wa.); is of value certainly; appears to have power of promoting absorption (W.). Cod-liver Oil, sometimes improves the condition, especially in scrofulous children (Wa.). [Compare Dropsy.] Hydrophobia. Belladonna, in all hyperasmic states of the brain and spinal cord, is one of the very best remedies (P.). Stramonium, is used by Brahmins in India with apparent success. Glonoin, may be of benefit (Wa.). Nicotine, rightly used, will probably prove to be our best remedy (B.). Amyl Nitrite, should be fairly HYDROTHORAX—HYPOCHONDRIASIS—HYSTERIA. 593 tried (B.). Curare, is encouraging, grm. 0.02 injected, 7 doses in hours, dispelled the symptoms, but replaced them by paralysis of limbs continuing over 2 months (Ros.); has seemed to antagonize the convulsive phenomena (B.). Chloride of Lime, a filtered solution injected into wound, very effective in snake bites (Binz.). Morphine, chiefly palliative. For deep injection into the tetanized muscles (B.). [See Tetanus.] Coniine, is indicated ; has not succeeded (B.). Cauterization, with hot iron or caustic potash after cleansing wound, which should be kept open by unguentum basilicon for 5-6 weeks (Ros., A.); with Silver Nitrate sharpened to a point, and applied freely to every sinuosity of the wound as preventive (Wa.). Excision, the safer practice (Wa.). Baths, warm and hot, produce calm (Ros.). Pasteur’s Inoculation, with a “ modified virus,” is claimed to protect the person bitten from the disease. Hydrothorax. Digitalis, in purely dropsical form, also in passive pleuritic effusions; used as a diuretic (3 j —ij of infusion bis die, or oftener) of great value (R.). Ela- terium, unquestionably of value as a derivative, though many fear it (P.). Jaborandi, produces good results (B.). Iodine, of tincture injected in re- turning hydrothorax (B.). Sanguinaria, has been used with the best effects (Wa.). Blisters, when effusion has taken place, certainly seem to stimulate the absorbents to action (Wa.). Dry Cupping, over the chest, gives relief (Da Costa). Thoracentesis, if much distress. [Compare Dropsy.] Hypochondriasis. Arsenic, in the aged, gives great comfort, especially when combined with opium (B.). Ignatia, is useful. Tincture, best (P.). Cimicifuga, of singular value in puerperal hypochondria, and in that accompanying spermatorrhoea, etc. (P.). Aurum, Chloride, gr. to ter die gives excellent results, when depression, vertigo, cerebral anaemia (B.). Valerian, quickly relieves flatulence (B.). Asafcetida, especially indicated in cases marked by flatulence and gloom (B.). Potassium Bromide, especially among female town-dwellers, but also in male (R.) ; effects are variable, relieves some, not others (Wa.). Hyoscyamus, when syphiliphobia (P.). Opium, stimulant doses of the tincture are of great importance (B.). Caffeine, the citrate (gr. j-v) has been used as a cerebral stimulant with advantage (B.). Alcohol, in hypochondriasis gives temporary relief; should never be given for its narcotic stimulant effects in these cases (W.). Cocaine, especially useful in cases marked by debility and nervousness, and in mental affections accompanied by depression; the fluid extract of Coca may be used, either alone or in wine (Br.). Turkish Baths, are useful for town- dwellers, with soft, flabby tissues, and mental depression (R.). [Compare Melancholia.] Hysteria. Ignatia, useful in many forms of hysteria, with feeling of suffocation, sensa- tion as of a ball rising to the throat, convulsive crying, flatulence, etc. (P.). Camphor, in hysterical excitement (P.). Musk, for many anomalous and dis- tressing symptoms (R.). Chamomile Oil, in the spasmodic and pseudo-neuralgic affections of hysterical women, a very excellent remedy (P.). Cimicifuga, in hysterical chorea, is rapidly curative (P.); for the headache (R.). Asafcetida, in hysterical convulsive affections, with flatulence and cough (P.) ; arrests paroxysm, valuable for flatulence (B.); removes headache, peculiar sensations in head, and flatulence (R.). Valerian, has great value, 3ss doses of fluid ex- tract (B.) ; useful in most cases, especially those of hysterical dyspepsia (P.). Zinc Valerianate, especially at the climacteric age, for hysterical symptoms which can be traced to no particular cause (R.). Ergot, with iron and other tonics (see formula below), in cases depending on sub-involution of the uterus, with indigestion and anaemia (B.). Nux Vomica, of great use in middle-aged subjects, with flatulence, weight on head, flushings and perspirations (R.). 594 ICHTHYOSIS—IMPETIGO. Atropine, for hysterical aphonia, gr. to morning and evening (B.). Ether, for the flatulence, and for the hysterical paroxysm in sudden seizures (B.). Ammonia, the aromatic spirits for the acidity and eructations (B.); the fetid spirit for flatulent colic, etc., may be given with great advantage in doses of 3ss-j (Wa.). Potassium Bromide, gives control, and prevents paroxysms. When verging on nymphomania large doses required (R.). Iron, a course often use- ful, especially when anaemia or uterine obstructions (R.). Phosphorus, in hysterical paralysis (R.). Arsenic, lessens mobility of nervous system, and improves nutrition (B.). Opium, gtt.j of laudanum with gtt. ij of tinctura nucis vomicae 3 or 4 times a day, for flushings, weight on head, depression (R.). Ovarian Compression, has in many cases relieved recent hysterical contractions, and many other similar phenomena (Bourneville). Electricity, for aphonia, paralysis and anaesthesia, and to educate the nervous control. Electricity is the sworn enemy of hysteria. Accessory Measures. Occupation of mind and body. Removal from influence of friends. Complete abandonment of use of alcohol. The shower-bath, or cold-bath, as an educator of the will, as well as to invigorate the body. Excitement to be avoided. The word “Hysteria” should never be applied to the case in the patient’s hearing. Disorders of vision are often found at the bottom of hysteria; look for hypermetropia and astigmatism. Prescriptions. R. Ext. Ergotoe, gj. Ferri Sulphatis, g ss. Ext. Nucis Vomicae, . . . gr. viij. Hydr. Chlor. Corros., . . gr. ss. M. Fiant pil. no. xxx. Sig.—One pill thrice daily. To improve digestion and anaemia. (B ) R. Tinct. Asafoetidae, Tinct. Valerianae Ammon., Tinct. Castorei, . . aa . . z ij. Aquae Camph., j|vij. M. Sig.—A tablespoonful or two every hour. Zinc, the ointment or glycerite of the oxide, especially the latter with a little camphor added to it, is a most useful application (Wa.); an ointment of the sulphate, 3j to SJ . found very efficient (Wilson). Sodium Bicarbonate, as oint- ment, gr. xv-xxx to §j, or lotion, gij-iij to Oj (Devergie). Copper Sulphate, gr. x ad §j Unguentum Sambuci, a useful application (Wilson). Ulmus, in decoction, used internally, has cured the disease (Wa.). Cod-liver Oil, applied locally with friction, has proved promptly curative. Warm Baths, may gener- ally be employed with benefit (R.); alkaline and vapor baths, with sapo mollis ; and inunctions of oil or simple ointment, to prevent Assuring of the new skin (Duhring); frequent alkaline baths, with internal and external use of oily preparations, as linseed and cod-liver oils, yield the best results (Bulkley). Ichthyosis Impetigo. Arsenic, is very useful. [See Eczema.] The iodide in doses of gr. has been employed with great success. Or Donovan’s Solution, (Wa.). Nitric Acid, internally, frequently benefits (Wa.). Glycerite of Tannin, an excellent application (B.); during day, with poultice at night to remove scabs (R.). Quinine, Mineral Acids, when from imperfect digestion (R., B.). Zinc, the ointment of the oxide, after subsidence from inflammation (R.). Sulphur, internally, serviceable (R.). Calcium Chloride, gr. xv-xxx, daily, in some vegetable infusion, well spoken of (Wa.). Mercury. Citrine ointment dilute, locally, is an excellent application (Wa.); a very weak white precipitate oint- ment answers best in impetigo contagiosa, with a little carbolic acid lotion (i to 20) if it does not yield (Bulkley). Calomel to cover the floor of the pustules, after opening, evacuating and washing them out (Da Costa). Laurel-water, relieves itching (P.). Grape-cure, has proved excellent (P.). Flexible Collo- dium, or liquor guttae perchae, to cover the pustules, if located where they are liable to irritation (Da Costa). [Compare Eczema.] IMPOTENCE INFLAMMATION. 595 Impotence. Phosphorus, no remedy more efficient. The pill of zinc phosphide the most convenient form (B.) ; gr. thrice daily. Phosphoric Acid, full doses, with gr. ss of pulvis cantharidis, an effective combination, especially in impotence of old age (B.). Chloride of Gold, prevents decline of sexual power (B.). Can- tharis, with iron, is beneficial (B.). In large doses (gtt. xx-xxx), with iron and phosphoric acid or nux vomica (R.). Of doubtful efficacy (Wa.). Cubebs, removes functional trouble (B.). Nux Vomica. Drop doses of tincture in atonic impotence (B.). In large doses when spermatorrhoea (R.). Sanguina- ria, has decided aphrodisiac properties, but useful only in functional form (B.). Serpentaria, in relaxation and feeble erections, will often restore power, gss doses of tincture bis in die (B.). Ergotin, hypodermically about the dorsal vein of penis, when its enlargement and too rapid emptying is the cause of impo- tence (B.). Cannabis Indica, is a useful remedy; the best combination for functional impotence would be one of Cannabis, Nux Vomica and Ergot (B.). Polygonum Hydropiperoides, is a useful remedy in the functional form, erections feeble, semen watery and testes soft (B.). Arseniate of Iron, acts as a tonic to the organs, and in full doses often benefits cases of functional form (B.). Damiana, has been brought forward as a genital stimulant, and a remedy for impotence, but there is probably no ground for any confidence in such claims (Stille). [Compare Emissions, Spermatorrhoea, also List of Aphrodisiacs, ante, page 47.J R. Ferri Arseniatis, gr. v. Ext. Ergotse, gr. xxx. Ft. pil. no. xxx. Sig.—One twice daily. Prescriptions. R. Sanguinaringe, gr. ij. Ext. Ergotse, gr. xx. M. Ft. pil. no. xx. Sig.—One pill thrice daily. R. Ext. Cann. Indicse, . . . . gr. x. Ext. Ergotse, gr- xl. Ext. Nucis Vom., . . . . gr. x. Ft. pil. no. xx. Sig.—One pill night and morning. R. Tinct. Sanguinarise, . . . g iij. Ext. Stillingise FI., . . . M. Sig.—15 to 20 drops in water, thrice daily. R. Quininse Sulph., gr. xxx. Strych. Sulph., gr. ss. Ext. Ergotae, gr. xv. Mas. Ferri Carb., . . . . gr. xlv. M. Ft. pil. no. xxx. Sig.—One pill 2 or 3 times daily. R. Phosphori, gr. ss. Ext. Nucis Vom., .... gr. vj. Mas. Ferri Carbonat., . . . gr. xl. Ext. Gentianae, gr. xxx. M. Ft. pil. no. xxv. Sig.—One 2 or 3 times daily. Inflammation Aconite, especially in inflammation of respiratory organs, eruptive fevers, and all inflammatory states of high temperature and sthenic reaction. Not in ady- namic states, or continued fevers, except for hyperpyrexia. May be advantage- ously combined with opium (B.); gives most brilliant results in many forms (R.). Always indicated in early stages of simple inflammatory fevers, in all inflam- mation of serous membranes, pneumonia, tonsillitis, acute rheumatism, ery- sipelas, etc. Is especially adapted to the uses for which bleeding was formerly employed (P.). Arnica is antipyretic, large doses (3ss of tinct.) in sthenic, small doses (ttbx) in asthenic inflammation (B.); in inflammation of serous membranes it has given good results (P.). Belladonna, in many forms no remedy more useful, notably scarlet fever, erysipelas, low fevers. Inflamma- tion of eyes, boils, carbuncles, etc., by atropine externally, belladonna inter- nally. When much fever, may be combined with aconite (B.); both locally and internally in inflammation of the eye; is effectual in inflammation which threatens to end in abscess (R.). In erysipelas, inflammatory sore throat, encephalitis, gouty and rheumatic inflammation, cystitis, pneumonia, etc. (P.). 596 INFLAMMATION. Gelsemium, especially inflammation of lungs and pleurae, and in pneumonia of fl. extr. every two hours) (B.). In acute stage of acute gonorrhoea is valuable (P.). Bryonia, exceedingly valuable in pleurisy and other serous inflammations, especially pericarditis. After the aconite stage (P.). Veratrum Viride, when much delirium and arterial excitement, useful at beginning only (B.). In pneumonia, Veratrine is most valuable, also in acute rheumatism and generally as an antipyretic (P.). Tartar Emetic, in frequent minute doses, gr. j renders incontestable service (B.). In pneumonia, tonsillitis, pleurisy, bronchitis, and other inflammatory affections (R.). Pulsatilla, in acute and subacute inflammations with muco-purulent discharges, especially of eyes, ears, and nasal passages (P.); also with aconite in epididymitis (Pf.). Mercury, in acute glandular inflammation of throat and neck, in ileo-colitis, iritis, syphilitic inflammations of serous membranes, laryngitis (B., R.). Silver Nitrate, locally in strong solution, gr. clx to §j of distilled water, painted over surface and beyond, after thorough cleansing and drying; no agent so safe, powerful or efficacious in subduing external inflammation (Higginbotham). A strong solu- tion in nitrous ether is a most efficient application to check inflammation in superficial parts, as boils, felons, orchitis, synovitis, erysipelas, erythema, eczema, etc. (B.). Iodine, as liniment in vicinity of local inflammation to pro- duce vesication (R.). Sulphides, especially that of calcium (doses gr.) appear often to arrest suppuration. After formation of pus they hasten matura- tion and circumscribe inflammation. In boils, abscesses, and deep-seated suppuration, they improve the condition and promote healing (R.). Antipyrine, Kairine, and other antipyretics. See under the title Fever. Alkalies, espe- cially ammonium and potassium salts, are very valuable in the stage of exuda- tion (B.). Astringents, locally in inflammations of mucous membranes (R.). Lead, the liquor plumbi subacetatis dilutus as a soothing and astringent appli- cation to inflamed and erysipelatous surfaces (Wa.); to eczema and other inflammatory diseases of the skin (Pf.). For Leadwater and Opium formulae see page 460. Digitalis, the German antipyretic, is especially useful in pneu- monia, bronchitis, rheumatic fever and scarlet fever (B.). Aconite safer and better (R.) ; locally and internally is useful in inflammations, especially those of joints, of breast, erysipelatous and varicose: a fomentation of a teasp. of the dried leaves in half a pint of boiling water, or 3j of tincture to the same quantity of water, applied by flannels to the part, will quickly subdue (Fair- bank). Quinine, in peritonitis (Tr.). It is indicated in most acute forms, unless objections occur (P.). Has power to arrest inflammation in formative stage. With morphine and in full doses (gr. xv-xx) may suppress many forms (B.). Chloral, excellent when temperature is high, much delirium; gr. v every 3 hours (B.). Opium, is important in most inflammations, but especially those of serous membranes ; a full dose (gr. % of morphine) at first, smaller doses after. Is especially curative in inflammation of intestines and peritoneum, and of cerebro-spinal meningitis, arachnitis, etc. (B., R.). Saline Purgatives, valuable as part of the denutrition treatment, and to diminish arterial tension (B.). Sali- cylic Acid is antipyretic, especially in septicaemic inflammation, and acute rheu- matism, erysipelas, pneumonia (B.). Salicylate of sodium more soluble (R.). Colchicum often exercises a happy influence over certain acute inflammations, as bronchitis, conjunctivitis, etc., especially if occurring in gouty subjects (P.). Cocaine, locally in commencing inflammations of mucous surfaces, to con- strict the bloodvessels of the part (R.). Pilocarpus gives good results in the exudative stage of pleuritis, iritis, keratitis, etc. (B.). Cold, by ice in bags, or cold water, a very useful agent. Heat, by hot water, fomentations, etc., often much better. Ice, in small pieces in a bladder applied to inflamed part(R.). Water, cold and hot baths and packing very useful in all inflammations (B.). Alcohol is constantly prescribed, and is of value in low states, if symptoms after its administration are ameliorated (B.). [See Fever.] Poultices, useful in many inflammatory states, but often abused (B.). To check formation of pus and assist in maturation (R.). Venesection, when pulse hard, strong, full and frequent, a plethoric state of the system and great intensity of morbid action ; if required the earlier it is done the better (Gross). Leeches very useful INFLUENZA. 597 in many forms where sthenic reaction and plethora. Value of blood-letting probably due to derivative and counter-irritant effect (B.); a remedy of great power for good or evil, now much neglected (Wa.). Local bleeding by leeches, cups, scarification, etc., should generally be preceded by some form of general depletion (Gross). Aliment: when no inflammation of digestive tract, use milk and beef-tea alternately every 3 hours. No starches or fats. In intestinal inflam- mation, milk, eggs, animal broths, oysters, fish, but must be used with great caution. Skim-milk treatment (B.). Cod-liver oil in many chronic inflamma- tions, as of heart, lungs, kidneys, etc. (R.). [Compare the various titles, as Bronchitis, Pleuritis, etc., also the list of Antiphlogistics, on page 43.] Prescriptions. R. Tinct. Aconiti, Tinct. Belladon., 7, ij- M. Sig.—Three or four drops in water every hour. (B.) R. Antim. et Pot. Tart., . . . gr. ijss. Magnesii Sulph., . . . . % ij. Morphinae Sulph., . . . .‘gr. Ac. Sulph. Aromat., . . . Tinct. Verat. Virid., . . . Syr. Zingiberis, ij. Aquae Destill., 3jx. M. Sig.— Tablesp. every 2, 4, or 6 hours. Antimonial and Saline Mixture. ( Gross.] R. Ammonii Chloridi, . . . 3 v. Acidi Acetici, Alcoholis, aa 2 x. Aquae, .... q. s. ad Jx. M. et fiat lotio. Evaporating and dis- cutient lotion. [See pages 460 and 461 for Lotion and Liniment formulae.] Sulphurous Acid, by fumigation or inhalation, a few drops on boiling water or as a spray, often controls (R.). Tartar Emetic has been recommended strongly, but is too depressant (Wa.). Quinine has been used beneficially throughout the disease, especially after the acute stage, for neuralgic pains (Wa.). Ammonium, the liquor ammonii acetatis, combined with nitric or chloric ether, is often of great service (Wa.). Sanguinaria, used with much benefit (Wa.). Cimicifuga has been given with much success (R.). Spiritus Etheris Nitrosi, in doses of 3j-jss, in any convenient vehicle, is a popular and efficacious remedy (Wa.). Cocaine, a 4 per cent, solution snuffed up nostrils or applied by spray-producer, very efficacious in the early stage (R.). Cubebs, 3ss or 3j doses of the tincture in of linseed tea thrice daily, for the subsequent cough, often curing like a charm (R.). Opium, best avoided in early stage, but later for the cough, with ipecac., gives great ease. Dover’s powder, with nitre and lobelia is a good form (Wa.). Potassium Nitrate, nitre largely diluted, as lemonade, 3j—ij in the course of the day, proves highly useful (Wa.). Turkish Baths have been employed with marked advantage (Wa.). Hot Fomentations, for headache (R.). Benzoin, the compound tinc- ture, c>ss-j, inhaled from a pint of hot water frequently (Da Costa). [Compare Bronchitis, Catarrh, Hay-Fever.] Influenza. R. Ext. Ipecac. FI., . . . . 3 ij. Tinct. Opii Deod., . . . . £iv. Tinct. Aconiti, gj. M. Sig.—Five to ten drops every two hours. For the bronchitis. Prescriptions. R. Ammonii Chloridi, . . . Morphinae Sulph., . . . . gr. ij. Tinct. Sanguinariae, Syr. Ipecac., . . . . aa 3 iv. Mist. Glycyrrh. Co., Aquae, aa M. Sig.—Teasp. as required for the cough. Each dose has of Morph. Sulph. gr- tV R. Ext. Cimicifugae FI., . . . ss. Tinct. Opii Deod., . . . 3 j. Syr. Tolutani, 5 xj. M. Sig.—Teasp. every four hours. 598 INSOMNIA INTERMITTENT FEVER. Insomnia. Chloral, the best hypnotic (gr. xv-xx), quite unrivaled. Cautiously in deli- rium tremens, which see (B.). In many forms of sleeplessness (R.); acts best in cases which are of purely nervous type (Wa.); in combination with alcoholic preparations, especially if potassium or sodium bromides are present, it is apt to separate to the top as an alcoholate. See ante, page 165. Croton Chloral, 3j may be given (R.). Potassium Bromide, when from cerebral overaction, gr. xv before each meal, and gr. xxx on retiring. Cumulative effect (B.). It increases hypnotic effect of hyoscyamus, belladonna, cannabis indica, ether and chloroform (R.). Hyoscyamus, an effective substitute for opium in chil- dren, of tinct. necessary, and without danger (B.); when opium dis- agrees (R.). Belladonna, hypnotic in some morbid states, especially those marked by prostration, low arterial tension, contracted pupils. Atropine, gr. to (B.). Paraldehyde, in doses of is an efficient hypnotic with little or no depressing action on the heart (C.). Ignatia, for sleeplessness from nervous erethism, better than morphine (Pf.). Gelsemium, in simple wakefulness (B.); and in that of drunkards, mania and over excitement (R.). Coffee, insomnia from lowering of nervous power, and chronic alcoholism (P.). Opium, Morphine the best form, gr. %-gr. ss, when pain (B.). Codeine and Narceine, also hypnotic, should be given to act at natural time for sleeping (R.). Sumbul, of tinct., with a little chloric ether, very efficient in the insomnia of chronic alcoholism (P.). Tartar Emetic, and opium, very effect- ive when due to cerebral congestion, and when opium stimulates (B.). Ether or Chloroform in a full dose (R.). Phosphorus, nutrition inactive. Insomnia of the aged (B.). Humulus, a hop-pillow effective (B., P.); tinct. lupulinae, 3SS-5SS, as cerebral sedative (B.). Cocaine has been used with some success (Wa.). Chamomilla, rr\j of the tinct. every quarter-hour, an excellent sedative for children (A. A. Smith). Cannabin Tannate, in 8-grain doses, a good hyp- notic (Fronmiiller) ; very inefficient (W.). Cannabis is very uncertain in its action (R.). Alcohol, if from cerebral anaemia, a full dose of whiskey or brandy ; or in some a glass of ale or beer answers better (B.). Water, a tepid bath just before retiring often effective. When head is hot, cold to it, and tepid bath to the body (B.). [Compare Nervousness ; also the list of Hyp- notics on page 27 ; also the Analogues of Chloral, page 163.] Prescriptions. R. Paraldehyde, gijss. Alcoholis (90 per cent.), . Tinct. Vanillae, zss. Aquae, 5j. Syr. Simplicis, . . . ad £ iv. M. Sig.—A teasp. or two every hour until sleep is obtained. ( Yvon's Hypnotic Elixir.') R. Potassii Bromidi, . . . . g iv. Chloralis Hydrat., . . . . 3 iij. Tinct. Asafoetidae, . . . . £iv. Syrupi, . iv). Aquae, . . . . . q. s. ad gv). M. Sig.—Tablesp. every 2 hours until sleep is induced. In the insomnia of hys- teria. R . Chloralis Hyd., 3 ij. Potassii Brom., giij. Tinct. Opii, Syr. Aurantii Cort., . . . 3 iij. Aquae, ad §ij. M. Sig. — Teasp. dose. May be re- peated if necessary. R. Potassii Bromidi, .... Chloralis Hydrat. . . aa 5 ss. Syr. Pruni Virgin., . . . . )|j. Aquae, q. s. ad J ij. M. Sig.—Teasp. in a winegl. of water. Repeat in one hour if necessary. Cinchona. Quinine as prophylactic, gr. v-x each morning in black coffee ; begin with gr. v, add gr. j each week (R.). In ordinary intermittents give 6 or 10 grain doses up to 20 or 30 grains, so as to have it all in 4 or 5 hours before the expected paroxysm ; give the sulphate and in solution to get its full action (Da Costa). For acute ague, gr. x in sweating stage, and same 5 hours before next paroxysm, and gr. x-xv at the septenary periods, until the third has Intermittent Fever. INTERMITTENT FEVER. 599 passed. In pernicious form, gr. xx-xl are required, by stomach, rectum or skin, to secure safety of patient. Best in combination with morphine, and with continuous administration of arsenic during intermissions. May be given in solution by rectum, or hypodermically (B., R.). Is almost specific in inter- mittents when uncomplicated, and of recent origin (Wa.). Chinoidine may be used as a substitute for quinine in doses twice as large (B.). Cinchonine, Cinchonidine, Quinidine, the sulphates of these alkaloids are scarcely, if at all, inferior to quinine as therapeutical agents. (Report of the Madras Commis- sion, 1866.) Average dose of each, gr. x (Wa.). Salicylate of Cinchonidine, promises well as an antiperiodic (B.). Opium, as morphine, gr. }4_X hypo- dermically, not only lessens the chill but aids the action of the antiperiodic; is to be strongly urged (Da Costa); is useful in the pernicious variety, in combi- nation with quinine (B.). Arsenic, the best remedy next to quinine, especially useful in long-standing agues, of quartan type (R.). Useful as adjunct to qui- nine daily, to prevent relapse. Most important in chronic ague, with iron; also as prophylactic small doses of Fowler’s solution (B.). Capsicum, the resins of black and red pepper, as adjuvants chiefly (B.); promotes action of quinine (Pf.). Nux Vomica, has been used with success, but now used as adjunct to quinine (B.); good in convalescence (P.); has antiperiodic value not inferior to quinine. Strychninae gr. equals gr. j of quininae sulphas (Wa.). Hydrastine, stands next after arsenic ; same indications as quinine (B.) ; in doses of gr. ij-ix is strongly recommended (P.). Pilocarpine, gr. x/% of the muriate, in the cold stage, is strongly recommended by high authority, to excite profuse perspiration and thus lessen the attack (Da Costa). Apiol, when prejudice exists against quinine. Gtt. xv during an hour, in divided doses, 4 hours before paroxysm (B.); is one of the minor remedies which often prove successful in mild cases (Wa.). Salicin, as substitute for quinine, but inferior (B.) ; grs. x-xl, in mild cases (P.). Chloroform, to prevent an impending paroxysm; (of spt.) before the chill, or by inhalation (B.). Narcotine, gr. ij-v ter die, is eminently antiperiodic. No drug (except quinine) cures intermittents so rapidly and surely, or with more freedom from disagreeable effects (Wa.) ; said to be superior to quinine (R.). Nitric Acid, full doses every 4-6 hours (B.). Sodium Chloride, in large doses during the apyrexia, 3viij-xij, may occasionally prove efficacious (Wa.). Eucalyptus, during con- valescence (B.); has been successfully used in treatment of ague, 3j-ij of a tincture (Wa.). Carbolic Acid, in 4-grain doses with infusion of ginger, cured a series of 8 cases which had resisted quinine (Wa.); its value established; rr\,ss-ij in mint-water; or gr. X in fflxx of water, hypodermically (Tessier); combined with iodine is of great value in chronic malaria, and in acute cases after quinine has stopped the paroxysm (B.). Mercury, uncalled for in ordi- nary cases ; but hydrarg. cum creta, quinine and rhubarb of service in obstinate intermittents of children in tropical regions (Wa.). Sodium Hyposulphite, gr. xv-xx every two hours is said to cure (R.). Cascarilla, Chamomile, Quassia, used (R.). Gentian, is valued chiefly as vehicle (P.). Ammonium Picrate, proved wonderfully effective in India, where 10,000 cases were treated there- with (Clark). Lemon, in decoction, exceedingly efficient in preventing recur- rence of the paroxysms after they have been broken up by the use of Quinine (Crudeli). Emetics, may cure many cases ; one each morning will assist the action of quinine. Ipecacuanha preferred to antimony (R.); only at com- mencement, inadmissible if gastric irritation (Wa.). Antimony, at the onset, and continuously in mild, uncomplicated cases. Tartar Emetic, gr. Y-1 every 2 hours, has been followed by complete cures (Moore). Antipyrine, is useless (Falkenheim). Resorcin, and similar agents, have no specific action, merely controlling the pyrexia (Wa.). Warburg’s Tincture is a remedy of great power, but produces such severe diaphoresis as to be dangerous to adyna- mic subjects (Prof. Maclean). Purgatives, in the intermission, before using the antiperiodic, is good practice ; podophyllum, colocynth or jalap (Da Costa). Iron is valuable in chronic cases ; the system should be thoroughly saturated with it (Da C.). Ergot, for the enlarged spleen (Da C.). [Compare the title Malaria ; also the List of Antiperiodics on page 43.] 600 INTERTRIGO INTUSSUSCEPTION, Prescriptions, R. Quininae Sulph., . . . . gr. xxxij. Mucil. Acaciae, g ij. Syr. Eriodyctii Aromat. (Parke, Davis & Co.), vel Mist. Glycyrrhizae Co., vel Velatine, . . . . q. s. ad % ij. M. Fiat emulsio. Sig.—A teasp. con- tains gr. ij of Quin. Sulph. Suspension of the quinine without dissolving it makes the bitter taste less perceptible (Squire), and the Syrup of Yerba Santa covers the taste well. (Potter.) R. Quininae Sulphat., . . . . gr. lxxx. Ac. Sulph. Diluti, . . . . q. s. Spt. Etheris Nitrosi, . . . g iv. Syr. Tolu, Aquae, . . . ad£ ij. M. Sig.—A teasp. contains gr. v of Quin. Sulph. (Da Costa.) R. Quininse Sulphat., . . . . gj. Ac. Hydrobrom. Dil., . . gij. Aquae, g xiv. M. Sig.—A teasp. contains gr. of Quin. Sulph. The acid directed prevents the unpleasant cerebral action. (B.) R. Ac. Carbolici, gj. Tinct. Iodi Comp g iij. M. Sig.—4 drops every 4 hours in suf- ficient water. (B.) R. Quininae Sulph., gss. Pulv. Acaciae, g ss. Syr. Zingiberis, giv. M. Sig.—A teasp. contains one grain of Quin. Sulph. A good formula for children, the quinine being suspended, not dissolved. R. Massae Ferri Carb., . . . gj. Ac. Arseniosi, ..... gr. j. M. Ft. pil. no. xx. Sig.—One thrice daily in chronic ague. (B.) R. Quininae Sulph., . . . . gr. xl. Ferri Sulph. Exsic., . . gr. xx. Ac. Arseniosi, gr. j. M. Ft. pil. no. xx. Sig.—One thrice daily. (B.) R. Quininae Sulph., gr. xxx. Capsici, gr. xv. Opii Pulveris, gr. iij. M. Ft. pil. no. xxx. Sig.—One to five pills as required. (Piffard.) Intertrigo. Bismuth, nitrate or carbonate, as dusting powder (R., B.). Tannin, the glycerite, excellent (R., P.). Camphor, added to dusting powders, to allay heat and itching (R.). Lime-water, to obviate irritating urine (R.). Soap, free ablution with, when caused by acid secretions; use greasy applications after- wards (R.). Boracic Acid, as ointment, 3jss to of vaseline, a very useful application (Wa.).. Glycerin, with tragacanth, etc. [See under Herpes for formula.] Calomel, as ointment, gj to is especially useful (Wa.). Zinc Carbonate. Calamine is a good dusting powder; so also is the oxide, or fuller’s earth. Intestinal Obstruction. Opium, even -grain doses every 4 hours, for 2-4 days, arrests dangerous symptoms, and brings a painless purgation (Brinton, P.). Morphine, endermi- cally (Wa.). Belladonna, often successfully employed (P.): gr. %-}{ every few hours, when from want of tone and partial spasm (Tr.). Strychnine, occa- sionally beneficial; cautiously in acute cases (Wa.). Mercury. A full dose of calomel, followed in a few hours by castor oil, and a turpentine enema, affords relief (Wa.). Caffeine acts upon the muscular tissue and often proves of the utmost value (Wa.). Senna, the infusion, in doses of §j-iij, forms an efficient purgative (Wa.). Purgation to be refrained from (Brinton). Enemata, insuf- flation and surgical measures are often necessary. [Compare Constipation, Intussusception, Hernia.] Intussusception. Belladonna, gr. iv of extract in an enema, has been successfully used (Wa.). Opium, in full doses carried to narcotism, has been successful in many cases (Wa.) ; must be used freely to prevent inflammation (Macleod). Effervescent Enemata, have been employed with success (B.). Tobacco Enema, may over- IRRITABILITY IRITIS JAUNDICE. come, and has proved exceedingly effective, but is dangerous. Produces most depressing nausea. Not safe to use more than giv of the infusion ; 3j-0j (B.). Inflation, of intestines with air [Hippocrates), seems a most reasonable mechan- ical remedy. Irrigation, by hydrostatic pressure is resorted to with success. Requires care and gentleness (B.). Hot water (Wa.); ox-gall, gr. x-xxx in the solution used, is especially efficient in cases arising from partial paresis of the bowels (Hawkins). The knee-chest position is the best during irrigation or in- flation. [Compare Hernia, Typhlitis.] Irritability. Ignatia, in small doses diminishes, in large doses excites irritability of cerebro- spinal axis. The remedy par excellence (Pfi). Chloral gr. v, 2 or 3 times a day, in irritability with nervousness and restlessness (R.). Chamomilla, is an excellent sedative for children, in doses of tr\j of the tincture every % hour (A. A. Smith). Opium, gives calm to the nervous system.if used in medium doses. Strychnine, in functional irritability of the nervous system. [Compare In- somnia, Nervousness.] Belladonna, locally and internally (R.); n\,v every 3 hours, also lotion (3j of extract to j|iv aquae), is of great value (P.). Atropine (solution gr. iv ad 5j) has a wide field of utility, as mydriatic (B.); should never be omitted (C.) ; is essential in the treatment of every form, should be applied early in the case and persevered in throughout its continuance (Lawson). Mercury, when of syphilitic origin, as it usually is (B.); the bichloride is of great service (R.). In plastic iritis of original severity, or in cases aggravated by improper treatment, mercury is imperative, gr. ij of blue pill twice a day, until blue line on gums (C.). Duboisine, as substitute for atropine, is more rapid for effecting dilatation, less irritating to the conjunctiva, and has less permanent after-effects (B.). Turpentine, in so-called “rheumatic iritis” is very successfully used; small repeated doses (P.). Opium, when much pain, an indispensable adjuvant. Morphine, hypodermically (C.). Copaiba, -jij in mucilage, thrice daily, gives excellent results in iritis and sclerotitis, diminishing pain in 24 to 48 hours, and restoring sight (Hall). Quinine and Iron, when the patient is feeble or anaemic. Irritants, or astringents should never be employed (C.). Surgical. Paracen- tesis when increased tension. Corelysis when only one or two adjacent ad- hesions. Iridectomy. Complete functional rest to the eyes, by atropine and a bandage with compression-pad, an absolute necessity during the whole period of treatment (C.). [Compare Syphilis.] Iritis. Prescriptions, R. Hydr. Chlor. Corr., . . . gr. j. Potassii Iodidi, %j. Tinct. Calumbse, . . . . 3ij. Aquae Destil., . . . . ad vj. M. Sig.—A dessertspoonful, in a wine- glass of water, 2 or 3 times daily. [Lawson.) R. 01. Terebinth., giij. Syr. Acacise, Sjss. Aquas Cinnamomi, . . . 3 ss. M. Sig.—A teaspoonful 4 or 5 times daily. R. Extracti Belladon., . . . gj. Ung. Hydrargyri, . . . . gvj. M. Sig.—For inunction to brow. Mercury, in attacks with depression, sickness and coated tongue, gr. of gray powder taken at onset, and repeated three or four times a day, very valuable (R.). As purgative in jaundice from both deficiency and excess of bile, singularly enough (B.). Gray powder with ipecac, followed next morning by castor oil, is well adapted to the jaundice of infancy and childhood (Wa.). Jaundice. 602 joint affections. Mercurials and podophyllum are better avoided, especially in obstructive jaun- dice, unless very marked indications for them exist (Da Costa). Celandine, was formerly employed as deobstruent (P.); energetically affects the liver (Pf.). Hydrastis, useful if continued for some time, in jaundice from catarrh of ducts (B.). Arsenic, has been used with success in jaundice from catarrh of bile ducts after catarrh of duodenum. Better for jaundice of malarial origin (B.). Nitro- Hydrochloric Acid, internally, and acid bath to right hypochondrium ; tempera- ture of bath 96°, j (B.); when jaundice depends on torpor of the liver, or is catarrhal in origin (W.); during convalescence, of the dilute acid in 3) of a compound elixir of taraxacum before each meal (Da Costa). Quinine, when due to malarial miasm, or when periodic (B.). Euonymin, an hepatic stimulant of especial power (B.). Podophyllum, in catarrhal and malarial jaundice (B.); when stools exhibit no trace of bile, one dose has cured (Wa.). Best avoided, unless markedly indicated (Da C.). Sodium Phosphate, no remedy superior in jaundice from catarrh of gall-ducts; 3} doses every four hours for adults : gr. for children (B.). Manganese, in jaundice from malarial origin, or catarrh of biliary passages (B.). Aloes, for simple jaundice of an atonic kind (B.) ; when hypochondriasis (P.). Rhubarb, for above mala- dies in children; white or clay-colored pasty stools; skin jaundiced (B.). Saline Purgatives to depurate the upper bowel, as Rochelle salt; with alkaline baths, diaphoretics and diuretics (Da C.). Ammonium Iodide, gr. j-iij in water every 2 or 3 hours in catarrh of bile ducts and jaundice. Also Ammonium Chloride, with fluid extract of taraxacum (B.). The Chloride, in 20-grain doses every 4 hours, produces a decided change (Wa.). Stillingia, relieves jaundice and torpid liver following intermittent fever (B.). Dulcamara, employed with advantage (P.). Iris, in malarial jaundice and that from duodenal catarrh (B.). Alkaline Mineral Waters, especially in catarrh of duodenum or biie-ducts (B.). Potassium Salts. The Chlorate in chronic or asthenic jaundice. The Sulphate the most useful saline purgative in jaundice (Wa.). Aliment. No starches or fats. Milk, eggs, oysters, beef broth, broiled or raw beefsteak, or whitefish (B.). Plenty of green vegetables at each meal, use cold water freely, avoid all high seasoning in food, and all liquors. [Compare Hepatic Cirrhosis, Hepatic Diseases, Calculi.] Joint Affections. Aconite, for pains in inflamed joints (R.); the liniment locally in chronic arthritic swellings (Wa.). Mercury, the oleate in chronic inflammation of the knee (R.). Diluted Ung. Hydrarg. Ammoniat. 3j to 3iv at first, then 3j to 3j, by gentle friction 2 or 3 times daily, in chronic articular inflammations by far the best application (P.). Rhus Toxicodendron, internally and as lotion, is invaluable for subacute stiffness and aching of joints after acute rheumatic fever (P.). Iodine, giij-vj ad glycerini 3iij, aq. destil. in numerous ob- stinate cases of joint affections consequent on rheumatism (Wa.). Ferric Iodide, with Iodine locally, in scrofulous affections of the bones and joints (Wa.). Iodoform has been used with satisfactory results in scrofulous affections of the joints and bones by many continental authorities (Wa.). Salicylic Acid, 3j with giv of Lanolin, and 01. Olivse, q.s. to make a paste, applied locally and covered with cotton, or rubbed in once daily for 3 or 4 days, then omitted for a week, and again renewed, is of proven value in many obstinate cases of stiff knees, pains from so-called rheumatism, painful ankle and wrist-joints, etc. (Aulde). Arsenic, often serviceable in rheumatoid arthritis and nodosity of joints. Large doses continued necessary (R.). Alcohol, and water, equal parts, an excellent evaporating lotion (B.). Silver Nitrate, a strong solution in nitrous ether is the most efficient application to check inflammation in small joints if applied early to adjacent vascular parts (B.). Cod-liver Oil, in strumous subjects (R.): the remedy on which most reliance may be placed in scrofulous joint affections (Wa.). Cold Douche, Galvanism, Turkish Baths, for stiff joints (R.). Digitalis, as fomentation, 3] of tincture to 0% boiling water, applied on flannel, has proved very efficient in acute inflammations of joints (Fairbank). KERATITIS LABOR. 603 Turpentine, the liniment a serviceable application in chronic enlargement of the joints (Wa.). Sulphuric Acid, as irritant ointment, 3j of acid to of lard, very beneficial in chronic diseases of joints (Wa.). [Compare Bursitis, Cox- algia, Gout, Rheumatic Arthritis, Rheumatism, Synovitis.] Keratitis. Atropine, renders great service by contracting vessels (B.). Atropine by instillation, with enforced disuse, and a protective bandage, should be regarded as measures of course (C.). Mercuric and ferric perchlorides, with cod-liver oil, will accomplish all that medicine can do for interstitial keratitis in syphilitic subjects (C.). Calcium Sulphide, proves most useful in doses of gr. T\y to thrice daily, in sugar-of-milk trituration (Snell). Arsenic, Potassium Iodide or Bromide, Iron or Quinine, for constitutional effects in vascular keratitis. Also counter-irritation by iodine painted on the temples till soreness (C.). Ferric Perchloride, successfully employed in panniform keratitis. A large drop of the solution dropped from a quill every second or third day (Wa.). Eserine, lowers intra-ocular tension (B.). Astringents or Irritants (as alcohol in any form, zinc sulphate, silver nitrate, etc.), are entirely inadmissible (C.). Iridectomy, is often beneficial in severe vascular keratitis (C.). Pressure-Bandage, in severe sup- purative forms, limits extent. Water, cold when inflammatory symptoms marked: hot (90-100° F.) in non-inflammatory form, to excite inflammatory reaction ; should be discontinued when marked injection. [Compare Corneal Opacities.] Prescription. R. Hydrarg. Chlor. Corr., . . gr. j. Ammonii Chloridi, . . . gr. vj. Tinct. Belladonnse, . . . ij. Aquae Destillatae, .... 3 viij. M. et fiat, collyrium. Sig.—A teasp. in a winegl. of tepid water, to be applied frequently with a pledget of lint on the closed lids. In phlyctenular keratitis of children. ( Turnbull.) Labor. Ergot, when uterine inertia, after the first stage passed. Is dangerous if any obstacle in front. Danger to child in paralysis of foetal heart (B.). Is best given when head has passed the brim of pelvis (Wa.). Anaesthetics, in pro- tracted and painful labor; cautiously with primiparae (B.); increase the risk of post-partum hemorrhage (W.). Chloroform, not to complete anaesthesia, lest uterine action be interrupted. Usually begin when os is dilated (Simpson). Chloral, of great value to relieve pain ; does not interfere with the exhibition of chloroform ; should be given in 15-grain doses every till effect pro- duced (Wa.) ; the best of all remedies for rigid, undilatable cervix, gr. xv every 20 minutes for 3 doses, perhaps a 4th after an hour’s interval (Playfair). Ethyl Bromide, a rapid, sure and safe anaesthetic, particularly suited to labor cases (Levis). Opium, facilitates dilatation, promotes expulsive power of uterus, lessens hemorrhage, stimulates longitudinal and oblique fibres of the os (Wa.). Cimicifuga, exercises special action, similar to that of ergot; is less dangerous to life of child and soft parts of mother (Wa.); for mental disturbance and suppressed lochia (R.); as partus accelerator in lieu of ergot, also to allay ner- vous excitement after labor, and to check post-partum hemorrhage (P.). Opium, a full dose of Morphine, gr. in tedious labors with severe pains, will aid patient greatly and promote progress of the child. No bad results ensue. Morphine, for relief of pains and after-pains, or painful complications (Wa.). Hypodermically in rigid os and cervix (R.). Belladonna, topically to uterus, of great service in long-protracted labors from rigidity of os and cervix (H.). Gelsemium, quiets the “ nagging ” pains of the first stage; requires physiologi- cal doses (B.) ; relaxes spasm in rigidity of the os (Wa.). Quinine, to strengthen uterine contractions ; used by many in place of ergot (R.). Cannabis Indica, the tincture gtt. xxx, as stimulant to uterine contractions, more prompt, less lasting, than ergot (Wa.). Ipecacuanha, after delivery ; to promote natural 604 LACTATION LARYNGISMUS STRIDULUS. functions (R.). Cotton-root, as excitant of uterine contractions may be more energetic than ergot (P.). Althaea, the decoction, as vaginal injection in diffi- cult labor (P.). Sodium Borate, excites activity of the uterus, and is well em- ployed in tedious labor, where there is deficiency of uterine contraction (Rigby). Amyl Nitrite, has acted admirably in a case of hour-glass contraction of the uterus ; seems to antagonize the action of ergot (Barnes). Oil of Eucalyptus is very valuable in effecting antiseptic midwifery (Wa.). Mercury. The bichloride, gr. vijss to a quart of hot water gives a 2 0 solution, probably the worst of all antiseptics for this purpose: is too dangerous for obstetrical use (Fleischman). [Compare Abortion, After-pains, False Pains, Hemor- rhage Post-partum, Lactation, Puerperal Convulsions,—Mania,— Fever,—Disorders.] Lactation. Pilocarpine, as a galactagogue, gr. of the muriate in brandy on retiring, the patient to be covered well in bed. Is efficient in direct proportion to its diaphoretic and sialagogue effects, these being evanescent, but its galactagogue power remaining for weeks, an occasional dose only being required to spur up the secretion when flagging (Minges). Belladonna, internally or externally or both in excessive lactation (R.). Atropine gr. aquae rosae on lint around the breast to arrest secretion of milk. Remove when fauces become dry and pupils dilated (B.). Camphor, locally to arrest the secretion ; a saturated solu- tion in olive oil or glycerin, is more efficient than belladonna (Wa.). Potassium Iodide, in 25 to 30-grain doses internally, for the same purpose, is very effectual (Rousset). Calcium Phosphate and Hypophosphite, in debility from over-lacta- tion (R., Wa.). Ammonium Chloride, for the intercostal neuralgia of suckling women; gr. x-xx, every 3 or 4 hours (Wa.). Quinine, Tannin, are used to arrest the secretion (R.). Alcohol, as beer or porter, often useful in excessive lactation—not always (R.). [Compare Abscess, Agalactia, Mastitis, Nip- ples, also the List of Galactagogues on page 49, ante.] Excreted in the milk, when taken by the nursing woman, are the oils of anise, cumin, dill, wormwood and garlic,—turpentine, copaiba,—the active principles of rhubarb, senna, scammony, and castor-oil,—opium, iodine, indigo, antimony, arsenic, bismuth, iron, lead, mercury, and zinc. Acids given to the mother cause griping in the child. Natural salts, as a rule, and the purgative agents above-named, act as purgatives to the child, and potassium salts as diuretics. Turpentine, copaiba and potassium iodide given to the mother, can be detected in the urine of the child. Opium given to the mother may narcot- ize the child, and mercurials in the same manner may salivate it (Br.). Atro- pine, hyoscyamine, the salicylates, and potassium sulphide, have also been found in the milk after their ingestion by the woman. R. Tinct. Aconiti, rt^xx. Antira. et Potass. Tart., . gr. ij. Spt. Etheris Nitrosi, Syr. Simplicis, . . . . aa 5j. Aquae Aurantii Flor., . . M. Prescription for Milk-Fever. Sig.—A teaspoonful in a wineglassful of sweetened water, every two hours. (Fordyce Barker.') Laryngismus Stridulus. Aconite, checks the spasm and relieves the croupous breathing (R.). Bella- donna, promises to be of value (Wa.). Atropine, gr. in a goblet of water (60 doses), of which give a teasp. every hour or will give prompt relief (A. A. Smith). Bromides, when uncomplicated except with convulsions (R.). Full doses will suspend an attack, and moderate doses steadily contin- ued, will prevent recurrence (B.). Ipecacuanha, an emetic dose to cut short an attack (B.). Lobelia, has been employed (R.). Chloroform, quickly cures LARYNGITIS. 605 the paroxysm, a few drops on a handkerchief sufficient (B.); may often be used with advantage (W.). Nitroglycerin, will speedily allay the spasm (B.). Chloral, gr. v-xv to prevent or arrest (B.). Quinine, given between attacks to prevent (B.); a most valuable remedy, but in small, repeated doses (P.). Emetics. Tartar emetic; mercuric sulphate (gr. iij-v) safer and better (B.). Conium, is valuable, carried to a point of physiological effect (B.). Water, wet pack to neck (B.) ; cold sponging twice or thrice daily more successful than anything else, with out-of-door exercise. Cautiously if hoarse voice indicates laryngitis (R.). [Compare Croup, Laryngitis.] Aconite, very valuable (R.); especially indicated in inflammatory states of respiratory parts; gtt. ss-j every half-hour till an impression is made on the fever, then every hour or two (B.). Antimony. Tartar emetic, gr. -£=$, a very excellent remedy internally; larger doses in cedematous laryngitis, gr. T\- with gr. iij of Dover’s powder every 2 or 3 hours (Da Costa). Iodine, inhaled; also as counter-irritant painted over neck (B.). Morphine, small doses to allay cough (A.). Sulphurous Acid Spray, is vaunted (Wa.). Leeches to throat are valuable auxiliaries to general treatment in sthenic cases; or cupping at the nape of the neck(Wa.). Rumex, has selective action on the laryngeal mucous membrane. See page 345. Zinc or Copper Sulphates, as emetics, in large quantities of warm water, where oedema slight (A.) ; a solution of zinc sulphate, gr. xx to §j on sponge to larynx with aid of the laryngoscope if possible to use it (Da C.). Scarification, by Mackenzie’s laryngeal lancet, of great service in the cedematous form (Da C.). A Purgative and Diaphoretic, with mucilagi- nous drinks, if given at the start may be sufficient (Da C.). Iron, Monsel’s solution, 1 part to 2 or 3 of water and glycerin, an excellent local application (Da C.). Heat, by poultices or fomentations (A.). Hot-water stupes may succeed (Wa.). Inhalations of hot steam, with benzoin, the comp, tinct. gtt. x-xv to j|j, with gtt. x tinct. opii, or hops, or conium, of great service (DaC.). Tracheotomy ought not to be delayed, if inhalations, leeches, and fomenta- tions fail (A., Wa.): is especially indicated in sudden attacks of cedematous laryngitis, as those occurring in Bright’s disease (Da C.). Ice, steadily applied in bags over the larynx, if tracheotomy refused, has succeeded in bad cases. Small pieces may be slowly swallowed (Da C.). [For Croupous Laryngitis, see Croup, Membranous ; for Spasmodic Laryngitis, see Croup, Catarrhal; for (Edematous Laryngitis, see Glottis, (Edema. Compare also Laryngis- mus Stridulus, Pharyngitis.] Laryngitis, Acute Catarrhal. Iodine, painted over neck as a counter-irritant, and inhalation of its vapor (B.). Sulphur. Sulphurous acid as spray in syphilitic or tubercular laryn- gitis, or a solution of sodium sulphite (3j to the oz.) in water (B.); by inha- lation, spray, or fumigation (R.). Carbolic Acid, where long-standing hyper- aemia with diminished secretion, 3j~ij to the 3 of glycerin is a most successful application (Morell Mackenzie). Silver Nitrate, powdered or in solution to chronically inflamed larynx, as in phthisis (R.); a solution of gr. x or xx ad §j, applied with a brush by the aid of the laryngoscopic mirror (W.). Form- erly much used, but is objectionable (B.). Should be used with great caution, and only when a particular point can be seen for it with the laryngoscope (Da C.). Ferric Perchloride, solution gr. lx-cxx ad §j glycerini as local applica- tion (A.). Zinc Chloride, gr. xx-xxx ad sj,in glycerin. Alternation of topical applications, of great value (A.). Copper Sulphate, gr. xx to §j of water, locally twice a week (Da C.). Bismuth, the sub-nitrate by insufflation, is highly recommended in the worst forms of laryngitis, even in that accompanying phthisis (Tr., Wa.). Guaiacum, as lozenges, very useful in mucous laryngitis (A.). Althaea, as pectoral lozenges to relieve laryngeal irritation (P.). Cubebs, the berries chewed are very efficient in relaxation of the larynx following a Laryngitis, Chronic. 606 LARYNGOTOMY LEPROSY LEUCOCYTHSEMIA. cold or long speaking (Wa.). Cocaine, a 20 per cent, solution of the hydro- chlorate by spray, mop, or brush, is very efficient in many laryngeal affections (Prosser James). Benzoin, in strumous laryngitis (Wa.) ; in chronic, benzoin on hot coals, or inhaled from boiling water, of great service (Tr.). Tannin, in chronic catarrh and ulcerations, a solution (gr. applied by hand-ball or steam atomizer (B., A.). Inhalations, or spray, of the best agents very grateful (B.); air loaded with vapors of ammonium muriate by inhaler, said to be used successfully (W.); vapors from boiling tar, turpentine, etc., placed on hot water, or better by steam atomizer (Da C.); chloroform, hops, benzoin, etc., by atomization (Walker). Insufflation, substances to be in small quantity, mixed with bland powder (B.). Functional Rest of voice often requisite, especi- ally in phthisical and syphilitic laryngeal ulceration (A.). Chronic Laryngitis includes many disorders of the larynx, which of late years have been differ- entiated, as—thickened vocal cords (chronic laryngitis proper), laryngeal ulcers, polypi, cysts, cauliflower growths, tubercular and syphilitic laryngitis, etc., in all the voice being similarly affected. Dysphagia, as a concomitant symptom, is constantly indicative of tubercular laryngitis (Da Costa). [Compare COUGH, Phthisis, Syphilis, Dysphagia.] Laryngotomy. Laryngotomy is more quickly and easily performed on the adult than trache- otomy, being farther from the lungs and less dangerous. It is usually directed to be performed by cutting longitudinally through the skin, then horizontally through the crico-thyroid membrane, which may be felt as a soft depression, an inch below the pomum Adami. In urgent cases, however, Prof. Wood recommends a narrow-bladed knife to be passed horizontally through both skin and membrane at once, and then to enlarge the opening laterally to the required extent. The advantage of having a horizontal incision in the skin is the greater openness of the wound when the patient throws up his head under a sense of dyspnoea (D.). In Laryngo-Tracheotomy, the deep incision is car- ried downwards from the crico-thyroid membrane, through the cricoid cartilage and one or two of the upper rings of the trachea (Cl.). Leprosy. Anacardium Orientale (Oil of Cashew), has been much lauded. Investiga- tion established that much of its success was due to hygienic measures and use of fresh meat as food (P.). Arsenic, with 5 or 6 times the quantity of black pepper, in esteem in India (Wa.). Sarsaparilla, as tonic and alterative, valu- able (P.). Gurjun (Wood Oil), as ointment and emulsion, has been used with success in alleviating the disease, by Dr. Dougall, Port Blair, Andaman Islands. The ulcers of 24 lepers healed thereby. Ferri Arsenias, gr. daily, is used with success (Wa.). Mercury, the oint. of the red iodide, diluted 1 to 10, or gr. j of the salt to 3v of unguentum, gives very good results (Wa.). Diet. Nutritious food, cleanliness, bath, will do much to prevent the manifestations of the disease (R.). Chaulmoogra Oil, see page 162, is credited with a few cures and many cases improved. The oil is mixed with Psoralea corylifolia as a liniment, and also used internally (Wa.). Hoang-Nan, is considered of utility by a number of writers on leprosy, and is given in combination with Alum 1, Realgar 2 or 1, and the drug 2 parts, the whole being made into 3-grain pills, one pill daily being given at first and gradually increased (Pf.). Argenti Nitras, is said to act as a tonic and alterative, and to control leprosy for a limited period (Pf.). Leucocythsemia. Alkaline Hypophosphites, have been used with more or less benefit (Wa.). Digitalis, in young subjects (B.). Nitro-muriatic Bath, should not be neglected, with tonics and nutrients (A.). Iron, is of little value (B.); large doses may do LEUCORRHOEA—LICHEN. 607 good in early stage, with careful diet, and Ergot to contract the spleen (Da Costa). Phosphorus, gr. increased to gr. 3*5, has proved successful in several cases (Wa.). Arsenic, in as full doses as can be borne, may be of service though hitherto ineffectual (Gowers). Galvanization of the spleen causes im- provement of the blood, increasing the number of its red corpuscles (Gowers); is curative in uncomplicated cases (B.). Leucorrhoea. Hydrastis, the fluid extract, undiluted topically, quickly improves in uterine and vaginal leucorrhoea (B.). Pulsatilla, 5-drop doses ter die for a few weeks ; also a teasp. in a pint of cold or tepid water, as vaginal enema daily, when pain in loins, depression of spirits, loss of appetite, etc. (P.). Silver Nitrate,, in solution locally, also tampon saturated with 3] each of alum and bismuth, when leucorrhoea due to granular vaginitis (Parvin). Balsam of Peru and Tolu, internally (P.). Glycerin, is largely prescribed for vaginal leucorrhoea, and for erosions and ulcerations of the cervix uteri (B.); the best vehicle for other agents (E.). Borax, 3} to Oj water as vaginal wash for the leucorrhoea of pregnancy (Parvin). Cimicifuga, is said to be useful (P.). Copaiba, has been used with success (P.). Cocculus Indicus, when sero-purulent discharge, pain in lumbar region (P.). Carbolic Acid, diluted, as injection (B.); for vaginal leucorrhoea (R.). Bismuth, with mucilage, as injection ; or with cocoa-butter as suppository (B.). Copper Sulphate, in solution, as injection (R.). Tannic Acid, in chronic cases serviceable as injection, gss of tannic acid in jfviij of claret wine (B.). If os ulcerated, a suppository of tannin and cocoa-butter to mouth of uterus (R.). Iodo-Tannin, an excellent application,, 3j of iodine to jfj of tannic acid, a sufficient quantity to be packed dry around the cervix (B.). Alum and Borax, makes a useful injection in vaginal leu- corrhcea (R.). Belladonna, with tannin as bolus where neuralgia or ulceration of os. When disease due to over-secretion of mucous glands about the os, and much pain present, inject sodii bicarbonas, 3j ; tinctura belladonnae, ; aquae, Oj (R.). Potassium or Sodium Bicarbonate, 3} to Oj aquae as injection, especially when discharge alkaline and copious (R.). Pareira, Uva Ursi, suc- cessfully used (P.). Sumbul, recommended in atonic form (P.). Myrrh, with iron or aloes, beneficial (P.). Ergot, said to be useful in some cases (R.). Potassium Permanganate, has no special advantage; is used in solution (gr. ij-gj (B.).* Potassium Chlorate, 3) to Oj of water as injection in simple cases (Parvin). Iron, the iodide, internally and externally has proven serviceable ; the mistura ferri composita, when anaemia and general debility (Wa.). The styptic preparations, locally (B.). Phosphates, for the cachexia (B.). The cal- cium phosphate, gr. j-ij several times daily, of great value in checking profuse discharge (Wa.). Injections, water at 6o° F. to prevent recurrence (R.). Hot water injections best tonic to pelvic vessels, to relieve venous congestion ; use with elevated hips (E.). [Compare Endometritis, Uterine Ulceration,. Vaginitis.] R. Aluminis, gj. Zinci Sulph., gss. Sodii Boratis, gr. iv. Aq. Rosse, gviij. M. Sig.—Injection. (B.) Prescriptions. R. Liq. Plumbi Subacet., ... 3 jss. Ac. Carbolici, M. Sig.—One-fourth to be added to a pint of water and used as an injection. Lichen. Aconite, sometimes useful (R.). Mercury, calomel and nitrate of mercury oint. mixed (also tar oint. added), in patches of obstinate lichen (R.). Silver Nitrate, the nitrous ether solution painted every day or two over patch (R.). Baths, warm or of sulphides (R.); sponging with alkaline lotions, diluted lead water, fluid extract of grindelia well diluted, or solution of copper sulphate,. 608 LITHAEMIA LOCOMOTOR ATAXIA. gr. x to the in miliaria, or prickly heat (lichen tropicus); with dusting pow- ders of lycopodium, zinc oxide or starch, singly or combined (Hughes). Potas- sium Citrate, or some other refrigerant diuretic, and light, unstimulating food (Da Costa). [Compare Eczema.] Lithaemia. Lithium Salts, especially the citrate, gr. xx thrice daily, is very efficient (Da Costa); the carbonate invaluable (Wa.).; the bromide, in solution of citrate of potassium, given after stomach digestion is completed, one of the very best agents (Aulde). Pichi, of great value in lithaemia with cystitis (Wyman). Arsenic, in small doses, is also useful- (Da C.). Nitric Acid, 10 minim doses of the dilute acid in half-glass of water thrice daily, with an occasional dose of pil. rhei compos, at bedtime, is the most efficient treatment for the class of patients who will not diet themselves (Hughes). Purgatives, especially alkaline mineral waters, to clear the portal system (Da C.). Sodium Phosphate, in laxa- tive doses, 3j thrice daily, gives good results. Alkalies, in biliousness; also the continued use of alkaline waters rich in potassium salts, for solution of calculi (B.). Acids, hydrochloric often of great service; also lactic acid, when faulty digestion and assimilation (Br.). Potassium Permanganate, prevents calculi by converting uric acid into urea (B.). Buchu, combined with an alkali, has been a beneficial remedy (P.). Colchicum, doses of the wine, twice or thrice daily; is very useful (Wa.). Chimaphila is believed to check the secretion of lithic acid (P.). Aliment, farinaceous vegetables and acid fruits are suitable (B.). Alcohol in any form is poison to a lithaemic (Da C.). Succu- lent vegetables and fruits, occasional abstinence from animal food. High living, alcoholic liquors, and sedentary habits are injurious. Milk diet, and frequent draughts of pure water also recommended. Removal to a locality where pure soft water can be procured, is often curative. [Compare Calculi, Dyspepsia, Gout.] R. Lithii Bromidi, 3 ss-j. Liq. Potas. Citrat., . . . g iy- Syrupi Simp., M. Sig.—A teasp. in a wineglassful or more of water, 2 hours after each meal. Reduce after a week. Prescriptions, R. Potas. Nitratis, zj. Ext. Pichi FL, 3). Elixir Simpl., i|iij. M. Sig.—A teasp. every 2 hours. R. Tinct. Belladon., . . . . rt\xviij. Vini Colchici Rad., . . . 3 ij. Liq. Potas. Citrat., . . ad Jiv. M. Sig.—A dessertsp. well diluted, every 3 hours. R. Vini Colchici Rad., . . . . g ij. Ext. Phytolaccse FL, . . . gj. Potas. Acetatis, Aquse, q. s. ad 3 vj. M. Sig.—A tablesp. four times daily. Locomotor Ataxia. Belladonna and Ergot are highly recommended by Brown-Sequard (R.). Silver Nitrate, when motor disturbances are very marked. Improved i in 20 (R.); gives the best results in doses of gr. X to gr. thrice daily, withholding it after a few weeks to prevent argyria. The Oxide may be used instead of the nitrate, in half-grain doses (Da Costa). Potassium Iodide, Corrosive Sublimate, or Chloride of Gold and Sodium, all in full doses, often retard the progress of the disease (Da C.). Physostigma has proved beneficial (R.). Phosphorus, use- ful, but may not cure (B.). Hyoscyamine, ameliorative, gr, gradually to gr. (B.). Electricity, galvanic, relieves pain ; faradic stops wasting of muscles (B.); in stage of irritation the constant current (ascending) through spinal column (R.). Water, one of the most efficient agents ; friction with a cloth dipped in water of 60-65° F., a cold compress to head; 4-8 minute bath of 70- LUMBAGO LUNG DISEASES. 609 750 gradually lowered to 6o°, then shower-bath, frictions (R.). Rest, as com- plete as possible, must be insisted on ; with good, nutritious diet, milk being desirable (Da C.). Pilocarpine produces general improvement if given in the incipiency, gr. j to of water, of which rr\,xxx twice daily (B.). Strychnine, gr. in 3) of syr. hypophosphitum, thrice daily, when the system is saturated with silver (Da C.). Suspension daily, by head, has seemed to give relief to pain and improve condition. Is known as Charcot’s treatment, but discovered by Matchoukowsky, of Odessa, and carried out systematically by Hessing, of Pesth, before Charcot took it up. Antipyrin, relieves the pains remarkably. Lumbago. Cimicifuga, said to be more effectual than any other remedy (R.); has some- times wonderful success; no indications can be given for it; 3ss-ij of fluid extract (B.). Curative (P.). Rhus Toxicodendron, in subacute muscular or tendin- ous rheumatism, worse at night; completely relieves some cases (Pf.). Veratrum Viride, the tincture useful (R.). Aconite in doses of tincture every two hours, with linim. aconiti locally (Wa.). Iodides, if referable to syphilis, mer- cury, copper, tin, or lead poisoning (B.). Ammonium Muriate, is very efficient in myalgic lumbago, gr. xx thrice daily for 2 days or until signs of congestion of the nasal mucous membrane appear,—then to be replaced by Quinine, gr. v, thrice daily for a week (Waugh). Antipyrine, gr. vij, hypodermically, completely banished it in a very bad case at the Hotel Dieu, Paris. Morphine, hypodermically to relieve pain (B., R.); gr. l/e with Atropine gr. hypoder- mically, will frequently cure lumbago in two or three hours (Da C.). Capsicum, a strong infusion applied on lint, and covered with oiled silk, very efficient in recent lumbago (R.); a capsicum plaster is a very efficient application. Potas- sium Nitrate, in ten-grain doses hourly or every two hours, when urine scanty and high-colored (R.). Belladonna, as plaster, very valuable for persistent lumbago remaining in a small spot (R.). Turpentine, in doses of rtFxx-xxx (carefully, lest strangury and nephritis), of greatest value when the bowels regular and urine clear and abundant (Wa.). Ether Spray, externally as freez- ing mixture (R.). Guarana, xv-xl-gr. doses removed severe chronic (Rawson). Chloroform Liniment, affords relief (Wa.). Canada Balsam, gr. v-xx, is useful or Burgundy Pitch, as plaster (P.). Acupuncture, occasionally gives instant relief (B.). Not when high fever (R.). Aquapuncture, has been employed with extraordinary success (B.). Heat, by hot douche to seat of pain (B.); or by very hot poultices for three hours, then the skin covered with flannel and oiled silk ; or a hot flat-iron (R.). Galvanism, the constant current (B.); is highly useful; faradization almost as successful as acupuncture (R.). Strap- ping from the thigh upwards with layers of adhesive plaster which overlap each other. Nothing is so instantaneously beneficial. Diet, should be generous and nutritive. Lemon-juice as a beverage. Absolute rest is of great importance. [Compare Rheumatism.] R. Collodii, Tinct. Iodi., Spt. Ammonise, aa part aeq. Sig.—Paint over the part with a camel’s- hair brush. (Burggraeve.) Prescriptions. R. Ext. Cimicif. FI., . . . . ?ij. Ammon. Chloridi, .... gj. Aq. Laurocerasi, Syr. Simplicis, . . aa , . §). M. Sig.—A teasp. thrice daily. (Potter.) Lung Diseases Aconite, is indicated in most acute congestions (P.); is especially indicated in inflammatory states of respiratory organs (R.); Belladonna, in n\, doses of the tincture frequently, is of great benefit in pulmonary oedema, to retard exu- dation of serum and to counteract the failure of the heart (A. A. Smith). Terebene, is very valuable in many conditions. Terpine Hydrate, is still more LUNGS, GANGRENE OF LUPUS. efficient and more easily administered. [See under Bronchitis.] Ammonium Acetate, serviceable not only in bronchitis, but in the whole range of acute pul- monary complaints as occurring in children (Dessau). See under Bronchitis, for formula. Veratrum Viride renders important service in acute parenchy- matous congestions (B.); gr. ye of resin in pill when temperature and pulse are high. It tends to induce prostration, collapse, etc. (A.). Blisters. Flying blisters to chest, and perhaps along pneumogastric nerves in hypostatic con- gestion (R.). Copaiba, exercises a powerful influence over the pulmonary mucous membrane, and is beneficial in lung diseases generally, when attended with excessive secretion (Wa.). Jaborandi, is serviceable for the attacks of breathlessness attendant on lung affections, but must be watched lest collapse ensue (Berkart). Liquor Potassae, in doses of rrLx-xv added to an ordinary expectorant mixture, is often attended with good results in congestions of bronchi and lungs, chronic bronchitis, plastic bronchitis, etc. (Walshe). Cimi- cifuga, is a useful sedative in many irritative affections of the lungs and bron- chial tubes, relieving cough, improving appetite, and ameliorating the general condition (Wood). Croton Oil, as liniment, is a highly useful counterirritant in many chronic lung diseases, and even in the bronchitis of infancy (Park). Cubebs, in small and oft-repeated doses, is efficient in chronic bronchitis and other lung affections of old persons, checking the excessive secretion and gently stimulat- ing the system (Wa.). [Compare Bronchitis, Emphysema, Hemoptysis, Phthisis, Pleuritis, Pleurodynia, Pneumonia.] Lungs, Gangrene of. Creasote, by inhalation, to obviate the fetor (R.). Carbolic Acid inhalations, are used with marked benefit (Wa.). Mineral Acids, especially nitro-hydro- chloric, with Quinine, the main reliances in chronic pulmonary gangrene (A.). Stimulants, as malt liquors, with general tonic treatment, are necessary (A.). Ammonium Carbonate, one of the most reliable remedies; is best given in decoctum cinchonas (Wa.). Eucalyptus, the oil with alcohol, equal parts of each, of which 3j as inhalation by steam atomization, is useful (Wa,). Turpen- tine, the spirit on boiling water inhaled for fifteen minutes every two hours, suc- cessfully employed (Skoda). [Compare Pneumonia, Phthisis.] Arsenic, in chronic cases, not of syphilitic origin (B.). Arsenious acid as caustic (R.). The best remedy in lupus of head and face (Wa,). The oleate of arsenic, in ulcerating forms, constantly applied, will destroy cell-infiltration in a mild and comparatively painless manner; is also well employed in the tubercular variety (Wa.). Iodine, useful, whether syphilitic or scrofulous ; the tinct. or a glycerin solution (B.); as tincture or liniment to edges and around (R.). Mercury, as ointments in erythematous lupus, calomel ointment in scrofulous and tubercular lupus of children (R.). Calomel int., gr. j-ij in- creased to iv, will quickly check (Wa.). Emplastrum hydrargyri very efficient in lupus erythematodes and allied affections (Kohn). Cod-liver Oil, internally and locally (B.). Lead, liq. plumbi, with one or two parts of glycerin, applied warm after removal of crusts, in milder forms (R.). Carbolic Acid, as a mild escharotic (B.). Zinc Sulphate, dried, as caustic, freely dusted over surface, and a poultice to remove slough (B.). Jequirity, a most useful application (Shoemaker). Sodium Ethylate on absorbent cotton, is the best of all caustics, followed by the Oleopalmitate of Bismuth as a soothing and astringent appli- cation (Shoemaker). Chromic Acid, an efficient local application, gr. aquae destil. (B.). Phosphorus, as substitute for arsenic (B.). Silver Nitrate, a weak solution gradually strengthened, in superficial forms (R.). Cauteriza- tion, with the actual cautery at white heat, after scraping out as much as possible of the diseased parts, so as to destroy the lupus cell. Seek to replace the lesion by a cicatrix, to prevent relapse in situ, and the development of the disease elsewhere. Internal remedies only useful for the general health. Lupus. LYMPHANGEITIS MALARIA. 611 Prescriptions, R. Iodi, Potassii Iodidi aa 3 ss. Glycerini 5jj. M. Sig.—Locally in Lupus. (McCatt Anderson.) R. Hydrargyri Bromidi, . . . gjss. Adipis, £v. M. ft. unguentum. Sig.—To cover the part affected, using cod-liver oil freely, and the following solution internally. In tuber- cular lupus of the face. (Hardy.) R. Ung. Arsenici Oleat., . . . gij. Ung. Simplicis, gj. M. ft. unguentum. Sig.—Use constantly over the affected surface. If pain sets in Opium may be added. (Shoemaker.) R. Potassii Iodidi, gr. Ixxv. Sodii Chloridi, ... . % ss. Aq. Destil., M. Sig.—Tablesp. before meals, night and morning. (Hardy.) Belladonna, the extract softened with glycerin, freely applied, is of great service ; when pain is severe, a poultice may be applied over the extract for a few hours only (Wa.). Lead, liq. plumbi subacet. dil.. as an external applica- tion, constantly applied, to soothe and restrain the inflammation (Wa.). Iodine, in strong tincture, around glands, to prevent suppuration (Roberts). Quinine, or Salicin, with alcoholic stimulants freely, in septic cases (Roberts). [Com- pare Bubo.] Lymphangeitis. Malaria, Chronic Quinine is less curative than when the infection is recent, but in periodical affections depending on the malarial cachexia it is of specific value, large doses being required (B.). Salicylates, of quinine and cinchonidine are especially effective in chronic malarial disease (B.). Arsenic plays an important role in chronic malarial disease (B.); diminishes splenic engorgement, and com- bined with iron is rapidly curative of many affections due to the paludal miasm (Boudin); is a powerful prophylactic against malaria, and in chronic malarial poisoning, with frequent return of fever and neuralgia, the continued use of arsenic is of great benefit (Fayrer). Iron, the sulphate has decided antiperiodic power, and is particularly successful in anaemic subjects and in those with enlargement of the spleen (Wa.); it improves the anaemia of chronic malaria, and should generally be combined with arsenic (B.). Iodide of Iron and Manganese, the syrup in doses of TT\,xx-xxx, js a successful remedy for chronic malarial infection, and the Sulphate of Manganese gives excellent re- sults in jaundice of malarial origin (B.). Cornus, Calumba, and other bitters, are highly efficient, especially the first-named, in chronic malarial poisoning, and in convalescence after malarial fever (B.). Carbolic Acid and Iodine com- bined are of great value in chronic malarial infection ; both are highly anti- periodic, and the latter is the best substitute for quinine and the most active reducer of splenic enlargement (Gimwell). Eucalyptus is of high utility to reconstruct the damages in the organs of assimilation (B.). Baths, the vapor- bath and Turkish baths are efficient aids to medicinal treatment in breaking up chronic cases, and may of themselves cure such by inducing profuse perspira- tion (Da Costa). [Compare Intermittent Fever, Remittent Fever.] Prescriptions. R. Cinchonidinae Salicylat., . £ij. Ac. Arseniosi, gr. j. Ferri Sulph. Exsiccat., . . gr. xx. M. ft. cachets no. xx. Sig.—One wafer thrice daily. R. Quininae Sulph., gr. xl. Ferri Sulph. Exsic., . . . gr. xx. Ac. Arseniosi, gr. j. M. ft. pil. no. xx. Sig.—One pill thrice daily. MANIA MASTITIS. R. Cornus, Calumbse, Liriodendri, Pruni Virgin., . . . . aa § vj. Eupatorii, Capsici, . aa % iv. Pulv. et misce. Sig.—A teasp. in cold or warm water, three or four times daily. A good tonic tincture may be made from the above combination. (B.) R. Tinct. Iodi, ....... g ij. Ac. Carbolici, %j. M. Sig.—Two to three drops three or four times a day in water. R . Ac. Arseniosi gr. j. Mas. Ferri Carb., .... M. ft. pil. no. xx. Sig.—One pill thrice daily. Mania Stramonium, of value ; allays irritation and induces tranquil sleep ; wild and furious delirium, but intermittent; also in nymphomania (P.). Many facts seem to confirm its reported value (Tr.). Daturine, gr. hypodermically in acute mania, but is less useful than atropine or hyoscyamine (Wa.). Duboi- sine, gr. -fa hypodermically in acute mania (Gubler.) Belladonna, is useful, especially in monomania, with fixed hallucinations, though a large dose causes a temporary insanity (Tr.); one of the very best remedies in all hyperasmic conditions of the brain (P.). Hyoscyamus, in violent intermittent forms, to procure sleep and calm violent delirium (R.); delirium with hallucinations but not congestion ; milder and less inflammatory forms ; also in hypochondriacal monomania (P.). Veratrum Viride, successfully combats the excitement in acute mania (B.). Camphor, has been used successfully ; its action is uncer- tain (P.). Opium, and tartar emetic are satisfactory for many cases; also mor- phine hypodermically to induce sleep (R.); narcotic effect of doubtful utility; better in insanity with depression (P.); will not produce narcotism in many cases, even in 2-grain doses. Cannabis Indica, 3} of tinct. with 3j of potas- sium bromide, is recommended (R.). Bromides are used in puerperal mania, that of pregnancy, nymphomania and other forms (R.). The combined use of potassium bromide and tinct. of cannabis indica, in equal parts, 3j of each thrice daily for weeks and months, has proved very efficient in acute and peri- odical mania, senile mania, and other forms (Clouston). Chloral, as calma- tive, hypnotic, has induced mental improvement, gr. v-xx (B.). Coniine, most suitable to acute mania, quiets muscular action 0T/4-iij,'or hypoder., com- mencing with n\,T\f). Very successful with morphine conjointly injected (B., R.). Digitalis, gss-Jj of tinct., valuable in acute and chronic mania, espe- cially when complicated with general paresis and epilepsy (Maudsley). Cau- tion ! watch the pulse for any marked intermittence (B.). A very valuable palliative in acute mania (Van der Kolk). Ergot, large doses, 3ss-j of fluid extract, to reduce excitement, shorten attacks, widen intervals between them, and prevent exhaustion, hence is very useful in recurrent and epileptic forms, and in chronic mania with lucid intervals (Crichton Browne). Iron, as a resto- rative, is frequently used in chronic mania with benefit, the tincture of the chlo- ride in 5-10 minim doses (B.). Gelsemium, is more useful than conium in mania with great motor excitement and wakefulness; large doses required, ttlxv-xx of tincture. Croton Oil, as a purgative, every hour, as revul- sive in mania from cerebral congestion (R.). Cimicifuga, is often efficiently used in cases of mania occurring during the puerperal or pregnant condition (R.). Galvanism, of the head and cervical sympathetic, has produced distinct improvement (B.). Paraldehyde, as a hypnotic, in doses of Trpxxx-1, is often decidedly useful (R.). Cold Douche, in maniacal delirium, the patient being in a warm bath during the application of the douche to the head (R.). Re- moval from home, from sympathetic friends, and from surroundings connected with the origin of the malady, is a prime necessity to a cure. [Compare De- lirium, Puerperal Mania.] Mastitis. Belladonna, Atropine locally (see Lactation), or combined with morphine and chloral, when much pain (B.). Especially as liniment to check secretion MASTODYNIA—MEASLES. 613 of milk when inflammation is imminent (R.); or when distended by milk (P.). When inflammation has set in, continuous application of Belladonna for 24 hours often arrests it. It is also useful when an abscess has formed. Fomen- tations useful in addition, but skin must be dried well before the belladonna is rubbed in (R.) ; of tinct. internally as well (P.). Camphor, a saturated solution in glycerin, locally, in mammary congestion threatening abscess (Wa.). Phytolacca, has power to arrest inflammation of the mammae and to prevent suppuration; the fluid extract in 10-minim doses internally, and the solid extract on a cloth to the inflamed breast (B.). Conium, the extract in small doses several times a day, of striking benefit in mastitis and impending abscess of breast (Wa.). Calcium Sulphide, internally in abscess, occasionally increases pain (R.). Hyoscyamus, as plaster, to relieve painful distention from milk (P.). Stramonium, fresh leaves as cataplasm to discuss indurated milk (P.). Iodine, tinct. and ointments to remove indurations of breasts after inflam- mation (B.). Mercury and Morphine, the oleate locally in mammary abscess (R.). Tobacco, leaves as poultice in abscess (R.). Digitalis, the infusion locally as fomentation in severe inflammation of the breasts, causes it to yield speedily (Fairbank). Ammonium Chloride, £j ad Oj spt. rosmarini, as lotion on linen rags, kept constantly to the part, especially in induration, after abscess has suppurated (Wa.). Tartar Emetic, in small and frequent doses, given early, is beneficial (Wa.). Oil frictions in first stage of inflammation of breasts, from circumference toward the nipple (L.). Rest, by supporting mammae with strips of plaster, and bandaging the arm to the side, to prevent motion (T.). Sponging, with alcohol (over proof) until part is cold; renewed if heat return. Heat, applied by a basin lined with flannel saturated with hot water, to relieve pain and prevent suppuration. [Compare Abscess, Lactation.] Mastodynia. Dr. Tanner advises non-interference in simple cases of enlargement and tenderness, which will spontaneously subside if let alone. In severe cases sup- port by strips or bandage, if breast pendulous; belladonna ointment or lini- ments ; amputation of mamma has been necessary. Conium, has specific anodyne action on the mammae and generative organs. Cimicifuga, relieves infra-mammary pains of uterine origin in spinsters. Olive Oil, 2 parts, to 1 of tinct. opii, may be used by gentle friction to painful breasts after parturition (Parvin). Aconite, for febrile symptoms, and especially to arrest the catarrhal pneu- monia (R.); a valuable remedy (P.); the best drug when fever is very high,. %-drop doses of the tincture every 2 hours (Da Costa). Jaborandi, with a hot bath, as diaphoretics, in cases of delayed eruption (Da C.). Asclepias, an infusion or decoction freely as a diaphoretic, to promote the eruption (W.). Veratrum Viride, has been employed (R.). Pulsatilla, for the catarrhal oph- thalmia, nasal and intestinal catarrh; 3j-ij of tincture to water as wash (P.). Ammonium Carbonate, dissolved in a solution of the acetate, is much vaunted. When feeble circulation, cyanosis, delirium, gr. v-x to 5ss-,§j liq. ammonii acetatis (B.); gr. iij-vj or vij, every hour or two, in cinnamon-water or milk; one of the reliable remedies (W.). Camphor, the mixture, with liq. ammon. acetatis, excellent when cough and catarrh the most urgent symp- toms (A.). Ipecacuanha, for cough and catarrh, gr. j-ij every 4 or 6 hours (A.). Antimony, preferred to ipecac by some (A.). Quinine, in small doses for the adynamia (gr. j-iij), or large (gr. xv) for hyperpyrexia, and catarrhal pneumo- nia, etc. (B.). Carbolic Acid, has been employed in several hundred cases with decided advantage; most useful at early stage (Wa.). Cod-liver Oil and Iron, to scrofulous children, a long course of such medication after convalescence (Da C.). Purgatives, must be given with caution (R.); the milder purging salts, as magnesium sulphate, to be preferred (A.). Mustard, as bath on sudden retro- cession of rash (R.); often increases the fever without benefiting the pneumonia Measles. 614 MELANCHOLIA MENINGITIS. and other complications (A.). Water, cold affusion at commencement; pack- ing, especially when retrocedent (R.); hot foot-baths for convulsions (A.); tepid bath with cold douche to head, if cerebral symptoms are severe (Da C.). Oil Inunctions, cocoa-butter very grateful, and reduces temperature. Also in roseola (B.). Hands and feet to be rubbed with a firm fat to remove heat and tightness produced by rash (R.). Aliment, low diet and slops; no animal food during whole course (A.). Hygiene, dark room, complete disuse of eyes, strict cleanliness (A.). [For Sequelae see Bronchitis, Cough, Ophthalmia, Otor- rhcea, Pneumonia, etc.] Prescriptions. R. Ac. Carbolici, Ac. Acetici, aa gj-^jss. Tinct. Opii Deod., . . . %j. Spt. Chloroformi, . . . . gj. Aquae, q. s. ad viij. M. Sig.—A tablespoonful every 4 hours, until fever abates. (Keith.) R. Tinct. Tolutanse, . . . . 3 ij. Syr. Senegse, ss. Ac. Acetici, 0-!ss‘ Syr. Pruni Virg ad % iv. M. Sig.—A teaspoonful as required for cough after convalescence. Melancholia. Aurum, gives excellent results; gr. to of chloride ter die, especially when cerebral anaemia coexists (B.). Bromides, sometimes afford relief which no other agent will; no indications (B.). Potassium Bromide for townspeople, especially women with unendurable despondency (R.). Cocaine, a useful tonic, especially beneficial in nervous affections accompanied by depression (Br.). Cimicifuga, in puerperal or uterine despondency, of singular value (P.). Ig- natia, has soothing effect in great mental depression (P.). Arsenic, in melan- choly of aged persons gives great comfort. Best with small doses of opium. Fowler’s solution, gtt. ij; tinctura opii, gt. iij-v, ter die (B.). Opium, in stimulant doses of tincture, gives good effects (B.); especially when paroxysms of acute anguish and despair, or when suicidal impulse (Wa.). Morphine hypodermi- cally is of great benefit in some persons who have a peculiar idiosyncrasy therefor (R.). Camphor has been highly recommended (R.). Musk and Castoreum are employed in melancholia with benefit (R.). Cannabis Indica, sometimes relieves (B.). Phosphorus, depression from over-work (R.). Chloral, as hypnotic, has been followed by marked amelioration and cure (Wa.). Valerian, in hysterical or suicidal melancholia, is often beneficial (Wa.). Caffeine has been useful (B.). Iron, as restorative. Tincture of chloride (B.). Water-cure, shower-bath, 15-20 seconds, or warm-bath, 950 Fah. for 30 min- utes ; the shower or cold douche may be usefully employed in certain cases where reaction takes place after it (Wa.). [Compare Hypochondriasis, Hysteria.] Meningitis, Cerebral. Aconite; is as serviceable in this as in the other acute inflammations; during the stage of excitation, the tincture, gtt. ij with gtt. v of deodorized tincture of opium, every 2 hours, gives admirable results (B.). Belladonna, in all hyperaemic conditions of brain and spinal cord one of the very best remedies, especially during the period of excitement (P.). Hyoscyamus, valuable in sub- acute form (P.) ; for nervous irritability during convalescence (A.). Gelsemium, extremely useful; rr\,v of fluid extract every 2 hours (B.). Mercury, as ointment gives good results in children (A.); Calomel in small, frequent doses, so as to bring the system under it quickly, a most valuable remedy apart from its purga- tive effects (Wa.). Potassium Iodide, has cured (Niemeyer), especially valuable in the tubercular form (B.). Ergot, the fluid extract in 3ss doses, with ->ss of potassium bromide, every 4 hours, to diminish the vascular excitement (B.). Potassium Bromide, in the convulsions following simple meningitis (R.). Opium, in small doses; by clinical evidence proved to be the best treatment, especially for the acute stage before exudation, or during the stage of excitation (B.). MENINGITIS. 615 When collapse, may sustain powers of life ; with tartar emetic has proved most beneficial, but should be used with great caution, as it may do great harm (Wa.). Bryonia, exceedingly valuable for serous inflammations in stage of effusion (P.). Pulsatilla, valuable in the acute form (B.). Purgatives, as soon as possible, unless exhaustion. Calomel and jalap the most active and search- ing (A.). Croton oil as a derivative and revulsive ; also locally to the shaven scalp, productive of the best results in tubercular meningitis (Wa.). Venesection, or arteriotomy (temporal artery) gives good results (B.); when high cerebral excitement and vascular action (A.). Blisters, on nape of neck if coma, after active symptoms are subdued (A.). Water. Cold water for hyperpyrexia (C.); pounded ice in bag or bladder, as a cap to the head (R.). [Compare Hydrocephalus.] Opium, no remedy so effective in small doses. Utility ends when effusion, stupor, and coma ensue (B.); large doses (Valleix), gr. j every hour in very severe cases (S.); has been used in France and Germany with much success (Tr.); is the best remedy of all, gr. j every hour for 4 days ; even such doses will not narcotize (Da Costa). Aconite, useful combined with opium (B.) ; affects the cranio-spinal axis from 3d nerve to phrenics, the region where this disease is most manifest (Harley). Gelsemium, extremely valuable, ttlv of fluid extract every 2 hours, to maintain constant physiological effect (B.); efficient for the delirium. Belladonna, in all hypersemic conditions of brain and spinal cord, especially during stage of excitement (P.). Iron, the tincture of the chloride, in 20-30 minim doses, every 2 hours, suggested by the simi- larity of the disease to erysipelas, has made many successful cures without leaving any sequelae (Klapp). Bromides to guard the opium and enable the latter to be pushed, 20-grain doses every 4 hours (Da C.). Hydrocyanic Acid, dilute, TT\j-ij, with gr. iij-v of sodium bicarbonate, every 3 or 4 hours, for severe vomiting (Delafield). Quinine in large doses at the commencement (B.); has been exhaustively tried in this disease and failed (Da C.). Potassium Iodide for the sequelae, a long course of iodides during convalescence is the best treatment (Da C.). Cold to the spine, the most satisfactory treatment (Radclifife); to head and upper spine for 5 minutes only at a time, for the headache and tetanic symptoms (Da Costa). Venesection, or arteriotomy (temporal artery), probably of service, but cautiously (B.); leeches at back of neck and on temples, to relieve the terrible headache, if patient is strong and vigorous (Da C.). Digitalis, in early stage (Rummel). Ergot, one of the best remedies (B.). Turpentine, enema, as derivative (B.). Stimulants, in small quantities (A.). Counter-irritation, by actual cautery freely applied to back, alleviates pain (A.). Water, cold baths or wet pack for hyperpyrexia; warm bath in uraemia (B.); hot-water bottles or sand-bags to trunk and extremities to keep up warmth. Bath of 102-106° for short time only, then wrapped in blankets (A.). Heat to the body, except the head and neck (Da C.). Aliment, nutritious and suitable food at short intervals, day and night (A.); tonics with fresh air and good diet during convalescence (A.). Ventilation, of dwellings, the best sanitary precaution when the disease is epidemic (Simon). Meningitis, Cerebro-Spinal. Prescriptions, R. Morphinse Sulph., . . . . gr. ss. Ac. Sulph. Aromat., . . . gj. Tinct. Cinchonae Co., . ad gvj. M. Sig.—Tablesp. every 2 hours, for a boy of 12 years old. (Meigs Pepper.) R. Potass. Iodidi, g iv. Tinct. Gentian. Conap., Syr. Sarsse Co., aa g ij. M. Sig.—Teasp. thrice daily, to pro- mote absorption during convalescence. Meningitis, Spinal. Aconite, is very useful (B.); with Ergot and an Opium impression to reduce the amount of blood in the vessels of the cord (Da Costa). Potassium Iodide MENORRHAGIA. see below. In the chronic form, with the bichloride of mercury when a specific history present (Hammond). Belladonna, strongly to be relied on, even when brought on by external violence (P.). Bryonia, in serous inflammations, when effusion, is extremely valuable (P.). Purging, by magnesium sulphate, combined with tinct. hyoscyami (A.). Quinine, when paralysis occurs, in 3-grain doses thrice daily, with % -grain doses of extract, belladonnas, or 20-30 grain doses of potas- sium iodide, and flying blisters along the spine (Da Costa). Opium, in some form must be used for pain (Bastian). Mercury, gr. of the bichloride, with increasing doses of potassium iodide, to promote absorption of inflammatory products, if the inflammation subsides (Bastian); a mercurial impression often benefits the paralysis (Da C ). Cold, by ice to spine is deemed necessary, and no doubt alleviates the pain, though heat would be a more rational application for the inflammation (Bastian). Menorrhagia. Opium,has specific action in reducing the uterine circulation,should be pushed, even to inducing habit, in severe cases (Lutaud). Ipecacuanha, in full emetic doses (Wa.); is excellent (B.); Ergot is better (P.). Savine, enlarged, relaxed, and passively congested uterus (B.). In 5-10 drop doses of tinct. in water every half-hour to three hours, has proved useful (P.); when due to want of tone in uterus (R.). Ergot, large spongy uterus ; bromides better (B.). Ergotin gr. j or ij in glycerin and water, undoubtedly efficacious as hypodermic injection (P.); all forms (R.); minim doses of the fluid extract are very beneficial (A. A. Smith). Hamamelis, has decided influence on venous system ; of high repute (Pf.). Arsenic and Iron, when from anaemia (B.). Cannabis Indica, often suc- cessful (R.); gtt. v-x of tinct., thrice daily, productive of extraordinary success (Wa.); has a stimulant action on the uterine muscular fibre, and may be given in combination with Ergot (B.). Iron, when dependent on anaemia (B.). Rue, low vascular tonus ; should never be used in the pregnant state (B.). Oil of Erigeron, in io-drop doses, is efficient (Wa.). Gossypium, a favorite uterine hemostatic in many hospitals, in 30-minim doses of the fluid extract every four hours (Parvin). Quinine, has been recommended (R.); after Ergot it is the very best agent, in 6-grain doses every 3 hours (Parvin). Digitalis, very useful, especially when from heart disease, in plethoric subjects (B., R.); gj-jss of infu- sion as dose will arrest menorrhagia when unconnected with any disease (P., R.). Aloes, debilitated and relaxed subjects, with Iron (B.). Cimicifuga, pas- sive, coagulated and dark(P.) ; for accompanying headache (R.). Gallic Acid, is very efficient (R.). Potassium Chlorate or Bromide, in doses of gr. xv thrice daily, combined with Ergot, has an almost infallible influence over uterine hemorrhage, unless caused by cancer, polypi, adherent placenta, or other similar affections (Tait). Bromides, usually arrest promptly (B.). That of potassium most useful in young women if loss occurs at natural period only ; commence bromide a week before and discontinue when discharge ceases till a week before next time. If loss occurs every two or three weeks give bromide continuously, 10-grain doses, but more when organic changes in womb (R., Wa.). Ammonium Chloride, for headaches (R.). Calcium Phosphate, in anaemia from excessive menstruation (R.). Magnesium Sulphate, very small doses with a little dilute sulphuric acid and syrup, is exceedingly useful (Wa.). Oil of Cinnamon, in drachm doses (R.). Water, hot-water bag to lower dorsal and lumbar verte- brae (R.); cold sitz-bath, feet in warm water, especially valuable. 6o°-6$0 Fahr. for 5-15 minutes, patient then quickly dried and put to bed. [Compare Metrorrhagia.] Prescriptions. 1£. Ext. Ipecac. FI., gij. Ext. Ergotse FI., iv. Ext. Digitalis FI., ij. M. Sig.—A half teasp. to a teasp. as | required until emesis. (B.) I i£ . Ext. Ergotse (Squibb’s), . . gr. xij. Ext. Opii Aquosi, . . . . gr. vj. M. et div. in pil. no. xij. Sig.—One pill every hour, in profuse menstruation of atonic type. MENSTRUAL DISORDERS METRORRHAGIA. 617 Menstrual Disorders. Aconite, gtt. j every half-hour to hour promptly restores discharge when sudden suppression from chill (P., B., R., Wa.); as emmenagogue (Tr.). Pul- satilla, often of the greatest value when menses scanty or delayed, or suppressed by fright or chill (P., B.). Ignatia, in suppression of hysteria (P.). Savine, a powerful uterine tonic ; as emmenagogue certain, powerful, safe (P.). Ferrum, in anaemic subjects (B.). Aloes, as emmenagogue [vide Amenorrhcea]. Cocculus Indicus, for irregular menstruation with colicky pains and scanty dis- charge. Should be given for a few days prior to and during period (P.); rr[ij-iij of a saturated tincture thrice daily. Opium, in suppression from violent mental emotions, a valuable remedy (Wa.). In many menstrual disorders opium proves invaluable, but must be cautiously administered lest the habit be formed. Cimicifuga, relieves heat and pains in the head, flushings in the face, pains in back and limbs, etc., when occurring as the result of menstrual perversion (Wa.). [Compare Amenorrhcea, Dysmenorrhcea, Menorrhagia, Climac- teric Disorders.] Mentagra. Mercury, the oleate, or the bichloride, gr. ij to jfj water, applied as lotion after each epilation (R.). Citrine oint. extensively employed (Wa.). Sulphurous Acid, with an equal part of glycerin, is an efficient application (Jenner). Arsenic has a more or less powerful influence, used internally in doses of of liquor arsenicalis thrice daily (Wa.) ; the oleate of arsenic is an efficient local applica- tion. Sulphur Iodide, as ointment 3j to gjss, is efficient, with Donovan’s solu- tion internally (Sir E. Wilson). Copper Sulphate, as lotion, 3j to of water, with §ss of zinc sulphate, and §jss of aquae laurocerasi (B.). Metritis, Acute. Opium, locally, in suppositories or enema is more effectual than if admin- istered internally (Wa.). Aconite, is invaluable in early stage of simple in- flammatory fevers (P.). [Compare Puerperal Fever.] Heat, to the feet, and by large poultice to the abdomen. Also hot water vaginal injection literally for hours, if possible; repeated at short intervals, from a Davidson syringe. The only means of aborting an attack of cellulitis (E.), which is the condition generally present in cases which are usually supposed to be ones of acute metritis (Playfair). Turpentine, as hot epithems ; few measures are more generally serviceable (Wa.). Linseed Poultices, produce great relief to pain and favorably affect the course of the disease (Duncan). Leeches, to the hypo- gastric region, may be required in patients of full habit. [Compare Puerperal Fever, Puerperal Metritis.] Metrorrhagia. Ipecacuanha, possesses considerable energy in arresting flooding (P.); in full emetic doses, gr. xx in evening, followed by an acidulated draught in the morning (Wa.). Hamamelis, when persistent oozing (R.). Ergot, the most valuable; full doses, repeated every hour or so (R., P.). [See Menorrhagia for formula.] Savine, 5 to io-drop doses of tincture in cold water every hour to 3 hours (P.). Iron, styptic preparations as injections (B.). [See Hemor- rhage, Post-Partum.] Opium, has specific action on the uterine circulation (see ante, page 296), and should be given freely in intractable cases of metror- rhagia from uterine fibroids or cancer, in which the establishment of the opium- habit is often advisable (Lutaud). Cannabis Indica, often arrests, especially when at climacteric; tincture gtt. v-xx ter die (P.); has had extraordinary success in number and rapidity of cures (Wa.). Sulphuric Acid, sometimes very effective, especially when due to fibroid or polypus. Ac. sulph. dil., gtt. v-xx, well diluted (B.) ; long extensively prescribed (Wa.). Cinnamon, is used with good effect (P.); has a specific action of the uterus (T.). Digitalis, in plethoric sub- MILIARY FEVER MUSCLE MYELITIS. jects. The infusion best, a tablesp. bis die (B., P.); the effect is prompt and decided (Wa.). Magnesium Sulphate, often succeeds (B.). Senegin, in 2-grain doses, successfully employed (P.). [Compare Amenorrhcea.] Ice, to abdo- men, or within the uterus (B.); ice in every form first thing to try (Wa.). Rest, absolutely necessary. Dry cupping over sacrum is found useful (R.). [Com- pare Menorrhagia, Uterine Tumors.] Prescription. R. Ext. Ergotse FI., Ext. Senec. Aur. FI., . . %j. Ext. Viburn. Prunif. FI., . jjj. 01. Myristicae, tipxx. Syr. Simplicis, . . . ad gvj. M. Sig.—A dessertsp. every hour until relieved, then reduce dose. Keep the head low, and apply cold over hypo- gastrium. Miliary Fever. Aconite, for the hyperpyrexia (R., P.). Cooling Drinks, purgatives and anti- phlogistics, in mild cases ; malignant ones sometimes occur, and are dangerous (A.). Lime-water applied by sponging, is very useful; or a lotion of zinc oxide suspended in lime-water, gr. xl to §j, painted on the affected parts of the skin, and permitted to dry thereon (E. Wilson). Potassium Iodide, very effectual in curing muscae depending upon hepatic derangement (Wa.). Valerian, often found curative (Wa.). Muscae Volitantes are due to shadows cast on the retina by fibrillae floating in the vitreous body, and are most visible to myopic persons. They do not merit attention unless very abundant, or steadily increasing (C.). Rest of the eye necessary. Neu- tral-tint glasses may be worn to render the muscae less visible, if troublesome. Muscae Volitantes. Arnica, the best agent for contused muscular fibre; also for shake, concus- sion, shock, npv-x every 2 or 3 hours in water (P.); a few drops of tincture internally removes stiffness, after packing with cold, wet sheet (R.). Cimici- fuga, often succeeds wonderfully, as often fails; no indications for its use (B.); general bruised sensation (R.). Ammonium Chloride, in 10 to 20-grain doses, the most efficient remedy (Anstie); is effective (R.). Veratrine, the ointment externally may control (B.). Belladonna, as liniment, is often successful (R.). Gelsemium, frequently cures but large doses are necessary, npv-xx of the fluid extract every 3 hours (B.). Coca, to relieve the sense of fatigue (P.). Opium, by frictions or poultices (R.). Iodine, ointment for pain and tender muscles of the chest, when skin may be pinched without pain (R.). Ammonium Muriate, is very efficient. (See Lumbago.) Xanthoxylum, externally and internally, has a deserved reputation (B.). Chloroform Liniment, with friction, often affords great relief (Wa.). Firing, sometimes very beneficial (B.). Packing, with dripping wet sheet (R.). Counter-irritation, by firing, aquapuncture, acupunc- ture (B.). Electricity, the constant current (B.). Baths, Turkish, in aching muscles, from over-exertion (R.). Poultices, very hot, followed by applications of lint and oilskin (R.). Rest, is the remedy of course (Wa.). Rest and support to weak muscles important till they regain their tone; especially in painful muscular affections following prolonged or excessive exertion, or in the sore- ness or stiffness which occur during convalescence from any long illness, or accompanying general debility. These are generally better after repose, but increase with fatigue. [Compare Pleurodynia, Lumbago.] Myalgia. Belladonna, is decidedly effective, especially when brought on by external violence (P.). Ergot, most successful; large doses are necessary (B.). Elec- tricity, in chronic, not in recent form (B.). Silver Nitrate, in chronic inflam- Myelitis. MYOPIA NT:VUS—NAILS—NASAL AFFECTIONS. 619 mations of the cord, one of the few remedies which are ever of service; gr. (W.). Phosphorus, of marked benefit in myelitic paraplegia from excessive venery (W.). Water-cure, ice-bag to spine, feet in hot-water; or better, hot douche to spine (B.). Cold, externally, by ice-bags, along the spine, with cupping or leeching if much localized pain or tenderness; spoon diet and a sparing amount of stimulants, also copious warm enemata to relieve the bowels and act as derivatives. Little, if anything, is to be done with mere drugs. Posture should be prone, or on side; absolute rest (Bastian). [Com- pare Meningitis, Spinal.] Myopia. Atropine, by daily instillation, systematically, for the purpose of sacrificing either the convergence or the accommodation, in cases where failure of the internal recti occurs, the disability assuming the form of muscular asthenopia (C.). Glasses, properly adjusted, should be worn from the commencement. Naevus. Ferrum Perchloride, injected, is effectual; but dangerous when applied thus to nsevi about the head (Wa.). Creasote, pencilled over twice a day, may re- move nsevi (Wa.). Chromic Acid, as escharotic, or local application, gr. c ad Hjj aquae destil. (B.). Electrolysis, or galvano-cautery, to remove naevi (B.). Nitric Acid, strong, as eschaiotic for small superficial naevi, followed by ol. olivae (B.). Zinc Chloride, Iodide and Nitrate, locally, especially the first named (R.). Setons, threads passed across the growth in various directions, to produce suppuration ; when pus appears the threads should be removed. So- dium Ethylate, prepared by adding the metal sodium, piece by piece, to abso- lute alcohol in a wide-mouthed bottle ; the crystalline substance found deposited after effervescence ceases is an excellent caustic for nsevi; painted over them it causes a rapid eschar, and usually gives but little pain (Richardson). Mercury, the Acid Nitrate an excellent caustic for removing moles from the face (Thomas). Liquor Potassae, a solution (3ij-3j) on cotton-wool in ingrowing toenail, to margin of nail at ulcerated surface, to soften the nail (B.). Glycerin, or Silver Nitrate, on a fold of lint, to the ulcerated surface (C.). Lead Carbonate, a piece softened between the fingers, and applied as plaster beneath the fungous cushion, cures in a few days (Tr.). Paring the nail, after softening in warm water, and cutting a V-shaped incision in centre of nail; the ingrowing portion should not be cut. Nails, Ingrowing. Nasal Affections. Ammonia, by inhalation, in pain and inflammations of nose and frontal bones (R.). Potassium Iodide, large doses (gr. xxx-lxxv daily), valuable in syphilitic affections of the nose (Wa.). Glycerite of Tannin, to excoriations of inside of nose, after measles, scarlatina, etc. Also for impetiginous eruptions of inside, most severe where hair grows, epilation sometimes needful. Also in discharge of greenish, black, stinking mucus (R.). Glycerin of Starch, or Zinc Ointment, applied often, a good supplementary application (R.). Hydrastis, in chronic catarrhal conditions and nasal ulcers, used internally and externally, with great benefit (P.). Pulsatilla, may be employed both internally and externally in nasal inflammations (P.), and in acute inflammation of nose (B.). Cod-liver Oil for chronic discharge (R.). Injections, by nasal douche, are used with benefit in catarrhal states (Wa.). Zinc Chloride, gr. ij to the §, or the Sulpho- carbolate, gr. v to the as solutions locally by cotton-wrapped probe to dimin- ish sensibility of the nasal mucous membrane (Sajous). Cocaine, has many applications in treatment of nasal affections; a 4 per cent, solution by mop or 620 NAUSEA NECROSIS NERVOUS AFFECTIONS. spray will empty the engorged venous sinuses, and is very useful in acute catarrh, hay fever, etc., also in posterior and anterior rhinoscopy (R.). [Com- pare Acne, Catarrh, Epistaxis, Hay Fever, Influenza, Polypus, Sneezing.] Nausea. Ipecacuanha, has no rival in sickness of pregnancy, scarcely less useful in that of chronic alcoholism. Very small doses, gr. -fa equals rt\J of wine (P.). Pulsatilla, in dyspeptic nausea, with coated tongue, flatulence, sick-headache, (P.). Cocculus Indicus, in cephalic nausea, violent but ineffectual efforts at vomiting (P.). Calumba, in nausea of languid stomach with flatulence, has considerable reputation (P.). Cinnamon or Cloves, will check nausea (P.). Nutmeg, the simple powder in wine (P.). Pimenta, Pepper, Peppermint, relieve (P.). Tartaric Acid, as effervescing draught, with a few drops of tinct. opii, tinct. calumbse, or hydrocyanic acid added, when from morbid gastric irritation (Wa.). Cold Compress or Ice-bag, over the stomach very useful. Bismuth Sub- nitrate, or the Liquor Bismuthi, when the salt in substance disagrees, is a rem- edy of established value in nausea and vomiting arising from gastric disorders ; may be combined with Hydrocyanic Acid (Wa.). [Compare Vomiting, Vom- iting of Pregnancy, Seasickness.] Necrosis. Sarsaparilla, a very useful medicine in diseases of the bones (P.). Rest, in a “Salter’s swing,” with poultices, water-dressing, or stimulating lotions, to aid work of repair (Cl., Hilton). Tonics, nutritious food, baths, good hygiene, all are necessary adjuncts to local treatment (Andrews). Acid Solutions, of no use as solvents, may be employed with benefit for detergent and alterative effects to expedite the sloughing and restorative processes (Gross). Operation to re- move sequestrum is generally necessary; or resection of the devitalized bone, the latter in young subjects greatly exhausted, where delay would endanger life. (Gross). Potassa cum Calce introduced into fistulse, to convert them into large openings, permitting the removal of diseased bone (Kirkpatrick). [Compare Caries, I3one Diseases, Syphilis, Scrofulosis.] Nervous Affections. Arsenic, of especial value in nervous affections resulting from malaria, in which large doses are required; of Liq. Arsenicalis, increased to rthxxx thrice daily (Wa.). Asafcetida, is a remedy of much value in nervous affec- tions connected with uterine derangement, also in dyspeptic hypochondriasis and other nervous affections; may be combined with bitter tonics and mild aperients (Wa.). Potassium Bromide, takes precedence in epilepsy, epilep- tiform convulsions, hysterical convulsions and spasms, tetanus, etc., is of great value in chorea, insanity, acute mania, insomnia, delirium tremens, some forms of neuralgia, and the numerous symptoms of vaso-motor disturbance, such as—numbness, coldness, deadness, pricking sensations, indefinable but distressing sensations in abdomen, hypogastrium or epigastrium; feelings similar to rigors, with anxiety, palpitation or fluttering of the heart,-—all due to interference with the local circulation (Reynolds). Valerian and Valerian- ates, are thought to exercise some special influence over nervous affections, especially the Valerianate of Zinc, in half-grain to grain doses in pill, or the Ammoniated Tincture of Valerian, from which every good that can be expected from the valerianates will be more certainly obtained (Wa.). Sumbul, acts as a nervous stimulant, and is especially efficacious in neurotic migraine, also in hysteria and the obscure paralytic affections associated therewith (Wa.). Caf- feine, is of signal value in neuralgia, hemicrania and other nervous affections (Shafter); grain-doses in solution hypodermically, afford great relief in dorso-intercostal neuralgia attending shingles, insomnia, etc. (Anstie). Cocaine NERVOUS EXHAUSTION NERVOUSNESS. 621 is a powerful nerve stimulant, destroying the sense of fatigue, and often evincing marked analgesic power in neuralgias. Is effective in melancholia, hypochondriasis, etc., as well as locally in nerve pain over a limited area. It acts as an excitant upon the central nervous system (R.) Opium, is a remedy of marked value in insanity, melancholia, mania, and all nervous affections accompanied by pain (Wa.); gives general repose t© both body and mind, is of decided value in diabetes, and produces marked improvement in melan- cholia and despondency (R.). Lupulin, is peculiarly useful in nervous affec- tions when Opium cannot be tolerated, especially in chronic hysteria attended with morbid vigilance, 10-grain doses every 6 hours afford great relief, without causing any unpleasant symptoms (Eberle). Santonin, in convulsions, epilepti- form seizures, and affections regarded as choreic, etc., the result of reflex irrita- tion from worms (Wa.). Phosphorus, of occasional utility in affections of the nervous system induced by mental exertion or over-excitement. Danger from its use is its liability to produce fatty degeneration of the internal organs (Wa.). Phosphate of Silver is regarded as of special value in myelitis with disturbance of bladder and rectum, and in sclerosis of the nervous substance (Wa.). Nitrate of Silver, the only remedy which has done good in progressive locomo- tor ataxia; gr. TVi two or three times daily, with Hypophosphite of Sodium, both to be discontinued when blue line appears on gums (Althaus). Cold Shower Baths, are often beneficial in nervous diseases unconnected with disease of the brain. [Compare Hysteria, Melancholia, Mania, Diabetes, Loco- motor Ataxia, Hemicrania, Neuralgia, Nervousness, Insomnia, Hemi- plegia, Paralysis, Spinal Paralysis, etc.] Nervous Exhaustion. Ammonia, the Aromatic Spirit proves very serviceable; Sss-j in water thrice daily (Wa.). Hypophosphites of lime or sodium, or iron, are actively tonic in cases of nervous depression and torpor, with occasional shooting pains (Wa.). Strychnine Acetate, a remedy of great promise, when com- bined with a rigid system of diet, mental discipline, etc. (Marshall Hall). Oxide of Zinc, often excellent as a tonic and sedative, in nervous irritability and depression from anxiety, over-study, etc., (Wa.). Phosphorus, of occasional utility in nervous breakdown from over-study, etc., (Wa.). Caffeine, gr. j or more in a cup of coffee, to relieve brain weariness and nervous exhaustion (Wa.). Cocaine, in doses proves serviceable in nervous exhaustion (R.). R. Strychninse Acetatis, . . . gr. j. Ac. Acetici Diluti, .... rt\pcx. Alcoholis, gij. Aquae destill., gvj. M. Sig.—Ten drops thrice daily. (.Marshall Hall.) Prescriptions. R. Ac. Phosphorici Dil., . . . 5 j. Elixir Calisayse (U. S. Disp.), % vj. Elix. Ammonii Valerian, . . % ij. Glycerini, Vini Xerici, . . . . q. s. ad Oj. M. Sig.— 35 j thrice daily. Nervousness. Aconite, gtt. j of tinct. at bedtime, repeated if needful, for restlessness and ■“ fidgets ” of men as well as women (R.). Ignatia, in small doses better than morphine for mental excitement and nervous erethism (P.); for the nervous exaltation of cinchonism (Pf.). Caffeine, for restlessness due to great lowering of nervous power (P.). Chamomile, lowers reflex excitability (P); minim doses of the tincture every 15 minutes an excellent sedative for children (A. A. Smith). Potassium Bromide, especially for women who are despondent, irrita- ble, and sleepless, from overwork, grief, worry, etc.; often connected with migraine (R.); gr. ss-j of any bromide every j4i-hour, is very efficient for the nervous disturbances of children (A. A. Smith). Conium, where a great deal of motor agitation, especially in the typhoid-like condition often resulting from 622 NEURALGIA. mental overwork, with insomnia, exaggerated nervousness and delirium,—it acts charmingly in securing sleep, by removing the motor agitation ; rrpx of a fluid extract of the unripe fruit, every ]/2 hour, carefully watched (Madigan). Strychnine, affords relief in functional irritability of the nervous system, mani- fested by restlessness and wandering neuralgic pains (B.) ; especially useful as a tonic in nervousness from over-use of tobacco (H.). Valerian, extremely useful as a sedative to reflex excitability, calms nervousness, does much good in fevers where restlessness, fidgets, anxiety, etc. (P.). Musk, serviceable in nervous affections when from uterine derangement (Wa.). Opium, calms the nervous system and gives general repose to both body and mind (R.). Sumbul, often invaluable in restlessness of pregnancy; tilpcxx-xl of tinct. with a little Chloric Ether as draught (P.). Camphor, a powerful subduer of reflex excita- bility (P.). Chloral, where restlessness, debility (R.). Chloroform, the spirit of chloroform internally (R.). Hops, the hop-pillow is deserving of trial. Lu- pulin, peculiarly useful when opium cannot be tolerated (Wa.). Water, warm sponging to induce sleep and calm restlessness in convalescence. Also, cold sponging (R.). [Compare Insomnia, Irritability.] Prescriptions. ft . Strychnin* Sulphatis, . . gr. j. Quinin* Sulphatis, . . . gj. Tinct. Ferri Chloridi, . . . g v. Ac. Phosphor. Dil., Syrupi Limonis ah 3 ij. M. Sig.—A teasp. in water thrice daily. (M.) ft. Potassii Bromidi, , . . . 5j. Ext. Guaranse FI., .... Sjss. Syr. Tolutani, j^iij. Aquas, q. s. ad % vj. M. Sig.—Teasp. to a dessertsp. three or four times daily. To relieve nervousness. Phenacetine, Antipyrine and Acetanilide, are giving great satisfaction in many forms. Of the three, Phenacetine in io-grain doses, is the safest and most efficient. Morphine, hypoder. in the neighborhood of the affected nerve, the best treatment. Caution ; morphine-habit (B.); gr. fa to % often relieves and frequently cures after a few repetitions (P.). No remedy promises more speedy and permanent relief than morphine by subcutaneous injection in sciatica, lumbago, tic douloureux and other neuralgic affections (Wa.). Aconite, when arterial excitement (B.); in congestive neuralgias, and acrodynic, at extremities ; has important, role (P.) ; as ointment or liniment, especially when fifth nerve affected ; also in neuralgic headache (R.). A remedy of great value (Wa.) ; a perfect physiological remedy against neuralgia, especially those forms which are based on congestive or sub-inflammatory affections ; but its action is often slow, so that Morphine must be given with it as a palliative. Aconitine, with Veratrine as an ointment locally, a good application (Da Costa) ; inter- nally the best agent of all in essential neuralgia; should be combined with quinine in intermittent forms and those which resist quinine alone. (See formula below). Belladonna, must be persisted in with full doses ; gr. -fa of atro- pine, or gr. fa to fa hypodermically, in vicinity of nerve, has special utility in tic douloureux and sciatica; also in peri-uterine and dysmenorrhoeal neuralgias (B.). rry of solution of gr. j-3(j of water hypodermically (P.). Spinal irrita- tion, intercostal neuralgia. The liniment or ointment of atropine in facial (R.). Gr. 0.15 of the extract every hour till giddiness, then lessen doses. Continue for several days (Tr.). Veratrum Viride, tincture, said to be very useful (R.). Veratrine, ointment for facial and sciatica (R.). Oint. (gr. frequently of much benefit (P.). Nux Vomica, is most useful in visceral neuralgias, as gastralgia, hepatalgia, etc., the tincture with carminatives in the former affec- tion ; or strychnine, gr. to fa twice or thrice daily. In all forms of neu- ralgia this remedy should be used in small doses (P.). Arsenic, cures by its influence on bodily nutrition; directly so in neuralgias of malarial origin, though inferior to quinine (B.) In various neuralgias, also in angina pectoris (R.). Phosphorus, gr. fa every few hours, has made very effective cures (B.). Neuralgia. NEURALGIA. 623 Gr. Tfjj to every 3 hours. Very useful in all forms, especially when uncom- plicated (R.); always a good remedy except for cases due to cold or inflamma- tion, and those not depending on depraved nutrition (H.). Quinine, large doses (gr. v-xx, in sherry), just before attack in periodical neuralgia, whether malarial or not. Useful also in small, frequently repeated doses in other types,, especially of supra-orbital nerve (P.); has selective action upon supra-orbital form (Spender). Salicylates in large doses cured a case of tic doul. of 12 years’ standing (Dercum). Sumbul, for certain types, of more value than any other remedy. Facial, sciatic, or ovarian, in women of nervous constitution, often yield to it at once (P.). Cimicifuga, in neuralgia of the 5th from cold, and in ovarian neuralgia (B.) Gelsemium, successful in neuralgia of 5th (B.); espe- cially dental branches (R.); of value in trigeminal, ovarian, etc. (W.); in suita- ble cases small doses answer as well if not better than large ones (Pf.); rr\jij of the tincture every y hour often succeed miraculously with no ill results in neu- ralgias about the head and face (A. A. Smith); no better remedy in tic doulou- reux, but must be given in large doses, of a strong tincture or fluid extract (H.). Zinc Valerianate, extremely beneficial in neuralgia from reflex irritation of female pelvic organs (B.). Spigelia Anthelmia, useful in facial (P.). Ammonium Valerianate, or Zinc Val. in neuralgia of face or head (R.); the latter in nervous cases, and uterine (Wa.). Chamomile, in neuralgia of 5th nerve (R.). Staphisagria, internally and externally often curative in obstinate facial and cervical neuralgia (P.). Ignatia, in hysterical and intercostal neu- ralgia, with nervous erethism, is valuable (P.). Ergot, much employed in visceral forms, especially gastralgia (P.); said to be useful (R.). Ammoniated Copper, in neuralgia of the 5th, lately used by Fereol with remarkable success; -grain doses pushed. Eserine, very efficient in neuralgia of the eye-ball, a solution of gr. ij to the % by instillation. Cannabis Indica, %-]/?. gr. doses of extract 2 or 3 times a day ; especially for neuralgic headache (P.); found useful (R.). Cod-Liver Oil, when low nutrition, faulty assimilation (W.). Iron, when from anaemia. Tincture of chloride (rt\, xxx-xl ter die), also chalybeate waters (B.). Moderate doses only required (R.). In chlorotic subjects, of whom nearly all will have neuralgia (Tr.). Iodides, for neuralgia of fifth, dependent on syphiloma of the nervous system, pain nocturnal chiefly (B.). Bromides, benefit some kinds, especially ovarian (B.); potassium bromide occasionally relieves (R.). Ammonium Chloride, half-drachm doses in facial and other neuralgias, is much used (R.); a very efficient and diffusible stimulant, gr. xx -3j at first, repeated every hour during the attack (H.). Chloroform, as anaes- thetic to relieve pain, is occasionally useful locally, also as spray for uterine neuralgia (R.); by deep injection into vicinity of affected nerve tt\, v-xv of pure chloroform, a very efficient method of dealing with long-standing cases (B.); used in one case it caused symptoms so severe as to imperil the life of the patient (W.). Theine, hypodermically, is promptly analgesic, and has pro- longed influence, but must be aided by remedies to improve the nutritive state of the affected nerves, or which are capable of removing the diathesis upon which the neuralgise depend (Mays). See Formula below. Caffeine, hypodermically has been found useful, especially in cervico-brachial neuralgia (P.). Cocaine, as a hypodermic injection, a 4 or 5 per cent, solution is very effective if admin- istered in the vicinity of the aching nerve (R.); also by instillation in neuralgia of the eyeball, and whenever it can be applied to the mucous surface in the vicinity of the pain. Croton Chloral, very effective, especially in tic douloureux and sciatica, gr. ij-v every hour till gr. xv are taken (B.) ; in facial, that from carious teeth, that of neck and back of head, tic douloureux, etc. (R.). Gr. j every l/& hour is a very efficient dose (A. A. Smith); rarely of any value, but when used is best given in 20-grain doses twice daily (H.). Chloral and Cam- phor, parts sequales, triturated together, and painted over surface (B., R.); also with morphine (B.). Aquapuncture, strangely relieves pain in a superfi- cial nerve, so much so, that some hold the curative effects of morphine injection to be due to the water (B.). Counter-irritation. Mustard poultices in neuralgic pains (P.). Blisters to a posterior branch of the spinal nerve-trunk from which painful nerve issues (Anstie). Amyl Nitrite, inhaled in dysmenorrhoeal neu- 624 NEURALGIA. ralgia (B.); and when of 5th nerve (R.) Nitro-glycerin, has often afforded great relief (Wa.). Carbonic Acid Gas, injected into vagina for neuralgia of uterus (R.). Digitalis, is strongly recommended in sciatica, also locally in earache (P.). Valerian, serviceable in facial neuralgia of hysterical type (P.). Bibiru Bark, in intermittent forms (P.). Pyrethrum, root, is chewed with benefit in facial neuralgia (P.). Capsicum, a strong infusion on lint covered with gutta- percha (R.). Coccus Cacti, has been very successful in 20-30 minim doses of a y$th tincture twice daily, the larger dose in the paroxysm (W.). Peppermint, Oil of, painted over the part in facial neuralgia (R.); especially the Chinese oil, which contains a large excess of Menthol, a very useful application in superfi- cial neuralgias (W.). Turpentine, has cured tic douloureux and sciatica (B.) ; often of wonderful service (P.). Potassium Chlorate, for facial neuralgia (B.). Alcohol, with much volatile ether; care must be taken in prescribing it (R.). Piscidia, almost specific in many forms, useless in many cases (W.) Tonga, is efficient in facial neuralgia, npx-xx every two hours (H.). Osmic Acid, a one per cent, aqueous solution with glycerin to prevent change, of which 5 to 10 drops hypodermically, has made striking cures of inveterate neuralgias, with no ill effects resulting (Shapiro). Wet Pack, is of great benefit, especially in sciatica. Intense Cold, produced by a spray of Chloride of Methyl,or concentrated carbonic acid gas, directed along the nerve from special apparatus, immediately relieves the pain, and usually cures (Jacoby). Compressed Air, by insufflation into the middle ear, in cases of persistent and paroxysmal temporo-occipital neuralgia, due to chronic follicular pharyngitis and inflammation of middle ear (Legal’s Disease). If these insufflations result in diminution of the pain, treatment should be directed to the naso-pharynx and Eustachian tubes (Masucci). Galvanism of the affected nerve, one of the most important cura- tive measures; a continuous current of 4 to 8 cells down the nerve generally answers best, though some cases are helped more by a rapidly interrupted faradic current. Electricity is of no value in cases dependent upon organic lesions, and in any individual case is purely experimental (W.). Diet. Animal fats necessary, as cod-liver oil, butter, cream, etc., in as large quantity as can be digested. Rest often needed, with protection from cold and damp, flannel clothing, bathing and shampooing. [Compare Gastralgia, Hepatalgia, Sciatica, Tic Douloureux, Hemicrania, etc.] Prescriptions. Local Use. R. Chloroformi, Tinct. Aconiti, . . . aa g ss. Linim. Saponis, gj. M. Sig.—Apply on flannel and cover with oiled silk for superficial neuralgia. Internal Use. R. Phosphori, gr. ss-jss. Alcoholis, q. s. ad solv. Spt. Menthse Piperitse, q. s. Glycerini, . . . . q. s. ad § iv. M. Sig.—A teasp. after each meal. (H.) R. Aconitine (Duquesnel), . gr. iv. Veratrine, gr. xv. Glycerini, g ij. Cerati, . . . . . . . . g vj. M. Sig.—To be rubbed over the part, avoiding any abraded surface carefully. (Da Costa.) R. Cupri Ammonio-sulphat., . gr. j-iv. Syr. Aurantii Flor., . . . gj. Aquae Destil., g iij M. Sig.—One-third as a dose, thrice daily. {Prof Fereol.) R. Mentholi, gr. xlv. Cocaine, gr. xv. Chloralis, gr. x. Vaselini, g v. M. ft. ung. Sig.—For local use. (Potter.) R. Quininae Sulphatis, . . . . gj. Ferri Pyrophosphatis, . . gj. Strychnine Sulphat., . . . gr. ss. Ac. Phosphor. Diluti, . . ,^ij. Syr. Zingiberis, Aquae q. s. ad g iv. M. Sig.—A tablespoonful twice daily. NIGHT-MARE—NYMPHOMANIA. 625 R . Veratrinae, gr. xl. Adipis,zWUnguenti, . . . M. Sig.—Local use. [Da Costa.) R. Aconitinae Crystal., . . . . gr. Quininae Hydrobrom., . . . gr. xx. M. ft. massa, et div. in pil. no. xij. Sig.—One every 4 or 5 hours. [Potter.) R. Theinse, Sodii Benzoatis, .... aagj. Sodii Chloridi, gr. x. Aquae Destil., Jj. M. Sig.—3 to 20 drops hypodermically at central seat of disturbance. [Mays.) rt\vj = gr. ss of Theine. R. Tinct. Aconiti, Tinct. Colchici Sem., Tinct. Cimicifugae, Tinct. Belladonnae, aa part aeq. M. Sig.—6 drops every hour until re- lieved. (Metcalf) Night-Mare. Potassium Bromide, in night-mare of adults : and children’s attacks of night- screaming often associated with squinting. Digestive organs may also require attention (R.). Camphor-water, a teaspoonful or two the most suitable medi- cine (H.). Sleep, in abundance, may prevent (H.). Diet, light; avoid late meals. Nipples, Sore, Fissured. Benzoin, an admirable local application (P.) ; the tincture locally for slight erosions (Parvin). Arnica, the cerate, or Glycerin of Starch, or glycerin, 1 to 2 of eau de cologne (R.). Silver Nitrate, touched lightly; effectual (Wa.). Sulphurous Acid, solution neat or diluted, constantly applied, or with equal quantity of glycerin as lotion (R.). Collodion, sometimes used (R.); useful for protection (P.); as coating (B.). Alcohol, brandy and water as lotion before delivery and after each suckling to prevent cracking (R.). Borax, saturated solution, beneficial (Wa.). Iron, the solution of the subsulphate diluted with 3 parts of glycerin, and applied with a camel’s-hair brush, an effective applica- tion for fissured nipples (B.). Tannin, the glycerite, one of the best applica- tions to fissured nipples (B.). Lead Nitrate, in glycerin, or ointment in fissured nipples (B.). Zinc Shield, constantly worn (R.). Balsam of Peru or Tolu, valuable as application, with oil of almonds, gum arabic, and rose- water (P.). Rhatany, as wash or cerate, has had great success in fissure (Tr.) ; 1 part of extract to 15 of cocoa butter (Wa.). Nipple-shield, to give the nipple rest while the child sucks, gives great comfort. [Compare Lactation, Mastitis.] Prescriptions. R. Balsam. Peruvian., . . . g ij. Olei Amygdalae, .... Mucil. Acaciae, g\). Aquae Rosae, q. s. M. Sig.—Apply to the nipples after each nursing. (Phillips.) R . Liq. Plumbi. Subacet. Dil., 3; ss. Ext. Opii Aquosi, . . . . gj. Aquae Rosae, g iijss. M. Sig.—Lotion, to be used after a bread-and-milk poultice, for inflamed nip- ples. [F. Barker.) Nodes. Mercury. The oleate of mercury and morphine externally, is very valuable (R.). Potassium Iodide, as ointment in conjunction with internal use, in syph- ilitic nodes of children ; also in non-syphilitic periosteal thickenings (R.). In syphilitic nodes it holds the first place, especially when pains are worse at night, and by heat of bed (Wa.). Stramonium leaves, locally, relieve (Wa.). [Compare Exostosis, Periostitis.] Nymphomania. Potassium Bromide, when from plethora; not useful when relaxation, or from cerebral lesion (B.) ; large doses required, at least gr. xx ter die (R.); an 626 OBESITY ODONTALGIA. abundance of evidence testifies to its value (W.). Tobacco, to nausea, effect- ually cures, but is horribly depressing (B.). Camphor, in considerable doses said to control inordinate sexual desire (R.); at present not much relied on (Wa.) Lupulin, seems worthy of fair trial (Wa.). Sulphur, or dilute sul- phuric acid, internally, when arising from hemorrhoidal congestion, not an infrequent cause (Wa.). Obesity. Banting Dietary is alone sufficient to improve the condition. Its chief fea- ture is the exclusion of two elements—starch and sugar—from the food. There- fore bread (except toast, or the crust of a common loaf), potatoes, sweet roots, butter, sugar, cream, beer, porter, and champagne, should be avoided. In one year, on this diet, Mr. Banting reduced his weight 46 pounds, and his girth about 12 inches ; at the same time, his numerous corporeal infirmities were greatly mitigated or altogether removed. Cannot be recommended indiscrimi- nately. This was the method of Hippocrates, avoiding all fats, starches, and sugars ; in fact, all roots or vegetables grown underground (B.). Meat Diet, very successful in 42 cases, the diet being confined to rump-steak, hot water and codfish, for 14 days, absolutely excluding everything else. (Dr. Smith in Brit. Med. Jour., Nov. 20th, 1888). The Schweninger or CErtel method is similar, using chiefly albuminous food, excluding fat and carbohydrates, limit- ing the fluids drank, especially at meals, and enforcing exercise. Iodoform, is highly efficient, but causes wasting, and anaemia by injuring red blood cor- puscles (B.) Iodol, in 2-grain doses thrice daily, is equally effective (B ). Al- kalies. Solutions of oxides or bicarbonates (R.); alkaline mineral waters, with exercise and dietary (B.); serviceable (Wa.). Liquor potassae 3ss in milk, thrice daily, of established value (Wa.); generally fails (R.). Ammo- nium Bromide, sets up gastric catarrh (B.); but lessens corpulency (Wa.). Sulphurous Waters, especially Blue Lick, !|iv before each meal (B.) Potas- sium Permanganate, for attendant dyspepsia and flatulence; also useful for the obesity ; gr. %-] ter die, in aq. dest. (B.). Vinegar, only successful at expense of serious injury to the body (R.). Fucus Vesiculosus, has power to reduce adipose tissue. An extract is sold under the title “Antifat” as a proprietary medicine (W.). Exercise, daily, in the open air is necessary, and if carried on systematically is the most efficient and least injurious method of reducing an excess of adipose tissue. Odontalgia, Aconite ointment or liniment for facial neuralgia due to diseased teeth, will succeed quickly if at all (R., Wa.). Arsenic, gr. as escharotic to destroy pulp, when used for pain may be mixed with opium. It sometimes at first aggravates pain (R., W.). Staphisagria, the alcoholic solution dropped into the cavity (P.). Alum, a solution of nitric ether (3ij-3vij) is said to be an effectual application (B.). Alum and salt powdered and placed in the cavity, excellent when nerve exposed. Chloral, rubbed up with equal weight of camphor, rubbed or put into cavity (R.). Chloroform or Croton-Chloral, equal parts of the former and creasote, a good application (R.). Tannin, a solution in ether is a good application to a carious tooth (B.). Creasote, with tannin or opium or chloroform, placed in the cavity of a decayed tooth, often gives relief (R.). Cocaine, a 5 per cent, solution of the hydrochlorate on cotton ap- plied to a cavity will often bring instant relief. Coniine, solution in alcohol placed into a hollow painful tooth (R.). Collodion and Carbolic Acid, equal parts as jelly for stopping carious teeth (R.). Opium, mixed with tannin or creasote inserted in cavity of painful tooth (R.). Morphine, hypodermically for severe toothache (R.). Oil of Cloves, inserted into cavity (B., P.). Camphor, with morphine and flaxseed, as a cataplasm to the cheek (B.). Xanthoxylum, a domestic remedy (B.). Capsicum, a strong infusion on lint (R.j. Gelse- mium, useful in some forms (R.). Zinc Chloride, to destroy exposed painful pulp (R.). Ginger, Mezereon, Pyrethrum, are useful masticatories in tooth- ache (P.). OESOPHAGUS OPHTHALMIA. 627 Prescriptions, R. Linim. Aconiti (B. P.), Chloroformi aagiij. Tinct. Capsici, Tinct. Pyrethri, Olei Caryophylli, Pulv. Camphorae, . . . aa 5 ss. M. Sig.—A few drops to be placed on a pellet of cotton and applied to the cavity. (Mason.) R. Creasoti, gij. 01. Caryophylli, . . . . ziv. 01. Menth. Piperit., . . . q)- Camphorae, 3 ijss. Alcoholis, . . . q. s. ad Oj. M. Sig.—“ Toothache Drops.” R . Ac. Tannici, gr. xx. Mastiches, gr. x. Altheris, § ss. M. Sig.—On cotton to cavity. (D.) R. Morphinse Sulph., . . . . gr. iv. Atropinse Sulph., . . . . gr. j. Aquae Destill., M. Sig.—A few drops on cotton, placed in the cavity. (B.) Belladonna, the liniment with frictions to the sternum, often very useful as a palliative in stricture of the oesophagus (Wa.). Conium, in spasmodic contrac- tions, with crampy pains of stomach, flatulence, and globus hystericus, has proved very serviceable (Wa.). Hyoscyamus, or Conium, in stricture of oesoph- agus, if much irritability ; with occasional leeching to relieve exacerbations of pain or spasm (D.). Silver Nitrate, in stricture of the oesophagus, a weak solution on sponge probang (D.). Anaesthetics, should be used only to meet temporary indications (W.). Nutrient Enemata, in stricture of the oesophagus, when swallowing impossible (R.) ; may, in some cases, even preserve life (Wa.). [See Enemata.] Bougie Dilatation, in non-spasmodic (structural) stricture, the only appropriate treatment (H.). [Compare Dysphagia, Choking.] CEsophagus, Affections of. Onychia and Paronychia. Silver Nitrate, a strong solution in nitrous ether, painted over the adjacent tissue, will abort if applied early (B.); frequently causes resolution of the inflammation (Wa.). Lead Nitrate, dusted over night and morning (R.) ; relieves pain, and hastens healing process (B.). Turpentine, applied on a piece of lint or other absorbent material, stops the pain at once, and seems to kill the felon. Mercury, as ointment, for 10 minutes in every hour; poultices in interim (R.). Arsenic, gr. ij. ad Adipis, as ointment, almost specific in onychia maligna (Wa.). Tartar Emetic, will shorten course, and render it milder (R.). Iodoform, oint. or powder dusted on (B.); or 1 part to 9 of Ether applied by a dropper in syphilitic onychia (Fox). Iodine, a strong alcoholic solution locally will often subdue the disorder (Wa.). Chloral, a solution locally, as antiseptic, and to promote healing (B.). Sodium Chloride, common salt roasted until chlorine is driven off, equal parts of this, castile soap and Venice turpentine, as a poultice, is a very efficient application. Carbolic Acid, to benumb surface during incision (R.) ; which should be carried down to the bone, especially in tendinous whitlow (D.). Cocaine, hypodermically, will accomplish the local anaesthesia more thoroughly, if delivered deeply into the tissue. Morphine, powdered, as local application to relieve pain. Heat, by poultices, is very use- ful. In Opening a felon avoid the lines of the arteries, on the sides of the fingers, and that of the flexor tendons which is the median line on the palmar surface. The incision should be made midway between these lines. If the sheath of the tendon be opened the tendon may slough, and the finger be ren- dered useless (Ashhurst). Silver Nitrate, a strong solution (gr. xx ad ]§j) in granular lids; cautiously when corneal ulcers exist (B.); solid stick diluted with 2 to 4 parts of potassium nitrate, applied lightly and quickly, or a solution (gr. ij-x ad 3;j) painted over Ophthalmia. 628 OPIUM HABIT. everted lids, which should be washed with a solution of common salt, and then with water before being replaced (C.); in solution, gr. v ad §j aquae destillatae, locally once a day in purulent ophthalmia of the new-born, washed off with a weak solution of common salt (Noyes); in solution, gr. iij to the to abort the discharge in catarrhal ophthalmia (Fox). Boro-Glyceride, in many catarrhal affections, especially ophthalmia neonatorum, is a most efficacious application, the solutions used being of 10, 25 and 50 per cent, strength (Fox). Alum, gr. viij ad §j aquae,applied every % or hour in purulent ophthalmia of children; success depends on the frequency of the application (R.); a crayon formed of a crystal of alum, a mild and occasionally useful application (C.). Mercury. Calomel dusted over membrane in phlyctenular ophthalmia; or after detaching scales rub in brown citrine ointment every night for eczema of margin of lids (B.). Pulsatilla, as lotion to conjunctiva 8 or 10 times in 24 hours, also inter- nally (P.); much used by homoeopaths (B.). Spigelia, useful in rheumatic ophthalmia (P.). Antimony. Tartar emetic, gr. to three or four times a day in strumous ophthalmia, with sharp purgation at commencement (R.). Belladonna, or Atropine, locally, of great service in strumous ophthalmia to relieve pain; constitutional treatment also required (Wa.). Atropine, gr. ij of neutral sulphate to the of aqua destillata, twice or thrice daily, as soothing application (C.). Arsenic, invaluable in inveterate cases of strumous ophthal- mia, especially when complicated with cutaneous eruptions (Wa.). Copper Sulphate, gr. j ad gj aquae camphorae as collyrium in purulent ophthalmia of infants; in substance to inner part of lids in granular conjunctivitis (Wa.). Tannin, powdered (or in solution gr. j-x ad gj) produces remarkable results (B.). Lead Acetate, gr. j ad 3j aquae destillatae, applied by camel’s-hair pencil to surfaces of everted lids, washed away before the lid is replaced. Or the Tannate of Lead \ l/z ad 3 parts fine oil, and 1 of fresh lard, a very small piece as ointment to lid (C.). Carbonic Acid Gas, said to relieve the pain and photo- phobia of strumous ophthalmia when locally used (R.). Physostigma, to reduce pupil and shut out the light (P.). Iodine, is employed in scrofulous ophthalmia, locally for its alterative stimulation (W.). Iodoform, in gonorrhoeal ophthalmia, and purulent conjunctivitis, of very great value locally, but should be pulver- ized very finely (Grossmann); does not bear out the claims made for it (Keyser). Zinc Chloride, gr. j ad §j aquae as collyrium, in gonorrhoeal ophthalmia, used with marked benefit; also a stronger solution (gr. ij-iv ad effectually arrests the muco-purulent discharge remaining after subsidence of purulent ophthalmia, and has succeeded admirably in diphtheritic conjunctivitis and pustular ophthalmia (Wa.). Zinc Sulphate, as collyrium, gr. j-iv ad is very serviceable in ophthalmia of infants or adults; liquor plumbi added improves (Wa.). Staphisagria, especially in tarsal ophthalmia (P.). Colchicum, when gouty diathesis (P.). Cod-liver Oil, in strumous subjects, tends to remove the manifestations of the disease (R.). Cold Wet Compresses, or iced, are held to be essential in early stage of acute purulent and gonorrhoeal ophthalmia (C.). [Compare Blepharitis, Conjunctivitis, Keratitis.] Opium Habit. Capsicum, very serviceable from its power as a stimulant to the stomach, and its sedative action on the cerebrum (B.); removes the sinking sensation at the pit of the stomach experienced by alcoholics, when trying to break off that habit (R.). Bromide of Sodium, in large and increasing doses, 3j twice daily, increased by 20 grains each day, to a maximum of 100 to 120 grains twice in twenty-four hours, with simultaneous gradual reduction of the opiate dose, so that from the 8th to the 10th day it is entirely abandoned. Each dose of the salt should be given in 6 or 8 fluid ounces of cold water (Mattison). A combination of bromides (see formula below), commencing with 40 grains twice daily, increasing to 100 grains twice daily, at 10 A. m. and 4 p. m., freely diluted with water, does not depress vitality, or produce the injurious results of the bromides as commonly administered. This, with gj of Warburg’s tincture before break- fast each morning, with the use of Spt. Etheris Nitrosi to eliminate the bromides OPIUM HABIT. 629 rapidly, electricity, a mixture of iron and strychnine, and an occasional hypo- dermic of 5 or 10 minims of a 4 per cent, solution of Cocaine for nervous rest- lessness, is the general line of my treatment (Mann). Bromides may do great harm, if recklessly administered, paralyzing the muscular system and causing prolonged delirium. Cocaine, or the fluid extract of Coca (Erythroxylon), has been used to relieve the depression caused by the withdrawal of the drug (B.); has been, by many careful observers, pronounced of great benefit, restoring appetite, inducing sleep, promoting digestion, while soothing the brain and inducing a feeling of contentment and calm (R.). Should never be entrusted to the patient, lest he jump out of the frying-pan into the fire. Gelsemium subdues the restlessness and motor excitement; proved of great value in one case where 30 grains of morphine were used daily; TT\j of tincture every hour (Pennoyer). Conium, in io-drop doses of a good fluid extract, to check motor activity and relieve the wandering pains. Sparteine, in doses of gr. y to y, hypodermically, at moment of systolic cardiac depression which answers to the period of craving, and corresponds to the truncated curve of the sphyg- mographic trace, which is characteristic of the period when the stimulant effect of morphine has passed (Jennings). Nitroglycerin acts in the same manner, but its effect is more rapid and more ephemeral (Idem). Cannabis Indica, may be required in full doses, for restlessness after withdrawal of the opiate, 3-doses of Squibb’s fluid extract, repeated every hour or two, as required (M.). Galvan- ism, is very efficient for the neuralgic pains in various parts ; a strong faradic current sometimes acting better (M.). Baths, if hot, 105° to 1120 F., are of great value to relieve disquiet; warm baths are worthless (M.). Chloral, as a hypnotic, fails in the first few days of abstinence; later in full doses, 45 grains at once, rather than three 15-grain doses, alone or with a bromide, it can be relied on (M.). Hyoscyamine, Merck’s amorphous, gr. T\ to J hypodermically, or more, is useful as a hypnotic, and perfectly safe, in patients of good general condition, in whom the disuse of Opium produces unusual insomnia and motor activity (M.). Lupulin, with Phosphoric Acid (see formula below), helps to sustain the patient, lessens the force of his suffering, and shortens its duration (Fleming). Zinc and Iron as blood tonics, given for a month at least, are valuable, and are best given on alternate days (see formula below) (Fleming). Piscidia Erythrina, has been proposed as a substitute, and highly commended, but is worthless, as are also Avena sativa and many other falsely termed sub- stitutes (M.); there is no remedy for the opium-habit (Da Costa). Zinc Oxide, for the vomiting and diarrhoea, beginning with gr. j once daily and increasing to tolerance (Da C.). Withdrawal of the drug suddenly and completely, is the method of Levinstein and other Germans, and is preferred when we can have absolute control and surveillance of the patient (Da C.); entails horrible suffering, and is utterly inexcusable (M.). A more gradual reduction is the method usually employed, taking off one-third the first day, one-fourth the second day, and then gradually reducing the amount until the sixth or seventh day, when it is entirely withdrawn. No agent is of any value unless strengthened by moral courage and perseverance on the part of the patient (Squibb). Use- less to try to cure a patient while he is pursuing his ordinary avocations. Failure will result unless there is complete seclusion and entire giving up to the treatment (Mann). Prescriptions. R. Tinct. Capsici, g iv. Potassii Bromidi, . . . . giv. Spt. Ammoniae Aromat.., . if iij. Aquae Camphorae, . .ad g vj. M. Sig.—A dessertsp. several times daily, in the depression of alcoholism and opium-habit. Instead of the bromide, Fow- ler’s Solution (Liq. Potass. Arsenitis), tt\J, may be added; or Tinct. Nucis Vomicae g ij, or Tinct. Aurantii Amari g v. [Ringer.) R. Strychninae Sulphatis, . . gr. ss. Tinct. Belladonnae, Tinct. Capsici, . . . aa g iij. M. Sig.—Ten drops every three hours, increasing three drops daily. R. Tinct. Cannabis Ind., . . rt\xl-lx. Spt. Aitheris, gj. Aquae, q. s. ad 3 j. M. Sig.—One dose, if insomnia is very protracted. (Fleming.) ORCHITIS OTALGIA—OTITIS, Combination of Bromides. R. Ammonii Bromidi, Sodii Bromidi, . . . aa 5ss. Potassii Bromidi, . . . .§]■ Liq. Potass. Arsenit., . . . %j. Syr. Tolutan., 5 j. Aquae Menthae Piper., . . 5jss. Syr. Hypophos. Comp., . . 3 iij. M. Sig.— to % ij in water thrice daily. Has a total of Bromides, gr. 21 in each 3 . (Mann.) R. Strychnine Sulph., . . . . gr. ss-j. Tinct. Gentianse Co., Tinct. Cinchonse Co., . aa % ij. M. Sig.—Teasp. before each meal, as a stimulant to the appetite and nervous sys- tem. R . Tinct. Nucis Vomicae, . . iij. Ac. Phosphor. Diluti, . • 3V- Syr. Pruni Virg., . . . . 5 ij. Aquae, q. s. ad 3 iv. M. Sig.— gij twice daily as a nerve- tonic. (Potter.) Pulsatilla, Tt\j or less, every hour, relieves pain rapidly, though not the oedema (St.). Belladonna, int., and as oint. (extract j ad iij adipis) when in- flammation has subsided (Wa.). Sodium Salicylate, in gonorrhoeal orchitis, subdues pain in a few hours. Iodine, tinct. locally to remove swelling after the acute stage has passed (B.). Mercury, the oieate locally (B.); Calomel gr. iij with Ipecac, gr. x at once, followed by a saline next morning, and smaller doses of calomel and ipecac, every 6 hours, with morphine hypodermically, gr. X into cellular tissue of scrotum (McElroy). Ammonium Chloride, makes a good evaporating lotion, in solution with alcohol and water (R.). Silver Nitrate, a strong solution to the scrotum, with gentle pressure (Wa.). Tartar Emetic, in acute orchitis (R.). Digitalis, locally, is found most useful (P.). Alcohol, with equal quantity of water, as evaporating lotion (B.). Ice, benefits and relieves pain (B.). [Compare Epididymitis.] Orchitis Prescriptions. R. Ammonii Chloridi, . . . gr. xl. Alcoholis, Aquae, . . aa ij. M. Sig. — Lotion, to be applied on j cloths to the part. R. Hydrarg. Ammoniat., . . 7,). Cerati Simplicis, . . . . §)■ M. ft. unguent. Sig. — Apply locally, with gentle friction. Aconite and Opium, equal parts of the tinctures, a few drops well down the external meatus, will often subdue the pain. Blistering Fluid, or Croton Oil Liniment, behind the ear often relieves earache (R.). Glycerin, for dryness of meatus (R.); or oil for accumulation of wax in external meatus dropped in every night, gentle syringing in the morning with warm water (Cl.). Opium, Morphine in solution, gr. iv to the Jj, with gr. j-ij of Atropine, is an excellent application (B.). Atropine, gr. in 3*x of water, a teasp. every three hours for a child in the acute otitis media of children from coryza, very successfully used to abort the otitis, and relieve the earache (Miot). Pulsatilla, internally and externally, is often used with advantage (P.). Cocaine, a 4 per cent, solu- tion sprayed over the tympanic membrane through the external meatus, and forced into the Eustachian tubes by inhaling the vapor and then expanding the tubes by Valsalva’s method; this repeated every three minutes, is a very sure method of curing otalgia (R.). Otalgia. Otitis. Pulsatilla, in inflammation of external auditory canal; in otitis, as lotion warmed and applied by syringe, three or four times a day (P.). Aconite, quickly relieves the pain (R.); should be used internally and locally. Carbolic Acid, a 20 per cent, solution instilled into ear in moderate otitis, relieves OTORRHCEA OVARIAN NEURALGIA—OVARITIS. 631 pain at once and checks progress. A solution in glycerin is best (Rohrer). Atro- pine, in the acute otitis media of children, is very efficient. See Otalgia, above. Blisters, behind ears, either kept discharging or repeated, often very useful (Wa.). Leeches, behind the ear, afterwards a small blister upon the same place, when leech-bites have healed (H.). Warm Douche frequently, to the ear, to secure cleanliness, then drying the parts (Roosa). Otorrhcea. Mercury, in chronic cases, the brown citrine ointment (B.). Lead lotions much employed (B.). [See Gonorrhcea, for formula.] Potassium Perman- ganate, as injection or spray, gr. j-jf j aq. destil. (B.). Silver Nitrate, locally, a solution of gr. iv to the (B.) ; gr. x to the § (Roosa). Copper Sulphate, gr. j-v to the % (Roosa). Tannin, the glycerite, locally, is successful (B.); especially in children (Wa.). Zinc Sulphate, locally, in solutions of gr. ij-viij to the 3 (B.); gr. j-v to the 3 (Roosa). Cadmium, gr. ij-gj rose-water (B.). Liquor Sodae Chloratae, Tt\pcv-xxx ad j aquae when discharge fetid: is highly useful as injection (Wa.). Quinine, with sulphuric acid, advisable in otorrhcea after scarlatina (Wa.). Boracic Acid, finely pulverized, as astringent and dis- infectant application; may be mixed with pulv. Alum, and just enough pow- dered Lycopodium to keep it dry;—this packed carefully through speculum, after washing with a weak and tepid alkaline solution. Absorbent Cotton, on holder, may be used every few hours by patient to keep pus removed from the canal. Syringing with warm salt water, once daily, as absolute cleanliness is essential in the treatment. Politzer Bag is a useful adjunct in keeping secre- tions out of tympanum and breaking up adhesions (Roosa). [Compare Otitis.] Ovarian Neuralgia. Atropine, subcutaneously, the best remedy for pain in the pelvic viscera (Wa.). Ammonium Chloride, gr. xxx with gtt. ij-v tinct. aconiti, repeated in %-hour if necessary to remove pain (W.). Camphor, with Cannabis Indica, of great service in relieving ovarian pain, especially when spasmodic in character (Wa.). Opium, often the cause; if use stopped entirely improvement may ensue (E.); one of the best remedies in ovarian pain of non-inflammatory character (Graily Hewitt). Hot Water, vaginal injections, night and morning; sunlight baths, fresh air (E.). Ether, the compound spirit, in doses of npxxx-xl as a palliative (Anstie). Gelsemium, deserves a trial; its power is great but not certain (Wa.). Leeches over the groin, or inside the thigh, where ovarian pain persistent, or tenderness and aching (Wa.). Surgical, Battey’s operation as a last resort (E.). [Compare Dysmenorrhcea.] Ovaritis. Turpentine Epithems, may be applied hot over the seat of the disease (Wa.). Tartar Emetic, as ointment for counter-irritation over seat of disease, in sub- acute ovaritis; at same time a pill of opium, hemp and camphor. See for- mula below (Hewitt). Opium, in suppository or enema, more effectual than internally (Tilt). Mercurial Ointment, combined with camphor and bella- donna, over the seat of the disease by friction (West). Blisters, in subacute ovaritis are often of great service, placed over the region or to the cervix uteri (Wa.). Enemas, of warm water, simple or medicated, in subacute ovaritis, are warmly recommended ; they should be retained as long as possible (Wa.). Salix Nigra, the “pussy willow,” in doses of rtpxxx of the fluid extract thrice daily, of decided benefit in ovarian hyperaesthesia, etc., of highly nervous women. Ergot, is valuable in chronic ovaritis, with rest and Potassium Bro- mide (Tait). Ice, in bag, over seat of pain, when intolerable, and patient too much reduced to bear leeches; is often of benefit (Wa.). Poultices of Linseed meal, as light as possible, often produce great benefit in ovarian inflammation. 632 OXALURIA—OZjENA PAIN. R . Ext. Opii, gr. iij. Ext. Cannabis Ind., Camphorae, aa gr. vj. M. ft. pil. no. vj. Sig.—One pill twice daily. (Graily Hewitt.) Prescriptions. R. Ung. Hydrargyri, . . . . Camphorae, gr. xl. Ext. Belladonnae, . - - 3 ij- M. ft. unguent. Sig.—To be rubbed in twice daily. (West.) Oxaluria. Mineral Acids, when eructations of sulphuretted hydrogen (R.). Nitro- muriatic Acid, is of important service (B.) ; especially in the condition show- ing general malaise, weakness, and depression of spirits, with oxalate crystals in the urine (W.); also in sciatica and other forms of neuralgic rheumatism accompanied with oxaluria, full doses (hbvj-x) of this acid, with an occasional brisk purgative, and cold douche, followed by friction (Wa.). Zinc Sulphate, often very serviceable in irritability of the nervous system, associated with dys- pepsia and oxaluria (Bird). Lactic Acid, aids imperfect digestion (B.). Gold, the auric salts are very serviceable in syphilitic ozsena (B.). Mercury, ointment of the nitrate in syphilitic form; the white or red precipitate with 58 times its weight of sugar snuffed after clearing the nose in non-syphilitic forms (R.). Potassium Permanganate, 3j-Oj solution as an injection or spray (B.). Hydrastis, the fluid extract locally (B.); 3j-,lviij solution as lotion with of the tincture thrice daily internally (P.). Bromine, as inhalation (see form- ula below); or Iodine with Carbolic Acid, or the latter in one per cent, solution, as inhalations (B.). Carbolic Acid, inhaled, 1 per cent, solution (B.). Silver Nitrate, applied behind veil of palate;—gr. v-xx ad (B.). Alum, solution (3j-Oj) for irrigation (R.). Glycerite of Tannin, by irrigation (R.). Salicylic Acid, in very weak solution (1 to 500), as cleansing, astringent, and disinfectant wash, used by retro-pharyngeal syringe, and followed by applications of Calo- mel, in powder, to the ulcerated portions of the mucous membrane (Massei). Cubeba, the oleo-resin, gtt. xv-xx on sugar after each meal, to restrain the secretion and perhaps modify its character (Cohen). Chloride of Lime, gr. xxx-lx with §j decocti krameriae; of which 3ij-iij, diluted with an equal quantity of water, should be injected twice daily after cleansing with salt and water (Cohen). [Compare Catarrh, Chronic Nasal.] Ozaena. Prescriptions. R. Tinct. Iodi, . . . . . . g iv. Ac. Carbolici, £j-ij. M. Sig.—Use on sponge in a wide- mouthed bottle as inhalation. {Potter.') R. Sodii Carbonatis, Sodii Boratis, . . . . aa g ij. Liq. Sodae Chloratae, . . . g ss- g ij. Glycerini 2j. Aquae, . . . . . q. s. ad 3 vj. M. Sig.—Apply by means of a hand- spray apparatus. (Thornton.) R. Bromi, g ss. Alcoholis, j ss. M. Sig.—Inhalation when vaporized by heat of the hand. R. Acidi Carbolici, rr^xx. Aquae Calcis, Oj. M. Sig.—Use as wash or spray. Opium, is universally used to quiet pain. Morphine, hypodermically, in vicinity of nerve, is curative when not so by stomach. Morphinae acetas vel sulphas gr. with atropinae gr. to Caution, morphine habit (B.). Sometimes a single injection curative of sciatica and neuralgia. Poultices con- taining laudanum useful in inflammation. Linimentum opii by friction, relieves Pain. PARALYSIS. 633 pleurodynia, neuralgias, etc. Opiates soon lose their influence in any certain dose, requiring increased quantities to keep up analgesic influence, so in chronic cases it is best to exhaust all other means before resorting to it (R.). Chloral, has no direct pain-relieving power, except in dangerous doses. To relieve pain and promote sleep, the best agent is a combination of chloral and morphine, cautiously, if heart trouble, or to old drunkards; gr. xv-xxx -f- gr. % (B.). Sometimes relieves neuralgia, chronic rheumatism, gall-stones, colic, gastralgia, and even cancer (R.). Aconitine, locally over seat of pain ; one of the most certain and powerful palliatives in neuralgic, rheumatic, and gouty affections (Wa.) ; especially serviceable in neuralgia of 5th nerve (B.). Belladonna, the best remedy for every kind of pain in pelvic viscera (Anstie). Atropine hypo- dermically in local pain, neuralgia, sciatica, glaucoma, etc. When it succeeds, has more lasting effect than morphine (R.); sciatica, tic douloureux, etc. (B.). Iodides, are magical in syphilitic nocturnal pains of head (B.). The iodide of ammonium, gr. iij ad §j ol. olivae, with friction; causes the disappearance of nocturnal syphilitic pains (W.). Cimicifuga, relieves many kinds ; neuralgia of 5th, rheumatic headache, ovarian neuralgia, dysmenorrhoea. Inferior to ergot in labor-pains or after-pains. 3j doses (B.). Conium, in cancer, rheu- matism, neuralgia, etc. (R.) ; also for the fulgurant pains of locomotor ataxia, chronic alcoholism, sciatica, phthisis, etc., doses of of a fluid extr. of the unripe fruit, every yi hour, well watched (Madigan). Iron, with Belladonna, for the wandering pains of anaemia, in which morphine is dangerous and bromides useless (Waugh). Antipyrina, a most efficient analgesic, may be ad- ministered hypodermically. Is especially adapted to neuralgias, migraine, and gouty pains. (See ante, page 106.) Theine, of very great value for neuralgic pain, affects the nerve outwardly along its course from the site of the injection (Mays). Chloroform, locally, inferior to other local anaesthetics, two or there drops on cotton into the ear for faceache or toothache ; vapor on raw surface of cancers, neuralgia of uterus, photophobic eye, etc., by inhalation in renal and biliary colic, and to produce general anaesthesia, which see (R.). Ether, syray for local anaesthesia ; inhaled for general anaesthesia (R.). Carbolic Acid, as local anaesthetic (R.). Cocaine, as a local anaesthetic to mucous surfaces, or hypodermically for minor operations involving a small area, as circumcision, eye operations, etc., has no equal; a 4 per cent, solution of the hydrochlorate is generally employed (R.); has many applications, as odontalgia, otalgia, neu- ralgia of superficial nerves, etc., etc. Iodoform, as suppository in painful dis- eases of the rectum or bladder (R.). Stramonium, is used as ointment (R.). Duboisine, used instead of atropine (B.). Rhatany, relieves the pain of ulcera- tive disease of mucous membranes, pain of burns, ulcers, and especially of blisters (Tr.) Cannabis Indica, formerly used (B.). Aquapuncture (B.). [See Neuralgia.] Galvanism, of an affected nerve gives certain relief. Positive pole on point of emergence ; negative over superior ganglion of cervical sym- pathetic (B.). Heat, if pain is without fever or inflammation (B.); warm injec- tions soothe the pain of cystitis, prostatitis and abdominal pains generally (B.). Cold, when pain is inflammatory (B.). [See After-pains, Anaesthesia, Boils, Chest-pains, Colic, Gastralgia, Headache, Hepatalgia, Inflam- mation, Lumbago, Myalgia, Neuralgia, Odontalgia, Otalgia, Rheuma- tism, etc.] Prescriptions. R. Antipyrinse, gr. xv. Aquae Destil., lt\,xv. Cocainse Hydroch., . . . gr. ss. M. Sig.—One-half as hypodermic in- jection, or the whole when rapid action de- sired. {See.) Paralysis. Strychnine, gr. -fa to [gr. to (R.)] ; also hypodermically into the affected muscles,—for hemiplegia, paraplegia, local, mercurial, paludal, rheumatismal, facial, infantile, and diphtheritic paralyses; in that of spinal 634 PAROTITIS. muscles, of bladder and all local forms (B.); often of use in hysterical (P.); all forms, except, according to Barwell, in cerebral and spinal paralyses (R.). Nux Vomica, in hysterical, and in that from lead-poisoning ; only in chronic cases (P.); in paraplegia from softening and wasting of cord (Brown-Sequard). Hyoscyamine, gr. fa gradually increased to fa in par. agitans, locomotor ataxia (B.). Rhus Toxicodendron, certainly efficacious in cases depending on rheu- matism (P.). Ammonium, the iodide and carbonate to aid in absorption of thrombi and thus promote cerebral nutrition in cases of incipient hemiplegia, due to endarteritis deformans reducing the lumen of the vessels in the brain (B.). [See formula below.] Arnica, paralysis of the bladder, and many forms (P.). Phosphorus, with cod-liver oil in paralysis agitans, small doses ; also in the paralysis of white softening of the brain (B.) ; in hysterical paralysis (R.) ; in myelitic paraplegia from excessive venery; the only drug which really affects the nerve-centres (W.). Belladonna, when depending on chronic inflammation of the cord (R.); externally as ointment along spine, with Ergot internally (Brown-Sequard). Physostigma, into the eye in ocular paralyses (B.); in general paralysis of the insane, also in progressive muscular atrophy without much mental disorder, long-standing hemiplegia, paraplegia, loco- motor ataxia (R.). Coniine, in some cases of paralysis agitans (B.). Ergot, in paralysis of bladder from over-distention (B.); paralytic dy- suria, sensation of but partial emptying of bladder (P.) ; said to be useful in paraplegia (R.); in paraplegia complicated with menstrual irregularity and forms of paralysis arising from spinal congestion (Wa.); has cured cases of constipation of the paralytic when all the most powerful cathartics failed (Curran). Cocculus Indicus, valuable in hemiplegia, paraplegia, and paralytic stiffness (P.). Ignatia, in paralysis of lower extremities (P.) Can- nabis Indica, for retention of urine from spinal disease (R.). Capsicum, in to 2-grain doses every 4 hours as general stimulant (P.). Colocynth, in cere- bral paralyses, sometimes seems to act favorably upon principles of revulsion or counter-irritation (P.). Mustard, as an emetic to stimulate failing heart in certain forms of paralysis (P.). Senega, in rheumatic, is a powerful help (P.). Nutmeg, the oil as external stimulant (P.). Oil of Bay, has been given ; is obsolete (P.). Cajuput Oil, efficacious in palsy (P.). Counter-irritation, by blistering fluid in peripheral paralysis of the 7th nerve (R.). Cod-liver Oil, Anstie insists on it when low nutritition and faulty assimilation (B.). Galvan- ism, in hemiplegia and many forms (B.). Electricity, faradization of the muscles affected. Localized electricity probably of more importance in confirmed spi- nal paralysis than medicinal treatment. Massage, in infantile paralysis, given with lacto-phosphate of calcium and cod-liver oil. Strychnine injected into the muscles (B.). [Compare Hemiplegia, Locomotor Ataxia, Tongue.] Prescriptions. R. Strychnine Sulph., . . . . gr. ij. Aquae Destillatae, . . . . j. M. Sig.—For hypodermic administra- tion : tt\v = gr. of strychnine sulphate. R. Ammonii Iodidi, . . . . % j. Ammonii Carbonatis, . . q ij. Liq. Ammonii Acetatis, . vj. M. Sig.—A tablesp. thrice daily. See Ammonium, above. (B.) Parotitis. Aconite, in febrile conditions (R.). Mercury, grain of gray powder, 3 or 4 times a day, very useful, relieving pain and swelling (R.). Poultice of flaxseed meal, a good local application for gland. Leeching, often gives speedy relief, when pain is great and resists hot fomentations (Wa.). Care to avoid chilling, important. Incision, when suppuration occurs. Stimulants and Ton- ics internally are very necessary in symptomatic parotitis, occurring as a com- plication or sequel of other diseases, with adynamic symptoms. PEDICULI—PEMPHIGUS—PERICARDITIS. 635 Pediculi. Mercury. Citrine ointment or wash of corrosive sublimate, for lice on all parts of body. The oleate destroys lice immediately, and also kills the ova (R.). For crab-lice the ordinary blue oint. is very disagreeable, and often toxic in its effect on the patient. A better preparation is Calomel in 5 per cent, oint., or the Bichloride, a 1 per cent, solution in alcohol, of which a teasp. to a pint of water, as a bath to parts twice daily. Cocculus Indicus, destroys pediculi (P.); the tinc- ture undiluted as a wash. Staphisagria, as oil or ointment of the powder (R.); 41 lice-bane ” (P.) ; the tincture a very efficient application, and much more cleanly than an oil or an ointment. Acetum. Vinegar will kill the nits, as it softens the adhesive chitin by which the ova are glued to the hairs. Ether, washed over the parts, effectually destroys crab-lice. Tobacco, a decoction of the leaf is an efficient application, but requires care, especially if the surface is abraded (Wa.)( Essential Oils, will kill, as rosemary, anise (P.); or powdered pyrethrum (R.). Cleanliness, cannot be dispensed with, and in many cases may alone be sufficient. Boil underclothing. Isolation of person, and of brushes, towels, etc., to prevent infection. In Vienna the following prescrip- tions are used:— R • Bals. Peruvian., Petrolei aa part. xv. Oil of Laurel, . . . part. j. To be applied and washed off after 3 hours. Prescriptions. U. Ac. Salicylici, . . part, ij-iij. Toilet Vinegar, . . part. xxv. Alcohol (80 per cent.) part. lxxv. To be rubbed on with a bit of flannel. Once often enough. Pemphigus. Arsenic, is curative, especially when chronic (B.); largest dose, liquor arsen. 3 times a day, on full stomach (R.); exercises a powerful influence (Wa.). Mercury, Citrine ointment is largely used (Wa.). Potassium Iodide, improves the condition in pemphigus (Wa.); with good, simple diet; quinine, cod-liver oil, etc. Silver Nitrate, in pemphigus, after the bullae have burst, and excoriations remain (gr. ij ad §j aquae) (Wa.). Water Dressings, on lint, covered with oiled silk, constantly, in pemphigus and rupia (Wa.). Cod-liver Oil, with nutritious diet, is a powerful auxiliary to treatment (Wa.). Puncturing the blebs and evacuation of their contents is necessary as soon as formed. Then dusting-powders of zinc oxide, starch, or buckwheat flour, or lotions of liquor plumbi subacetatis dilutus. Pericarditis. Aconite, when violent throbbing and extreme pain (R.); of great value, if given early (P.) ; proves in the highest degree serviceable, when object is to diminish vascular excitement or irritability (Wa.), Spigelia Anthelmia, useful in rheumatic pericarditis (P.). Digitalis, when rapid and feeble heart, cyan- osis and dropsy (P. N.) ; in second stage when heart flags, a tablespoonful of the infusion every 4 hours is beneficial. Bryonia, exceedingly valuable in second stage, that of exudation ; fully equals any remedy in pericarditis (P.). Opium, regularly in grain doses, every 3, 4, 6, or 8 hours, is very beneficial (Wa,), Veratrum Viride, extract made by inspissating the juice of the root, of which gr. ij, with j of calomel, every 2 hours, valuable (Waring-Curran). Quinine, gr. xv-xx may suppress an acute attack, if given at critical moment (B.); may be used as an antipyretic. Counter-irritation, has been much abused ; useful at commencement, but not in acute inflammatory stage (B.). Iodine painted over the cardiac region, or flying blisters in the second stage. Iron, the tinc- ture in full doses may be required in the second stage. Poultices, large, hot, often renewed (R.). Ice may be used instead of poultices in the early stage. Paracentesis, by aspiration may be required in the second stage. [Compare Endocarditis.] 636 PERIOSTITIS—PERITONITIS PERSPIRATION. Periostitis. Mezereon, in the rheumatic and scrofulous form (P.). Mercury and Mor- phine. The oleate externally (R.). Potassium Iodide, in syphilitic children, also in non-svphilitic periosteal thickening (R.); holds the first place for syphi- litic affections of the bones (Wa.). Ammonium Iodide, cures periostitis most readily when syphilitic (Wa.). Staphisagria, when long bones affected (P.). Iodine, the tincture, or blisters locally of great service in chronic form (R.) ; under the external use of Iodine it often rapidly improves (Wa.). Poultices, after an early and free incision, when suppuration takes place (C.). Incisions, carried deeply, should be made without waiting for fluctuation, when great ten- sion exists and there is a tendency to suppuration. The sides of the abscess should then be brought together with compresses and a bandage (Gross). Tonics and stimulants, as milk-punch, quinine, iron, and opium, in full and sustained doses, are imperatively demanded in many cases (Gross). [Compare Nodes, Onychia.] [Peritonitis. Aconite, of great utility when sthenic reaction; see Opium (B.); should be given early in all inflammations of serous membranes (P.). Bryonia, exceed- ingly valuable in second stage, when exudation (P.). Mercury, when tendency to fibrinous exudations, is employed with good effect (W.). Opium, to quiet intestinal movements (R.); by far the best agent (P., B.). Morphine, gr. ]/z hypodermically, will often abort, if given early. Aconite and Opium, the tinc- tures, gtt. ij of the former with gtt. vj of the latter, in water every hour or two ; a larger dose of opium if pain is severe (B.). Large doses easily borne in this affection (Wa.). Cocculus Indicus, for tympanites ; a few doses will often re- move the pain and relieve distention (P.). Quinine, strongly urged by Trous- seau ; is naturally indicated in most inflammations (P.). Turpentine, for tym- panites (P.); turpentine stupes, v-xv drops of turpentine on flannel wrung out of hot water during acute stage, then blisters for a short time (B.). Leeches, to abdomen, if patient plethoric, and sthenic reaction, relieve pain (B.). Purga- tives, are inadmissible when from perityphlitis or inflammation of appendix vermiformis (B.). Poultices, large, hot, and frequently renewed. Should be thin, and covered with cotton-wool (R.). Ice, to abdomen (B.). Cold relieves (W.). Water, hot fomentations to relieve pain, sometimes cold compress better. Ice, sucked or swallowed, to assuage the vomiting; sips of cold water. Diet, after acuteness of attack passed, should be mild and unstimulating. [Compare Puerperal Peritonitis.] Belladonna, as liniment locally, also the tincture internally, especially in weakly children who sweat profusely (R.). Atropine, gr. to 1JTT hypoder. (or in exceptional cases even gr. in pill) in sweating of phthisis and exhaust- ing diseases (R.); gr. at bedtime for sweats of phthisis (B.). Jaborandi, gr. ■fo of pilocarpine, thrice daily, checks profuse perspiration (R., Pf.). Naphthol, in a 5 per cent, ointment or alcoholic solution, is a very efficient application for local sweating (Kaposi). Potentilla Sarmentosa, the Cinquefoil, an infusion of the vine, leaves and root, may be drank ad libitum, and is a very efficient remedy for night-sweats, having stopped them when Atropine failed to relieve (Pope). Agaricine, is used very successfully. (See formula below.) Salvia, the ordinary sage-tea is very efficient, used internally and locally by sponging the body. The infusion for night-sweats of phthisis (DaC.). Quinine, in exhaust- ing diseases. In many, a night-draught of quinine, sulphate of zinc, and sul- phuric acid, useful (R.). Opium, as Dover’s powder, may succeed in profuse colliquative sweating (R.) ; a fact, though hard to account for it (Wa.). Aro- matic Sulphuric Acid, to check sweats of phthisis. Bad for digestion (B.). Muscarine, has been used with great success in the sweats of phthisis and of other morbid states (R.). Zinc Oleate, rapidly controls excessive and offensive sweating on slight exertion in the axillae and groins, also the night-sweats of Perspiration. PERTUSSIS. 637 phthisis (Murrell). Zinc Oxide, gr. iij, with gr. ss of ext. belladonnae, in a pill at bedtime for the sweats of phthisis (R.). Gallic Acid, is very useful for the same condition, and may be combined with extract of belladonna (B.). Tannic Acid, may also be used with benefit. Aluminium, the oleate, checks hyperi- drosis and antiseptizes the sweat, thus forming a useful application to the axillae and groins of children (Wa.). Potassium Permang., gr. for fetid perspira- tions of axillae, feet, etc. (B.). Salicin, profuse sweats of hectic fever (Wa.). Salicylic Acid, in solution with borax, the most agreeable and efficient deodor- ant for fetid perspirations (B.). Carbolic Acid, 2 parts to 3 of glycerin and water, twice daily for fetid sweat (Wa.). Oils, rubbed into the whole skin to prevent sweating accompanying exhausting diseases, as phthisis ; but sponging with a weak acid wash better (R.). Ergot, said to arrest sweating (R.). Sponging, with acidulated water, or very hot sponging in phthisis (R.). [Compare Feet.] R. Acidi Gallici, gr. xxx. Ext. Belladonna, . . . . gr. ij. M. ft. pil. no. x. Sig.— Two pills at bed- time (B.). For sweating of phthisis. Prescriptions. R. Agaricinae (Merck), . . . gr. x. Atropinse Sulph., . . . . gr. j. Ac. Sulph. Aromat., . . . rr\,i200. Solve et filtra. Dose, in syrup or simple elixir, 5 or 6 hours before retiring, as action is slow. R. Acidi Tannici, gr. xxx. Pulv. Digitalis, gr. xv. Ext. Cinchona q. s. M. ft. pil. no. xx. Sig.—One pill at bed time. Aconite, in all acute congestions (P.); as a preventive or abortive remedy very efficient, when associated with ipecac, and cherry-laurel water (Dervieux). See formula below. Amyl Nitrite, with Carbolic Acid, in steam atomizer, has proved a very efficient inhalation (Bayliss). Ipecacuanha, useful in many cases (R.) ; try for 5 years of age, every hour or two, with the greatest relief (P.) ; when bronchitic or pneumonic complications, combined with ammonium bro- mide (Wa.). Pulsatilla, gr. of anemonine (P.). Belladonna, obviously of value in febrile stage, is of special use when dentition is in progress ; relieves the congestion of air-passages and also the determination of blood to the head (P.); good when profuse bronchial secretion ; best in spasmodic stage. Chil- dren bear this drug well; of tinct. may be given hourly to a child 2 or 3 years old (R.). Benzoate of Sodium is highly efficient. See formula below. Conium, or the Hydrobromate of Coniine, in doses of gr. to gr. £ according to age, a very efficient remedy (W.). Drosera, small doses are very effective (Murrell). Chamomile Oil, a very useful remedy (P.). Coccus Cacti (Cochi- neal), in doses of gr. l/3 thrice daily for infants, has been highly recom- mended (W.) ; proves very effective in most cases. Hydrocyanic Acid, very serviceable in cough by habit, after cessation of whooping-cough proper, or in nervous sympathetic cough of mothers (B., P.). Opium, in convulsive stage, to produce and maintain slight heaviness (R.). Cocaine, a 5 per cent, solution, painted on tonsils, fauces, back of tongue, and if possible on larynx, is very efficient (Labrie). Bromides, relieve spasmodic element (B.); that of ammo- nium will readily cure many cases ; gr. ij or iij ter die for infants (Wa.). Lobelia, in spasmodic stages ; well tolerated by children ; Ttpx of tinct. every hour for child 2 years old ; also additional dose when cough is imminent (R., P.). Alum, when acute stage over and no complication, gr. ij—vj every three hours, or less every hour in glycerin or honey (R.). Chloroform or Ether, to lessen severity of the paroxysms ; as inhalations (R.). Chloral, gr. v-x in spasmodic stage, relieves quickly (B.); gr. iij-viij every 4 hours (Porter). Carbolic Acid, as vapor, with steam atomizer; found to be very beneficial (J. L. Smith). Castanea, a decoction of chestnut leaves has been used with much success; dose ad Pertussis. 638 PHARYNGITIS. libitum (B.); the fluid extract, in 5-doses, exercises a remarkable influence over the cough (W.). Valerian, said to control the paroxysms (R-). Nitric Acid, well diluted in sweetened water, after the subsidence of the catarrhal stage (B.). Gelsemium, in spasmodic stage (B.). Mono-bromide of Camphor, gr. v in mucilage and syrup, tolu. 3 or 4 times a day, has been very serviceable (B.). Zinc Sulphate, gr. %-) with ext. belladon. gr. has varying degree of success (B.). Lactucarium, the syrup as vehicle for cough-mixtures (B.). Quinine, in solution, locally to fauces (Dawson); the tannate with sodii bicarb, of each 5, and pulv. acaciae 100 parts, used with an insufflator (Pollack). Petro- leum, on rags around head of the bed, is recommended highly by Hildebrandt. Silver Nitrate, when acute stage passed (Tr.); probably inferior to alum (Wa.). [Compare Cough.] R. Chloralis, 3). Potassii Bromidi, ... 3 ij. Syr. Pruni Virgin., . . . Sj. Aquae, gj. M. Sig.—A teasp. thrice daily for in- fants in the convulsive stage. (Dessau.) Prescriptions. R. Sodii Benzoatis, gr. lxxx. Aquae Menth. Pip., Aquae Destillatae, . . ,aa3x. Syr. Aurantii, 3 ij. M. Sig.—A dessertsp. every hour or two. (Letzerich.) R . Ext. Aconiti, gr. j. Syr. Ipecacuanhse, . . . Aquae Laurocerasi, . . 3 j. Mucil. Acaciae, . % vjss. M. Sig.—A teasp. to a tablesp. accord- ing to age, every hour. (Dervieux.) R. Acidi Carbolici, 3 ss. Potassii Chloratis, . . . . 3 ij. Glycerini, 3 iv. Aquae, q. s. ad 3 vj. M. Sig.—Use with steam atomizer thrice daily. (J. Lewis Smith.) R. Olei Morrhuse, Mellis Despumat., Succi Limonis, . . . . aa p. aeq. M. Sig.—A teasp. or two as required. (Sir Wm. Gull.) R . Amyl. Nitritis., 3; ss. Acidi Carbolici, .... Glycerini, Alcoholis, aa^ss. M. Sig.—Use by inhalation with steam atomizer. (Bayliss.) Pharyngitis Aconite and Belladonna, for acute attacks (B.); when high temperature (R.). Belladonna, is very useful, relaxes the pharyngeal muscles (W.). Capsicum, as gargle, 5j ad aquae, in very early stage only (R.). Alum, gargles, in chronic inflammations (R.). Silver Nitrate, gr. v-xx ad §j, on sponge probang, suc- cessful if systematically applied (B.); in early stage of inflammation ; also in chronic on brush, or as spray (R.). The solid stick to each diseased follicle, after scraping (A.). Ammonium Chloride, gr. ij with Ttpxv of tinctura cubebae, every half-hour, often controls acute pharyngitis; when a gouty diathesis exists add ttlx of the ammoniated tincture of guaiac, and give every hour (A. A. Smith). Xanthoxylum, a decoction of the bark locally to throat, and Ttpx-xxx of the fluid extract thrice daily, a very successful remedy for chronic pharyngitis (B.). Tannin, insufflation to affected surface (B.). Cubebs, powdered, locally, useful (B.). Glycerin, pure, locally, with tannic acid, very serviceable (B.); in chronic inflammation of the throat (R.). Hydrastis, the fl. extr., locally, and gtt. v-x per stomach (B.). Alcohol, dilute, gargle in relaxed throat (R.). Cimi- cifuga, when pharynx dry and spotted over with inspissated mucus (R.). Ipe- cacuanha, the wine as spray in non-inflammatory sore throat, with hoarseness from congestion of vocal cords (R.). Pomegranate Bark, as gargle (P.). Potassium Chlorate, as lozenge to stimulate the follicular secretions to a healthy condition (A.). Iron, Quinine, and Strychnine, as tonics, are mainly indicated A.). Zinc Sulphate, as gargle, occasionally employed in relaxed throat (R.). Inhalation of vapors, or of pulverized fluids, by the atomizer, found very bene- PHIMOSIS PHLEBITIS PHLEGMASIA. 639 ficial (Wa.). Food, of piquant kind, spices, pepper, mustard, etc., should be strictly prohibited. All fluids should be used at a moderate temperature (A.). Water, by throat compress, relieves ; also in daytime, in obstinate cases. Rest to voice, and cultivation of beard, are useful aids. Prescriptions. R. Tinct. Aconiti, Tinct. Belladonnse, . aa . 3 ss. Tinct. Guaiaci Ammon. . . z v. Syr. Limonis, ss. Aquae Cinnamomi, . . ad iv. M. Sig.—A teasp. every 3 hours for acute pharyngitis. R. Aluminis gr. xxx- 3 ij. Sodii Boratis, gjss. Glycerini, gij. Tinct. Myrrhae, .... Z ij. Aquae, . . . . q. s. ad 3iv. M. Sig-—Use as an astringent gargle, 4 or 5 times a day. R. Tinct. Aconiti, 3 ss. Ac. Hydrocyan. Dil., . . . rr\xl. Liq. Ammonii Acetat., . . M. Sig.—Teasp. every 2 or 3 hours according to the severity of the case. In acute and subacute pharyngitis. R. Acidi Tannici, gr. lx. Alcoholis, rr\,xxx. Aquae Camphorae, . . . . 5 iv. M. Sig.—An astringent gargle, to be used several times a day. Phimosis Belladonna, as ointment, extract vij-ad xx of lard, has proved effectual (Wa.). Lupulin, 5-15 gr. doses, of advantage after operation, to keep penis at rest (Wa.). Surgical. Division of the prepuce by a bistoury and director ; circumcision (D.). Cocaine, a 4 per cent, solution injected at several points around edge of prepuce, as local anaesthetic during the operation of circumci- sion. Chloroform, or Ether, may be used as anaesthetic in paraphimosis, before attempting reduction (Wa.). Phlebitis. Hamamelis, has as decided an influence on the venous system as Aconite on the arterial (Pfi). Mercury, in frequent and liberal doses, to early and decisive constitutional impression, the best form being Calomel, or Calomel and Blue Mass (Gross). Rest, fomentations, poultices, early incision of abscesses, aperients, opium to relieve pain and insure quiet of mind and body (D.). Blister, over course of an inflamed superficial vein (R.). Diet, nutritious, and wine, espec- cially if great loss of blood (D.). Stimulants, as Quinine and Iron, especially the tincture of the Chloride, also milk-punch, are needed to combat the depres- sion which is sure to arise. The disease is always dangerous and often fatal (Gross). Incisions, must be freely made if abscesses form, and the internal organs watched for multiple abscess. Ulceration, if it occur, must be watched for hemorrhage, which should be arrested by compression and styptics (Gross). [Compare Phlegmasia, Varicosis.] Belladonna, and Mercury, equal parts, as ointment, often of much benefit (Wa.). Hamamelis, has specific action on venous system (P.) ; extolled by Dr. Preston (R.). Blisters, in early stage; are extremely useful if judiciously em- ployed (L.). Ammonium Carbonate, often valuable where great prostration; full doses (Wa.). Creasote, injections daily (Wa.). Hydrochloric Acid, of dilute acid in Oij of barley-water, with of potassium chlorate, to be taken daily (Mackenzie). Opium, large doses internally, with leeches and anodyne ointments (Wa.); laudanum, if pain severe, sprinkled on hot fomentations (L.). Leeches, of great service during the acute inflammatory stage (Wa.). Bandag- ing, when the more acute symptoms subside; at first with flannel, afterwards with ordinary roller bandage (L.). Regimen, should be tonic (L.). Water, compresses in active stage ; douches, hot and cold in chronic form. Phlegmasia Alba Dolens. PHLEGMON PHOTOPHOBIA PHTHISIS. Phlegmon. Aconite, or Belladonna, are certainly efficacious. Aconite best (R.). Sulph- ides, to abort, or, if inevitable, to promote ; gr. ss-j every hour or two of Potassa Sulphurata (B.). Silver Nitrate, strong solution may check if applied early in the vicinity (B.). Carbolic Acid, injections ; a 2 per cent, solution (B.); used with great success (W.). Iodine Injections, after evacuation (B.). [Compare Erysipelas.] Photophobia. Atropine, a neutral solution of the sulphate, gr. j ad §j, for adult, dropped into the eye every 4 hours (C.). If much lachrymation, so as to dilute the solution, it may be applied more frequently. In some cases belladonna irritates and has to be abandoned (Wa.) Conium, in scrofulous photophobia, gr. ss of Coniine in gj of 01. Amygdalae, locally twice or thrice daily ; or the vapor of Coniine (Wa.). Mercury, Calomel by insufflation (C.). Canthoplasty, for the spasm of the orbicularis in severe photophobia (C.). Glasses of cobalt blue, the best (R.). Arsenic, in the condition described by old writers as strumous ophthalmia, with its attendant photophobia, is very valuable as an internal remedy (C.). Chloroform, the eye exposed to the vapor of a few drops in severe photophobia will be speedily relieved (Jones). Croton-Chloral, gr. v-x, in young people and those suffering from syphilitic corneo-iritis (Bader). Potas- sium Chlorate, internally, is most useful in some cases (Vernon). Cocaine, a solution of the hydrochlorate, from 2 to 4 per cent., a few drops upon the con- junctiva, will be found promptly efficient in most cases. Phthisis. Creasotum, gives excellent results (Bouchard); is directly curative, at least in the initial stage of the disease (Frantzel); promotes the sclerotic change by means of which recovery is found to occur (Jaccoud); Morson’s beechwood creasote should be used, in doses of Try in whiskey and glycerin, every 3 or 4 hours. Should be largely diluted to prevent irritation, and continued for many months,—relieves cough, diminishes expectoration, stops night-sweats, increases weight, decreases fever, promotes appetite, and in many cases im- proves the local condition, as shown by the physical signs (Robinson). Crea- sote, tar or carbolic acid, to check expectoration (R., P.); Creasote is often curable in many forms, gr. iij in a pill with Bals. Tolu., three or four times daily, the dose being increased until urine is darkened ; or it may be inhaled with Iodine from hot water (B.). Iodine, or Iodoform with creasote, carbolic acid, eucalyptus, chloroform, alcohol and ether, as combination for an antiseptic inhalation (Br.) ; extremely useful; also as intra-pulmonary injection, a solu- tion of the compound tincture of iodine 1 to 4 of distilled water, of which ttlx-xx injected once every 4 or 5 days, through the 1st, 2d or 3d intercostal spaces, anteriorly or in the axillary region, avoiding the pericardium and great vessels (Robinson). Iodoform internally, has proved extremely effective in all forms, as witnessed by numerous observers in various countries (S. Smith); though not one of the most active germicides, it is very destructive to the bacillus tuberculosis (B.). Iodol may be advantageously substituted for Iodo- form (B.). Cod-liver Oil, holds first rank as a remedy and food in the chronic forms ; a teasp. after meals ter die is enough; when not well borne may be combined with aqua calcis, comp, tinct. of gentian ; or, when not digested, with ether (B., R.); is of great utility by improving nutrition, and by affecting the tubercle; give 35s thrice daily one hour after meals, with n\,x-xv of Ether, or an equal quantity of malt or whiskey; do not give it in hot weather (Da C.). Terebene, with Thymol and Carbolic Acid, equal parts of each, and gss to a pint of hot water as an inhalation : is extremely useful for the dyspnoea (Cam- man). Aconite, in small doses for the irritative fever, is a remedy of much value (DaCosta). Antipyrine in a 2y2 grain dose hourly for 3 doses daily, for the hectic fever (Pribram). Cinchona, for the hectic and sweats, gr. xv-xx quinine (B.); if small doses fail, a dose of 6 or 8 grains at once, or in portions PHTHISIS. 641 repeated hourly (R.). Ipecacuanha, spray to throat when bronchial asthma and emphysema combined with fibroid phthisis (R.). Opium, or Morphine, in a viscid vehicle for cough, or morphine lozenges when cough due to inflamed throat (R.) ; must in time be given for the cough, which is an irritative one. Codeine, gr. to in simple elixir, is useful and does not constipate (Da C.). Alcohol, an important remedy; may be given with cod-liver oil; or spt. fru- menti with some bitter, immediately after meals, or the stronger wines. If it disagrees, it harms. Curiously, it induces an intractable form of phthisis (B.). Verbascum, the Mullein-plant, has long been a popular remedy in phthisis ; it facilitates expectoration, improves the general condition, and palli- ates the cough. Calcium Phosphate, in diarrhoea, and in chronic forms of phthisis, with little or no fever (R.). Iodine, should be more used than it is ; the compound solution, gtt. j-iij thrice daily, or when anaemia and not much fever use Iodide of Iron, gr. xv of the syrup pushed to 3j ter die (Da Costa); as inhalation in chronic phthisis ; to lessen expectoration and cough ; also as liniment painted under clavicles, to allay harassing cough, and to check secre- tion (R.). Cimicifuga, useless in tuberculosis, but in phthisis it relieves cough, improves appetite, lessens intercurrent bronchitis, and so improves the patient’s general condition (Wa.). Arsenic, valuable in chronic forms as is no other remedy; but not in caseous, or where much hectic ; may be given by stomach or fumigation (B.). [See under Asthma.] As cigarettes, useful in the diar- rhoea, probably diminishes temperature ; caution required (R.) ; of great value in early stage, in later stages it is of no avail, Arsenious Acid, gr. or rt\jij of Fowler’s solution, thrice daily (Da Costa). Cocaine, locally, for the throat symptoms, to be applied just before meals are eaten (Da C.). Sulphurous Acid, by inhalation, spray, or fumigation, in chronic phthisis (R.). Sanguinaria, helps expectoration, and revives the enfeebled stomach (P.). Chloroform, with glycerin or honey, for the cough in fibroid phthisis (R.) ; by inhalation con- tinuously as germicide, in connection with other agents of same action (Pot- ter, see Pacific Medical Journal, October, 1890). Ferrum, often pre- scribed ; has no especial influence on deposit (B.). Prescribed in tuberculosis (Tr.). Liquor Ferri Perchloridi, 3j ad aquae, the most serviceable local application in laryngeal phthisis, diminishing irritability of the mucous mem- brane, and quieting cough (Mackenzie). Mercury, gr. of corrosive sublim. every two or three hours, for the diarrhoea (R.). Benzoin, as inhalation, to lessen cough and expectoration (R.). Acids, Mineral, for the indigestion. The acidum muriaticum dilutum (B.). Prunus Virginiana, the wild cherry has a domestic reputation, probably due to its influence over cough; the syrup is much used as vehicle for cough-mixtures (B.). Hypophosphites, are very useful in chronic cases (B.); have no special effect (Da C.). Digitalis, as antipyretic ; deranges intestinal canal, therefore injurious in phthisis (B.). Phosphate of Copper in nascent form soluble in an alkaline body, is held to be specific by Prof. Luton of Rheims. His formula contains Neutral Acetate of Copper 0.15, Cryst. Phosphate of Sodium 0.75, Glycerin and Pulv. Licorice, aa q. s. for one pill. Copper Sulphate, gr. or Silver Nitrate, gr. %, or Bismuth, gr. xx, for the diarrhoea (Da C.). Gaseous Enemata, Bergeon’s treatment, made a noise for a few months, but soon fell into contempt. Baths, sea-bathing, if chronic, little or no fever, without active deposition of tubercle, or scrofulous pneumonia; Turkish baths for the cough (R.). Grape-cure, is serviceable (B.). Aliment, should be nutritious and digestible, malt liquors better than wine or spirits. Extract of malt, cod-liver oil, plenty of meat, and alcohol in moderation (Da C.). Warm clothing, bathing and friction of skin, moderate exercise, and a suitable climate. Forced Alimentation, when anorexia appears, and super-alimentation at all times, necessary to successful treatment. Washing out the stomach daily by syphon-tube, with warm water alkalinized with borax, and then feeding through tube (Robinson). Climate, the best by far is that of Egypt, or Algeria ; next coming New Mexico, Southern California, especially in the desert along the Colorado River, South Carolina, and portions of Georgia and Florida; the latfer being especially suitable for cases having a co-existing bronchitis. For some cases Colorado is very good, and the Adirondack region for early cases 642 PITYRIASIS. in which there is no tendency to hemorrhage (Da Costa). Tuberculin or Koch’s Lymph has been a deceptive bubble which for a short time commanded the attention and admiration of the whole world, but which has been ruthlessly pricked by the critical scalpel in the hands of the father of modern pathology (Senn). [Compare Cough, Hemoptysis, Hectic Fever, Perspiration.] R. Quininse Sulph atis, . . . gr. xviij. Pulv. Digitalis, . . . . gr. vj. Pulv. Opii, gr. iij. M. ft. pil. no. xij. Sig.—One pill thrice daily, for the irritative fever. (Niemeyer.) Prescriptions. R. Codeinas Sulphat., . . . . gr. v-viij. Ac. Hydrocyan. Dil., . . tTLxx. Syr. Tolutani, f, ij. M. Sig.—A teaspoonful several times daily, for the cough. (Potter.) R. Pepsini (Jensen), .... gr.xl. Ac. Hydrochlor. Dil., . . 3 ijss. Glycerini 3 v. Succi Limonis, 3 iv. Aq. Aurantii Flor., q. s. ad |;iv. M. Sig.—Dessertspoonful with meals for the dyspeptic symptoms. R. Tinct. Belladonnas, . . . . 3 ij. Syr. Scillae, 3 ij. Morphinae Sulph., . . . . gr. j. Syr. Tolutani ad iv. M. Sig.—Tablespoonful at bedtime, for cough and restlessness, to be repeated if necessary. (H. Gibbons, Jr.') R. Creasoti (beech-wood), . . ttpyj. Glycerini, Sj. Spt. Frumenti, gij. M. Sig.—For one day’s use, as directed, in doses. [Robinson.) R. Extr. Opii Fluidi, . . . . 3j. Syr. Rhei Aromat., . . . . 3 iv. Syr. Glycyrrhizae, 3j. Liq. Ammon. Acet., . . . % v. M. Sig.—Shake well. A teaspoonful every 2 or 3 hours. A soothing mixture, to quiet cough, allay nervousness, and stimu- late the patient. (Johnson.) R. Iodoformi, gr. xxiv. Creasoti, rqjv. 01. Eucalypti, rtq^viij. Chloroformi rr^xlviij. Alcoholis, Etheris, . . . aa q. s. ad § ss. M. Sig.—10 to 20 drops on the sponge of perforated zinc inhaler, to be worn 20 minutes thrice daily. (Brunton.) R. Iodoformi, Creasoti, Pulv. Benzoini, Bals. Tolu aa gr. j. In pill, of such 2 to 4 daily. (.Huchard.) R. Petrolei Massae, . . . . . Pulv. Cubebse, Pulv. Doveri, aa ss. Cinchonidinse Sulph., . . 3 ij. M. ft. massa, et div. in pil. no. cclxx. Sig.—One pill every 3 or 4 hours. (Griffith.) R. Olei Morrhuse, 3 ss. Mucil. Acaciae, 3 ij. Sacchari, 3 ij. Tinct. Lavandulae Co., . . rtyxx. Aquas, 3 ss. M. Sig.—Teaspoonful for children. An agreeable mixture. (Farquharson.) [For a Cod-liver Oil Emulsion see formula on page 459.] Pityriasis Alkaline and Tonic Remedies generally control mild cases, together with baths and emollients ; the more severe ones requiring constant envelopment in oil, as linseed or cod-liver oil (Bulkley). Mercury, in obstinate cases, Dono- van’s solution of Arsenic and Mercury is highly successful (Wa.); the green iodide, gr. x to §j of lard, or a 5 per cent, solution of the oleate of mercury in oleic acid with one-eighth part of ether, applied by a camel’s-hair brush (B.) ; citrine ointment, especially when the hairy parts of the face are affected (R.); an ointment of ammoniated mercury and calomel is very useful in ordinary cases of dandruff or pityriasis simplex (Bronson). Sulphur, 3j of sulphur lotum to §j of vaseline applied every morning to the scalp, with sweet almond oil anointing at night (Jackson). Soap, the'tincture of green soap as shampoo every morning for cleanliness, or Borax and water, or the yolks of three eggs PLETHORA—PLEURITIS. 643 beaten up in a pint of limewater with j$ss of alcohol, all of which make good shampooing mixtures (Jackson). Borax, to cleanse the scalp, a saturated solution ; or the glycerite of borax (R.). Lead, the liquor plumbi, with glycerin equal parts, and two parts of water, as lotion for cases where there is high in- flammation and abundant weeping (R.). Carbolic Acid, 2 parts to 3 of glycerin and water, twice daily, with the daily use of a carbolized soap, is often effectual (Wa.). Sulphides, §ss of Potassa Sulphurata to Oj of Lime-water, as a lotion, or the Bareges Pomade, see formula below (B.). Baths, frequently, and hard rubbing after shampooing the scalp; avoid stimulating food in bad cases, as well as the use of a fine-toothed comb on children’s heads. [Compare Sebor- rhcea, and for Pityriasis Versicolor, see Tinea Versicolor.] Prescriptions. R. Sodse Sulphuratee, Sodii Carbonatis, . . . aa 5f ij. Axungiae, ijss. M. Sig.—Pomade de Bareges. I R. Hydrarg. Ammoniat., . . gr. xx. Hydrarg. Chlor. Mitis, . . gr. x. Petrolati, gj. M. ft. unguent. Sig.—Local use. Plethora. Aconite, is useful for affections, of plethoric subjects. Decidedly the best remedy for apoplexy in the plethoric (P.). Arsenic, used with advantage when determination of blood to the head (Wa.). Sulphur, as mild purgative for plethora, from cessation of the menses (Wa.). [Compare Abdominal Ple- thora] Pleuritis. Aconite, no remedy more effective prior to stage of effusion (R., P.). [See Inflammation.] The tincture in doses of drop every 3 hours to a child 3 years old, for 2 or 3 days (J. Lewis Smith). Veratrum Viride. Opinions differ as to whether it should be used in sthenic or asthenic forms (R.); gtt. viij of tincture every 3 hours, with a drop added to each dose until pulse reduced or nausea (Wa.). Bryonia, exceedingly valuable in second stage; should follow aconite (P.). Tartar Emetic, see Inflammation. In early stages and young plethoric subjects, when much febrile action, small doses (gr. Yg- to j£) may be useful (Wa.). Digitalis, as antipyretic (R.); deranges intestinal canal (B.); aconite preferred (P.); the tincture in doses of one drop every 3 hours to a child of 2 years old (J. Lewis Smith). Potassium Iodide, to promote absorption of effusions, steadily for a long time (R.); also chest painted with tincture of iodine, one day on each wall alternately; may be washed off with iodide of potassium, alcohol or ether (B.); as a diuretic to remove effusion (Clark). Iodine, also as injections, with great benefit and with- out risk, in empyema and hydrothorax (B., R.). Quinine, has abortive power, increased by combination with morphine (gr. xv + gr. ss); also as restorative tonic in low-type cases (B.). Opium, cannot be too highly extolled (P.); is es- pecially beneficial; gr. ss of morphine hypodermically at beginning will often cut short an attack. During the disease, its effects are very beneficial. A slight physiological effect should be maintained (B.). Morphine for severe pain (R.). Burgundy Pitch, plaster externally as a mechanical support (P.). Asclepias, the popular “pleurisy-root,” is a favorite remedy in the south (W.). Pilocar- pus, in subacute cases to remove fluids (Caro) ; or the nitrate of pilocarpine, gr. bis die, for children (Vigier) ; is too depressing and therefore unsafe (Smith). Sodium Chloride, gss in §j of water, flavored with licorice, in tablesp. doses every 3 hours, often very useful in causing absorption of pleuritic serous exuda- tions ; but is contraindicated when exudation is purulent (Br.). Bloodletting, by cups or leeches, useful by reason of counterirritation produced, and to relieve pain, only in robust sthenic cases (B.). Blisters, often greatly abused ; are harmful during inflammatory stage (B.). Poultices, large, hot, and frequently renewed (R.). Water, cold wet-pack to chest probably better than a hot one, pinned tightly to limit movemdht of chest-walls (B.). Thoracentesis, by aspiration, if the quantity of fluid seriously embarrasses respiration. [For 644 PLEURODYNIA PNEUMONIA. Chronic Pleurisy see Empyema, also compare Hydrothorax, Pleuro- pneumonia.] Prescriptions. &. Potassii Acetat., jZj. Infusi Digitalis, . . . ad % iv. M. Sig.—Teasp. every 3 hours to a child of 4 or 5 years, in the second stage. K. Morph. Sulphat., . . . . gr. j. Tinct. Aconiti, n^xxiv. Liq. Potas. Citratis, . . . gij. M. Sig.—A teasp. every 3 hours. Pleurodynia. Cimicifuga, curative when rheumatic, valuable in sympathetic cases from irritability of uterus (P.); or uterine derangements (R., Wa.). Croton Oil, in obstinate pleurodynia especially when blackened feces (R.). Belladonna, plaster or liniment; the latter generally best (R.). Chloral, made liquid with equal weight of camphor, rubbed in gently, often affords instant relief in severe pleurisy (R.). Sodium Salicylate, gr. xv-xx, every 2 or 3 hours, useful in most cases (Hughes). Ether, as spray, sometimes immediately and permanently removes the pain (R.). Opium, liniment rubbed in after warm fomentations (Wa.) ; or a hypodermic injection of morphine (R.). Iodine, as liniment painted on the chest, often relieves where mustard fails (R.). Blistering, often success- ful when other means fail; sometimes strong vesication necessary (R.). Rest, is important and may be obtained by strapping the affected side with strips of adhesive plaster. Poultices, very hot, followed by application of lint and oil- skin. Belladonna liniment generally better (R.). Mustard, as a poultice, is generally efficient, and can be renewed when pain returns (R.). [Compare Neuralgia, Myalgia.] Pleuro-Pneumonia. Bryonia, often of great service; limits effusion and assists absorption (P.). Carbolic Acid, a 2 per cent, solution injected parenchymatously, once or twice a day, has had remarkable success (B.). Sanguinaria, as a contra-stimulant (P.). Turpentine, as a fomentation (P.). Arnica, the tincture in doses of n\,x every 3 or 4 hours, very useful in controlling the heart's action (Wa.). Pilocarpine, gr. ss, or gij of the tincture of Jaborandi, benefits cases of pleuro- pneumonia (Wa.), [Compare Pneumonia.] Aconite, gives good results in catarrhal and fibrinous (B.); has marked effect (R.); very valuable in first stages (P.); in several cases it apparently cut short the attack (Wa.) ; to reduce circulation either Aconite or Veratrum Viride, until pulse is impressed (Da Costa). Veratrum Viride, valuable (P.); in the very incipiency (B.); opinions differ as to whether it should be used in sthenic or asthenic cases (R.). Bryonia, when pleural complications (P.). Phosphorus, especially when typhoid symptoms; approved by Fleischmann (R.). Bella- donna is useful in the first stage (P.); Harley esteemed it highly in pneumonia (Wa.); as an adjuvant to Digitalis in infantile pneumonia, to soothe the irri- table nervous system and curtail superabundant secretion (Brown). Tartar Emetic, formerly given in large doses; now abandoned; small doses may be useful, but should be used with care, lest depression ensue (B.); at com- mencement with alcoholic stimulants, if patient be weak (R.); may benefit young, robust subjects (Wa.). [See Pleuritis.] Sanguinaria, as a contra-stimu- lant, when fever abated, and graver symptoms have amended (P.). Iodides, none more efficient; the Iodide of Ammonium with Arsenic, to prevent casea- tion of inflammatory products (R.); Ethyl Iodide, gtt. v-xx ter die by inhala- tion, very valuable in catarrhal form (B.). The Iodide of Sodium is useful in catarrhal pneumonia (Da C.). Ipecacuanha, the wine in infantile pneumonia, should never be dispensed with, as it promotes expectoration, controls hemor- rhage and regulates secretion (Brown). Senega, in advanced stages as expec- torant, when cough is dry, irritating and painful, tightness and oppression of chest (P.). Opium, morphine by injection, sometimes needed for severe pain Pneumonia. POLYPUS. 645 (R.); opium is very desirable in many cases, relieves the symptoms and arrests delirium (Wa.). Copper Acetate, Kissel regards it curative; under it the mor- tality was only 4T per cent. Ammonium Carbonate, at crisis for depression ; give in infusion of senega (B.); see formula below ; is useful as expectorant late in disease when lung tissue breaks down (Da C.). Digitalis, of doubtful value ; may be useful for high temperature, ischaemia, and low tension of ves- sels (B.); as case goes on and circulation is to be further controlled, digitalis is indicated (Da C.) ; the best agent to slow the heart in infantile pneumonia, with Belladonna as an adjuvant (Brown).* Antipyrine, to reduce pyrexia; is deci- dedly more serviceable in pneumonia than quinine (Wa.); gr. xv several times a day, or 3 hourly doses each of gr. xxx, then stopping until temperature rises again (R.). Stimulants, in asthenic cases, those of malignant type, and those occurring in aged people (Wa.). Ammonia, the aromatic spirit as substitute for Ammon. Carbonate, in doses of 3ss in simple elixir (Da C.). Turpentine, as stimulant at crisis (B.). Serpentaria, with carbonate of ammonium in low types, as a stimulant about the crisis. Quinine or Salicylic Acid, to reduce tem- perature (R.); Quinine as a tonic in cases which are asthenic from the first (P.); in conjunction with Aconite and Veratrum, gr. viij-xij daily at start, is beneficial (Da C.). Blisters, useful at very beginning only or at crisis of dis- ease ; harmful in inflammatory stage (B.); to lessen the pain, but should be used in moderation (R.). Wet-pack, hot, tightly pinned to limit motion of chest- walls (B.). Poultices, encircling whole chest in children (R.). Diet, farina- ceous, mucilaginous drink, and rest in warm room (R.). R. Tinct. Verat. Viridis, . . . Tt^xl. Spt. iEtheris Nitrosi, . . . gvj. Liq. Potassii Citratis, . . zivss. Syr. Zingiberis, . . q. s. ad 3 vj. M. Sig.—A tablesp. every 3 hours, in the early stage. (Da Costa.) Prescriptions. R. Ammonii Carbonat., . . . gr. xl. Infusi Serpentariae, . . . g iv. M. Sig.—A teasp. every 3 hours, as a stimulant about the crisis. (B.) R • Ammonii Iodidi, . . . . gr. xl. Spt. Ammon. Aromat., . . g\). Elixir Simplicis, .... j|j. Aquae, q. s. ad viij. M. Sig.—One-eighth thrice daily, in syphilitic lobar pneumonia, together with the following pill. (Da Costa.) R. Sodii Iodidi, gjss. Morphinee Sulph., . . . . gr. ss. Elixir Simplicis, M. Sig.—Teasp. thrice daily, with blis- ters over the apex, in catarrhal pneumonia. (Da Costa.) R. Potassii Iodidi, gj. Ammonii Muriatis, .... £jss. Mist. Glycyrr. Comp., . . M. Sig.—Tablesp. 4 times daily, to pro- mote absorption, together with blisters to the chest. (Univ. Penna.) R. Digitalis, gr. vj. Quininse Sulph., gr. xij. Extr. Opii, . . gr. iij. Extr. Ipecac, gr. iij. M. ft. pil. no. xij. Sig.—One pill thrice daily, with the preceding mixture. (Da Costa.) Sanguinaria, has been employed as snuff for nasal polypi (P.); with doubtful benefit (Wa.). Tannin, finely powdered, as snuff blown daily into nostrils through a quill, is especially adapted to the soft and gelatinous varieties ; while it has apparently no effect on the healthy mucous membrane, it causes the complete withering of the polypus (Wa.). Zinc Chloride, has been injected interstitially with success in a case of naso-pharyngeal polypus (Barthelemy). Iron, a solution of the perchloride is advised as an interstitial application (Auger). Acetic Acid, glacial, injected into the body of the tumor, will cause it Polypus 646 POULTICES PREGNANCY. to shrink up and to drop off in a few days. Alum, in powder, applied to point of origin to prevent recurrence (D.). Surgical. A nasal polypus should be seized with polypus forceps and twisted off at the neck; it may be removed through the mouth or the nostril. In a few cases the nostril must be dilated with a speculum, or the ala slit to give access to root of tumor (D.). Poultices and Fomentations are simply local baths utilizing warmth and moisture, relaxing the tissues and relieving pain. If applied early they will check inflammation, or assist the evacuation of pus when suppuration has set in. Poultices should be applied thick (thin in peritonitis), as hot as possible, covered with cottonwool, and frequently changed ; large at onset, very small after maturation. Belladonna and Glycerin, partes aequales, smeared over tis- sues under a poultice, aid the latter greatly, also Tinctura Opii, especially where skin is broken. Linseed-meal or Oatmeal, Starch, Bread, Bran, are best in the order mentioned; add meal to boiling water, stir and spread quickly on warm linen. Charcoal under the poultice, when foul sores are being treated. An excellent method of preparing poultices is to make a lot of bags of various sizes, and of the fabric known as “ Swiss,” filling each one half-full of the lin- seed-meal or other agent employed before sewing up its open end. When wanted for use one of these bags is submerged in boiling water for a few minutes, and on taking it out the meal is found to have swelled so as to fill the bag, which should then be squeezed enough to rid it of the superfluous water, laid on the part and covered with oiled silk and a bandage. Fomentations. Flannel should be wrung very dry out of boiling water, and covered with oiled silk. Spongio-piline, a fabric composed of sponge and wool, coated with india-rubber, is an excellent vehicle for the application of warmth and moisture. The inner surface is moistened with hot water; and its utility may be increased by sprinkling the moistened surface with charcoal, yeast; or saturating it with any desired lotion or liniment. Poultices. Pregnancy, Disorders of. Mercury, a few grains of blue pill to correct clay-colored stools (L.). Iodine, the tincture internally for cardialgia (Wa.). Aloes, have cured piles in preg- nancy, by removing constipation ; cautiously (P.). Alum, Tannin or Catechu, in medicated pessaries for vaginal leucorrhoea (L.). Castor Oil, an excellent laxative (P.) ; to clear out the bowels in diarrhoea (L.). Cocculus Indicus, when intestines much distended with flatus, and frequent desire to urinate from flatulent pressure on bladder (P.). Bismuth, Calumba and Antispasmodics, with minute doses of Opium, for gastrodynia and pyrosis (L.). Potassium Bro- mide, with chloroform, as an antispasmodic in dyspnoea (L.). Sumbul, is invalu- able in restlessness;—n\, xxx-xl of tincture with a little chloric ether, giving quiet nights for a long time (P.). Galla, unguentum gallas cum opio, the best local application to hemorrhoids, also fomentations with sponges wrung out in very hot water, to relieve pain (L.). Digitalis, in infusion, very beneficial in albuminuria (L.). Potassium Acetate, with Basham’s mixture (Liq. Ammonii Acetatis), when albuminuria with anaemia. Calcium Phosphate, believed to exert an influence on the foetus if administered during pregnancy, so that mothers who have borne only rachitic or scrofulous children will bear healthy ones (W.). Berberine, found very useful in the periodical neuralgiae of pregnancy, even in cases in which quinine had previously failed (Maclagan). Camphor, liniment for lumbar pains (Wa.). Senna, the confection proves a mild and efficient purgative in the constipation of pregnancy (Wa.). Milk-diet, for albuminuria of pregnancy the best remedy, if strictly carried out (Parvin). Injections, must be used carefully, even tepid water often induces uterine contractions (L.). [Compare Vomiting of Pregnancy, Ptyalism, Albuminuria, Nephritis, Nervousness.] PROLAPSUS ANI PROSTATORRHCEA. 647 Prolapsus Ani. Nux Vomica. Strychnine, especially when in children, with constipation ; in the latter event add nux*,vomica to a purgative, as tincture of rhubarb (R., P.), or strychnine hypodermically, gr. T for an adult every 48 hours, inch from anus and parallel to rectum, into the cellular tissue; generally requires 4 to 8 injections (Weber). Piper, the confectio piperis in doses of gr. lx-gr. cxx, persevered in for 3 or 4 months, in chronic, weak subjects (Wa.). Sulphur, has a beneficial effect in addition to its laxative value (R.). Alum, in solution, gr. vj to the § (R.). Ice, locally, when parts inflamed (R.). Ergot, the fluid extract injected into the perineum, is followed by immediate relief (Vidal). Ferrum Sulphate, 3j to viij aquas, of which one-third by enema twice daily. Podophyllin, in small doses for rectal prolapse in children (P.). Tannin, injec- tion to restrain the prolapsus (R.). Hydrastis, by enema, or as a lotion (P.). Prolapsus Uteri. Cimicifuga, to prevent miscarriage in prolapsus uteri (R.); has a remarkable effect upon the uterus (P.). Astringents, decoctum quercus, decoctum gallae, (Wa.). Pomegranate bark (P.). Tannin, as catechu, kino, red gum, rhatany. Alum, a solution gr. vj ad gj (R.); lb. j ad Cj aquae, as hip-bath, also should be passed well up vagina (Wa.). Ice, locally when parts inflamed (R.) ; ap- plied to the spine (Wa.). Pessaries, in any form, are of but temporary benefit, and in the end positively detrimental (E.) ; but many cases cannot be treated without mechanical support of some kind. Prostate, Hypertrophied. Alkalies, for the cystic irritation with acid urine. Great benefit from liquor potassae, citrates and acetates of potassium (B.). Triticum Repens, benefit follows its use in the prostatic enlargement of old men (Sir H. Thompson). Ammonium Benzoate, for the cystitis, urine alkaline (B.). Ammonium Chloride, is occasionally useful, gr. xv-xxx, 3 or 4 times daily (Wa.). Iodine Injections, through rectal walls (B.); a weak ointment applied by rectum (Wa.). Iodine, has been tried in all forms, but is of no value (Thompson). Iodoform, as sup- pository in rectum, has proven of great value (B.). Colchicum, in persons of a gouty diathesis (Wa.). Medicine is not likely to have any control over this condition, which is a simple hypertrophy. [Compare Cystitis.] Prostatitis. Cantharides, gtt. j of tincture (5 may be required) 3 or 4 times a day (R.). Triticum Repens, is found to be of benefit (Sir H. Thompson). Urino-Genitals, especially turpentine, cubeb, juniper, cantharis (B.); cubeb, in doses of gr. xx daily, is found of much benefit (Wa.) ; buchu relieves (P.). Silver Nitrate, a solution (gr. v-x ad 3jj), applied to the prostatic urethra in chronic prostatitis, may be useful (Wa.). Blisters, in chronic prostatitis, a small blister on each side of the raphe of the perineum, kept open 4 to 6 weeks, has given the best results (Wa.). Tonic medicines and regimen should be prescribed (Wa.). Hot Injections, to relieve pain (R.). [Compare Prostatorrhcea.] Iron, the tincture of the chloride, when there is much debility (B.) ; chalybeate tonics with quinine and strychnine (Gross). Atropine, indicated in all cases, with potassium bromide (Gross). Potassium Bromide, when irritability and excitement (B.) ; indicated in all cases (Gross). Lead, injections of Goulard’s extract, 3j to §x of water, night and morning, for io minutes at a time (Gross). Ergot, when relaxation exists (B.). Bougie, methodically introduced, is one of the best local measures (Gross). Hydrastis, locally applied, a useful medicine (B.). [Compare Prostatitis.] Prostatorrhcea. 648 PRURIGO PRURITUS. Prurigo. Alkaline Baths, followed by a carbolized ointment, and carbolic acid inter- nally, are of value in the papular eruption, known as prurigo (Bulkley). Sul- phides, Potassa Sulphurata, with tar and benzoated lard, as ointment in genuine prurigo (R.). Arsenic, in doses of tr\,v of liquor arsenicalis thrice daily and gradually increased, has exercised a more or less powerful influence (Wa.) ; has only a moderate effect (Bulkley). Belladonna, controls cases which have resisted ordinary treatment (B.). Carbolic Acid, locally and internally, is especially serviceable in prurigo senilis (B.). Mercury, the bichloride, gr. xx with Ammonii Chloridi, gr. xxx, in Oj of pure water, as lotion in prurigo con- tagiosa, “ army-itch ;” nothing equal to it (White). Borax, a saturated solution in rose-water locally (R.); gr. v-x to §j of hot water for pruriginous eruptions on mucous membrane of vulva and vagina (R.). Galvanism, when prurigo is referable to alterations in the cutaneous nerves (B.). Tonics, are required, nerve-tonics as well as general ones, Cod-liver Oil, Quinine, Strychnine and Phosphorus (E. Wilson). Quinine, in large doses, gr. v-x, will control violent exacerbations (Wilson). Baths, the Turkish, frequently repeated, with inunc- tion of the skin, may be regarded as curative in most cases (Wilson). ] Com- pare Pruritus.] Pruritus. Alkaline Baths, locally, followed by the application of Carbolic Acid Oint- ment, give great comfort in all forms of pruritus (Bulkley). Sodium or Potas- sium Carbonate preferred (Tr.) ; in solution locally, giij ad §iv (B.). Carbolic Acid, as lotion with glycerin, to the itching surface, gives great relief (Bulkley); internally and locally in pruritus senilis (B.); a one per cent, solution as lotion in pruritus ani (R.). Mercury, strong solutions of the Bichloride, black wash, yellow wash or mercurial ointment, in itching of skin affections (R.); Yellow Wash is one of the most efficient applications for pruritus ani. Solutions of the Bichloride are very useful applications in pruritus vulvas et ani (Tr.); for pruri- tus vulvae a lotion of the Bichloride i to 2500 parts of water, with alum and starch, is recommended (B.). Calomel 3j to of lard, as ointment, is the best application, except in the pruritus of urticaria; very useful in pruritus ani, less so in pruritus pudendi (R.). The Oleate, a 5 per cent, solution in oleic acid with one-eighth part of ether, applied by a camel’s-hair brush, in pruritus ani et pudendi (Marshall). Alum, a strong solution is very useful for pruritus vulvas (Tr.). Hydrocyanic Acid, diluted as lotion, often very serviceable; may be prescribed in solution with borax (B.); or laurel-water as lotion, especially in pruritus senilis (P.). Potassium Cyanide, 3} to Oj of water, as lotion for pru- ritus of various kinds when the skin is unbroken (R.) ; as ointment or solution, if strong enough, relieves greatly, but must be used with caution (B.); or rr\_xxx of the dilute acid of the Br. Pharmacopoeia in of water or glycerin, may be used instead (R.). Silver Nitrate, a solution, gr. xx ad %j, painted over the affected parts in pruritus vulvae, is very effective (B.). Tobacco, is an effective but dangerous application (B.). Iodoform, as ointment, 3j ad §j adipis (R.). Iodine, for itching of the nose or inner canthus, sneezing, etc., iodine inhala- tions have a marked effect (R.). Arsenic, for itching of the nose, accompany- ing asthmatic symptoms (R.). Benzoin, the compound tincture painted on the skin, for the itching of eczema, urticaria, etc. (R.). Boracic Acid makes an excellent lotion in pruritus pudendi, a teasp. to the pint of hot water (R.). Borax, gr. v-x ad §j hot water (R.). See Prurigo. Balsam of Peru, is a very good application in pruritus ani, scabies, and many other forms of itching (Auerbach). Camphor, with Chloral, rubbed together, makes a liquid which, added to vaseline, makes an ointment which is powerfully antipruritic (Bulkley); added to dusting powders, allays heat and itching of eczema and intertrigo (R.). Chloroform, as ointment to allay itching of skin diseases (R.). Gelse- mium, of the tincture every half hour, up to 3j. for itching which is out of proportion to the cutaneous lesion (Pelcher). Lead Lotions, to ease the itching of urticaria, pruritus pudendi, etc., especially when the mucous membrane is red PSORIASIS. 649 and excoriated (R.). Salicylic Acid, as ointment, in pruritus ani et vulvae (R.). Sodium Salicylate, in 15-grain doses by mouth every four hours, will greatly relieve pruritus vulvae, when due to diabetes (Goodell). Tar, as ointment, is strongly recommended (Tr.) ; for general pruritus, if no cause can be found, the two best remedies are Tar and Sulphur, as lotion or bath (Sparks); oint- ments containing Tar give relief in many instances (Bulkley). Sulphur, may be employed as a bath, Potassa Sulphurata, ad Cxv of hot water (Sparks); or the alkaline sulphites locally (Wa.); the iodine of sulphur externally and internally, in pruritus senilis (Wa.). Chlorine, the liquor Sodae Chloratae, diluted, a useful application in pruritus ani (Wa.). Cocaine, in 5 per cent, solution or oleate, is by far the most efficient of all antipruritics; relieves the itching of scrotal eczema, pruritus ani et pudendi, and especially in lesions of the epider- mis where the oleate or solution can penetrate at once to the true skin. [Com- pare Eczema, Erythema, Lice, Pediculi, Prurigo, Scabies, Urticaria.] Prescriptions, R. Ac. Carbolici, 3 ij. Glycerini, 3j. Aquae Rosae, . . . q. s. adgxiij. M. Sig.—Lotion for pruritus. R . Ac. Hydrocyan. Dil., . . 3 ij. Sodii Boratis, zj. Aquae Rosae, 3 viij. M. Sig.—Lotion. {Fox.) R. Ac. Hydrocyanici Dil., . . 3 ss-j. Infusi Althese, M. Sig.—Lotion. (Fox.) R. Potassii Cyanidi, . . . . gr. vj. Pulv. Cocci, gr. j. Ung. Aquae Rosae, . . M. Sig.—Ointment. (Anderson.) R. Potassii Cyanidi, gr. xv. Aquae Laurocerasi, .... § viij. M. Sig.—Lotion. (Anderson.) R. Cretae Praeparatae 3 j. Coal Tar, sjj-ij. 01. Lini, 3 ijss. M. ft. unguent. R. Liq. Carbonis Detergentis, . if ss. Glycerini, 5j. Aquae ad£it. M. Sig.—Lotion. (Sparks.) R. Gummi Camphorae, Chloralis Hydratis, . . aa £j-ij. Rub together until liquefied, then add, slowly with friction,— Unguenti Aquae Rosae, . . j|j. Sig.—Ointment for itching. (.Bulkley.) R. Acidi Benzoici, gr. cx. 01. Caryophylli, . . . . gtt. xl. Alcoholis, % ijss. Solve et adde— Cerati Simplicis § viij. Balsami Peruviani, . . . j. M. ft. unguentum. Especially good for scabies, but may be used for any pruritus. R • Hydrarg. Chlor. Corr., . . gr. j. Pulv. Aluminis, gr. xx. Amyli, gjss. Aquae, 5J vj. M. Sig.—Apply locally. (Goodell.) Psoriasis Arsenic, at first apparently aggravates, but soon heals the disease (R., B.); in lepra must be persistently used for a long time (B.); exercises a powerful influence (Wa.) ; maximum dose upv liquor arsenicalis ter die, never on empty stomach (R.). Mercury, in patches of obstinate psoriasis, especially of hands even when not syphilitic. Calomel and mercuric nitrate ointment may be mixed, and tar ointment added (R.). Lappa Major, a tincture of the seeds in whiskey, used by tablespoonful doses, curative of psoriasis of long standing (Reiter). Carbolic Acid, 1 to 4 of lard, as ointment (Wa.). Mezereon, a useful adjunct (Wa.). Sulphur, internally (R.); a solution of potassa sulphurata in 650 PTERYGIUM—PUERPERAL CONVULSIONS. water, is excellent in chronic psoriasis (B.); not in acute (R.). Sulphur Iodide, externally and internally, in doses of gr. j-vj used with great advantage (Wa.). Silver Nitrate, in psoriasis of tongue and buccal mucous membrane occasion- ally ; if syphilitic, mercurials best (R.). Chrysarobin, has the most decided effect on psoriasis, 3ss-ij ad of ung. aquae rosae ; often irritates, and should be employed at first with caution (Bulkley). Nitric and Nitro-Hydrochloric Acids, when symptomatic of imperfect digestion and assimilation (B.). Phos- phorus, as substitute for arsenic (B.). Coptis, has reputation in New England (B.). Copper Sulphate, applied solid to spots (R.). Lead, the ointment of the iodide (B.). Tar, painted on, in obstinate cases (R.). Oils, Cod-liver Oil inter- nally and locally, is the sheet-anchor, especially when of strumous origin (B.); oils and fats to lubricate skin, with warm baths (R.). Diet and Hygiene, nourishing diet, frequent small quantities of raw vegetables. Cod-liver oil for growing persons, especially when stale fish the cause. Rest and change for overworked subjects. Daily baths and cold sponging. Free, open-air exercise is also most useful. Warm or tepid soft-water baths at night, with use of pure soap. Pterygium. Silver Nitrate, locally, especially when pterygium with catarrhal conjunc- tivitis (Wa.). Treatment unavailing. Benefit seldom derived from any opera- tion (C.). Arlt’s Operation, the most satisfactory ; cut away as little tissue as possible, dissect cleanly, close with suture (Green). Ptosis. Veratrine, gr. x in 3ij of sulphuric ether and jfj of alcohol, brushed over the eyelids, brows and temples every morning, till a slight burning sensation is produced; conjoined with the use of electricity (W.). Ergot, aqueous infusion as collyrium (Wa.). Electricity, the constant current may often relieve recent cases (C.). Operation for shortening the lid, by removing an elliptical piece of skin and subjacent muscle (C.); is not advisable unless the ptosis is nearly or quite complete, and of great inconvenience. Ptyalism. Iodine, as gargle, Z'\] of tinct. ad gviij aquae (R.); is worthy of trial (Wa.). Acids, as astringents, small medicinal doses (R.). Sulphuric, int. and as a gargle with decoctum cinchonae, of great benefit in mercurial ptyalism (Wa.). Potassium Chlorate, in simple or mercurial ptyalism (R.) ; in the latter form oj ad 5vj aquae as mouth-wash, and internally in teasp. doses, 4 or 5 times daily (St.). Belladonna, very effective in mercurial ptyalism, and that of preg- nancy. Gtt. v-x, or Atropine gr. to every 4 to 6 hours (B.). Atropine hypodermically (R.) ; should be useful (W.). Tannic Acid, in mercurial ptyal- ism is an excellent gargle, £>j of tannin to of mel rosse, and of water (B.). Alcohol, diluted, as a gargle (R.). Potassium Iodide, sometimes bene- ficial in mercurial ptyalism, but often aggravates it (R.). Prescriptions. R. Tinct. Myrrhas, J^j, Aquae, 5 vj- M. Sig.—Mouth-wash. R. Sodii Boratis, , . . . . . gij. Pulv. Myrrhae, g j. Aquas, . |vj. M. Sig.—Mouth-wash or gargle.. Puerperal Convulsions. Aconite, one of the best agents (P.); gtt. j-ij of tinct. every io or 15 minutes for the first hour, then at longer intervals (B.). Belladonna, the tincture in- ternally with atropine hypoder., of verified utility (P.). Veratrum Viride, in 3ss doses of fluid extract every 15 minutes, to nausea, invaluable (R.); the fl. extract, in doses of nvviij-x hypodermically, may be repeated in half-hour PUERPERAL DISORDERS PUERPERAL FEVER. 651 with Morphine, or n\,x by enema, promptly efficient in the worst cases (Elmer) ; a very bad case cured by 20-minim doses every hour for 5 days (Dunn); the worst case seen in my 30 years’ experience, after 14 seizures was promptly cured by a hypodermic injection of rryv of Norwood’s tincture in a little water (Etheridge). Pilocarpine Nitrate, gr. every 2 hours, very suc- cessfully used in several cases (Finniss). Potassium Bitartrate, administered for a month prior to confinement, in quantity sufficient to bring about free action of kidneys and bowels, will certainly prevent puerperal convulsions. (Anderson). Opium is apt to induce eclampsia, unless its use be preceded by free purgation or venesection (Idem); as morphine hypodermically ; the most important agent for cure of uraemic convulsions (B.); with the lancet, some- times required (P.). Anaesthetics, especially chloroform (R.); utility unques- tionable, when not due to cerebral hemorrhage (B.). Chloral, full doses (gr. xx-xxx) every 2 hours, may arrest (B.); a remedy of the greatest value, a full dose, gr. xx-xxx, before proceeding to one of the bromides (Playfair, Barnes, etc.). Amyl Nitrite, by inhalation (B.); may cause alarming hemorrhage (W.). Ice, to the head (R.); and mustard poultices at same time to the feet (Wa.). Venesection, by far the most efficient measure (Wallace); when great cerebral congestion and vascular tension, shown by a livid face, a full and bounding pulse, and strong pulsation in the carotids (Playfair).. Puerperal Disorders. Cimicifuga, in puerperal hypochondriasis, and depression (Wa., P.). Opium, either alone or with alteratives, highly serviceable in puerperal intestinal irri- tation ; a few drops of tincture effectually arrests the diarrhoea (Wa.); when shock and marked exhaustion, a moderate dose is of benefit (L.). Castor Oil, undoubtedly the best laxative (L.); purgatives generally are not required. Castor oil the very worst (Fordyce Barker); action uncertain (Parry). Rhu- barb, or enemas, best means of stimulating bowels after fourth day (L.); gr. xx-xxx in some aromatic water a good aperient (Wa.). Aliment, in puerperal state should be easy of digestion and sustaining (L.). Catheter necessary often for several days when bladder paralyzed, if warm water lavements fail to excite (L.). Water, tepid sponging of external parts, vaginal washings daily with warm water, with part carbolic acid (L.). [See After-pains, Hemorrhage, Labor, Lactation, Mastitis, Nipples, Phlegmasia Alba-Dolens, etc.] Puerperal Fever. Aconite, drop doses every one or two hours steadily, with an occasional dose of castor oil, and repeated hot poultices or laudanum fomentations, the most successful treatment, even in the worst cases, but is useless if not promptly efficient (P.). Veratrum Viride, is used with great benefit in most cases (F. Barker). Opium, for wakefulness and delirium (B.); a very valuable remedy, tending to allay pain, and reduce excitement of the nervous and vascular systems (Wa.). Alkaline Sulphites, especially valuable in early stages, inter- nally and locally ; gr. xx-xxx of magnesium or calcium sulphite every 2 or 3 hours, with injections every day (Wa.). Stramonium, when cerebral excite- ment (P.). Potass. Permang., gr. %-] ter die, has been given with benefit (B.). Alcohol, freely used, until all evidence of sepsis subsided, caused recovery in one of the most desperate cases of puerperal septictemia, of three weeks’ stand- ing, with temp, falling to 950 and rising to 107° (Hills). Calumba, preferable to cinchona (P.). Quinine, only large doses are useful: gr. v-xx every 4 hours (B.); reduces temperature (P.). Turpentine, when depression of vaso-motor nervous system, cardiac weakness, and tympanitic distention of abdomen (P., R.). Resorcin, is much used in Vienna by Braun ; gr. xl repeated p. r. n.' Antiseptic Injections into uterus, opposed very strenuously by many of our best men. See N. Y. Med. Rec., 1884, p. 14. For antiseptic treatment by Hydrarg. Bichlor., see Dr. Garriguesin N. Y. Med. Rec. of December 29, 1883, and N. Y. Med. Jour, of March 1, 1884, and the discussion in the N. Y. Academy of Medi- 652 PUERPERAL MANIA—PURPURA. cine, reported in the N. Y. Med. Record of January 5 and February 16, 1884, et seq. Water, hot fomentations frequently to parts, a valuable preventive. Rest, and quiet but attentive nursing ; frequent liquid nourishment. Warburg’s Tincture, is more efficient than the largest doses of quinine in cases of puerperal malarial fever, every four hours until fever abates, then in diminishing doses to 3j-ij. until convalescence is established (Fordyce Barker). [Compare Puerperal Peritonitis.] Puerperal Mania and Melancholia. Stramonium, will allay cerebral excitement, and soothe nervous system ; when delirium wild and furious, but intermittent; tendency to suicide or to destroy the child, of tinct. every 3-4 hours (P.). Hyoscyamus, in milder cases; nervous system greatly excited (P.). Aconite, in puerperal mania, with high fever, restlessness; speedy and marked success if given soon after chill (P.). Cimicifuga, has cured (B.); its effects are truly remarkable in mania, and hypochondriasis of puerperal state (P.). Chloral, often alleviates symptoms (B.) ; to produce sleep (Wa.). Potassium Bromide, in sthenic cases (R.); its effects are very variable (Wa.). Anaesthetics, ether inhaled in violent paroxysms of mania (B.). Tartar Emetic, in frequently repeated doses (Wa.). Quinine, when much weakness; skin cold and sweating (B.). Chalybeates, tinct. ferri chlor. (nuv-xx) in anaemic form (B.). Opium, cautiously (B.) ; gives the best results in such doses as may be necessary to allay irritation and procure sleep (Wa.). Poultices, hot fomentations, enemas, or gentle laxatives; nutri- tious and stimulating diet. Lochia should be watched (P.). Weaning, impera- tive in melancholia; not so in acute mania. Puerperal Peritonitis. Aconite, has cured cases of the usual type (P.). [See Puerperal Fever.] Cimicifuga, in rheumatic form especially, has remarkable effects (P.). Opium, its curative power in this, one of the best established facts in therapeutics (B.); is good, but aconite often better (P.); especially valuable in adynamic cases (Wa.) ; the drug of all others to be relied on (Godson). Turpentine, as stimu- lant, frequently repeated; better than alcohol (B.); enemas, also hot tur- pentine epithems, may be used with advantage (Wa.). Quinine, in consider- able doses, with or without opium (B.); gr. x-xx twice daily as an antipyretic (Wa.). Antimony, as Tartar Emetic, gr. to every hour to shorten attack and render it more mild (R.). Cathartics, advised by many, prohibited by as many ; evidence is in favor of mild aperients combined with Dover’s powder or Hyoscyamus (Wa.). Poultices, hot, of very great value (B.). Water, ice in mouth or swallowed, hot fomentations to abdomen. In some cases cold com- presses best. [Compare Puerperal Fever.] Pulse. Aconite, for a quick, resisting pulse (P.); a moderate dose, while it makes the pulse less frequent, renders it fuller, stronger and less compressible (R.). Veratrum Viride, reduces febrile heat with abnormal rapidity of pulse (P.). Veratrine, pulse at first quick and strong, then slowed; afterwards quick, weak and irregular (R.). [Compare Vascular Stimulants, etc., ante, page 34.] Purpura. Sulphuric Acid, often acts happily (B.). Ergot, has been strongly urged (R.); is most useful in removing purpura (P.); many cases are recorded as cured by hypodermic injections of Ergotin (Wa.). Turpentine, has been used (R.); with invariable benefit (Wa.). [See Hematemesis.] NuxVomica.no prescription more generally useful than the Syrup of Iron, Quinine, andStrych- PUSTULE, MALIGNANT—RACHITIS. 653 nine (B.). Iron, when due to anaemia ; the tincture of the chloride (B.); is preeminently the curative remedy for purpura hemorrhagica, arresting the hemorrhagic tendency in 24 to 48 hours (Pize). Vinegar, and water, is an excellent application by sponging over the body (E. Wilson). Quinine, or Hux- ham’s tincture of bark, are much used (H.). Potassium Nitrate, gr. x thrice daily in purpura simplex, used successfully (Wa.). Styptics, as the ammonio- ferric alum, tinct. of ferric chloride (Tr.); tannic and gallic acids, used in some cases (H.). Alum, and brandy, or whiskey and water at such temperature as is not chilling, applied by sponging the body, is the best local measure (H.). Wines are generally indicated (B.). [Compare Hemorrhage, Scurvy.) Pustule, Malignant. Nitric Acid, strong, applied steadily (after thorough cleansing and drying) to destroy the diseased mass (D.). Bromine, to saturate the surface (D.). Car- bolic Acid, undiluted, as caustic, or with oil, the favorite (D.) ; the most prefer- able caustic (Greenfield). Quinine and Carbolic Acid, internally, are indicated in all forms, also stimulants, as Ammonia, Ether, and Alcohol (Greenfield). Eschar should be promptly destroyed, to avoid contagion (R.). Excision and cauterization demanded, when from direct inoculation ; the two most successful remedies (Greenfield). Pyaemia and Septicaemia. Quinine, large doses only (gr. xv-xx) are useful (B.); supposed to diminish the temperature (R.); to cinchonism, in childhood the best remedy (Wa.); is probably the most useful medicine, given in full and frequently repeated doses (Haward). Salicin, to reduce the temperature in septicaemia and to relieve the cerebral symptoms (R.). Salicylic Acid, has decided value (B.). Potassium Permanganate, given with advantage, gr. %-gr. j thrice daily in distilled water (B.). Boracic Acid, a saturated solution to wounds, ulcers, etc. Also Chlorine, as disinfectant (B.). Oleum Caryophylli, locally. Also olei gaultheriae, thymi, etc. (B.); as antiseptics. Water, cold, as dressing. Hot better, 95°-ioo° F. Hamilton’s immersion plan for wounds (B.). Stumps to be immersed in a warm bath, to avert pyaemia (R.). Sulphites, may do some good in chronic cases, but the use of sulphurous acid has not given the results in man which Polli obtained from its use on animals (Haward). Turpentine, is a better stim- ulant than alcohol (B.). Ice, dissolved in the mouth (Wa.). Aliment. Plentiful nourishment, with wine and good ventilation, are not to be neglected (Wa.). Malt liquors are justly esteemed (B.). Stimulants necessary; brandy the best (Wa.). Abscesses, must be opened early, especially when in joints. Pyrosis and Cardialgia. Capsicum, in atonic dyspepsia, with heartburn and diarrhoea (P.). Nux Vomica, of the highest possible value in atonic dyspepsia with heartburn, hic- cough, regurgitation, etc. An excellent combination is lAv-x of the tincture with rt\,xv of dilute nitric acid for one dose (P.). Pulsatilla, a good medicine in heartburn of dyspepsia in phlegmatic subjects (P.). Podophyllin, gr. T\y night and morning in obstinate heartburn, with liver derangement (P.). Almonds, six or eight blanched, said to relieve heartburn (P.). Diet, lemon-juice, aerated bread, plain biscuit, etc.; but avoid new bread, much vegetable food, and pastry. [Compare Acidity, Dyspepsia.] Rachitis. Lime, as lime-water, or the carbonate, or the syrupus calcii lacto-phosphatis (B.); in small doses (R.); the phosphate may be advantageously combined with cod-liver oil (Wa.). Iron, the syrup of the iodide preferred ; calcium and ferric phosphates excellent in combination (B.); must be continued a long time 654 RECTUM, DISEASES OF—RELAPSING FEVER. (R.). Nitro-hydrochloric Acid, as baths, gives excellent results (Wa.). Qui- nine, often very valuable (P.). Aliment, food rich in phosphate of lime and other phosphatic salts ; oatmeal, Graham bread, etc. (B.). Cod-liver oil, the best constructive agent (B.). A full animal diet (Wa.). Cold sponging (R.). Rectum, Diseases of. Podophyllum, in doses of gr. to night and morning, for a child, may relieve prolapsus of the rectum (P.). Belladonna, the extract locally in fissure (R.); and irritable ulcers (P.); internally and locally to remove ulcers, also excellent in burning pain following defecation, or with mercurial ointment in equal parts, for fissures and ulcers (P.). Phosphorus, in chronic inflammation of the rectum, has been highly recommended (R.). Cocaine, gr. xl to §j of Glycerite of Starch, applied by Seeley’s Pile-pipe, very efficient in controlling spasm of the rectum. Potassium Bromide, in 5 parts of glycerin, locally, fis- sures and painful growths (R.). Iodoform, as suppository in painful diseases, relieves greatly (R.). Pepper, the confection, as gentle stimulant in fistula, ulcers, hemmorrhoids (PA Castor Oil, in fissure and hemorrhoids, is commonly used as purgative (R., P.). Sulphur, with confectio sennae, in irritable rectum, is very soothing (Wa.). Stramonium, ointment from fresh leaves to alleviate pain (P.). Conium, the extract in doses of gr. x to allay pain and irritability in cancer (Wa.). Purgatives, best for proctalgia (D.). Surgical, in ulcer or fissure, an incision through mucous membrane, and in severe cases to divide part of the sphincter. A flake of cotton should be laid in the wound, so that it may heal by granulation (D.). [See Anus, Diarrhoea, Dysentery, Rectum Ul- ceration of, Hemorrhage Intestinal, Hemorrhoids, Prolapsus.] Rectum, Ulceration of. Mercury, the red oxide, 3} to the of unguentum, as ointment in flat ulcers of rectum existing just within the anus (Coulson). Belladonna, locally the extract for rectal ulcers, is very efficient (P.). Carbonic Acid, the gas, per anum, is strongly advised (Wa.). Chloroform, as ointment, in irritable ulcer of rectum (Curling). Iodoform, in suppository, extremely useful in painful ulceration (R.); used in many cases with very satisfactory results, but in some instances poison- ing occurs; hence it should be used with caution (Wa.). Phosphorus, as an internal remedy, is highly recommended in chronic inflammation of the rectum (R.). Copper Sulphate, with opium, may often be used internally with advan- tage, and a weak solution of the same, or of Silver Nitrate, locally (Curling); the writer had a case which resisted treatment for 3 years, and in which a cure was effected by a persevering use of a pill of Cuprum Sulphate, Extract of Opium, and Quinine Sulphate. Silver Nitrate, gr. combined in pill with Opium, gr. ss; and a solution, gr. x-xx to the pint, by enema (B.). R. Cupri Sulphat., Morphinae Sulphat., . . aa gr. ij. Quininse Sulphat., . . . . gc. xxiv. M. ft. pil. no. xxiv. Sig.—One pill thrice daily. (Potter.) Prescriptions. R. Chloroformi, j—ij. Zinci Oxidi, 3 ss. Olei Olivse, • . . gj. Cerati Cetacei, g iv. M. ft. unguentum. (Curling.) Relapsing Fever. Cathartic, mild at beginning (H.); if jaundice or other hepatic derange- ment, a calomel purgative, cautiously, lest irritation (Wa.). Potassium Citrate, as cooling diaphoretic. Quinine, in moderate doses after the crisis, at least until the relapse, which will not be prevented by any amount of quinine (Wa.). Leeches or Cupping, best for headache (A.). Alcohol, required by some pa- tients. Diet, supporting, especially in third week, beef-tea, etc. Urine, should be watched carefully (A.). [Compare Typhus Fever.] REMITTENT FEVER RHEUMATIC ARTHRITIS. 655 Remittent Fever. Aconite, in hot stage, if any febrifuge is required, frequently repeated doses (B.); is next in value to quinine for high fever and headache, gtt. j of a good tincture every hour (Da Costa). Quinine, 20 to 30 grs. in single dose once or twice daily till temperature is reduced, with other appropriate remedies (B.) ; 15 to 20 grs. at most (Maclean); 30 to 50 or 60 grs. in severe cases of pernicious remittents several times a day without regard to exacerbation (P., B.). Warburg’s Tincture, has achieved a very high reputation, but must be used in less dosage than directed, and supporting treatment given when its sudorific action commences (Wa.). Gelsemium, exercises a really beneficial influence; depresses temperature (B.); valuable in bilious remittents of the South (Pf.). Morphine, gr. hypodermically to abort pernicious remittent fever (B.). Purgation, by calomel with jalap or salines afterward, is very necessary during course of the disease (Da Costa). Quassia, an excellent tonic in convalescence, combined with mineral acids (Wa.). Packing, by wet sheet, is resorted to with advantage, except when hepatic or splenic congestion (Wa.). Retina, Affections of. Mercury, in syphilitic retinitis is of great value ; calomel gr. j-ij with opium gr. every 4 or 6 hours ; also mercurial inunction till the gums are affected or the disease yields (Wa.). Potassium Iodide and Bromide, in combination, in retinal hemorrhage, to promote absorption of the effused blood, and benefit congestion (C.). Eserine, locally to contract pupil, and diminish the amount of light admitted to the eye (Wa.). Iron, in full doses, generally the tinct. of the perchloride, in pigmentary retinitis ; seems to have a tendency to arrest the malady (C.). Leeches, to the temple better than general bloodletting (Wa.). When much local congestion present, depletion by artificial leech is almost always indicated (C.). Pilocarpus, in detached retina and optic neuritis; has been found a very useful remedy in retinal affections generally. [Compare Amaurosis.] Rheumatic Arthritis. Aconite, highly spoken of; as liniment, conjoined with internal use (Wa.). Cimicifuga, when joints enlarged and much stiffened, and when traceable to uterine derangement, is very useful (R.); when pains worse at night (Wa.). Iodine, tinct. internally, said to be better than potassium iodide (R.). Iodoform, 10 parts to 20 of Ether and 20 of Alcohol, as liniment to the joint, applied by a pencil, and covered with oiled silk (Gubler). Iodides, often signally benefit, especially when due to syphilitic, mercurial, or mineral poisoning (B.). Large doses of potassium iodide sometimes required (R.); combined with guaiacum, or corrosive sublimate, often curative in cases resisting these remedies given separately (Wa.); Potassium Iodide should always be fairly tried (Da Costa). Guaiac, the ammoniated tincture, in doses of 3j-ij in milk, often gives excel- lent results (Da C.). Colchicum, with alkalies, extremely useful (B.). [See Gout, for formulae.] Arsenic, when referable to nervous affections (B.); as a bath containing [|iv washing soda and gr. xx arseniate of sodium; in large doses, continued for some time, sometimes of great benefit, but action is capri- cious (R.) ; in small doses is of great benefit (Da Costa). Lithium Salicylate, very efficient in acute and progressive subacute articular rheumatism, and has some effect also in chronic cases, where some of the joints are deformed, swollen and painful; 3j may be given daily, in doses of gr. vij to x, in water (Vulpian). Lithium Bromide, of great value in acute and chronic (B.). Potas- sium Bromide, sometimes allays the severe pain (R.). Arnica, the tincture and infusion are said to be of great value (P.). Cod-liver Oil, internally and locally, of much value (R.). Baths, Turkish or sulphur. The cold douche, which may be slightly warmed in winter; use for one or two minutes and rub dry (R.). Adhesions may be broken up under the anaesthetics (Da C.). Mas- sage may be used with benefit to ameliorate the condition in chronic cases,where a cure cannot be obtained (Da C.). 656 RHEUMATISM, ACUTE. Prescriptions. R. Vini Colchici Sem., . . . 3 iij. Spt. Ammon. Aromat., . . 3 xiij. M. Sig.—A teasp. every 3 hours, until some physiological effect is produced. (B.) }£. Lithii Bromidi, iij. Syr. Zingiberis, 3ss. Aquas, ' M. Sig.—A teasp. thrice daily, con- jointly with a lotion of the same. (B.) Aconite, very serviceable when much heat and dry skin (B.); subdues pain in inflamed joints and perhaps shortens the fever (R.); small doses frequently repeated of the greatest value, and if used from the start prevent permanent organic disease (P.); is not reliable as a cure, but a valuable adjunct to other remedies (Wa.). Veratrum Viride, tinct. said to be useful (R.) ; as antipy- retic, small doses ; may be combined with opium (P.). Bryonia, has proved useful, especially for painful and stiff rheumatic joints (P.). Salicin, gr. x-xxx every 2, 3, or 4 hours. Gr. xv every 3 hours in powder mixed with water (Mac- lagan), or same dose of Salicylic Acid, is of great benefit; good effect gener- ally experienced within 48 hours (R.); the acid is better than the salicylates, but must be abandoned if not effective after 3 or 4 days (Da Costa). Salol, the great remedy, none superior (B.). Sodium Salicylate, behaves as Salicin (R.). Oil of Gaultheria, as a substitute for salicylic acid, used very successfully in form of emulsion (B.). Rhus Toxicodendron, positively invaluable in after- stage, also in subacute forms, muscular or tendinous, worse at night (P., Pf.). Hydriodic Acid, the syrup, in dessertsp. doses every 2 or 3 hours, the best remedy for acute and subacute rheumatism, relieving pain and swelling in 18 to 24 hours (Craig). Cimicifuga, excellent reports from (B.); has been much used, said to quell the pain speedily (R.); found very serviceable (P.). Dulca- mara, recommended especially in persons who are subject to catarrhal affec- tions in cold and damp weather (P.). Ammonium Bromide, a very excellent treatment, followed by quinine ; gives a very low proportion of cardiac compli- cations, gr. xv-xx every 4 hours (Da C.); disagreeable but strongly recom- mended (B.). Arnica, lowers pulse and temperature, relieves articular pain and swelling, diminishes urea (P.). Trimethylamine, in peppermint water, often has remarkable power in acute rheumatism and gout (B.). Spi- gelia Anthelmia, rheumatic pericarditis and endocarditis; rheumatic fever with pain shifting from joint to joint (P.): seems to fix the disease in certain joints, and prevent its shifting around (P.). Sulphurous Acid, fumigation, and patient covered with blankets exposed to strong fumes, produces perspiration, sleep and relief (R.). Colchicum, alleviates the symptoms, and shortens their duration (Wa.). Laville’s Mixture, is said to be a tincture of quinine and colocynthine, but it is more than probable that colchicine is the active agent therein. (See N. Y. Med. Record, Dec. 5, 1885, page 642.) Quinine, as antipyretic; not so useful as wet pack or cold bath ; gr. ij-v after the more acute symptoms have subsided (B.); is best for the head symptoms (Da C.). Opium, strongly recom- mended as anti-rheumatic ; gr. j every 2 or 3 hours, increased to gr. xij in 24 hours ; tolerance remarkable in this disease. Also, in rheumatic carditis it is indispensable (Wa.) ; a very good remedy in moderate doses (Da C.). Lithium Bromide, equally good in all forms, especially for insomnia, delirium, etc. (B.). Digitalis, in powder, gr. ij every 4 hours, usually effective after 2 to 7 days; especially useful in cardiac complications with cyanosis and cedema. Iron, tincture of chloride very serviceable in pale, delicate subjects, every 4 hours; also as prophylactic where tendency (Anstie); harmful to the plethoric and overfed (B.). Alkalies. The alkaline treatment is now seriously ques- tioned ; an injurious dyscrasia results from their use (B.). Potassium Bicarbon- ate, gr. xxx every 4 hours, in a dilute solution, until joint-symptoms and fever disappear (Wa.). Lime-juice, 3viij daily, lemon-juice inferior (R.). Blisters, are a very effective method ; a number of small blisters applied to vesication around a joint (B.) ; large flying blisters around a joint (R.). Water, cold baths for the hyperpyrexia (Da C.); the wet pack very efficacious in rheumatism, also Rheumatism, Acute. RHEUMATISM. 657 a vinegar vapor bath (B.); the wet pack, 20 or 30 minutes, and tepid (70°) shallow bath 1 or 2 minutes. Cold applications only when skin hot and dry, and temperature high. Warm baths, or hot compresses very useful. Spongio- piline an excellent substance for applications. Diet, low during the fever, water, barley water, milk-and-water, gruel, etc. All through use liquid food. Avoid malt liquors, port wine, and sugar. Lemon-juice maybe used freely. Blankets, instead of sheets to sleep in, and flannel underclothing are useful adjuncts. Pack the joints with cotton covered with rubber cloth or oiled silk. Plans of Treatment, may be resolved into three, viz.,—(1) that by Salicin, (2) that by Alkalies, (3) that by Iron. Salicylic Acid and the Salicylates, in 20-grain doses, to not less than 3ij in 24 hours, in solution with excess of alkali, is especially suited to vigorous, sthenic subjects, whose stomachs will bear it, in whom it often effects a cure in 3 or 4 days. Alkalies, for flabby, fat subjects; alkaline carbonates, as the Potas. Carb., gjss, every 24 hours, alone or with a vegetable acid, until the urine becomes neutral or alkaline, when it may be reduced one-half, and so maintained for some days, when quinine or iron may be used. If successful, this treatment brings about a cure in two weeks. Tincture of the Chloride of Iron, for the feeble, anaemic, and nervous subjects, every 4 hours, with an occasional saline laxative, blisters around joints, and Atropine as an anodyne rather than Opium, used hypodermically in the vicinity of the affected joints (B.). Iron and Salicylic Acid in combination, should be most valuable, but as heretofore prescribed has always made an insoluble precipitate. This is overcome by Dr. Peabody in the formula given below, which makes a ruby-red mixture, and has the advantage of preventing the anaemia which results from Salicylic Acid given alone. Cardiac Complications require Ammonium Carbonate, in 5-grain doses fre- quently, also Infusion of Digitalis with hypodermics of Morphine, and a blister over the praecordium, followed by Iron and Quinine after the acute symptoms have subsided (B.). Prescriptions. R. Olei Gaultheriae, gj. Acidi Salicylici, gr. lxxx. Sodii Boratis, ...... gj. Syr. Picis Liquidae, . . . gij. Aquae Anisi, M. Sig.—A dessertsp. every two hours. R. Potassii Iodidi, gij. Vini Colchici Sem., Syr. Simplicis, . . . . aa giv. Aquae Menthae Pip., . . . M. Sig.—Tablesp. every 4 hours. [New Orleans Charity Hosp.) R. Ammonii Phosphatis, . . . gjss. Tinct. Colchici Seminis, . . gj. Tinct. Aconiti, zij. Syr. Simplicis, j|iij. M. Sig.—A teasp. every three or four hours. [Corson.) R. Propylaminae Chlorid., . . gr. xxiv. Aquae Menthae Pip., . . . gvj. M. Sig.—A tablesp. every two or three hours. (Tyson.) R. Sodii Salicylatis, ss. Tinct. Lavand. Co , . . . . giij. Glycerini, gvj. Aquas q. s. ad g vj. M. Sig.—A tablesp. every three hours, well diluted. R. Acidi Salicylici, gij. Ferri Pyrophosphat., . . . gj. Sodii Phosphatis, . . . . gr. xij.. Aquae, jvj. M. Sig.—A tablesp. every 2 hours. [Peabody.) Rheumatism, Chronic. Arsenic, is very good in most cases, given in small doses steadily (Da C.); with Guaiac instead of Sulphur in the Chelsea Pensioner (see ante, page 470), the latter is more efficient (Fothergill). Bryonia, is useful, especially for pain- ful and stiff joints (P.). Rhus Toxicodendron, a very powerful agent in sub- 658 RHEUMATISM. acute muscular or tendinous rheumatism, worse at night (Pf.); the tendons, ligaments, and fasciae are most benefited ; externally, as lotion on compresses ; also, internally, small doses every two hours (P.). Potassium Iodide, especially when pains are worse at night, or of syphilitic origin (R.); should always be fairly tried in chronic rheumatism (Da C.); was Sir Astley Cooper’s remedy for rheumatism. Cimicifuga, sometimes has wonderful success, yet often fails ; no indications (B.) ; in rheumatic neuralgias and headaches, and rheumatism of uterus (P.); signally beneficial in many forms (R.). Mercury, and Morphine, the oleate locally, for joint affections.(R.). Colchicum, is of decided advantage in neuralgia of chronic rheumatism (B.). Mezereon, strongly recommended (P., R.). Phytolacca, has been useful (B.). Iodides often prove very satisfac- tory, especially in strumous or syphilitic subjects (B.). Aconite, the extract as plaster to joints is unquestionably very useful (P.); is more useful in chronic than acute rheumatism (Wa.) ; the liniment of the B. P. locally over the sciatic nerve when affected (Fothergill). Dulcamara, has been employed with advantage (P.); Sulphur, locally, also sulphides as baths (R.); is certainly of benefit (B.); sulphur waters are undoubtedly efficient (DaC.); sulphur is an ingredient of the Chelsea Pensioner (see ante, p. 470), an old English remedy for rheumatism. Iodine, for pain around joints (R.). Lithium Bromide, gives excellent results, when smaller joints swollen, tender (B.). Lithium Salicylate, in 15 to 20 grain doses every four hours, gives good results in lingering, sub- acute cases after acute attacks (Da C.). Quinine, in rheumatism with debility, shown by night sweats, or sweats during sleep, and only then (Wa.). Arnica, the tincture and infusion are useful (P.). Cajeput Oil, internally and externally in muscular rheumatism (P.). Turpentine, benefits and relieves the pains; in- ternally and externally as liniment (P.). Guaiac, used with varying success (B.); often gives excellent results; the ammoniated tincture, 3j-ij in milk (Da C.); is vile to the taste. Eucalyptus, the leaves wrapped around the affected part, renewing them daily for a week or more, often very efficient as a local stimulant, and will produce vesication if too long continued (Gibbons). Xanthoxylum, has long had deserved reputation, ttlxv-£ij fluid extract (B.). Thuja Occidentalis, is useful for rheumatic pains (P.). Manganese Sulphate, is one of the remedies (B.). Belladonna, the extract locally very valuable for pains (P.). Cod-liver Oil, internally and externally, exercises some influence (B.). Chimaphila, may prove useful, especially when lithiasis (P.). Lupulin, as an anodyne (P.). Burgundy Pitch, as plaster locally (P.). Aliment, avoid alcoholic and malt liquors, coffee, also starchy, animal and saccharine food. The farinaceous vegetables and acid fruits suitable (B.). Alkaline mineral waters have deserved reputation (B.). Turkish Baths, in chronic muscular rheumatism (B ); steam bath daily of great benefit, may be obtained at home by pouring water on hot bricks in a tub, the patient sitting on a board or chair above, enveloped in a blanket (Brick). Red Flannel, next skin, very popular, but white better, as the red gives rise often to eruptions (Da C.). [Compare Lumbago, Myalgia, Pleurodynia, Rheumatic Arthritis, Sciatica.] Prescriptions. R . Pulv. Resin. Guaiaci, Potassii Iodidi, . . . . aa gj. Tinct. Colchici Seminis, . . 3 iij. Aquae Cinnamomi, Syrupi, . . . . aa q. s. ad !|vj. M. Sig.—A dessertsp. to a tablesp. thrice daily. (Pepper.) R. Linim. Aconiti (13. P.), Linim. Belladon., . . . aa 3 ij. Glycerini, . . . . q. s. ad gij. M. Sig.—Apply locally over the seat of pain. (.Fothergill.) R. Tinct. Guaiaci Aither., . . . Tinct. Colchici Aether., . . ijvj. Tinct. Cann. Ind. yEther., . gij. M. Sig—25 to 30 drops on sugar, every 4 hours, for rheumatic and neuralgic symp- toms. [Atlee.) R. Olei Sinapis, gss. Olei Terebinth., . . . . sjiij. Camphorae, £iv. Liq. Ammon. Fort., . . . giij. Tinct. Capsici, giv. Alcoholis, . . . . q. s. ad M. Sig.—Russian Spirit, a liniment for rheumatism. RHEUMATISM SCABIES. 659 R. Ac. Arseniosi, gr. iij. Pulv. Guaiaci, 3 iij. Pulv. Capsici, Pil. Aloes et Myrrh., . . . g iij. Ft. pil. no. cxx. Sig.—One thrice daily. The modified Ghelsea Pensioner. {Fothergill.) R. Potassii Iodidi, gj. Potassii Nitratis, 3 ss. Ext. Cimicif. FI., Glycerini, aa^ss. Vini Colchici Sem., . . . out §ij. M. Sig.—A teasp. after each meal. {Potter.) Rheumatism, Gonorrhoeal Opium, as Dover’s powder, in the acute stage, full doses (Wa.). Potassium Iodide, with tonics and stimulants, after the acute stage has passed, followed by friction, shampooing, and passive movements of the joints (Wa.). Ammonium Chloride, in free doses, especially when the muscles are affected (Fuller). Potassium Chlorate, internally, and as urethral injection, until urethral dis- charge is entirely stopped, then tt\,xx of tinct. ferri. chlor. 4 times daily, with gr. x of quinine daily, and good food (Da Costa). Aspirate, when pus is dis- covered around the joints, as the case will be one of pysemic rheumatism, and may involve more joints than one (Da C.). Rheumatism, Muscular. Diaphoretics, as Dover’s powder, with Potassium Nitrate, or Salts of Ammo- nium, with dry heat to the part involved and rest in bed (Da C.). Morphine and Atropine, gr. \ and gr. together hypodermically, are of great service in most forms (R.). Lithium Bromide, is almost specific (B.). Jaborandi, or Pilocarpine hypodermically, to get the skin acting freely, a great desideratum (DaC.). Potassium Iodide and Colchicum,or Quinine, gr. xij-xvj in 24 hours, if case lingers over a week (Da C.). Liniments are of little use except to amuse the patient, but Chloral §j in of Linim. Saponis, makes a good one (Da C.). Capsicum, powdered, with lard, 3>j ad §j, rubbed over the part, night and morning, with a gloved hand, is very efficient (Macdonald). Cimicifuga, is often very efficient in lumbago, myalgia, pleurodynia, and similar conditions (Wa.). Xanthoxylum, gives relief in some cases of muscular rheumatism (B.). Lithium and its salts, where there is a uric-acid diathesis (B.). Colchicine, 5-minim doses of a solution of Merck’s, hypodermically into affected muscles, thrice daily, very effective in cases resisting other treatment. [Compare Lum- bago, Myalgia, Pleurodynia, Torticollis.] Roseola. Scarcely any treatment called for ; no local application needed, as the rash is but slightly irritating. Aconite or Belladonna, according to the symptoms, or the Carbonate of Ammonium, answers all the indications. [Compare Measles.] Sarcinae. Sulphites and Hyposulphites, have been employed to destroy sarcinae and torulae in the stomach (R.); or Sulphurous Acid, diluted, before each meal (Wa.). Scabies. Sulphur, a solution of potussa sulphurata gss-ljj, as local application. Art extemporaneous sulphide may be made by boiling one part of quick-lime and two of sulphur in ten of water (B.). Sulphurous acid, as gaseous bath, the quickest method. Hebra’s mixture of sulphur, chalk, tar, soap and lard, less irritating, and equally sure (R.).' Calcium Sulphide, as a bath (W.). Sul- phuric Acid, internally, has cured when other remedies failed (Wa.). Storax, equally serviceable and not irritating as is sulphur, one part to two of olive oil, with a warm bath (R.). Mercury, the bichloride is very efficient, if used. 660 SCARLATINA. strong enough, but caution is required in its employment (B.). See formula below. Staphisagria, a certain remedy; 3 parts to 5 of lard, boiled at 2120 F. for 24 hours, when cooled after straining add a little essence ; friction with this 4 times daily (Wa.). Balsam of Peru, the best of all applications, killing the acarus, relieving the itching and dermatitis, and disinfecting the parts; rub in 3j over the body after a warm bath (Bruce) ; is fatal to the itch-mite (Oldberg). Manganese, the oxide, 3ij~3j adipis suilli as ointment (B.). Copper Sulphate, as lotion (gj-Oj) has been used with great success, after crusts are thoroughly removed with soap-and-water (B.). Alkalies, as soaps or ointments to remove cuticle and break up burrows (R.). Carbolic Acid, locally (B.). (See Tinea for formula.] Cocculus Indicus, as ointment, useful (P.). Tar Ointment, relieves itching quickly and cures disease in 10 to 12 days (P.). Anise, Ka- mala, as ointments, efficient (P.). Benzoic Acid, gr. x-xx ad 0}4 aquae, as lotion, effectual for the pruritus (R.). [See last formula on left-hand column, under Pruritus.] Linen should be immersed in boiling water ; other gar- ments well fumigated with sulphur vapor to destroy insects or their ova, or baked in oven (R.). Prescriptions. R. Styracis Liquidis, 3 ij. Ung. Sulphuris, 3iv. Ung. Petrolei, ad%)- M. Sig.—Apply after washing. {Bulkley.') R. Sulph. Sublimat 3 j. Balsam. Peruv.,. zss. Adipis, M. Sig.—For children. (Duhring.) R . Hydrarg. Chlor. Corr., . . . gr. iv. Alcoholis, 3 vj. Ammonii Chloridi, . . . . 3 ss. Aquae Rosae q. s. ad% vj. M. Sig.—Lotion for scabies, phthi- riasis, and tinea versicolor. [Fox.) R. Sulph. Sublimat., Olei Cadini, aa3'j- Cretae Preparatse 3 ijss. Saponis Viridis, Adipis, aa^j. M. ft. unguentum. (Bulkley.) Scarlatina. Aconite, of the highest value for all marked increase of temperature (B., R.); helps the development of eruption when due (P.); in the early stage, when not decidedly adynamic, is very useful (W.). Belladonna, during the erup- tive stage, when depression exists, and rash is imperfectly evolved (B.). As prophylactic has been recommended (R.); is often efficacious as prophylactic (P.); the preponderance of evidence is certainly in favor of such use of the drug (Pf.); this virtue is claimed by imposing authorities; when so given its dose is gr. several times a day (Tr.). Mercury, of gray powder every hour has marked effect on inflamed tonsils (R.). Ammonium Carbonate, feeble circulation, cyanosis, delirium (B.); in all forms, especially if given early (R.); one of the most reliable remedies; gr. iij-vij, according to age, in milk or cin- namon water, every hour or two (Wa.). Potassium Iodide, in full doses, a very satifactory remedy (Mitchell). Mineral Acids. Muriatic, internally and as gargle; Nitric, to sloughs in throat (R.). Carbolic Acid, internally and as gargle, successfully used. [See Measles, for formula.] Seems to exercise some influence as prophylactic (Wa.); is good for the vomiting and for its gen- eral effect on the disease; every 2 or 3 hours (Da Costa). Veratrum Viride, in convulsions (R.). Rhus Toxicodendron, of great service, if typhoid or rheumatic symptoms (P.). Digitalis, very useful; lowers temperature and maintains kidney action (B.); the best antipyretic and diuretic, the infusion with dry cups for the renal dropsy in its inception. Later on, milk diet and Basham’s Mixture (Da C.). Potassium Permanganate, locally to throat, and internally (gr. }(-} ter die) has undoubted benefit (B.). Sulphurous Acid, by inhalation, spray, or fumigation, in malignant sore throat (R.). Chlorine Water, in sloughing of throat (R.) ; seemingly prophylactic (Wa.). Quinine, small doses, in adynamic states, large in hyperpyrexia (B.); very successful when SCIATICA. used systematically from the start (Wa.). Ferrum Perchloride, the tincture in doses of according to age, in advanced stage, when with albuminuria and hematuria, is very valuable (Wa.). Potassium Chlorate, in grain-doses every ]/2 hour, will not injure the kidneys, and will give equal results as larger doses on the throat inflammation (A. A. Smith). Asclepias, to promote the eruption (W.). Zinc Sulphate, gr. TV every 3 hours, believed to have specific influence on the disease (Hoyt). Sodium Benzoate, is highly efficient, having slower but more permanent effects on the fever than quinine or the salicylates (Klebs). Boric Acid, makes an excellent gargle (Da C.). Juniper, as diuretic when dropsy (R.). Magnesium Sulphate, as purgative, to prevent sore throat and other sequelae (R.). Sodium Sulpho-carbolate, as a means of introducing carbolic acid into the system. Has been successfully employed (Wa.). Mustard Bath, on recession of rash, to bring it back (R.). Oil Inunctions, very grateful, especially useful in desquamative stage. Cocoa-butter the most elegant (B.). Ice sucked, in the sore throat (R.). Water, cold baths with oil are all that are needed in mild cases. When temperature above 104°, urine scanty and rash retroceding, the cold wet-pack renders signal service (B., R.). A cold wet compress to neck, through the whole course, renewed every 3 hours (R.). Diet, fruit, if ripe, in season, toast, gruel, etc., in simple cases. In malignant, extract of beef, stimulants as per pulse. Milk the most suitable aliment, both as nutrient and as diuretic. Prescriptions. R. Acidi Salicylici, gij. Tinct. Aconiti, gtt. xij. Infusi Digitalis, Spt. Ammon. Aromat, . . ,^iij. Syr. Aurantii Cort., . . . Aquae, §j. M. Sig.—Teasp. every 3 hours, for a child of five years. (Brown.) R . Ac. Borici, 3 ss. Potassii Chloratis, . . . . 31). Tinct. Ferri Chloridi, . . g ij. Glycerini, Syrupi, . . . aa 5j. Aquae, Jij. M. Sig.—Tablesp. every 2 hours, to a child of five years. (Smith.) R. Acidi Carbol., £ss-j. Vaselini, giv. M. Sig.—By inunction to the entire sur- face. R . Acidi Borici, giij. Glycerini, 3 iv. M. Sig.—For a pint of water as a gar- gle. (Da Costa.') Sciatica. Aconite, locally (P.); as ointment controls in some instances (R.) ; valuable and efficient in many obstinate forms (Wa.). Rhus Toxicodendron, a very pow- erful therapeutic agent in various rheumatic affections of the fibrous tissues (P.). Cimicifuga, is highly extolled (R.). Turpentine, causes an exquisite sensibility along the track of the great nerves (Tr.); occasionally of great value in sciat- ica, yet not a specific, nor have we scientific indications for its use (P.); §ss doses for 4 or 8 successive nights (R.). Sulphur, locally, believed to relieve the pain ; effect probably due to the flannel surrounding it (R.) ; is worthy of trial after active symptoms are subdued (Wa.). Phosphorus, in neuralgic form ; less satisfactory in sciatica than in other neuralgias (R.). Nux Vomica, often successful in chronic (Wa.). Belladonna, has afforded relief (R.). Atropine, hypodermically, is curative ; large doses, gr. to in vicinity of nerve (B.). Cocaine, hypodermically along the nerve, has afforded instant relief (Wa.), Veratrine, as strong ointment; Veratrum Viride, as tincture, is also recom- mended (R.). Ammonium Chloride, in mild forms (R.) ; occurring in the young (Anstie). Ether Spray, generally of temporary value (R.) ; Chloroform, on flannel along course of nerve, covered with oiled silk (Wa.); injected deeply into vicinity of nerve, gives the best results in old cases, vt\,xv of the spirit hypo- dermically (B.). Stramonium, gr. X- every 3 or 4 hours for 4 or 5 doses, often affords decided relief. Stop when slightest symptoms of narcotism appear (P.). Opium, internally and externally (Wa.) ; Morphine, hypodermically is 662 SCLERODERMA—SCROFULOSIS. especially curative in sciatica (B.); 3 or 4 injections of gr. l/e each; it may almost be regarded as a specific (Wa.) ; a single application sometimes cures long-standing cases permanently; if not it may be repeated every second day or so (R.); should be injected deeply into the adjacent muscular structure (Pepper). Iodides, in syphilitic or metal poisoned subjects (B.); often fails (R.). Potassium Iodide in doses of 3j daily, dissolved in decoction of sarsaparilla, most efficacious in subacute or chronic (Wa.). Salicylic Acid, as paste locally, 3j with givof Lanolin and 01. Olivse, q. s., also Rhus Tox., gtt. j. of a 1 percent, solution of the fluid extract every 4 hours, cured one very obstinate case (Aulde.) Salol, gr. vij in evening and gr. xv more at midnight, completely cured me after 3 weeks’ suffering in bed, unrelieved by other remedies (Aschenberg). Cold of intense degree, produced by refrigeration of limb by Methyl Chloride, extremely efficient (Jacoby). Has been found effectual when applied to the sound limb. Cantharides, as counter-irritant, to free vesication (R.). Aquapuncture, has had extraordinary success (B.). [See under Neuralgia.] Acupuncture, occasionally affords instant relief (B.); often cures cases of long standing (R.). Nerve-stretching, by forcibly flexing the thigh on the abdomen (Lange). Poul- tices, applied very hot (R.). Turkish Baths, are often very useful (R.). Elec- tricity, produces excellent results (B.) ; does great good, but often aggravates ; the continuous current best, when stage of acute inflammation past (W.); gal- vanism often quickly relieves the pain (Pepper). Cod-liver Oil, should always be tried in obstinate cases (W.). [Compare Neuralgia, Rheumatism Chronic.] Prescriptions. R . Tinct. Colchici Seminis, Tinct. Belladonnse, Tinct. Aconiti, . . . . aa g;j. M. Sig.— every 6 hours. Remark- ably efficient. {Metcalf.} R • Tinct. Cholchici Sem., Tinct. Cimicifugae, Tinct. Belladonnse, Tinct. Aconiti, . . , . aa Tt^xv. M. Sig. —TTLiij every 3 to 6 hours. {Metcalf.} Scleroderma. Cod-liver Oil, our sheet-anchor, used internally and locally (B.). Electricity, is used successfully (B.); with stimulating inunctions offers the best prospect of improvement (Bulkley). Iodides, the Iodide of Ammonium when glandular enlargement; that of Iron when debility and emaciation, a powerful and efficacious remedy; also in anaemia of scrofula, the syrup ter die (Wa.); disappointing, useful in simple glandular hypertrophy (B.). Iodine, tinct. or oint. applied over scrofu- lous glands—take care not to increase inflammation (R.). Iodine and Iron the best remedies, but all medicines utterly useless without strict hygiene (A.). Calcium, the chloride, in doses of gr. x-xx in milk after food, when glandular enlargement of neck and chronic diarrhoea. The phosphate of great use for sores (R.); is of eminent service as a palliative (Wa.); see Sulphides below. Spongia Usta, formerly held in high repute ; has fallen into perhaps unmerited neglect. Contains sodium iodide, magnesium bromide, calcium phosphate, and ferric protoxide, in small quantities (Wa.). Iron,ferrum and calcium phosphates combined give good results, also chalybeate waters (B.) ; must be long continued (R.). Sulphides, for sores, abscesses, suppurating glands ; gr. y or of cal- cium sulphide every hour or two (R.). Coniine, gr. y2 to 3j almond oil, locally, two or three times a day to conjunctivas in “ scrofulous” photophobia ; has proved very successful (P.). Cod-liver Oil, the best remedy to promote assimilation (B.); of great service in the various manifestations of this disease (R.). Stillingia, a domestic remedy, used with much success (B.). Capsicum, in scrofulous and fistulous ulcerations, a weak infusion becomes a useful stimu- lant (P.). Mezereum, strongly recommended (P.). Sarsaparilla, useful by reason Scrofulosis. SCURVY SEA-SICKNESS SEBORRHCEA. 663 of its tonic and alterative properties (P.). Hyoscyamus, the bruised leaves as cataplasm for scrofulous ulcers (P.). Phosphates, for mal-nutrition (B.). Prunus Virginiana, is found very useful in the hectic (P.). Chimaphila, holds a cer- tain amount of reputation as a useful remedy (P.). Tussilago, was employed by Cullen (P.V Gentian, is valued. As infusion a useful vehicle for chaly- beates, etc. (P.). Blisters, for scrofulous glands (R.). Grape-cure, renders much service (B.). Alcohol, no doubt as to its great value ; with cod-liver oil, or in small amounts at meals (Wa.). Phosphorus, eminently serviceable in scrofuloderma, gr. x in 01. Olivae £j, doses of TTv-x, thrice daily after meals (Broadbent). Aliment, raw or broiled meat, the latter for children. Abun- dance of fresh air and sunshine. Sea-air, sunlight, moderate exercise, and light, digestible food are necessary. [Compare Cachexia, Glands, Coxalgia, Ophthalmia.] Scurvy. Citric Acid, used with great advantage, though inferior to lemon-juice (Wa.). Lemon- or Lime-juice, of the utmost value, both as preventive and a curative agent. Efficacy believed to be due to its potassium salts. Oranges highly useful (Wa.). Acids, especially vinegar, to prevent scurvy, in the absence of lime-juice or fresh vegetables (R.); dilute Muriatic Acid, gtt. v, thrice daily with juice of three lemons daily, vegetables and fresh meat (Da Costa). Po- tassium Chlorate, is probably a remedy of some value (Wa.); is not (W.). Cinchona, a decoction, or the dilute tincture with myrrh or the chlorates, a very useful gargle. Quinine, internally when much prostration, combined with mineral acids (Wa.). Alcohol, diluted, as gargle (R.). Atropine, hypo- derm. for salivation (R.). Alum, a solution in water with tinct. myrrhae several times daily as lotion for ulceration of the gums (W.). Liquor Sodse Chloratae, 3vj ad aquae, as a mild application to gums (Wa.). Dietetic Treatment alone required. Lemon-juice plays no essential part in the treat- ment. The full diet of an hospital, comprising fresh meat, vegetables, and milk, is generally sufficient. [Compare Cancrum Oris, Purpura.] Sea-sickness. Chloral, the most effective remedy ; gr. xv-xxx every four hours (R.). Sta- phisagria, has given relief (P.). Creasote, checks the vomiting (R.). Chloro- form, drop doses pure (R.); rr[ij-v on sugar (B.). Atropine, hypodermically, gr. in epigastrium, will relieve (B.); gr. to given with Strychnine, gr. to hypodermically, is really specific in most cases, and in some if given before sailing, will prevent for the whole voyage, though but one dose be ad- ministered (Giberson). Cocaine, quite efficient, the hydrochlorate in water i to ioo, of which rryv-v on a bit of ice thrice daily (Otto). Morphine, gr. y to hypodermically, will often relieve severe cases (B.); often fails (Wa.). Amyl Nitrate, by inhalation (B.); is strongly recommended, but must be cautiously used. Champagne, iced ; tablesp. doses every quarter-hour (B.). Calumba, a few drops of the tincture will sometimes relieve (B.). Spinal Ice-bag, often successful (R ). Cocaine is reported quite successful. Bromides, in lull doses (Beard). [Compare Nausea, Vomiting.] Seborrhcea. Glycerin, especially useful; with lead acetate, borax, zinc, diminishing secre- tion ; also acts efficiently when there is a want of sebaceous secretion (W.). Zinc Oxide, 3j, plumbi carbonat. 3j, cetacei §j, ol. olivae q. s. Ft. unguent (B.). Oleate of Arsenic, is of benefit (Wa.). Mercury, an ointment of the white precipitate is serviceable on the scalp, with an occasional shampoo with tar soap or green soap in solution, followed later by mildly stimulating iotions (Bulkley). [Compare Acne, Pityriasis.] 664 SNEEZING—SPERMATORRHCEA. Sneezing. Arsenic, a drop of liquor arsenicalis three times a day in paroxysmal sneez- ing, allied to asthma (R.). Potassium Iodide, gr. x, several times a day (R.). Iodine, inhalations in paroxysmal sneezing, with itching of nose (R.). Camphor, in incessant sneezing, with profuse running from eyes and nose. The powder should be snuffed, or the alcoholic solution inhaled (R.). [Compare Catarrh, Hay-fever, Influenza.] Potassium Bromide, will give decided relief in the somnambulism of children allied to epilepsy, often with squinting, which may become permanent; generally the result of deranged digestion. The nightmare of adults will usually yield to the same drug (R.). [Compare Nightmare.] Somnambulism. Spasmodic Affections. Aconite, ext. and int. for spasms not of a severe type ; Aconitine, as ointment in the most severe, as well as in the milder local spasmodic affections ; in angina pectoris, spasmodic asthma, cough, etc. (P.); in spasmodic laryngitis of good effect (R.). Camphor, in many forms said to relieve, as strangury, etc. (R.). Belladonna, of value for spasms of sphincter muscles, especially of pelvic organs (P.) ; atropine hypoderm. in local spasm (R.). Strychnine, of great value in spasmodic asthma (P.) ; also in tetanus, chorea, and epilepsy (Pf., S.). Vera- trine, as solution, brushed over lids once a day in painful spasmodic contraction of the orbicularis (Wa.). Opium, very useful as an antispasmodic, especially if given with a stimulant, as alcohol, ether, or chloroform (R.). Ipecacuanha, in spasms of respiratory organs, of great value (P.). Chamomile Oil, in spasms of hysterical persons, in 4 to 6 14, doses, a very excellent remedy ; also useful in pseudo angina pectoris (P.). Lobelia, a valuable antispasmodic in cautious hands (P.). Lupulin, in gouty spasms (P.). Tobacco, in spasmodic asthma, and for relaxation of muscular spasms (P.). Sumbul, in gastric spasms is of use (P.). Cardamoms, are usefully employed in gastric spasms (P.). Ammonia, useful in children’s colic (R.). Chloroform, inhaled for intestinal spasm (R.). Sulpho-carbolates, in flatulent “ spasm,” sometimes phosphorus better (R.). Mustard Poultice, an excellent counter-irritant in spasmodic affections (P.). [Compare list of Antispasmodics on page 28, and in this section the titles Angina Pectoris, Asthma, Chorea, Colic, Cough, Convulsions, Croup, Dysuria, Epilepsy, Gastrodynia, Hydrophobia, Hysteria, Laryngismus, Pertussis, Tetanus, Torticollis, Trismus.] Potassium Bromide, when plethora-erections normal, but persistent and teasing; is harmful in debilitated states, or daily losses (B.) ; with cold sponging and use of a hard bed (R.). Digitalis, 3j or ij of the infusion twice or thrice daily; few remedies are more successful in arresting spermatorrhoea (R., P.) ; feeble erections, frequent emissions, cold hands and feet (B.). Cantharis, defi- cient tone of seminal vesicles, erections feeble, sexual feeling torpid; tinct. gtt. ij-iij ter die (R.); with Iron internally in emissions (R.). Phosphorus, for the induced physical and mental debility; also, hypophosphites of lime and soda (R.). Gelsemium, as anaphrodisiac, may be combined with Belladonna or Cimicifuga (B.). Nux Vomica, relaxation and atony (B.). Strychnine, in large doses, especially when impotence (R.). Quinine, has been recommended (R.). Belladonna, gr. of extract with gr. jss zinci sulphat., three or four times a day, often successful in nocturnal emissions (R.). Atropine, relaxed genitalia, no dream or orgasm (B.). Camphor Bromide, has been useful (W.). Lupulin, is a good anaphrodisiac; with Camphor, when a genital sedative is required (B ). Iron, the iodide, useful in anaemic cases (B.). Ergot, beneficial in relaxed Spermatorrhoea. SPINA BIFIDA—SPINAL PARALYSIS. 665 state (B.). Hydrastis, is a useful injection, gtt. x of the fluid ext. through a urethral tube to the prostatic portion of the urethra (B.). Cimicifuga, useful in weak, relaxed conditions (B.); with hypochondriasis, very beneficial (P.). Silver Nitrate, a vesicating solution applied to perineum generally useful, and without danger (B.). Arsenic, when from weak and relaxed seminal vesicles. Kind Advice, frequently the best treatment, as this is often the phantasm of a morbid imagination. Bladder should be emptied after the first sleep. [Compare Emissions, also List of Anaphrodisiacs on page 47.] Prescriptions. R. Potassii Bromidi, . . . . gj. Sodii Bicarbonat., . . . . gr. xv. Infusi Digitalis, 3 ss. Atropinae Sulphat., . . . gr. g1^. M. Sig.—One dose, to be taken at bed- time. (Gross.) R . Tinct. Gelsemii, .... 3 j. Tinct. Belladonnas, . . . 15 ij. M. Sig.—15 drops thrice daily. (B.) R. Lupulini, gr. x. Pulv. Camphorse gr. vj. Ext. Belladonnas, . . . . gr. ij. M. ft. pil. no. xij. Sig.—One pill thrice daily. (B.) R. Tinct. Cantharidis, . . . gij. Tinct. Ferri Chlor., . . . 5J vj. M. Sig.—20 drops in water thrice daily. In impotence with spermatorrhoea, of great utility. (H- C. Wood.) Iodine, injected into the sac, gss of tinct., or gr. ss, with potassium iodide gr. v, aquas 3j, has cured numerous cases (B.) ; iod. gr. pot. iod. gr. )4 ad aq. oj (Wa.). Collodion, as a means of compression (B.). Spina Bifida. Lead Water and Opium, as lotion over the seat of injury (A.). Leeches, if pain persistent (A.). Spinal Concussion. Ergot, gives excellent results (Brown-Sequard). Turpentine, hot epithems, useful (Wa.). Antiphlogistic measures, with rest and absolute diet; wet cups or leeches to the column ; cool affusions to the spine while patient in a warm half-bath (Ros.). [Compare Meningitis.] Spinal Congestion. Spinal Irritation. Aconite, as ointment locally (R.). Belladonna preparations, locally, gen- erally are better than Aconite (B.). Ignatia, in small doses diminishes irrit- ability of cerebro-spinal axis (Pfl). Strychnine, persistently, will ameliorate wandering neuralgic pains due to irritability of nervous system (B.). Ergot, large doses for congestion (Hammond). Conium, in functional derangement of the cord, with excessive irritability of the reflex function (Wa.). Firing, sometimes very beneficial (B.). Electricity. An inverse galvanic current gives much relief (Hammond). Blisters, with hot-water bag to spine, large doses of strychnine, phosphorus, phosphoric acid, and opium, are the methods based upon the anaemic theory of the disease. Out of 156 cases 133 were thoroughly cured (Hammond). [Compare Meningitis, Myelitis.] Ergot, to starve the inflammation by occluding the spinal arteries (Ham- mond). Electricity, best; galvanic current from spine to nerves and muscles (Ros.). Treatment must be palliative and supporting only, in softening (H.). Spinal Paralysis and Softening. 666 SPLENIC AFFECTIONS STERILITY. Splenic Affections. Mercury Biniodide, gr. j ad unguent. 3j, rubbed in before a hot fire, has given excellent results in chronic malarial enlargements of spleen (Wa.). Quinine, in simple malarial enlargement (B.); gr. xv or xx or more daily, one of the most effectual remedies (Wa.). Ergot, the most effective remedy for enlarged spleen (Da Costa). Ammonium Iodide, effective in chronic splenitis, with unguent, hydrarg. iod. rubri externady; also small doses frequently re- peated in all splenic derangements from malaria (B.). Iodine, locally in chronic forms (B.). [Compare Leucocyth^emia.] Sprains. Arnica, is very useful; the infusion internally and externally (P.); the tinct. diluted as lotion is very effectual (Wa.). Aconite, the liniment to painful sprains often affords speedy relief (Wa.). Turpentine, the oil as a liniment (P.). Ammonium Chloride, in solution, as lotion, or with bread as poultice, to remove discoloration from sprains (W.). Rhus Toxicodendron, the tinct. £ss to Oj of water a good external application to sprains. Oil of Bay as stimulating liniment (P.). Cold Douche, salt may be added. The force must be regulated by the condition of the tissues (R.). Rest, the most essential measure, should be perfect. Warm fomentations, or cold affusion, opiates, and plain diet (D.). A roller bandage with splints, often required to secure rest of the part. Nitrate-of-silver Stains may be removed by washing with Potassium Cyanide £ijss; Iodine, gr. xv ; Water, ; or, after moistening the spots, drop on them a few drops of Tinct. Iodine, and wash out with a solution of Sodium Hyposulphite, (B.). Blood-stains, if on dark-colored materials are best seen by an artificial light. After a few hours they become of a rusty, reddish-brown color, which they maintain for years. The microscope shows the characteristic corpuscles. These stains when on iron are difficult to dis- tinguish from rust; the latter is not soluble in water, while blood is extremely so. Heat applied to the metal will cause the blood to peel off, unless the stain has been exposed long enough to have rust mingled with the blood. A solu- tion of blood in water, heated, forms a coagulum which is soluble in hot caustic potash, the solution thus formed is green by transmitted light, and red by reflected light. Menstrual blood cannot be distinguished from that resulting from a wound (Husband). Stains. Stammering. Vocal Training. The rhythmical method, the most successful; the chief end in view is to regulate the precipitate, irregular form of respiration. Long continuance necessary, six months, a year, or more, in special institutions (Ros.). The patient must be taught the use of language anew, treated with especial kindness, and never subjected to mockery or punishment. [See Potter on Defects of Speech, Lea Prize Essay, Philadelphia, 1882.] Sterility. Aurum, cures sterility when dependent on chronic metritis or amenorrhoea or coldness, more certainly than any other remedy. Auri chlor. gr. (B.). Potassium Iodide, when due to syphilis (R.). Dilation of os and cervix care- fully when sterility depending on obstruction, with dysmenorrhoea (H.). Ster- ility is frequently associated with uterine displacement (Meadows) ; less often with atresia. In persons of good health may be caused by an acid discharge from the uterus, which kills the spermatozoa; for this Vichy water internally STINGS AND BITES STOMATITIS. 667 and per vaginam, and alkaline baths (Charrier). Is due to aspermatism of the husband in more cases than generally believed (Gross). Many cases are due to blocking of the cervical canal with a morbid discharge from the cervical glands, and such may be relieved simply by repeated cleansing thereof with a cotton-wrapped probe or forceps. Stings and Bites. Ammonia or Alkalies, a weak solution, in stings of insects, to neutralize the formic acid (R.). Ammonia, as nervine stimulant in snake-bites, more useful than brandy or any other stimulant; n\,x-xx of liquor ammoniae in water or wine, every half-hour or oftener; also externally or hypodermically, 1 part to 2 aquae into a vein (Wa.). Carbolic Acid, a weak solution sponged over the body, to keep off mosquitoes (R.). Salicylic Acid, 1 to 19 of Flexible Collo- dion, locally for bites of insects, allays pain at once, and only in rare cases is the neighboring tissue swollen. Mercury. The Bichloride, 1 to 1000 of Flexible Collodion, is equally effective. Potassium Permanganate, in strong solution, 1 to 6, locally, is promptly efficient for all reptile-bites and insect- stings. If wound is small, make incision to enlarge it, and insert lint soaked in the solution. If a rattlesnake-bite, inject the solution hypodermically above the wound (Dupon). Viola Cucullata, the common violet, is used as an inter- nal remedy in Pennsylvania for rattlesnake bite, and is successful in a remark- able degree. The leaves are eaten, and a poultice of indigo and salt is at the same time applied to the wound. Arsenic, 1 part to 5 of black pepper, is the “Tanjore Pill,” highly esteemed in India for bites of venomous snakes (Wa.). Chloride of Lime, a filtered solution injected into wound from snake-bite, suc- cessful in seventeen cases (Binz). Silver Nitrate, the sharpened stick applied to every sinuosity of the wound. Excision safer (Wa.). Sugar, applied to stings of wasps, said to relieve almost instantly (Wa.). Ipecacuanha, as poul- tice or paste, allays pain and irritation ; is regarded by some as almost specific (Wa.). Stimulants, in snake-bites, freely; most important. Liquor ammoniae the best (Wa.); stimulants are indicated in snake-bites, but there is no remedy of any value (Gross). Sting, should always be removed if left in the wound ; pressing upon it with the barrel of a small key will expose it. Prescriptions. R . 01. Picis Liquidae, 01. Olivse, 01. Hedeomse, . . . . a& §j. Spt. Camphorae, Glycerini, aa ss. Ac. Carbolici, 3 ij. M. Sig.—Shake well. Lotion against mosquitoes, for fishermen and hunters. R. Carbo Vegetab., Ibj. Potassii Nitratis, . . . . Ac. Carbolici, 3 jss. Persian Insect Powder, . . viij. Mucil. Tragacanth., q. s. To make fumigating pastilles for use against mosquitoes. Stomatitis. Potassium Chlorate, locally and internally. Large doses necessary (gr. x-xx); in ulcerative stomatitis of nursing women, and aphthae; of no value in mercu- rial form (R.). Hydrastis, fluid extract locally in mercurial and aphthous stomatitis (B.). Carbolic Acid, concentrated, in glycerin, carefully, as a mild caustic in aphthous stomatitis (Wa.). Alcohol, Brandy-and-water an excellent lotion (B.). Acids, Mineral, pure Hydrochloric on pine wood to ulcers (B.). Eucalyptus, a decoction of the leaves an efficient local application (B.). Gly- cerin of Tannin, in ulcerative stomatitis (R.). Copper Sulphate, solution painted over edges of gums in ulcerative stomatitis; generally dry alum better (R.). Alum, in ulcerative, applied dry with the finger several times a day, especially when disease affects one-half the jaw (R.). Salicylic Acid, to ease the pain of catarrhal stomatitis. One part (dissolved in sufficient alcohol) to 250 parts of water (R.). [Compare Aphthae, Cancrum Oris.] 668 STABISMUS SYNCOPE. Strabismus. Belladonna, for the strabismus of encephalitis (P.). Atropine, with strong convex glasses, to suspend accommodation for months, or years if necessary; may cure convergent strabismus in its earlier stages, in children of 3 years of age or younger (Green in C.). Operation, required in most cases, especially when of congenital origin. Glasses, properly adjusted to sight, serve to strengthen the weak muscles in children, and to pull the axes right (Gould). Strophulus. Glycerin, locally, combined with bismuth, and digitalis (Wa.). Lancing the gums is proper (H.). Sunstroke. Water, Cold affusion when patient is stricken down unconscious (R.); abso- lute rest and quiet, free air, loose clothes. Potassium Bromide, in cold water enemata. Stimulants when frequent and feeble pulse. Chloroform, if convul- sions. Leeching, in stage of reaction (Wa.). Veratrum Viride, and Gelsemium, as sedatives, instead of stimulants, when pulse full and strong (Ely). Suppuration. Sulphides, small doses (gr. ss-j), frequently repeated, are very serviceable (B.). Calcium Sulphide, when ichor secreted instead of pus; also arrests sup- puration, or if that is impossible will hasten maturation (R.). Quinine, recom- mended in profuse suppuration (R.); to sustain system when suppuration pro- longed (B.). Sarsaparilla, is very useful (P.). Phosphates, Parrish’s to repair waste from suppuration (B.). Iodide of Manganese and Iron, the syrup in cachectic states resulting from suppuration (B.). Alcohol, an excellent anti- septic dressing (B.). [Compare Abscess, Boils, Carbuncle, Pyaemia.J Surgical Fever. Aconite, quickly and repeatedly in early stages, during chill or soon after, the safest treatment (P.). Salicylic Acid, or Salicylate of Sodium, especially useful as an anti-pyretic (B.). Chloral, gr. xx-xxx of the hydrate every 2 hours, no better treatment (Wa.). Sycosis. Nitric Acid, to Oj aquae, as wash, used frequently (R.). Boracic Acid, Sjss finely powdered and incorporated with of vaseline, is found most use- ful (Wa.). Mercury, citrine ointment has been extensively employed, also the oleate of mercury, both with good results (Wa.). Arsenic, the oleate is found beneficial, and the Solution of Arsenic and Mercury, Donovan’s solution, inter- nally is highly useful. Mercurial Ointments are extensively employed (Wa.). Sodium Sulphite, 3j ; glycerini, gj ; aquas, 3iij I locally, when of parasitic origin (Wa.). [Compare Condylomata, Mentagra.] Syncope. Cinnamon, the oil, as a powerful stimulant, sometimes employed (P.). Alco- hol, as brandy, or wine, when heart suddenly enfeebled from fright, etc. (R.). Amyl Nitrite, in some forms, especially in anaemic subjects, its inhalation speedily restores consciousness (O’Neill). Atropine, gr. subcutaneously, the best means of resuscitation, there being no medicine which so promptly exalts the force and rapidity of the heart’s action (Harley). Ammonia, internally, or breathed into the air-passages (R.); the carbonate as “smelling salts” (Wa.). Lavandula, the compound tincture (Wa.). Chloroform, internally, for hysteri- cal people, as cardiac stimulant (R.). Position, leaning forward, with head as low as possible (R.). Galvanization of pneumogastric (B.). Cold Water over the face, and volatile substances to the nose (R.). Cold affusion always (Wa.). SYNOVITIS—SYPHILIS. 669 Synovitis. Potassium Iodide, with iron and quinine, in syphilitic patients with consti- tution broken down (D.). Iodide, in chronic, painted around joint; the solu- tion injected into white swelling (R.). Quinine, and free stimulation in all cases of pyaemic synovitis, such as occurs in acute rheumatism of gonorrhoeal causation, occasionally in typhoid fever, and may from a trifling injury in strumous subjects. Mercury, and Morphine, the oleate locally (R.) ; an ele- gant and efficient application (B.); in syphilitic cases Mercury internally when acute symptoms have subsided (D.). Aconite, for pains in inflamed joints (R.). Silver Nitrate, locally, to vesication almost, often very beneficial (Wa.). Car- bolic Acid, injected into joint (B.). Alcohol, and water, equal parts, an excel- lent evaporating lotion (B.). Blisters, a flying blister every night in chronic synovitis (R.). Cod-liver Oil, in strumous cases (B.). Surgical Treatment. Splints to keep limb motionless in all cases arising from injury ; during acute stage splint should be fastened at some distance above and below joint, and not touch joint itself. Straight position, leeches io joint, or cupping near it; ice, evaporating lotions or hot fomentations. Blisters inapplicable until acute stage subsides (D.). If suppuration occurs the joint must be dealt with as any other abscess cavity (MacCormac). Heat, as fomentations or poultices in the acute form. Bandage, or Strapping, to cause absorption of fluid; bandages (cold water) after alternate bathing with hot and cold water, in chronic. [Compare Coxalgia, Joint Affections.] Syphilis. Mercury, the mainstay in earlier and later stages ; the protiodide in pills of gr. % each, one after each meal increased by one every third day, until teeth sore or bowels disordered, then drop two pills from each dose (Keyes). The best remedy for primary and secondary, not so in tertiary, or in chancroid; small doses are best, to stop short of ptyalism (B.). Blackwash, calomel or citrine oint. very useful in mucous sores, tubercles, and elevated indurations ; in syphilitic ozasna, psoriasis, rashes, condylomata, etc., the bichloride, gr. ij- v in alcoholis, painted over syphilitic mouth lesions daily (Keyes). The serious secondary and tertiary symptoms can be produced both by syphilis and by mercury; the phenomena produced by mercury are singularly similar to those which result from syphilis. Mercury believed to be a true vital antidote against the vii'us (R.); used for at least two years can eradicate it (Keyes). Nitric Acid, in secondary forms (R.) ; holds a high place as an internal remedy (Wa.); when sponginess of gums excessive, aq., teasp. 4times daily; also use locally (St.); as cautery for the initial lesion, the fuming acid, if done at all, should be early and thoroughly, followed by Blackwash locally on lint (Bulkley). Potassium Iodide, approached by no remedy in constitutional syph- ilis ; also for mercurial cachexia, syphiloma of nervous system, and many dis- orders of syphilitic origin. Will certainly arrest ulceration of nares, palate, etc., if given in large doses, gr. every 4 hours (R.); is of little value in early stages ; in later should be combined with mercury (St.). Iodine, as gargle for ptyalism ; the tincture applied to syphilitic sores of the throat (R.); or of tincture to Jiv syr. fusci; a teaspoonful well diluted ter die, after meals, when Pot. Iod. cannot be borne (St.). Iodoform, powdered and dusted over ulcers (B.). Aurum, after mercury and the iodides, in old cases of secondary and tertiary, ulceration of the throat, ozaena, phthisis, syphilitic bone-diseases (B.); its beneficial action incontestable (Tr.). Stillingia, with nitric acid in chronic cases of broken-down constitutions from mercury and iodides; has been most satisfactory (B.). Cascara Amarga, is said to have remarkable powers as an alterative in syphilis, but to be useless if alcohol and tobacco are used at the same time. Sanguinaria, in secondary and tertiary, is held to be very useful (P.). Sarsaparilla, a most important remedy, as adjunct to, and in abuse of mercury (P.) ; with guaiac and mezereon, as the compound decoction of sarsa- parilla, in tertiary form (B.). See Guaiac, below. Belladonna, with mercurial 670 TABES MESENTERICA, ointment, for secondary ulcerations of rectum (P.); tincture 3iv ad aquae, a teaspoonful 4 times a day in water, instead of mercurials (St.). Iron, the iodide in constitutional syphilis, to promote constructive metamorphosis (B.); where anaemia exists (R.) ; the potassio-tartrate, gr. xv-xx, every 4 hours, especially in the gangrenous form (Otis). Guaiacum, in tertiary only ; or as vehicle for potassium iodide and mercuric chloride (B.). Carbolic and Salicylic Acids, locally to syphilitic abscesses, carbolic best (B.). Zinc Chloride, Iodide, Nitrate, locally to syphilitic ulcers (R.). Denutrition. The Arabic “ hunger- cure ” efficient, but unpopular (B.). Turkish Baths, or wet packing, amelio- rate and aid cure of constitutional syphilis (B.). Hygiene, is of the greatest importance in syphilis (Bulkley). Cod-liver Oil, remarkably improves condi- tion resulting from prolonged use of mercury and iodides, the syphilodermata, and squamse ; internally and by inunction (R.). [Compare Chancre, Con- DYLOMATA, ULCERS, PTYALISM.J Prescriptions, $ . Massse Hydrargyri, . . . gr. ij. Ferri Sulph. Exsiccat., . gr. j. Extr. Opii Aquosi, . . . gr. In pill, thrice daily. (Otis.) R. Hydrarg. Chlor. Corr., . gr. viij. Potassii Iodide, .... 3 viij. Syr. Sarsaparillae Co., . . 3 viij. M. Sig.—“ The Three Eights]'—Dose, a teasp. thrice daily. R. Hydrargyri Bichloridi, Ammonii Chloridi, . . aagr. iij. Tinct. Cinchonae Comp.,. 3 iij. Aquae, iij. M. Sig.—A teasp. thrice daily. Each 3 contains gr. y of corrosive sublimate. {Bumstead.) R . Hydrarg. Iodidi Rubri, . gr. ij. Ammonii Carbonatis, . . gr. xx. Potassii Iodidi, iij. Tinct. Gent. Comp., . ad iv. M. Sig.—A teasp. in water after each meal. {Fox, for the Mixed Treattnent.) R . Hydrarg. Iodidi Rubri, . gr. iij. Potassii Iodidi, .... 3 iij—vj. Tinct. Aurantii Cort., Syrup. Aurantii Cort., aai|j. Aquae, gviij. M. Sig.—A teasp. thrice daily after meals. (Otis, for the same.) R • Potassii Iodidi, . . . . g ij. Ammonii Carb., . . . . Tinct. Cinchonae Comp., 3 iv. Glycerini, . . • 3 j. Syr. Aurantii Cort., . . . M. Sig.—A teasp. in plenty of water after each meal. {Keyes.) R. Hydrarg. Bichloridi, . . gr. iv. Tinct. Benzoini, . . . . i|ss. Aquae Cologniensis, . . 3). Aquae Rosae, 3 ivss. M. Sig.—Apply locally with sponge to skin for 20 minutes. For squamous syphil- ides. (S. W. Gross.) R. Hydrarg. Chlor. Mitis., . gij. Lycopodii 3 ij. M. Sig.—Use as snuff thrice daily, in lesions of the nostrils. {Diday.) Tabes Mesenterica Lime, the chloride and phosphate (R.); the chloride is a powerful remedy if kept up (Wa.). [See Scrofulosis.] Iodine, by inunction with cod-liver oil (El.); locally over glands ; carefully, lest inflammation be increased (R.). Potas- sium Iodide in small repeated doses, valuable (Wa.). Mercury. Corrosive Sublimate with bark(gr. j ad £ij tinct. cinchonae) after meals, for chronic gland- ular disease (D.). Phosphates, for malnutrition (B.). The hypophosphites act slowly but surely (Wa.). Iron and Iodine, in various forms are the most useful remedies in scrofulosis, but medicine is powerless without strict hygienic meas- ures (A.) ; the Iodide or Phosphate of Iron and Cod-liver oil, as for tubercle TASTE TEETH—TESTICLES TETANUS. 671 elsewhere (El.). Fel Bovinum, is worthy of trial, though at best a palliative (Wa.). Cod-liver Oil, is the best remedy to promote assimilation (B.); of great service (R.). Chaulmugra Oil, is of benefit, used by inunction (Wa.). Aliment. Raw meat, cream, chocolate, and cocoa, are valuable nutriments in these cases (El.). Peptonized foods are of inestimable value (Wa.). Hygiene. Change of air, especially to sea-air, is all-important (El.). [Compare Scrofulosis.] Taste, Disordered. Mercury or Podophyllin, as purgative for cankery taste unconnected with alcoholism ; or half-glass of pure cold water daily half an hour before break- fast (R.). Teeth. Potassium Iodide, in doses of gr. x, thrice daily, often cures looseness of teeth from periostitis of alveolar processes (Wa.). Iodine, tincture painted over gums close to the teeth when the gums begin to recede ; also to remove tartar (R.). Cinchona, powdered bark often used in tooth-powders (R.). Collodion, on cotton, as stopping for carious teeth (P.). Liquor Sodse Chloratae, 3vj ad ,5xij aqua;, a highly useful application in fetid discharges from carious teeth (Wa.). [Compare Dentition, Odontalgia.] Mercury, the ointment, locally in indurations and enlargements of testes (Wa.). Corrosive Sublimate, with cinchona or sarsaparilla in sarcocele (D.). Water, cold applications in neuralgia of testes, with tonics and neuralgic treat- ment generally (D.). Suspensory Bandage, with rest, in many affections of the testes (D.). [Compare Hydrocele, Orchitis, Varicocele.] Testicles. Strychnine, of decided service (P.); cured 8 cases of traumatic form, in doses of gr. to J (S.); is conclusively curative, especially in chronic and spontaneous, rather than in traumatic. Strychninae Sulphat., gr. to (B.). Aconite, has benefited many cases (P.); its success warrants further trial (W.). Belladonna, successfully used in many cases; the extract, internally, and locally to wound (Wa.); gr. atropine injected into muscle (B.); bleeding, vapor-baths, and large doses of belladonna have cured tetanus (Tr.). Nico- tine, by rectum or hypodermically, appears to be useful in many cases (R.); much evidence for it as the best remedy (P.); effective but dangerous (B.). Physostigma better (Wa.). Potassium Bromide, not less than 3SS during the day, with chloral at night as a hypnotic ; out of 21 cases but 3 died. Its physio- logical action indicates it to be the best remedy known (W.). Chloral, in large doses (gr. xx) no remedy more effectual (B.) ; has sometimes cured (R.); best used in combination with potassium bromide (W.). Gelsemium, cured several cases (P.). Hyoscyamine, gr. gradually up to gr. j ameliorates (B.). Cocaine. A mixed solution of Cocaine and Morphine, of each 5 per cent., 3 syringesful hypodermically, immediately relieved and finally cured a bad case of idiopathic tetanus unrelieved for 3 days by chloral, morphine, etc. (Lopez). Physostigma, has been used with excellent results (P.); the fluid extract by mouth if possible, at very beginning, and must be pushed until just short of arresting breathing (B.); evidence is discrepant (W.). Apomorphine, may prove antagonistic (P.). Curare, hypodermically, has much evidence for its power (P.). Cannabis Indica, used with marked success in traumatic form (P.). Difficult to obtain an active extract (W.). Anaesthetics. Ether, to relieve pain (B.). Chloroform, in small and frequently repeated doses, also by fric- tion, has been useful in many instances (Wa.). Amyl Nitrite, used in 3 cases with marked benefit as spinal sedative (W.); has been used with success (R.). Tetanus. 672 THIRST TIC DOULOUREUX. Morphine, hypodermically, deeply into tetanized muscles (B.); of no value (Wa.). Conium, is indicated, but has not been successful (B.). Water. Warm baths, and cold, or ice, afford only temporary amelioration (B.). Spinal Ice Bag, extremely useful (R.). Division, or stretching of any nerve-trunk connecting wound with spinal cord. [Compare Spasms.] Thirst. Acid Drinks, promote secretion of saliva in fevers (R.). Tepid Drinks, are useful in the thirst of diabetes (R.). Ice, sucked, allays thirst (R.). Throat, Sore. Aconite, when temperature high, half-drop doses of tincture, every hour for 2 hours, then every hour, will almost certainly prove efficacious (R.); valu- able in ordinary sore throat (P.). Belladonna, is very admirably adapted to the treatment of ordinary sore throat. When much fever, combine with Aco- nite (R., P.). [See Catarrh, Acute.] Mercury, in acute tonsillitis, which see (R.). Nitre, dissolved in mouth, to abort a sore throat (Wa.). Tannic Acid, as powder, gargle, spray (P.). Glycerin of Tannin, after acute inflamma- tion ; in ulceration of aphthous sore throat daily when tendency to catarrh (R.). Ipecacuanha, the wine as spray, in non-inflammatory sore throats and hoarse- ness from congestion of vocal cords (R.). Capsicum, 3j of tincture to aquae as gargle, in some sore and malignant sore throats (R., P.). Potassium Chlorate, in grain doses every half-hour (A. A. Smith). Alum, dry, or in solu- tion (R.). Myrrh, as gargle in ulcerated sore throat (P.). Cimicifuga, in simple (R., P.), and malignant forms when mucous membrane dry and spotted with inspissated mucus (R.). Arsenic, in medicinal doses, in sloughing of throat or malignant sores (R.). Iodine, tincture, locally to sores, whether syphilitic or not (R.). Rhus Glabra, a very efficient gargle, a decoction, gj- ad Oj, boiled to O^, with Potassium Chlorate, ifss (W.). Nitric Acid, undi- luted to sloughs (R.). Silver Nitrate, locally, in early stage of inflammation may cut it short (R.). Sulphurous Acid, by inhalation, spray, or fumigations for malignant sore throat, scarlatinal or otherwise (R.). Water, cold compress nightly, to harden the throat when tendency to catarrh (R.). Ice, constantly sucked (R.). [Compare Tonsillitis, Pharyngitis, and formulae for Gargles, on page 460.] Prescriptions. R. Hydrarg. Bichlor., . . . . gr. iv. Alcoholis, J; ij. Solve, et adde— Decocti Cinch onse, Mellis Rosas, Tinct. Myrrhae, . . . aa i$ij. M. ft. gargarysma. Gargle, to be di- luted if too severe. For ulcerated forms of syphilitic sore throat. (Sir Ckas. Bel/.) R. Tinct. Guaiaci Ammon., Liq. Potassse, . . . . aa giij. Tinct. Opii, . . . . . . pf ij. Aq. Cinnamomi, ... ad £ viij. M. ft. gargarysma. Sig.—To be used every hour, as a gargle, in clergyman’s sore throat. (Garner.) Arsenic, cures, influences nutrition (B.). Phosphorus useful; gr. T£n to every 3 hours (R.). Belladonna, Aconite, Spigelia, Iodides, Morphine, Cimici- fuga, Gelsemium, Turpentine, Galvanism (B.). [See under NEURALGIA.] Croton-Chloral, palliative in doses of gr. v every )/2 hour till gr. xxx taken (W.). Salicylates, in large doses, cured a case of 12 years’ standing. Stramo- nium, gr. % to }4 every 3 or 4 hours for 4 or 5 doses, often affords decided relief; stop if narcotic symptoms appear (P.). Laurocerasus, sometimes removes (P.). [Compare Hemicrania, Neuralgia.] Tic Douloureux. TINEA CIRCINATA TINEA TONSURANS. 673 Tinea Circinata—(Ringworm of the Body). Mercury, the bichloride, i part to 250 of water, as parasiticide solution, after depilation (A.). [See also T. Tonsurans.] Carbolic Acid, a very efficient application ; 3j ad glycerini, locally (B.); or equal parts of Carbolic Acid and Glycerin, is a very efficient application. Sulphurous Acid, better and safer (A.); must be fresh to be of use (Bulkley). Cocculus Indicus, the decoc- tion locally, after washing the skin well (P.). Oil of Cade, the best depilatory known (A.). Arsenic will not cure, but may do service as a nerve tonic or an improver of nutrition, in connection with other remedies (Bulkley). Cuprum Acetate, gr. x ad §j adipis, as ointment, is very effective (B.). Sodium Hypo- sulphite, §j ad aquce, locally, used by Dr. Tilbury Fox. Mercury. Calo- mel ointment (3j ad useful (B.). Hydrarg. nitrate as strong citrine oint- ment, rubbed in twice daily, often effectual. Hydrarg. oxid. rubrum, as oint- ment, often cures ringworm on body or limbs, when other remedies fail (Wa.). Cocculus, ointment from kernels, or decoction (P.). Iodine, liniment once applied (R.); with oil of tar (1 to 4 of latter) locally, is excellent (Wa.). Kamala, used locally by the Hindoos (P.). Tar Ointment, is used with good effect (P.). Acetic Acid, applied to cut it short (R.). Cod-liver Oil, a power- ful auxiliary in weakly and cachectic subjects (Wa.). Diet and Hygiene, are important. Food should be nutritive and abundant, especially animal fats. Daily baths, out-of-door exercise. Fungus, is the Tricophyton tonsurans (A.). Tinea Decalvans—(Alopecia Areata). Parasiticide Lotions, must be used after epilation, and washing of head daily with soft or black soap. Stimulants (as Collodium with Ether Cantha- ridalis, equal parts), after fungus is destroyed (A.). Tonics are necessary, especially to the nervous system (Bulkley). Fungus—Microsporon Audouini (A.); but I have never seen it, though having made repeated and thorough searches (Bulkley). Tinea Favosa—(Favus). Mercury. Hydrarg. chlor. corr. gr. xx ; cerat. simplicis §j; efficient when used early (B.); or gr. ij ad 3j aquae after each epilation (R.). Sulphurous Acid, Sulphites, and Hyposulphites, as parasiticides. R. Sodii hyposulphitis ; ac. sulphurosi dil. ; aquae q. s. ad §xvj (Startin). Carbolic Acid, Cod- liver oil, locally (B.). Oils, to facilitate removal of scabs; head to be greased freely to prevent spreading. A mild mercurial pomade, or quinine in glycerin best (R.). Cleanliness, and free use of soap and water, is a sine qua non, and in some cases of tinea may be alone sufficient to produce curative results. Isolation of person, and brushes, towels, etc., necessary to prevent infection. Fungus—Achorion Schonleinii (A.); a very rare affection in this country (Bulkley). Tinea Tonsurans—(Ringworm of the Scalp). Mercury. Hydrarg. chlor. corr. gr. xx ad § j unguent, simplicis, an effective application when used early (B.); must be employed with great caution. Sulphurous Acid, with glycerin (R.). Carbolic Acid, £j ad §j glycerini (B.). Viola Tricolor, the leaves are employed in Italy for tinea capitis (P.). Cocculus Indicus (P.). [See T. Circinata.] Potassium Sulpho-cyanide, §ss with §j glycerini, aquae, as lotion (R.). Iodine, ->ij ad Sj of oil of wood tar (R.). Arsenic Iodide, the best constitutional remedy; gr. increased to gr. % for an adult: gr. fa to fa for children, with alkaline lotions locally (Wa.). Lead, in chronic porrigo capitis; the ointment of the iodide (B.); will complete a cure after alkaline lotions (Wa.). Fungus—Tricophyton tonsurans (A.). [Compare Tinea Circinata.] 674 TONGUE TONSILLITIS TONSILS. Tongue. Potassium Chlorate, gr. v internally and 3j-ij ad Oj aquae locally ; in ulcers of tongue (Wa.); also in rawness of tongue in advanced phthisis. Potassium Iodide, in syphilitic ulcers of tongue (D.) ; and in hypertrophy (A.). Potas- sium Bromide, 3j to §vj water as wash, may soothe morbid sensibility of the tongue (A.). Borax, gr. xl; glycerini jfj; aquae As application in cracked tongue (Wa.). Iodine, the tincture locally by a fine brush, or as a gargle with 7 or 10 parts of water and some honey, has given uniform success in malignant ulcers (Wa.). Conium, thought to act specifically with benefit in ulcer of the tongue (Wa.). Cinnamon, the oil as a powerful stimulant in paralysis of tongue (P.). Ginger, Cochlearia, Pyrethrum, as gargle; Cloves, Mezereon, Pepper, as masticatories, in paralysis (P.). Fraenum, should be divided in tongue-tie ; use blunt-pointed scissors, directing the points down, close to the jaw, so as to avoid wounding the ranine artery (D.); better to cut as little as possible, and that directly backwards, as the artery of the frae- num may proceed from the sublingual (Holmes). [Compare Glossitis, Ran- ula.] Tonsillitis. Aconite, when accompanied by fever and elevated arterial tension, relieves greatly; gtt. ss-j every or hour (B.) ; every %-hour for 2 hours, then every hour, will almost certainly prove efficacious (R.). Belladonna, of surprising efficacy ; gtt. v of tinct. every 3 hours in ss aquae (P.). Mercury, often speedily removes. Calomel, gr. -Ay, or hydr. cum creta, gr. £ every 2 hours ; not in chronic forms (B.); gr. l/s of gray powder every hour when ton- sils almost meet, has marked effect. The oleate of mercury and morphine in obstinate and painful tonsillitis (R.). Silver Nitrate, locally may abort, if applied early (R.); the solid stick, once thoroughly applied in first stage, rarely fails to prevent suppuration (Howard). Guaiac, disagreeable, but very effec- tive (P.); |jss doses of tincture every 4 hours has remarkable power; should be given in emulsion with mucilage or yolk of an egg (B.); makes an excel- lent gargle, see page 460 for formula. Tinctura Guaiaci and Glycerin, equal parts, in teaspoonful doses every hour or two, gives excellent results in acute tonsillitis. Opium, gr. v-x of Dover's powder at bedtime, is in many cases curative (Shoemaker). Cocaine, in 10 per cent, solution, locally, at intervals of 15 minutes, removes pain at once and promotes resolution. A very efficient application in 5 or 10 per cent, solution, but causes temporary paralysis of pala- tal muscles, so that liquids regurgitate through nose (Bceckel). Alum, dry or in solution (R.). Potassium Iodide, locally (gr. j-v-3), is useful (B.). Potas- sium Chlorate, in grain doses every half-hour, very efficient (A. A. Smith). Capsicum, the dilute tincture in a gargle, or in powder applied on a swab, is useful in severe tonsillitis, especially in that accompanying scarlatina (W.). Quinine, gr. x-xv will sometimes abort (B). Tannic Acid, is useful (P.) ; as gargle, see page 460. Ice and wet pack, extremely grateful (B.). Cold Wet Compress, nightly, useful (R.). Incision, of the tonsils gives immediate and marked relief in all cases, especially those which are not amenable to ordinary treatment. Sodium Bicarbonate, locally by wetted finger to surface of tonsils every five minutes for y2 -hour, then every hour during the same day, will pre- vent necessity for lancing (Lyon Medical). Prescription. R. Tinct. Aconiti, 3 ss. Tinct. Guaiaci, 5 ss. Syr. Zingiberis, 3 ss. Syr. Simplicis, Jij. i M. Sig.— gss-ij, every 2 hours accord- ' ing to age. In severe cases, with high j fever, bounding pulse, severe headache. (Shoemaker.) Tonsils, Enlarged. Ammonium Iodide, 3ss in §j glycerin, applied every night by a camel’s hair brush, very efficacious (Wa.). Baryta Iodide, in hypertrophy of the tonsils, TONSILS TYMPANITES. effects a rapid diminution in their size, even when indurated for years (Hale). Liquor Ferri Perchloridi, 3j-ij ad %j, painted over tonsils twice daily, is one of the most effective astringents (Mackenzie). Aluminium Sulphate, a satu- rated solution applied daily by a brush, as a mild caustic (W.). Ergot or Ergo- tine, injections into tonsils (Meigs). Zinc Chloride, as caustic, the most efficient and least annoying method ; a saturated solution applied on a wire cotton- holder to each crypt and held there a few seconds; a few applications will shrink the gland in a week. Tannin, a strong solution touched daily to tonsils (H.); a few sips of a saturated solution (gss in giij aquae) slowly sipped, will stop bleeding, if profuse (A.); gr. xx to %j aquae, hypodermically, as in nasal polypus. Silver Nitrate, touched daily to tonsils, will sometimes make them shrink (H.). Catechu, a serviceable astringent gargle; the infusion §vj with tincture of kino 3ij, as gargle (Wa.). Oxgall, locally, is praised (Wa.) ; is of real utility (W.). Citric Acid, rubbed daily to tonsils, is highly praised in enlargement thereof. Excision of a part of tonsil (H.). Mackenzie’s double guillotine removes both tonsils at once. Hemorrhage seldom happens; ice will generally check it (A.). Surgical measures should receive unprejudiced consideration, as the medical treatment is tedious in the extreme. Tonsils, Ulcerated. Coptis, the infusion as a gargle (B.). Sulphurous Acid, dilute, locally by spray, or a solution of sulphite of sodium in water (3j-3j) (B.). Potassium Iodide, will arrest syphilitic ulcerations at once (B.). Carbolic Acid, a 5 per cent, wash with tincture of myrrh, a good application by sponge to throat (Wa.). Cimicifuga, a decoction of the root as a gargle (Wa.). Cimicifuga, has curative efficacy (P.). Capsicum, a handful of the crushed pods infused for 36 hours in a pint of hot or cold water, and applied on lint covered with gutta-percha (R.) gives striking results (Wa.). Opium, as lini- ment with friction, or an opium plaster, is often serviceable (Wa.). Galvaniza- tion of affected muscles, and faradization of opposed ones quickly relieves (B.). Torticollis. Trismus. Aconite (A.), Atropine (R.), hypodermically. Cannabis Indica, has been used successfully in trismus neonatorum (B.). Opium, n\,% doses of laudanum, with castor oil and warm bath, in trismus infantum. Treatment of any kind seldom effectual (D.), never (El.). Ether, Chloral, Gelsemium, Physostigma (B.). [See Tetanus.] Mercuric Bromide, in yi gr. doses, has benefited abdominal tumors (Wa.). Chloroform, in diagnosis of abdominal tumors when deep-seated, and when walls of the belly are hard and rigid; also in phantom tumors (R.). Pepsin, hypodermically, to dissolve. Hyoscyamus, the leaves as cataplasm or fomenta- tions to painful tumors, afford great relief (Wa.). Electrolysis, employed with more or less benefit in sebaceous, lipoma, bronchocele, enlarged glands, etc. (Wa.). Iron, the liquor ferri perchloridi is found to be valuable as a curative application to fungous or hemorrhoidal tumors (Wa.). Galbanum, as plaster to indolent, non-malignant tumors, to diminish or cause their absorption (Wa.). [Compare Cancer, Cysts, Glandular Enlargement, Goitre, Polypus, Uterine Tumors, Wen.] Tumors. Turpentine, often greatly benefits (P., Wa.); Sj every 6 hours in tympanites of typhoid, with prostration but without diarrhoea (R.). Asafcetida, in hysteri- cal, internally or as enema, beneficial (P.); also in that of fever (Wa.). Capsi- Tympanites. 676 TYPHLITIS TYPHOID FEVER. cum, gr. ss-ij, every4hours (P-). Cocculus Indicus,a few doses of tincture will often succeed in the tympanites of peritonitis and enteric fever (P.). Ginger, with drastic purgatives (P.). Aspiration, in extreme cases and as a last resort. [Compare Typhoid Fever, Peritonitis.] Typhlitis. Opium, of undoubted curative power (B.). Purgatives, are inadmissible; Epsom salts may be used, but no drastics (B.). Leeches, should never be omitted when tenderness and fever begin (B.). Ice-bag, over the swelling (B.). Typhoid Fever. Baptisia, is very useful in the early stage (W.). Mineral Acids, are very useful generally, especially HC1 acid (Wa.). Nitro-hydrochloric Acid, is to be preferred over all other plans of treatment, 20-drop doses in simple elixir; Sul- phuric is useful for intestinal hemorrhage (Da Costa). Sulphurous Acid, is highly praised by Dewar, and has real antidotal power; iTLijss-ithxx every 4 hours according to age, continued for a week or ten days, until the patient’s complaints show him to be saturated. If diarrhoea be present, add Sulphuric Acid and Opium (Wilks). [See formulae below.] Opium, small doses at night, for insomnia with delirium ; also as injection for the diarrhoea (R.); in one case, when vital powers seemed hopelessly depressed, gr. ]/2 opii caused improve- ment (Wa.); for spreading tenderness (peritonitis), give 10-minim doses of the deodorized tincture, also gr. j in suppository every four hours (Da C.). Vera- trum Viride, to reduce temperature (R.) ; delirium ferox (B.) ; strongly recom- mended (Wa.); its efficacy difficult to believe (S.). Cinnamon, efficiently used to abort the disease. [See ante, page 183.] Potassium Bromide, is as much a specific for typhoid fever as quinine sulphate is for ague, aborting the fever in 8 or 10 days (Hawkins). Carbolic Acid, 3j. with Tincture of Iodine 3ij, of which iTy-hj every 2 or 3 hours is a very good plan of treatment (Da C.). Turpentine, invaluable, when hemorrhage and extreme tympanites (P., R.); rr\,xxx-lx in starch mucilage, of liquor opii (P.); n\,v-x frequently for hemor- rhage or every 2 hours in advanced stage, with dry tongue (R.); coma, stupor, etc.; often arouses the vital powers (Wa.) ; rt\,vij with gr. of morphine ; of especial value when marked fever and congested lungs, as well as for the tympany (Da C.). Chloral, is the best drug for nervous symptoms, but must not be used when the heart is weak (Da C.). Arnica, highly extolled: its “picture” shows definite powers in this disease (P.); small doses in asthenic conditions (B.) ; when vital powers greatly depressed (Wa.). Belladonna, con- tracted pupils ; low, muttering delirium (B.) ; thought to counteract the poison of typhoid (Wa.). Mercury, corrosive sublimate gr. every 2 or 3 hours for the diarrhoea. Calomel in small doses at onset (R.); gr. x in one dose the first day, gr. iij per diem for 3 or 4 days, the German “specific treatment” (B.). Bismuth, gr. x-xxv of the subnitrate with gr. y2-j of Opium every 3 hours for the severe diarrhoea (Da C.). Ergotin, gr. ij-vj hypodermically, or 3j of the fluid extract of Ergot, for intestinal hemorrhage (Da C.). Tartar Emetic, with opium, when wakefulness and delirium. Minute doses (gr. -jtg), frequently, are of great service (B.). Digitalis, of value in many cases as a sustainer of heart power, but may be dangerous in the later stages (Anstie, Murrell). Quinine, may have efficacy in typho-malarial; is less effective as the typhoid element predominates ; useless in purely continued fevers (B.); is justly abandoned, but may be used to maintain the circulation, in tonic doses, gr. vj-x in the 24 hours (Da C.). Antipyrine, for hyperpyrexia, also Thymol, gr. ss-ij in solution (Da Costa). Digitalis, used by the Germans when there is no cardiac weakness. Gr. xj-xxij, as antipyretic, over a period of 36 hours (P.). Serpentaria, useful when much depression exists. Cautiously, if intestines at all irritable (B.). Hydrastine, when copious sweats (P.). Lead Acetate, with opium for the purg- ing (R.). Also Alum (R.). Ergot, for intestinal hemorrhage, hypodermically, if symptoms urgent (R.). Sodium Chloride, should not be withdrawn from the TYPHUS FEVER. 677 food (Wa.). Aromatic Spirit of Ammonia, for great accumulation of mucus in the throat (Da C.). Copper Sulphate, gr. T\, with Opium, gr. , for the diar- rhoea (Da C.). Strychnine, is the remedy for the functional palsies (Da C.). Purgatives, only the very mildest, and they with the greatest caution (Wa.). Water, a most important agent. Cold baths when temperature above 102° (B.); in mild cases, cold wet compresses or wet sheets, or washing with cold water ; in severe cases, affusion, shower, or general cold bath, 50° to 550 Fah., or better 950 cooled gradually to 6o° (R.). Medicine will never abort a case of true typhoid ; its natural duration is from 28 to 30 days (Sir William Jenner). Stimu- lants, freely, with quinine, for py£emic cases, showing joint complications. See under Synovitis. Aliment. Milk alone, or alcohol with milk, eggs, broth (B.). Coffee, a better stimulant than alcohol (P.). Alcohol is needed to sustain the heart’s action (Da C.). Milk must be used with great caution, if the curd be undigested great evils arise ; give essence of meat alone (Sir William Jen- ner). Avoid the extremes ; an absolute milk diet required if intestinal symp- toms are grave; no solid food until health is restored fully ; a scalded-milk diet exclusively may be depended on. Adjuvants, water, especially the abdominal compress, cleanliness, ventilation, absolute rest and quiet. Discharges should be received in vessels containing carbolic acid or a solution of corrosive subli- mate, and buried instantly. [Compare Hemorrhage, Intestinal, Rectal Ulceration, Tympanites.] Prescriptions. R. Tinct. Iodi, Ac. Carbolici, . . . . aa p. aeq. M. Sig.—gtt. j-ij every 4 or 6 hours. In typho-malarial fever. {Bartholow.) R. Ant. et Potassii Tartrat., . gr. j-ij. Morphinae Sulphat., . . . gr. jss. Aquae Laurocerasi, . . . % j. M. Sig.—A teasp. every 2, 3 or 4 hours. (Bartholow.) R. Quininae Sulphatis, . . . . gr. x. Ac. Hydrochlor. Dil., . . % ss. Vel Ac. Sulphur. Dil., . . . . 3ss. Syr. Aurantii, J j. Aquae Carui, ad^vj. M. Sig.—A tablesp. in an equal quan- tity of water, every 3 or 4 hours. {Murchison.) R . Ac. Sulphurosi, 3 ij. Ac. Sulphur. Dil., . . . . 3 ij. Tinct. Opii Deodor., . . . rrycx. Syr. Aurantii, iij. Aquae, ad^vj. M. Sig.—One-sixth to be taken every 4 hours. (Wilks.') R. Ac. Sulphurosi, 3 ij. Syr. Aurantii, 3 iij. Aquae, ad%vj. M. Sig.—One-sixth every 4 hours. (Wilks.) R . Ac. Sulphurosi, tqpcv. Ac. Sulphur. Dil., .... tt\,xv. Tinct. Opii Deodor., . . . Trpij. Syr. Aurantii, 5J iv. Aquae, . . . .- . . . adgj. M. Sig.—For infants, one-sixth to be taken every 4 hours. ( Wilks.) R . Ac. Sulphurosi, .... Ttpxv. Syr. Aurantii, . . . . g iij. Aquae, tfdgj. M. Sig.—For infants, one-sixth every 4 hours. (Wilks.) Typhus Fever. Baptisia, is said to have proved very useful (W.). Belladonna, to cleanse and moisten the tongue ; controls the delirium, shows and strengthens the pulse, reduces the temperature, shortens course of disease (R., P.). In the early stages, relieves severity of symptoms (P.) ; contracted pupils (B., Wa.). Arnica, very highly extolled (P., Wa.). Hyoscyamus, mild brain symptoms (P.). Opium, fulfils many important indications; never when contracted pupil (Wa.). Mineral Acids. Hydrochloric, nitric, sulphuric; their use recommended in all countries (Wa.). Tartar Emetic, with opium in the delirium with insomnia (R.). [See Typhoid.] Chloral, to produce sleep, and allay violent delirium (R., Wa.); 678 ULCERS AND SORES. its use has often been followed by amelioration of the symptoms (Wa.). Anti- pyrine or Quinine, as antipyretics, it being more necessary than in typhoid to keep the temperature within safe limits (B.). Podophyllin, gr. £ as mild laxative at onset, when constipation, congestive headache, biliary derangement (P.). Digitalis, in large doses, a favorite remedy in Germany (P.). Rhatany, as tonic, in advanced stages (P.). Serpentaria, in low stages, delirium, watch- fulness; tongue dry and brown, or black. Combine with ammonium, sesqui- carbonate (P.); given occasionally to excite diaphoresis, and support the vital powers (Wa.). Camphor, a remedy of considerable value ; contra-indicated when flesh-red tongue, tender abdomen, diarrhoea (Wa.). Purgatives. [See Typhoid Fever.] Coffee, better than alcohol for the adynamia (P.). Stimu- lants, are not needed under the use of mineral acids and a supporting diet, in many cases (Wa.); are needed sooner than in typhoid, as the adynamia is more profound and appears sooner (B.). Diet, nutritious persistently. Beef-tea, egg-nog ; nutrient enemata. Isolation, imperative, as the disease is eminently contagious (B.). [Compare Delirium, Typhoid Fever.] Ulcers and Sores. Arsenic, improves rodent ulcer (B.). Belladonna, has a remarkable influ- ence over various ulcerative processes (P.). Mercury, Calomel ointment or black wash in scrofulous or tuberculous lupus, and in open scrofulous sores (R.) ; corrosive sublimate, i per cent, solution, as application to syphilitic ulcers (Fox); the Ung. Hydrarg. Nitratis, for serpiginous ulcerations, diluted one-half, or the iodide, gr. xx-xl ad §j Vaselini, in syphilitic ulcerations (Keyes). Lime, as carbonate or lime-water to check discharge ; the sulphide when thin ichorous discharge ; the phosphate has influence on scrofulous sores (R.). Phytolacca, as a local application (B.). Hamamelis, employed with satisfaction in varicose ulcers (Pf.). Opium or Morphine, with glycerin, as an application to relieve pain (R.); gr. j-ij, daily, also locally, has a decidedly curative value in phage- denic and indolent ulcers ; not so useful in so-called “irritable” ulcers (Pf., P.). Tannin, or glycerite of Tannin, to coat over wounds, or discharging sores (R.). Potassium Chlorate, in solution as a wash to clean and stimulate foul ulcers (R.); in impalpable powder, a better application than is Iodoform (B.). Cin- chona, powdered bark dusted over foul, indolent, sloughing, and gangrenous ulcers, promotes healing (R.). Conium, locally, by means of a poultice, will ease pain and improve the sore (R.). Chlorine Solution, as a wash for slough- ing and indolent sores (R.). Iodide of Starch, cold as a poultice (R.). Lead, the soluble salts as lotions to unhealthy, over-secreting sores (R.). Pyrogallic Acid, an excellent application in venereal ulcers (Vidal). Chloral, in lotion, gr. v-xx ad §j aquae, for sluggish sores (Keyes). Nitric Acid, as escharotic, applied with a glass rod ; oil to protect surrounding tissues ; arrest by alkaline wash. 3j-Oj is a good acid lotion for washing (B.); the lotion to indolent and painful ulcers (R.). Hydrastis, internally and externally, employed with excel- lent results in rodent ulcer, and ulcers of legs, rectum, and uterus (R.). San- guinaria, locally, to repress fungous granulations of indolent ulcers, I to 80 parts glycerini (P.). Carbolic Acid, and Salicylic, locally (B.). The glycerin of carbolic acid a good application to fetid sores (R.). Balsams of Peru and Tolu, excellent (P.). Camphor, dusted over indolent sores (R.). Charcoal, locally to sloughing sores (R.). Alcohol, to cover sores with thin protecting layer of coagulated albumen (R.). Alum, dry or in solution to relaxed and abundantly-secreting sores (R.). Turpentine, internally for ulceration of bowels (P.). Collodion, as protective covering (P.). Capsicum, a weak solution useful as a stimulant in scrofulous or fistulous sores (P.). Savine, as acrid (not chemical) caustic (P.). Potassa Fusa, or the milder Vienna paste, as escharotic ; to arrest, dilute acid (B.). Zinc Chloride, the most efficient escharotic consistent with safety (B.). Zinc Sulphate, dried, dusted over (R.). Iodoform, dusted over surface (B.) ; prevents granulation in all ulcers, and does no good except to relieve pain (Gross). See Potassium Chlorate above. Silver Nitrate, as caustic, quickly rubbed over (B.). Applied to unhealthy ulcers, also ulcers of UR/EMIA URETHRITIS URETHRAL STRICTURE. 679 the mouth (R.). Copper Sulphate, to indolent ulcers. Touch with a crystal, or frequently apply a solution, gr. ij-x ad gj (B., R.). Coptis, the infusion has high reputation (B.). Chimaphila, Copaiba, Catechu, Myrrh, Rhatany, Rhu- barb, Storax, Benzoin, Tar water, locally, are useful (P.). Oxygen, to atonic, painful ulcers (R.). Galvanic Couplet (B.). [See Bedsores.] Yeast, as poul- tices (R.). Section of exposed nerve-filament, in irritable ulcer, by bistoury passed beneath the sore (Hilton on Rest and Pain). Cod-liver Oil, especially for ulcerations of the glands, or indolent ulcers with excoriated edges, lupus, etc. Water, is sufficient as dressing in the majority of cases. Rest and support of great value. Cleanliness, bandaging and recumbent position in ulcer of legs facilitate recovery; also daily washing to restore the lost vitality of parts ; elastic stockings, and the Esmarch bandage in chronic cases. [Compare Chancre, Chancroid, Bedsores, Throat, Gastric, Intestinal, and Uterine Ulcera- tion, Syphilis.] R . Iodoformi, ij. Mucil. Acaciae Ttpxv. Ol. Menthse Pip., rt\]j. Glycerini, npxx. M. Sig.—For unhealthy ulcers. (Bronson.) Prescriptions, R. Hydrarg. Chlor. Corr., . . . gr. xv. Ac. Carbolici, rrpxxv. Aquae, q. s. ad J iv. M. Sig.—For syphilitic ulcers, pack on cotton, and renew daily. (Fox.) R. Emplas. Plumbi, j^ij. Ung. Hydrargyri, ss- Olei Cadini, sjij. M. Sig.—Spread on linen, and apply to inflamed patches on palms from syphilis. (Bumstead and Taylor.) R. Ung. Petrolei, %ij. Ung. Hydrargyri, . . . . $pv. Olei Cadini, 3 ij. M. Sig.—Apply after removing scales to chronic palmar and plantar lesions. (Bumstead and Taylor.') Digitalis, the infusion, or a poultice of leaves to abdomen and back (B.). Jaborandi, diaphoretic; eliminates urea (B.); or Pilocarpine hypodermically. Opium, Scanzoni and Loomis urge morphine, hypodermically, as the most efficacious agent (B.); in acute, not in chronic uraemia (Pf.). Colchicum, as diuretic (B.). [See Dropsy.] Saline Cathartics, active are required (B.). Hydragogue Cathartics. 01. tiglii (gtt. i-ij), or elaterium (gr. to J), to procure free watery evacuations. Cautiously (B.). Transfusion, in uraemic eclampsia (B.). Water, the vapor bath, or hot wet-pack to induce powerful diaphoresis (B.). [Compare Bright’s Disease, Puerperal Convulsions, Scarlatina, and the list of Diuretics and Diaphoretics, on pages 43 and 46.] Uraemia. Urethritis. Aconite, is used to advantage in urethral fever ; also for prevention of chill after passage of sound (Pf., W.). Silver Nitrate, locally, very efficient in chronic urethritis in females (Wa.). Tannin, on bougies, once a week for 15 minutes, most efficient for urethritis in the female (Wa.). Zinc Sulphate, cast in sticks, for introduction into the urethra (Wa,). Potassium Bicarbonate, with Potassium Acetate, aa gr. x in a large cup of flaxseed tea or a glass of Vichy water, every 4 to 6 hours ; with absolute rest in bed, a calomel purge, and urination under hot water, sufficient for most cases of urethritis, which may arise from lithiasis, leucorrhcea in females, etc. Many cases of aborted gonorrhoea (so-called) were really simple urethritis (Otis). [Compare Gonor- rhoea.] Urethral Stricture. Aconite, is of great service in spasmodic stricture (P.). Cocaine, locally by catheter (Smith). Buchu, in irritable urethra, spasmodic stricture, and gleet (P.). Opium, in full dose or an opiate suppository, with fomentations and a warm bath, will often suffice in spasmodic stricture (Cl.). Catheterization, 680 URINARY DISORDERS. under an anaesthetic in spasmodic stricture if other measures fail to relieve. Also for gradual dilatation in organic stricture, the safest and most generally applicable treatment (Cl.). Oil, injected before dilatation (Wa.). Thorough Division, by a dilating urethrotome the best operation for a radical cure ; 600 cases thus treated without a death or permanent disability (Otis). Urinary Disorders. Aconite, of great service in retention from chill, sub-inflammatory (P.). Tur- pentine, in hematuria and chronic catarrh of the bladder, incontinence from atony, etc. (B.). Strychnine, sometimes employed with marked benefit in retention or incontinence of the old (P.). Cantharis, frequent or involuntary micturition, especially when coughing, in women from weakness of sphincter; one or two drop doses (R.). Cannabis Indica, in retention from spinal dis- eases (R.). Digitalis, holds high as a diuretic, 3j or ij of the infusion night and morning, or oftener if necessary ; in sudden suppression from cold or damp or after scarlatina, if danger threatens (P.). Benzoic Acid, or the Benzoate of Sodium, in 10-15-grain doses, to render alkaline urine acid, and check the formation of phosphates (B.). Nitro-hydrochloric Acid, dilute, gtt. x-xv thrice daily in water, for phosphatic deposits (Mears). Ammonium Carbonate, in 6-grain doses, 3 or 4 times a day, to make acid urine alkaline. Triticum Repens, a favorite remedy with Sir Henry Thompson, in pint doses daily of its infusion or decoction (§ij-iv ad Oj), for strangury, cystitis, and many other complaints, connected with the urinary apparatus. Alkalies, to neutralize acid urine, and control chronic cystitis ; the liquor potassae preferable to the bicar- bonates, tartrates, and citrates, which all have diuretic action and increase the frequency of micturition ; Liquor Potassae mixed with the tinctures of Hyoscy- amus or Belladonna, may undergo chemical changes, but it materially controls painful and frequent micturition in bladder troubles (Thompson). Buchu, renders more help than any drug known in incontinence or retention from catarrh of bladder implicating the ureters, and even the kidneys (P.). Water, copious injections are beneficial in some cases of suppression (R.). [Compare the list of diuretics on page 43 ;—and in this section see Bladder Irrita- ble, and Paralysis of; Cystitis, Diabetes Insipidus, Dysuria, Dropsy, Enuresis, Hematuria, Lithiasis, Nephritis, Oxaluria, Uraemia, Ure- thral Stricture.] R. Pulv. Scillae, Pulv. Digitalis, Hydrarg. Chlor. Mitis, . aa gr. xij. M. ft. pil. no. xij. Sig.—One pill as a diuretic twice daily. (A. Clark.) Prescriptions. R. Potassii Bicarb., Acidi Acetici, Aquae, j iij. M. Sig.—Teasp. doses as required, as a diuretic. Each contains about gr. x of Potassium Acetate. R. Potassii Citratis, !|j. Sodii Bicarbonat., , . . . %v. Syr. Limonis, j. Aquae, q. s. ad % iv. M. Sig.—A teasp. every 2 hours, to render the urine alkaline. {Roberts.) R. Acidi Benzoici, 3 ij. Sodii Boratis, 3 iij. Aquae, Jxij. M. Sig.—A teasp. in water, thrice daily, to keep urine acid. {Emmett.) R. Tinct. Digitalis, gss-j. Spt. Titheris Nitrosi, . . . £iij. Liq. Ammon. Acetat., . . . 2 ss. Aquae • q. s. ad 3 vj. M. Sig.—One-sixth every 3 hours, to re-establish the renal secretion. (Goodeve.) R. Ext. Belladon. FI., .... 3ss-j. Ext. Buchu FI., zj. Spt. zEtheris Nitrosi, . . . 3 ij. M. Sig.—A teasp. 3 or 4 times daily, for dysuria in women. URTICARIA UTERINE CONGESTION. 681 Urticaria. Chloroform, as ointment to allay itching (R.). Potassium Cyanide, or Hy- drocyanic Acid (R.). [See PRURIGO.] Nitric Acid, a dilute wash, controls itching and prevents wheals (R.). Benzoin, the compound tincture painted on the skin for itching (R.). Sodium Salicylate, gr. ij every hour, is re- markably efficient (A. A. Smith) ; gr. xx thrice daily is effective. Copaiba, in full doses will produce urticaria, but drop-doses every hour will sometimes control it (A. A. Smith). Strychnine, with emetics and purgatives, when the affection is chronic (Guibout). Colchicum, in gouty persons (R.). Lead, lotions to ease itching (R ). Alkalies (R.). [See Prurigo.] Warm Baths, may be employed with benefit. R . Acidi Benzoici, gr. viij. Aquae, iv. M. Sig.—Lotion for urticaria. (Squire.) Prescriptions. ; R. Atropinse Sulphat., . . . gr. ]/(,. Aq. Destil., Glycerini, . aa gss. Pulv. Tragacanthse, q. s. I Ft. pil. no. x. Sig.—One bis die. Conium, useful as a palliative, 3 iij-iv ad Oj aquae, as injection for extreme pain of uterine cancer (Wa.). Arsenic, small doses for a long time, with a strong iodine solution and glycerin locally (Atlee). Opium, stands first in the list of palliatives, quieting irritation, allaying pain (Wa.). Morphine, the spe- cific action of morphine upon the uterine circulation should be utilized in hope- less cases of this disease (Lutaud). Carbolic Acid, a weak solution as injection, an excellent cleanser, healer, disinfector and allayer of pain (R.). Bromine, the best escharotic for destruction of the mass (E.). Glycerite of Tannin, checks discharge and stench. Better still if mixed with glycerite of carbolic acid (R.). Iodoform, with cocoa fat as bolus inserted into excavation produced by cancer (R.) ; gr. v-x in each bolus (W ). Iodine, the saturated tincture thoroughly applied to the entire surface of the mass, is frequently of great use in checking hemorrhage, and seems to temporarily check the extension of the disease (E.). Chloral, as anodyne, will agree with most persons (E.); relieves the pains (W.). Chloroform Spray, for some minutes (R.). Cannabis Indica, to allay the pain (Wa.). Surgical Measures, advisable ; medicine can only palliate. Uterine Cancer. Aurum, salts of, often beneficial in chronic metritis with scanty menstruation (B.). Ergotine, long continued, successful in chronic metritis; lessens con- gestion (B.) ; long continued has produced remarkable results in fibroids and polypi and chronic metritis; large, spongy, subinvoluted uterus (P.) ; by inter- stitial injection into the cervix, has been of great benefit (Goodell). Carbolic Acid, undiluted, on cotton-wrapped probe. No better treatment for uterine catarrh (B.). Iodine, has proved the most valuable of all remedies, as local stimulant, and a reliable alterative (Thos., E.); and excitant of uterine con- traction. Use a saturated tincture to any part not exposed to the air (E.); may be injected into cervix (G.). Iodo-tannin, or Iodoformi 3j, Ac. Tannici §j ; a serviceable application in many inflammatory and hypertrophic condi- tions. Iodoform suppositories in chronic metritis (P.). Potassium Bromide, our main stand-by in uterine troubles ; apart from its soothing properties it seems to divert the blood from the womb, and to lessen uterine congestion (Goodell); a specific cure for simple subinvolution, the benefit being derived from the potash (Tait). Digitalis, in subinvolution (B.). Glycerin, on cotton tampon to cervix as local hydragogue (Thos.). Caustic Potash, and Potassa cum Calce, said to be effective in chronic metritis; must be used cautiously (B.). Chromic Acid, a strong solution to interior of uterus, a very useful ap- plication. Ipecacuanha, in subacute metritis of the puerperal state (Tr.). Iron, locally in uterine catarrh (R.) ; as tonic, Iron and other restoratives, a Uterine Congestion and Hypertrophy. 682 UTERINE DISEASES UTERINE DISPLACEMENTS. cardinal rule in the treatment of all uterine disorders, with Ergot, Quinine, Arsenic or Potassium Bromide, whenever the womb as a whole is congested or hypertrophied. Syr. Ferri Iodidi, with Cod-liver Oil, wins half the battle (G.). Zinc Valerianate, in 2- to 4-grain doses thrice daily, is one of the best nervines in these cases (G.). Scarification, after dry cupping, in chronic metritis (Thos.). Electricity, in chronic congestive enlargement, a galvanic current of moderate intensity, slowly interrupted (B.). Water, hot injections or douche, also cold alternately ; one of the most effective measures ; a gallon very hot, ter die (R.);—especially valuable in congestion, which is generally venous ;—ele- vated hips a necessary part of treatment (E.). Cold water is often better than hot (G.). Rest, to the patient and the organ, is of prime importance. Abdomi- nal bandage, skirt-supporters, pessary if anteversion or retroversion, abstinence from sexual intercourse (Thos.). Prescriptions, R. Ext. Humuli, j|j. Elix. Ammon. Valerianat., Syr. Lactucarii, . . . . aa^ss. M. Sig.—A dessertsp. at bedtime, or during the day when needed, as an anti- spasmodic. (Goodell.) R. Iodi, Potas. Bromidi, . . . . aagr. xx. Tinct. Iodi, gj. Aq. Destillat adg iv. M. Sig.— to be injected into cer- vix by 3-5 punctures. (Goodell.) Cimicifuga, to prevent miscarriage in irritable uterus and prolapsus (R.); promises to be a valuable remedy in uterine affections (Wa.); is remarkably efficient in neuralgia and sympathetic pains arising from an irritable uterus, no matter what their precise character (P.). Belladonna, with tannin, as supposi- tory in uterine neuralgia (R.) ; as vaginal or rectal injections, in neuralgic or inflammatory pains (Tr.). Arsenic, in irritable uterus, of decided benefit; gr. ■fo ter die, after meals (Wa.). Carbonic Acid, injection up vagina for neuralgia (R., Wa.). Opium, with starch as injection into the rectum will subdue the pain of uterine diseases (R.) ; gives more speedy relief than any other remedy in irritable uterus, but long-continued is one of the worst (Wa.). Iodized Phenol, has proved the most generally efficient agent for intra-uterine use during eight years’ experience, applied by hard-rubber probes wound with cotton-wool. It removes cervical mucus, gives freedom from pain, softens and dilates the cervix, heals abrasions, removes induration, removes villosities, regulates the menses, improves appetite and digestion, acts as a general alterative, overcomes barren- ness, etc., if used long enough, but rapid results are not attainable by any method of treatment (Battey). Lead, as plaster for pain in the back due to uterine disease (R.). Chloroform, spray, in neuralgia (R.). Aqua-puncture, has had extraordinary success in uterine colic (B.). Baths of warm salt water remarkably useful in nervous or inflammatory hysteralgia (Tr.). [See Abor- tion, Amenorrhcea, Climacteric, Dysmenorrhcea, Endometritis, Hem- orrhage, POST-PARTUM, LeUCORRHCEA, MENORRHAGIA, MENSTRUAL DIS- ORDERS, Metritis, Metrorrhagia, Prolapsus Uteri, etc.] Uterine Diseases Uterine Displacements. Anteversion without prolapse, not a mal-position (E.). Ice, locally when parts inflamed (R.). Hot-water injections, to give tone to the vessels, essential. Also valuable after reduction of mal-positions (E.). Mechanical Means, only reliable or safe in retroversion and prolapse ; the sound, as a means to restore a retroverted uterus to position, cannot be regarded as free from risk, even in skillful hands (E.). Pessaries, harmful unless expertly fitted ; should be adjusted so as to restore the uterus to the normal line, where the circulation will be least obstructed ; not too high. Should never be employed while cellulitis exists (E.). ■Cotton Roll, as a substitute for the orthodox pessary, is far superior. Use the UTERINE TUMORS VAGINISMUS. 683 Borated cotton in flat sheets, rolling it into a roll 2 inches long by 1 inch diameter, and saturating it in Boroglyceride gj, Aluminii Acetatis §j, Glycerini Pur. q. s. ad Oj. If an astringent is required, the Acetate is replaced byAlum- inii Sulphas (Wylie). [Compare Prolapsus Uteri.] Uterine Tumors. Mercury, the bichloride in small doses, long continued, of undoubted value in treatment of fibrous or polypoid growths ; gr. every 6 hours, sometimes restrains the hemorrhage, when other remedies fail (Wa.). Calcium Chloride, in 30-gr. doses thrice daily, has by prolonged use cured uterine fibroids, (Hewitt); calcifies uterine arteries, also those of the body generally, and is dangerous thereby (Tilt, Wells). Ergotin, hypodermically for fibrous tumor (R.); gr. ij-vj, on alternate days, give excellent results (B.); nine cases of fibroid treated by Hildebrandt with good results (P.); this method often causes great pain and severe local inflammation (W.); one grain each of Ergotin and Ferri Sulphas Exsiccat., in pill thrice daily, persistently, for uterine fibroids, using for the hemorrhages a tampon saturated with Tincture of Iodine or Monsel’s Solution (Parvin). Opium, has specific action upon the uterine circulation, and in bleeding from hopeless cases of cancer or from fibroid tumors, should be used freely, regardless of danger of opium habit. (Editorial, N. Y. Med. Rec., Dec. 10, 1887.) Ammonium Chloride, in fibrous tumors, gives more benefit than any other remedy, gr. x, twice or thrice daily, for weeks and months consecu- tively (Atlee). Ferric Subsulphate, injected to restrain bleeding. Cautiously ! (B.). Saline Mineral Waters, especially those at St. Catherine’s Canada, are useful (B.). Aliment, carefully regulated, chiefly of animal food ; with recum- bent posture while flowing, and long-continued use of Ergot in small doses, may accomplish something (E.). [Compare Cysts.] Uterine Ulceration. Hydrastis, quickly improves ; the fluid extract undiluted as topical application in uterine and vaginal leucorrhoea, ulcerations and erosion of cervix (B.). Carbolic Acid, pure, over the surface twice a week in simple ulceration (R.). Silver Nitrate, a serviceable application, but is often abused (B.). The solid stick applied to surface, after cleansing, and drying with cotton-wool (Wa.). Alum, as hip-bath, ft>j ad Cj, and vaginal injection is of great utility in ulcerations of the os uteri, or of the uterine cavity (Recamier). Glycerin 25, Alcohol and pure Creasote 1 part, an excellent application to ulcers of the neck. Bismuth Subnitrate, with enough Glycerin to make a thick cream, is the best of all applications for ulceration of the os and cervix uteri (Suesse- rott). Vegetable Astringents, Infusions or decoctions of galls, oak-bark, hamamelis, geranium, alum-root, etc. The glycerite of tannin, tannin and iodoform, packed around cervix (B.). Tannin, Rhatany or Zinc, as astringent lozenges, for relaxed uvula (A.). Amputation, of elongated part (A.). Uvula. Aconite, with Belladonna ointment for erysipelatous redness after vaccination (R.). Zinc Oxide, dusted over, to allay the subsequent local irritation (Wa.) ; with Pulv. Amyli, equal parts, over the surface. Lead Acetate, gj to Oj water, as lotion for irritable pock (Foster). Carbolic Acid, 3j to Oj water, as lotion for excessive redness, with burning and itching. Vaccination. Vaginismus. Ether, to ascertain cause; usually a displacement, fissure, or cellulitis (E.). Hygiene, sun-baths, hot-water injections, fresh air, removal from husband, etc. 684 VAGINITIS—VARIOLA. (E.). Operation (Sims’), removal of hymen with scissors and insertion of glass plug till parts are healed, when the cicatrix is to be divided, etc. (E.). Tents to gradually dilate vagina, may be impregnated with various sedatives (Gallard). Iodoform in a suppository, when redness and excoriation. Belladonna, the extract, 1 part with 8 or 9 of fresh lard, if only pain (Gallard). Vaginitis. Tannin, the glycerin of tannin in chronic vaginitis of children (R.). Silver Nitrate, gr. aquae, applied within cervical canal, and over the vaginal mucous membrane (E.). Emollient Injections, with Opium (Goodsell). [Com- pare Gonorrhcea, Leucorrhcea.] Pinus Canadensis. The concentrated extract (colorless), locally, has a very soothing influence in acute vaginitis. Diet, no animal food, milk best; which, with careful attention to the bowels, patient to be kept cool with light covering, and use of a mattress rather than a feather bed, is all the treatment required (A.). Saline Mixture, if high fever. Quinine, during convalescence. Complications to be treated symptomatically. Varicella. Varicocele. Hamamelis, appears to have permanently cured one case (R.). Ergot, gr. ij-vj of Ergotin hypodermically, the needle to be inserted among the affected veins, care being taken not to puncture a vein, is effective; severe pain follows for a few hours (R.). Water, cold douche to the perineum and buttocks, with suspension of testicles in cold water (R.). Radical Cure, consists in obliterat- ing the veins by wire ligatures, etc. (Cl.). Varicosis. Hamamelis, is employed with satisfaction in varicose veins and ulcers (Pf.). Digitalis, by fomentation, in acute inflammation from varicose ulcers (R.). Ergotin, injected alongside of vein, but not within it, has cured (B.). Bandage, or elastic stocking; with cold sponging, and rubbing upwards, as palliatives (Cl.). [Compare Hemorrhoids, Ulcers.] Cimicifuga, is given internally by some, who assert that it prevents pitting (R.). Mercury, in ointment or plaster, to prevent pitting in semi-confluent, or barely confluent cases (Wa.) ; formerly used (R.). Camphor, is said to restore the eruption, if retrocedent; in confluent malignant smallpox, camphor alone, or with Opium, may be used for great depression of the vital powers (Wa.). Belladonna, successfully used both as prophylactic and curative agent (Erasmus Wilson). Gr. %-] every 3, 4 or 6 hours, to dilatation of pupil and some stupor; found effectual (Wa.). Carbolic Acid, is used with decided ad- vantage (Wa.). [See Measles.] Has been much used on theoretical grounds, but not with success (B.). Ammonium Carbonate, has had cheering success (Wa.). [See Scarlatina.] Quinine, small doses in adynamic states, larger in hyperpyrexia (B.). Chloral, temperature high, much delirium, and restless- ness (B.). Opium, low, muttering delirium ; not so much used now as formerly (B.); morphine in the insomnia of the advanced stage, once or twice only, but not when copious salivation or mucous expectoration (Wa.). Silver Nitrate, on a sharp-pointed stick, inserted into each vesicle after rupture, to prevent pitting (B.); or simply paint skin with a solution of gr. xx to the £ (R.). Iodine, the tincture to prevent pitting, is painted ten times over face if on first day of eruption, 12 if on the second day, 12-16 times if on third day (B.). Collodion, or solutions of India rubber or gutta percha in chloroform, to prevent pitting ; or cotton-wool dipped into lime liniment, applied to face or neck (R.). Water. Variola. VERTIGO—VOMITING. 685 Cold baths and cold pack of great utility (B.). Packing especially on retro- cession of rash (R.). External Applications, as powdered starch, flour; zinc carbonate, 3 parts to 1 of zinc oxide with olive oil; cold or tepid water with vinegar, sponged over body twice or thrice daily (Wa.). Diet. Tea and dry toast, raw eggs beaten in cold milk, beef-tea, grapes, roasted apples, ripe fruits in season. Cold water may be drank freely. Fats. Bacon-fat smeared over the face, to allay itching and prevent pitting. [Compare Vaccination.] Digitalis, in small doses, alternately month by month with tincture of larch, and with a long course of the citrate of iron and strychnine, in essential ver- tigo, without any other head symptoms, and with general depraved nutrition, the most effectual treatment (Wa.). Potassium Bromide, often controls par- oxysmal vertigo, without coexistent spasm, or organic brain-disease (Wa.). Ammonium Bromide, in an effervescing form with cascarilla, for vertigo from overwork, where there is usually restlessness, insomnia, depression of spirits, with a sense of impending evil (Wa.). Alkalies and Bitter Tonics, give the best results in vertigo of gastric origin. Sodium Bicarbonate, after meals, tonics before meals. Strychnine with Iron, thrice daily, gives good results. Corrosive Sublimate, in small doses, with attention to the bow’els and diet. Cod-liver Oil, giddiness of the aged, when no serious brain-disease (R.). Is mostly symptomatic of disorder of the stomach, or of the liver (cholaemia); sometimes of general debility ; rarely of disease of the brain (H.). Vertigo. Ipecacuanha, in small doses, will arrest certain kinds—a curious fact; espe- cially useful in certain forms ; rr\J of vinum ipecac., every hour or more (B., R., P.); in sick stomach of nervous origin, minute doses are of undoubted value (W.). Arsenic, in many forms of stomach vomiting, especially that of alcoholism, and chronic ulcer (B.), and in the vomiting of cholera (R.) ; gtt. ss of Fowler’s solution, every hour for 6 or 8 doses, often relieves vomiting after a debauch, the a.m. vomiting of drunkards, and that of pregnancy (A. A. Smith). Nux Vomica, stands next to arsenic; is useful in many ways (B.); may be given with Ipecac., especially when tongue coated (R.). Iris, in vomiting with blinding right supraorbital pain ; liver deranged (P.). Bismuth, in many forms of vomiting in children, especially when from gastric catarrh (R.). Carbolic Acid, with or without bismuth (B.) ; in nervous vomiting (W.). Creasote, in the vomiting of cancer, gastric ulcer, etc. (R.) ; gtt. j-ij (W.). Cocaine, in doses of gr. % thrice daily, controlled the vomiting of gastric car- cinoma, after all other means failed (Meigs) ; io-minim doses of a 4 per cent, solution every hour, of inestimable value in the vomiting of yellow fever (Jen- nings). Potassium Nitrate, one of the surest remedies against vomiting and nausea, gr. in of cold water every 4 or 5 minutes, until relieved, in all cases, except reflex ones, and those due to irritant poisons (Moore). Mercury, gr. of gray powder every two hours, especially in children with clayey stools (R.) ; Calomel, gr. j to Oj aquae, first dissolved in §j of lime water—a teasp. every ten minutes for the regurgitation of food in nursing children (A. A. Smith). Sulphurous Acid, well diluted, or less effectively, sodium sul- phite. Sulphites often curative in vomiting of sarcinae, and acid matter, due to acid fermentation of starchy elements (B.). Cocculus Indicus, efficient in cephalic vomiting (P.). Opium, will arrest many kinds ; best in that of biliary or renal calculi, dysmenorrhoea, sea-sickness, pregnancy. Morphine, hypoder., gr. to )4 (P.). Bryonia, bilious vomiting and headache (P.). Veratrum Album, in vomiting and purging of summer diarrhcea (R.). Hydrocyanic Acid, often very serviceable in nervous vomiting; acts promptly if at all (R.). Hy- drobromic Acid, Sss in §j of water, four times daily, useful for the vomiting due to gastric ulcer. Chloroform, n\jj-v, on sugar, for non-inflammatory vomiting (R.); see Yellow Fever for formula. Bromides, in cerebral vomit- Vomiting. 686 VOMITING OF PREGNANCY. ing only; not in the gastric form (B.); potassium bromide in that of uterine disease (W.). Cinnamon or Cloves, will check vomiting (P.). Calumba, in vomiting from kidney disease and renal caculi; frequently allays that of preg- nancy and dentition (P.). Serpentaria, for bilious vomiting (P.). Cerium Oxalate, in that of pregnancy and from cancer (B.) ; gr. j every three hours (R.). Sodium Bicarbonate, £>ss-j to a pint of milk, for infants especially if constipated (R.). Ammonium Carbonate, may relieve when vomited matter is acid (B.). Milk and Lime water, often relieves when other methods fail ; also the effervescing soda powders in the vomiting of acute diseases, and the exanthemata (B.). Alcohol. Iced brandy or champagne in spoonful doses every yz hour in vomiting of cholera, pregnancy, and delir. trem. (B.). Counter-Irritation, at epigastrium (R.). Nutrient Enemata (B.). [See Ene- mata.] Ice, sucked, with horizontal posture, absolute rest and quiet (Wa.). Iced champagne, |;ss every y hour (B.). Pepsin, for vomiting of food after meals ; gr. x-xv before or during meals. Kumyss, has proved efficacious when no other food would remain on the stomach. [Compare the List of Anti- emetics, on page 37, also the articles entitled Hematemesis, Nausea, Sea- sickness, Vomiting of Pregnancy.] R. Ac. Hydrocyan. Dil., . . . zj. Aquae Laurocerasi, . . . 3 ij. M. Sig.—A teasp. every 2 hours, for nervous vomiting. Prescriptions. R. Ac. Hydrobromici Diluti, . ij. Sig.— Half a teasp. in a winegl. of I water, 4 times daily. I Vomiting of Pregnancy. Ipecacuanha, or Nux Vomica, either will generally succeed where the other fails (R.); no other remedy of equal value to Ipecacuanha (P.). Nux Vomica, is useful but often fails; gtt. ss-j every hour or two in water (R.); in very minute doses (S.); gtt. ij-iij of the tincture every two or three hours, or gtt. x before each meal, with very hot water as a drink, is the best treatment (Parvin). Arsenic, Fowler’s solution, gtt. j before each meal, will often relieve, when vomiting of food, retching and straining, with blood and pain (B.). Creasote, checks the vomiting (R.). Carbolic Acid, drop-doses of crystals liquefied by heat, in mucilage ter die (Wa.). Staphisagria, has subdued when other reme- dies failed (P.). Cerium Oxalate, gr. j every three hours (R.); ordinary doses far too small, give as high as io grains (B.). Morphine, hypodermically in severe vomiting (R.). Pepsin, has been used with success. Ingluvin, seems almost specific (B.). Potassium Bromide, is often efficacious (W.) ; £ss doses thrice daily, exceedingly effective in the combined diarrhoea and vomiting of pregnancy. The first dose should be given an hour before rising. Hydrocy- anic Acid, often the best remedy (P.). [See ante, Vomiting.] Copper Sul- phate, sometimes effective, not more than gr. ter die (B.). Iodine, n\,v of the tincture in §ss of sweetened water, repeated in ]/z hour, of magical effect in a bad case which had resisted every other treatment. Is often useful (B.). Cocaine, locally to cervix, promptly cured a most intractable case of several months’ duration, though it failed when used internally (Bois). Has given excellent results when used internally. See formula below ; or may use tablet triturates of gr. each. Calumba, as tincture often useful; drop-doses every hour or two (B.). Bismuth, and Carbolic Acid, are effective (B.). Atropine, frequently effective (R.) ; never failed to give relief in many years of using it (Boys). Ether, sprayed over the epigastric region and the corresponding part of the spinal column, for 3 to 5 minutes every 3 hours, gives immediate relief (Lubelsky). Pop-corn, is a god-send in this complaint, having acted marvel- lously in several cases in which I have used it (Sweringen). Aconite, in full doses, is often very successful (W.). Dilatation of the cervical canal, by the index finger, is regarded as extremely efficient, and reasonably safe. It may bring on abortion, if too extensive, but from records of several cases since 1875, VULVA VULVITIS WARTS. 687 it may be said that it is a safe and sure remedy (Copman). Ice-bag to spine, an efficient measure (R.). Prescriptions. R. Atropinse Sulphatis, . . . gr. j. Morphinse Sulphatis, . . . gr. iv. Acidi Sulph. Aromat., . . 3 iij. Aquse, 3 v. M. Sig.—Ten to twenty drops, thrice daily. (Boys.) R. Cocainse Muriatis, . . . . gr. xv. Acidi Carbolici, lT^x. Aq. Cinnamomi, . . . . 3 ss. Syr. Zingib., . . . q. s. ad ijj. M. Sig.—10 drops, gradually increased to 20, in a little water every hour until re- lieved, then every 2 or 3 hours. (Potter.) R. Cerii Oxalatis, gr. xij. Ipecacuanhse, gr. xv. Creasoti, gr. xxiv. M. ft. pil. no. xij. Sig.—One every hour. (Goode IL) R . Cerii Oxalatis, gr. xxiv. Ext. Hyoscyami, . . . . gr. xxxvj. M. ft. pil. no. xij. Sig.—One pill twice daily. (Goodell.') R. Bismuthi Subnitrat., . . . gr. clx. Cerii Oxalatis, gr. xl. Morphinse Sulphatis, . . . gr. jss. Syrupi, et Acacise, . . ad ij ij, M. ft. emulsio. Sig.—A teasp. every hour until vomiting ceases. (Van Valzah.) Vulva. Sodium Hyposulphite, an unfailing remedy in lotion for aphthse of the vulva (R.). Arsenic, much used for eczema (T.). Lead Acetate, a concentrated solu- tion in glycerin, for eczema of vulva (T.). [Compare Pruritus, Prurigo.] Vulvitis. Alum, as lotion in vulvitis of children ; gr. lx-Oj aquse, or less strong if found to increase discharge (R.). Lead, solutions of the acetate or the diacetate as wash, after the acute stage has subsided. Lime Water, as wash (R.). [Com- pare Vaginitis.] Warts. Thuja, worthy of recommendation in the highest terms, for the cure of warts with a narrow base and pendulous body. A strong tincture locally three times a day, for one or two weeks, with 5 drops in a wineglassful of water internally, night and morning (P.). Iron, tincture of the chloride and dilute HC1 acid, applied night and morning, equal parts, very effective (Bulkley). Nitric Acid, 3j-ij of the dilute acid to a pint of water, as wash, to keep small syphilitic warts constantly moist (R.). Sabina, as caustic (P.); j-ij of alum (Wa.). Rue, the oil, with honey, locally (P.). Arsenious Acid, as a caustic ; enough to be used to excite active inflammation. Liq. arsenicalis painted over warts (R.) ; may be taken internally (B.). Mercurial Ointment, containing 5 per cent, of Arsenic, or a plaster having in each 8 square inches 154 grains of Arsenic and 77 grains of Mercury (Unna). Tannin, and Burnt Alum, equal parts, pow- dered over warts twice daily, gives good results. Chromic Acid, gr. 100 to §j aquse, with a glass rod, to saturate diseased growth. Remove any superfluous acid ; dress with dry lint (R., Wa.). Mercuric Nitrate, locally (R.). Silver Nitrate, as caustic, but is usually too superficial (R.). Dermal Curette, is much used in Vienna to remove warts by enucleation. Strangulation, by tying a string tightly around the base, will cause them to drop off in a few days. Heat, is a most thorough measure for their radical removal; it may best be applied by touching the wart 3 or 4 times daily with the hot end of a cigar; the first few applications only give pain. Caustic Alkalies, locally (R.) ; a saturated solution of potassa fusa, carefully applied by a brush or sponge fastened to the end of a stick, is to be preferred (E. Wilson). [Compare Condylomata.] 688 WEN WORMS. Extirpation, the least troublesome and most speedily effective method. Run a scalpel through it, seize the cut edge of the cyst, and gently tear it out with a touch or two from the knife. Dressing of lint and carbolic oil to cause suppu- ration and contraction (D.). Wen. Filix Mas, Brayera (Kousso), Rottlera (Kamala), Pepo, Granati Fructus Cortex, as taeniafuges (B.). Filix Mas to be taken on an empty stomach, for tape-worm, and followed by a purge (R., P.). Pepo, Jjij as emulsion, taken fasting, one of the most efficient remedies against taenia (B.). Santonin, the best anthelmintic; laxative in morning, fasting all day, a dose (gr. ss-v) of santonin and calomel, or troches of santonin (j-x), at bedtime, a senna draught next morning. For ascarides (B., P.). For round and thread-worms, in castor oil by mouth, or as injection (R.). Iron, the Syrup of the Iodide in- ternally and a solution of the tincture locally, for ascarides (B.); the tincture ferri sesquichlor. ad Oj aquae, a good injection for thread-worms; coagu- lates albumen (R.). Quassia, the infusion an effectual injection, conjoined with simple bitters internally, for ascarides (R.). Pelletierine, the alkaloid of Granatum, is by far the best vermifuge for a tape-worm, repeated after a week for a second worm, as many as 3 having been found in one patient (Da C.); gr. xv-xx of the tannate, followed in a few hours by Castor Oil (R.). Chloroform, a very efficient taeniafuge, 3j in 3jj of mucilage, after 20 hours’ fasting, followed one hour later by 3j of Castor Oil; this is an adult dose, 3j should never be exceeded (Wilde). Lime Water, as injection for thread- worms (R-); repeated, for ascarides (Wa.). Sodium Chloride, in 3ss doses on empty stomach, expels ascarides and prevents reproduction (Wa.). Quinine, as a tonic; also cold sponging, out-door exercise and judicious diet. Useful probably by preventing the production of the abundant mucus which favors the growth of worms (R.); especially useful for ascarides; also as injec- tion for thread-worms and taenia (Wa.). Ignatia, for convulsive symptoms (P.). Kamala (Rottlera), excellent for taenia, requires no purge (P.) ; gr. cl-clxxx for an adult (Wa.). Eucalyptus, as injection, for ascarides (B.). Aloes, are efficacious for ascarides (P.). Ailanthus, decoction of fresh bark, for taenia (B.). Tonics, as cod-liver oil and iron to restore intestinal canal to healthy condition (R.). Turpentine, as poison to tape and thread-worms (R.); also for taenia (Wa.). Scammony, for thread-worms in rectum (R.); with calomel, effective (Wa.). Tannin, as catechu, kino, red-gum, rhatany, haematoxylum, in injec- tions to destroy thread-worms (R.). Alum, as solution for injection (R.). Am- monium Chloride, to prevent formation of thick mucus which serves as nidus for worms (R.). Valerian, especially when convulsions (R.). [Compare the List of Anthelmintics on page 40.] Worms. R. Chloroformi, Ext. Filicis Maris, . . aa gj. Emuls. 01. Ricini (50 per cent.), giij. M. Sig.—One dose after 24 hours’ fast- ing. Does just as well if Male Fern be omitted. (Smith.) Prescriptions. R. Granati Corticis, . . . . Sjij. Ft. infusum. Sig.—To be taken before II A. M.—and followed after 2 hours by — R . 01. Ricini, iij. 01. Terebinth. £j. Ext. Filicis Maris Aether., gj. M. ft. haustus. Fasting unnecessary. (Wilde.) R. Ext. Spigeliae FI., .... 5 j. Ext. Sennae FI., gss. M. Sig.—A teasp. to a child of 3 to 5 years. {Smith.) R. Magnesii Sulphat., . . . . i|ij. Sodii Chloridi, 3 ss. M. Sig.—A fluid ounce in half a glass of water, with gtt. v of Carbolic Acid, night and morning, for ascavides. Persevere. {Barkley.') R. Ext. Spigelke et Sennas FI., gj. Santonini, gr. viij. M. Sig.—A teasp. to a child of 5 years. {Smith.) WOUNDS YELLOW FEVER. 689 Wounds. Arnica, very useful for external bruises and cuts, also for internal injuries; unites surfaces very rapidly after amputations. The infusion or decoction best (P.) ; very effectual (Wa.). Aconite, valuable in surgical fever (P.). Carbolic Acid, solutions check suppuration, and correct fetor (B.). The “antiseptic” treatment of wounds (Lister), especially surgical wounds. See Ag. vol. 1, page 187. Bismuth Subiodide, dusted into a wound, one of the most effi- cient antiseptics, non-irritant, and a prompt stimulant of granulation. An excellent dressing for wounds after approximation of the edges, the powder to be dusted thickly over the edges, and thoroughly smeared with Flexi- ble Collodion (Potter). Sulphurous Acid, in solution, diluted or not, con- stantly applied (R.); in solution or by fumigation, is regarded by some as superior in efficacy to carbolic acid, and less irritant (Wa.). Salicylic Acid, Thiersch prefers to Carbolic ; may be applied pure in powder to gangrenous and sloughing wounds (B.). Mercury, the bichloride, gr. vijss to quart j of hot water, stirred with a stick, makes a solution of 1 to 2000; the best of all anti- septics for washing a wound or cavity, and for saturating the dressings. See List of Antiseptics on page 51. Boracic Acid, also applicable as Carbolic Acid (B.). Balsam of Peru, excellent for closing recent wounds (P.). Benzoin, the basis of healing “balsams ” (P.). Aloes, topically as a slight stimulant; often purges (R.). Gum Tragacanth, a thick aqueous solution to granulating sur- faces, to protect them from the air (Wa.). Opium, to quiet intestinal move- ments in wounds of the abdomen (R.); forwards the reparative processes (P.). Tannin, or glycerin of tannin to coat over wounds (R.). Collodion or Liquor Gutta-perchae, to secure primary union of incised wounds (B.); as protective covering (P.). Iodoform, powdered and dusted over sloughing wounds, irri- table and ill-conditioned ulcers, sores (B.). Iodoform 1, Collodion 9 parts, painted on a superficial wound while edges are held together (Gross); may be painted over edges when stitched together : gives excellent results. Galvanic Couplet, to wounds of indolent form (B.). [See Bedsores.] Nitric Acid, as escharotic for gangrene (B.). Turpentine, one of the most efficient applica- tions in hospital gangrene (B.). Aloes, pulverized fine, as a dressing for wounds, favoring cicatrization and closing them, also relieving the pain at once; re- quires removal only at long intervals (Millet). Poultices, are often abused. Yeast or Charcoal best for foul wounds (B.). Alcohol, an excellent antiseptic dressing when suppurating; also favors cicatrization of open wounds (B.). Water, in universal use as dressing. Cold water often abused. Hot-water dressing as advocated by Hamilton, of New York, promises better results (B.). Turkish Baths, for pain in the seat of old wounds (R.). Ice and Salt, applied to wound prevents inflammation (R.). [Compare Hemorrhage, Inflammation, Pyaemia, Surgical Fever, Gangrene, Ulcers.] Prescriptions. R. Acidi Tannici, "xi). Alcoholis Absolut., . . . . 3 ss. i vEtheris, ijss. Collodii, 3 x'j- M. Sig.—Styptic Colloid. R. Collodii, 5 j. Olei Ricini, 3SS. Acidi Carbolici, 3 ss. M. Sig.—Carbolized Collodion, for wounds. Yellow Fever. Treatment must all be done at the beginning, no time to be lost. Cold sponging early and frequently repeated. Calomel, Quinine and Salines at the start. Potassium Acetate for the kidneys. Morphine for gastric irritation, the feet to be in mustard water (Da Costa). Diaphoretics and Diuretics, also Lax- atives, are very important throughout the disease (Da Costa). Pilocarpine, in dose of gr. % hypodermically, in first stage, carried to the induction of emesis and catharsis, as well as that of diaphoresis, the most efficient treatment known, absolutely jugulating the paroxysm (Habersmith). Mercury, a calomel purga- YELLOW FEVER. tive, gr. ss, 2 or 3 times on the first day, followed by a warm-water enema, is good treatment (B.); has many advocates, and many opponents (Wa.); should generally be abstained from (S.). Duboisine, gr. subcutaneously, the most efficient hypnotic and calmative (B.). Turpentine, when cardiac weakness, depression of vaso-motor system, dissolved state of the blood ; ; small doses, with tinctura ferri chloridi, in hemorrhagic form (B.). Quinine, has some strong evidence in its favor as an abortive agent, one large dose (gr. xxx-xl) with opium at outset (Wa.); is not a specific ; may hasten recovery in mild cases (S.); gr. xx per rectum, to reduce temperature (B.). Liquor Calcis, with milk, has been found efficient for the vomiting (Wa.). Capsicum, to obvi- ate the black vomit, is highly spoken of (Wa.). Cocaine, for the vomiting, nothing equals it in efficiency, it also acting as a diuretic, 10-minim doses of a 4 per cent, solution, by mouth, every hour for 2 or 3 doses, acts like a charm (Jennings). Chloroform, for the vomiting, a few drops to prepare the stomach for reception and retention of food; effects transitory, has to be repeated before each meal (Wa.); the Ammoniated Chloroform in zymotic pyrexia ; its action is sedative, analgesic and antipyretic (Richardson). Carbolic Acid, by stomach and hypodermically, remarkably efficacious, even after the ominous “ coffee- grounds ” vomit (Lecaille). Chlorodyne, is excellent for restlessness, insomnia, irritability of stomach (A.). Veratrum Viride, gtt. j-x hourly, according to age, till pulse and temperature subdued; successfully used in connection with mercury, etc. (White and Ford). Stimulants, only in typhus form (B.); in 3d stage must be bold, prompt and continued (Da C.). Diet, of the blandest description (A.) ; milk and lime-water, half and half, in small quantities, is the best aliment, in convalescence, the utmost care is necessary in giving aliments (B.). Rest is very important (DaC.). Iced Champagne, in tablespoonful doses every % hour, for the vomiting (B.). Purgation, throughout the disease (Da C.). [Compare Remittent Fever.] R. Potassii Carbonat., . . . . gr. xx. Tinct. Opii Camphorat., . . gj. Aquae, M. Sig.— every hour or two, as a diaphoretic. » [Dickson.) Prescriptions. R. Chloroformi, Tinct. Camphorae, . . . aa M. Sig.—Two drops as required for the vomiting, APPENDIX. LIST OF LATIN WORDS, PHRASES, ETC., USED IN WRITING PRESCRIPTIONS; WITH THEIR CONTRACTIONS, AND THE CORRESPONDING ENGLISH EQUIVALENTS. Word or Phrase. Contraction. English Equivalent. Abdomen Abd. The belly. Absente febre Abs. feb. Fever being absent. Accurate Acc. Accurately. Ad Ad To, or up to. Ad duas vices Ad 2 vie. At twice taking. Ad secundum vicem Ad sec. vie. To the second time. Ad tertiam vicem Ad 3 tiam vie. For the third time. Adde Add. Add. Addantur Add. Let (them) be added. Addendus Add. To be added. Addendo Add. By adding. Ad defectionem animi Ad def. an. To fainting. Ad gratam aciditatem Ad grat. acid. To an agreeable sourness. Adhibendus Adhib. To be administered. Adjacens Adjac. Adjacent. Ad libitum Ad lib. At pleasure. Admove Admov. Apply. Admoveatur Admov. Let (it) be applied. Admoveantur Admov. Let (them) be applied. Adstante febre Adst. feb. The fever being on. Adversum Adv. Against. Aggrediente febre Aggr. feb. While the fever is coming on. Agitato vase Agit. vas. The vial being shaken. Aliquot Aliq. Some. Alter Alt. The other. Alternis horis Alt. hor. Every other hour. Aluta Aluta Leather. Alvo adstricta Alv. adst. The bowels being confined. Alvus Alv. The belly. Am plus Amp. Large. Ampulla Ampul. A. large bottle. Ana A. or aa Of each. Aqua Aq. Water. Aqua astricta Aq. astr. Frozen water. Aqua bulliens Aq. bull. Boiling water. Aqua communis Aq. com. Common water. Aqua fervens Aq. ferv. Hot water. Aqua fluviatilis Aq. fiuv. River water. Aqua fontalis Aq. font. Spring water. Aqua fontana or fontis Aq. lont. (< U Aqua marina Aq. mar. Sea water. Aqua nivialisor nivalis Aq. niv. Snow water. 692 LIST OF LATIN WORDS, PHRASES, ETC. Word or Phrase. Contraction. English Equivalent. Aqua pluvialis, or pluvia- Aq. pluv. Rain water. tilis Aqualis Aqualis Pertaining to water. Aut Aut. Or. Balneum arense B. A. Sand-bath. Balneum marige, or maris B. M. Salt-water bath. Balneum vaporosum, or B. V. Vapor bath. vaporis Balsamum Bals. Balsam. Barbadensis B. B. Barbadoes. Bene Bene Well. Bibe Bib. Drink (thou). Biduum Bid. Two days. Bis Bis Twice. Bis in die, or dies Bis die Twice a day. Bolus Bol. A large pill. Bulliat or Bulliant Bull. Let boil. Butyrum But. Butter. Caeruleus Caerul. Blue. Calefactus Calef. Warmed. Calomel or Calomelas Cal. The mild chloride of mercury. Cape Cap. Take (thou). Capiat Cap. Let him take. Capsula Capsul. A capsule. Caute Caute Cautiously. Charta Chart. Paper. Chartula Chartul. A small paper. Cibus Cib. Food. Cochlear, or Cochleare, or Coch., Cochleat. A spoonful, By spoonfuls ( 3j). Cochleatim Cochleare amplum Coch. amp. A dessertspoonful (3 ij). Cochleare magnum Coch. mag. A tablespoonful ss). Cochleare medium, or Coch. med. or mod. A dessertspoonful ( 3 ij). modicum Cochleare parvum Coch. parv. A teaspoonful (3j). Coctio Coct. Boiling. Cola Col. Strain. Colaturae Colatur. To the strained liquor. Col at us Colat. Strained. Coletur Colet. Let it be strained. Colentur Colent. Let them be strained. Collutorium Collut. A mouth-wash. Collyrium Collyr. An eye-wash. Coloretur Coloret. Let it be colored. Compositus Comp. Compounded. Concisus Concis. Cut. Confectio Conf. Confection. Congius Cong. A gallon. Conserva Cons. A conserve, also Keep (thou). Continuantur remedia Cont. rem. Let the medicines be continued Contusus Contus. Bruised. Coque, Coquantur Coq. Boil, let them be boiled. Coque ad medietatis con- Coq. ad. med. con- Boil to the consumption of half. sumptionem sump. Coque secundem artem Coq. S. A. Boil according to art. Coque in sufficiente quan- Coq. in S. A. Boil in sufficient water. titate aquae Cor, cordis Cor. The heart. Cortex, corticis Cort. The bark. LIST OF LATIN WORDS, PHRASES, ETC. 693 Word or Phrase. Contraction. English Equivalent. Coxa Cox. The hip. Cras, Crastinus Crast. Tomorrow. Cras mane sumendus Cras mane sumend. To be taken to-morrow morning. Cras nocte Cras nocte To-morrow night. Cras vespere Cras vesp. To-morrow evening. Crastinus Crast. For to-morrow, early. Cujus, Cujus-libet Cuj. Of which, of any. Cum C. With. Cyatho them Cyatho these In a cup of tea. Cyathus, vel Cyathus vina- Cyath., C. vinar. A wine-glass (g j—ij). rius Da, detur D., det. Give, let be given. De De Of, or from. Deaurentur pilulas Deaur. pil. Let the pills be gilded. Debita spissitudo Deb. spiss. A proper consistence. Debitus Deb. Due, proper. Decanta Dec. Pour off. Decern, Decimus Decem. Ten, The tenth. Decoctum Decoct. A decoction. Decubitus Decub. Lying down. De die in diem De d. in d. From day to day. Dein vel Deinde Dein. Thereupon. Deglutiatur Deglut. Let be swallowed. Dejectiones alvi Dej. alv. Stools. Detur in duplo Det. in dup. Let twice as much be given. Dexter, Dextra Dext. The right. Diebus alternis Dieb. alt. Every other day. Diebus tertiis Dieb. tert. Every third day. Diluculo Diluc. At break of day. Dilue, Dilutus Dil. Dilute (thou), Diluted. One-half. Dimidius Dim. Directione propria D. P., or Direct, prop. With a proper direction. Dividatur in partes D. in p. seq. Let it be divided into equal parts. sequales Dividendus, -a, -um Divid. To be divided. Dolor Dolor Pain. Donee Donee Until. Donee alvus bis dejicia- tur Donee alv. bis dejic. Until the bowels have been twice evacuated. Donee alvus soluta fuerit Donee alv. sol. ft. Until the bowels shall be opened. Donee dolor nephriticus exulaverit Donee dolor neph. exulav. Until the nephritic pain is removed. Dosis D. A dose. Drachma Dr. or 3 A drachm (60 grains). Durante dolore Dur. dolor. While the pain lasts. Eadem (fem.) Ead. The same. Eburneus Eburn. Made of ivory. Ejusdem Ejusd. Of the same. Electuarium Elect. An electuary. Emesis Emesis Vomiting. Enema En. A clyster or enema. Enemata Enem. Clysters. Et Et And. Evanuerit Evan. Shall have disappeared. Exhibeatur Exhib. Let it be exhibited. Extende Ext. Spread. Extende super alutem Ext. sup. alut. moll. Spread upon soft leather. modern Extractum Extr. An extract. 694 LIST OF LATIN WORDS, PHRASES, ETC. Word or Phrase. Contraction. English Equivalent. Extrahe Extrahe Extract thou. Fac F. Make. * Fiat Ft. Let be made (sing.). Fiant Ft. Let be made (pi.). Fac pilulas duodecim F. pil. xij Make 12 pills. Farina Farina Flour. Fascia lintea Fas. lint. A linen bandage. Fasciculus Fascic. A bundle which can be carried under the arm. Febre durante Febr. dur. During the fever. Febris Febr. Fever. Femoribus internis Fem. intern. To the inner thighs. Fervens Ferv. Boiling. Fac cataplasmatem Ft. cataplasm. Make a poultice. Fiat ceratum Ft. cerat. Let a cerate be made. Fiant chartulae xij Ft. chart, xij Let 12 powders be made. Fiat collyrium Ft. collyr. Let an eye-wash be made. Fiat emplastrum vesica- torium Ft. emp. vesic. Let a blister be made. Fiat emulsio Ft. emuls. Let an emulsion be made. Fiat enema Ft. en Let an enema (an injection for the rectum) be made. Fiat injectio Ft. inject. Let an injection (for the urethra) be made. Fiat lege artis F. L. A. Let it be made by the rules of art. Fiat massa, et divide in Ft. mas. div. in pil. Let a mass be made, and divide it pilulas xij xij into 12 pills. Fiant pilulae xij Ft. pil. xij Let 12 pills be made. Fiat pulvis Ft. pulv. Let a powder be made. Fiant pulveres xij Ft. pulv. xij Let 12 powders be made. Fiat pulvis in chartulas Ft. pulv. in chart, xij Let a powder be made to be divided xij dividenda div. into xij little papers. Fiat solutio Ft. sol. Let a solution be made. Fiant suppositoria iv Ft. suppos. iv Let 4 suppositories be made. Fiant trochisci xxiv Ft. troch. xxiv Let 24 troches be made. Fiat unguentum Ft. ung. Let an ointment be made. Fiat venesectio Ft. venesec. Let a bleeding be done. Fictilis Fict. Earthen. Filtra Filtra Filter (thou). Filtram, Filtrum Filt. A filter. Fistula armata Fistul. arm. A syringe ready for use. Fluidus Fluid., FI. Liquid. Formula Form. A prescription. Frustillatim Frust. In small pieces. Fuerit Fuerit. Shall have been. Gargarysma Garg. A gargle. Gelatina quavis Gelat. quav. In any kind of jelly. Gingivas incide Ging. incid. Lance (or cut) the gums. Gradatim Grad. By degrees, gradually. Grana sex pondere Gran, vj pond. Six grains by weight. Granum, Grana Gr. Grain, Grains. Gramme Grm. Gram. Gratus Grat. Pleasant. Grumus Grum. A clot (of blood.) Gutta, Guttse Gtt. A drop, Drops. Guttatim Guttat. By drops. Guttis quibusdam Gtt. quibusd. With a few drops. Harum pilularum suman- tur tres Har. pil. sum. iij Let three of these pills be taken. LIST OF LATIN WORDS, PHRASES, ETC. 695 Word or Phrase. Contraction. English Equivalent. Haustus Haust. A draught. Haustus purgans noster H. p. n. A purgative draught after my own (formula). Hebdomada Hebdom. A week. Herba Herb. An herb. Herbarum recentium Herb, recent. Of fresh herbs. Heri Heri Yesterday. Hie, time, Hoc Hie, Hsec, Hoc This. Iiirudo Hirudo A leech. Hirudines appone Hirud. app. Apply leeches. Hora H. An hour. Horit sornni Hor. som. At the hour of sleep. Hora undecima matutina Hor. xj matut. At the eleventh hour of the morning. Horae decubitus Hor. decub. At bedtime. Horae unius spatio Hor. j spat. After one hour. Horis intermediis Hor. interm. In the intermediate hours. Idem Id. The same. Idoneus Idon. Proper. Imprimis Impr. First. Incide, Incisus Inc. Cut (thou), Being cut. In dies Ind. Daily, or From day to day. Infunde Infun. Pour in. Infusum Infus. An* infusion. Injectio Injec. An injection. Injiciatur enema Injic. enem. Let a clyster be given. In pulmento In pulm. In gruel. Instar Instar. As big as. Inter Inter Between. Internus, -a, -um Int. Inner, or Internal. Intus Intus Inwardly. Tam Jam Now. Julepus, Julepum, Julap- ium Jul. A julep. Tusculum Juscul. A broth. [uxta Juxta Near to. Kali praeparatum Kal. ppt. Prepared Potash, or the Carbonate of Potassium. Lac, Lactis Lac. Milk, of Milk. Lagena Lag. A flask, or bottle. Lana Lana. Flannel. Languor Lang. Faintness. Lateri dolenti Lat. dol. To the painful side. Lectus Lect. A bed. Libra Lb. or lb A pound. Ligatura Lig. A ligature. Linimentum Linim. A liniment. Linteum Lint. Lint. Liquor Liq. A solution. Lotio Lot. A lotion. Macera Mac. Macerate. Magnus Mag. Large. Mane Mane In the morning. Mane primo Mane primo In the very early morning. Manipulus M. or Man. A handful. Manus Manus The hand. Massa Mass. A mass, or pill mass. Matutinus Matut. In the morning. Medius Med. Middle. Mensura Mensur. By measure. 696 LIST OF LATIN WORDS, PHRASES, ETC. Word or Phrase. Contraction. English Equivalent. Mica panis Mic. pan. Crumb of bread. Minimum M. or Min. A minim. Minutum Minut. A minute. Misce M. Mix. Mistura Mist. A mixture. Mitte Mit. Send. Mittatur Mit. Let (it) be sent. Mittantur Mit. Let (them) be sent. Mitte sanguinem ad uncias Mit. sang, ad uncias Take away blood to 12 ounces at duodecim saltern. xij salt. least. Modicus Modic. Middle-sized. Modo prsescripto Mod. prtesc. In the manner prescribed. Mora Mora Delay. More dictu Mor. diet. In the manner directed. More solito Mor. sol. In the usual manner. Morturarium Mort. A mortar. Ne trades sine nummo. Ne tr. s. num. Do not deliver without the money. Necnon Necn. Also. Nisi Nisi Unless. Non Non Not. Non repetatur Non repet at. Let it not be repeated. Noc, Noctis Noc, Noct. The night, of the night. Nocte maneque Noct. maneq. At night, and in the morning. Nucha Nucha The nape of the neck. Numero No. In number. Numerus No. Number. Nux Moschata Nux Mosch. A nutmeg. Octarius 0., Oct. A pint (ijxvj). Octavus Octav. Eighth. Octo Octo Eight. Oleum Lini sine igne 01. Lini sine ig. Cold-drawn Linseed Oil. Oleum olivse optimum 01. 0. opt. Best olive oil. Omni hora Omn. hor. Every hour. Omni bihorio Omn. bih. Every two hours. Omni quadrante horse Omn. quadr. hor. Every % hour. Omni mane Omni mane Every morning. Omni nocte Omn. noct. Every night. Opus Opus Need, or occasion. Ovum Ov. An egg. Pannus Pan. A rag. Pars, Partis Partes sequales Par., Pt. A part, Of a part. Pt. aeq. Equal parts. Partitis vicibus Part. vie. In divided doses. Parvulus Parvul. An infant, A parvule. Parvus Parv. Little. Pastillus, Pastillum Pastil. A Pastille. Pediluvium Peduliv. A foot-bath. Penicillum camelinum Penicil. cam. A camel’s-hair pencil or brush. Per Per Through, By. Peracta operatio emetici Peract. operat. emet. When the action of the emetic is finished. Per deliquium Per deliq. By deliquescence. Per fistulam vitream Per fistul. vit. Through a glass tube. Pergo, Pergere Perg. To go on with. Phiala prius agitata P. P. A. The bottle having been first shaken. Phiala Phil. A vial, or bottle. Pilula Pil. A pill. Poculum Pocul. A cup. Pocillum Pocill. A little cup. LIST OF LATIN WORDS, PHRASES, ETC. 697 Word or Phrase. Contraction. English Equivalent. Pond ere P. By weight. Pondus civile P. civ. Civil weight (avoirdupois). Pondus medicinale P. med. Medicinal weight. Pone aurem Pone aur. Behind the ear. Post singulas se des li quid as Post sing. sed. liq. After every loose stool. Pot us Potus Drink. Pneparata Prsep. Prepared. Primo mane Primo mane Very early in the morning. Primus Primus The first. Pro Pro For. Pro ratione aetatis Pro rat. set. According to the age of the patient. Pro re nata P. r. n. Occasionally. According to circum stances. Pugillus Pug. A pinch. Pulmento Pulm. Gruel. Pulvis Pulv. A powder. Pulverizatus Pulvz. Powdered. Pyxis Pyxis A pill-box. Quadrans,—antis Quad. A quart. Quantum libet Q. lib. As much as you please. u u a << «< Quantum placet Q. P- Quantum vis Q. v. <( u n n << Quantum volueris Q. vol. u << a a «( Quantum sufficiat Q. s. As much as is sufficient. Quantum satis Q. s. <( u u « (i Quaqua hora Qq. bor. Every hour. Quaque Qq. Each, or Every. Quart us Quart. Fourth. Quater Quater Four times. Quatuor Quat. Four. Quibus Quibus From which. Quinque Quinq. Five. Quintus Quint. The fifth. Quoque Q. q. Also. Quorum Quor. Of which. Quotidie Quotid. Daily. Ratio Ratio Proportion. Recens, -entis Rec. Fresh. Recipe R Take. Redactus in pulverem Red. in pulv. Let it be reduced to powder. Redigatur in pulverem Redig. in pulv. (t a u u Regio umbilici Reg. umbil. The umbilical region. Reliquus Reiiq. Remaining. Repetatur Rept. Let it be repeated. Repetantur Rept. Let them be repeated. Respondere Respond. To answer. Retinere Retin. To keep. Saltern Saltern At least. Saltim Saltim By leaps. Saturatus, -a, -um Scarificare Sat. Saturated. Scarif. To scarify. Scarificatione explicata Scarif. expl. Scarification having been effected. Scatula Scat. A box. Scilicet Scil. Namely. Scrupulum Scrap, or 7) A scruple (20 grains). Secundum artem S. A. According to art. Secundum naturam S. N. According to nature. Secundus Secund. Second. Sedes Sed. The alvine evacuation. 698 LIST OF LATIN WORDS, PHRASES, ETC. Word or Phrase. Contraction. English Equivalent. Semel Semel Once. Semis, or Semissis Ss. A half. Semi-drachma Semidr. Half a drachm. Serai-hora Semih. Half an hour. Septem Sept. Seven. Septimana Septim. A week. Sesuncia Sesunc. An ounce and a half. Sesquihora Sesqh. An hour and a half. Sex Sex Six. Sextus Sext. Sixth. Si Si If. Signa Sig. Write, or Mark (thou). Signatur nomine proprio Sig. nom. prop. Let it be written upon with its proper name. Simul Simul Together. Sine Sin. Without. Singularum Sing. Of each Singulorum Sing. Of each. Si non valeat Si non val. If it does not answer. Si opus sit Si op. sit If necessary. Si veres permittant Si vir. perm. If the strength will bear it. Sit Sit Let it be. Solus Sol. Alone. Solve Solv. Dissolve. Solvo, Solvere Solv. To dissolve. Solutus Solut. Dissolved. Somnus Somnus Sleep. Spiritus, -us Spt. Spirit. Spiritus vini rectificatus Spt. vin rect. Rectified spirit of wine (i.e. Alco- hol). Spiritus vini tenuis Spt. vin. ten. Proof spirit. Spiritus vinosus Spt. vinos. Ardent spirit (of any strength). Statim Stat. Immediately. Stet, or Stent St. Let it (or them) stand. Stratum superstratum S. S. S. Layer upon layer. Subactus Subact. Subdued. Sub finem coctionis Sub fin. coct. When the boiling is nearly fin- ished. Subinde Subind. Frequently. Sumat talem Sum. tab Let him take one like this. Sume Sum. Take. Sumat “ Let him take. Sumatur U Let it be taken. Sumantur (< Let them be taken. Sumendus u To be taken. Summitates Summit. The summits. Superbibendo haustum Sup. bib haust. Drinking afterwards this draught. Supra Supra Above. Syrupus, -i Syr. Syrup. Tabella Tab. A lozenge. Tabs Tab Such a one. Tempori dextro Tempor. dext. To the right temple. Tempus, -oris Temp. Time, or Temple. Ter Ter Thrice, or Three times. Ter in die, or Ter die T. i. d., or T. d. Thrice daily. Tere Tere Rub. Tere simul Tere sim. Rub together. Tero Tero I rub. Tertius Tert. Third. LIST OF LATIN WORDS, PHRASES, ETC. 699 Word or Phrase. Contraction. English Equivalent. Tinctura Tinct. or Tr. Tincture. Tincturae Herbarum Re- Tinct. Herb. Recent. Tinctures of Fresh Herbs. centium Tres Tres Three. Triduum Trid. Three days. Tritura Trit. Triturate. Trochiscus, Trochisci Troch. A lozenge or troche, Lozenges or troches. Tussis Tus A cough. Ultimo (or Ultima) prse- Ult. prsesc. The last ordered. scriptus Una Una Together. Uncia Unc. or An ounce. Ut dictum Ut diet. As directed. Utendum Utend. To be used. Uto, Uti Uto, Uti To make use of. Vas vitreum Vas vit. A glass vessel. Vehiculum Vehic. A vehicle, or menstruum. Vel Vel Or. Venaesectio brachii Venaesec. brach. Bleeding in the arm. Vesper, -eris Vesp. The evening. Vices Vic. Turns. Vinum Vin. Wine. Vires Vir. Strength. Vitellus Vitel. Yolk. Vitello ovi Solutus Vitel. ovi Sol. Dissolved in the yolk of an egg. Vitellus ovi Vitel. ovi Yolk of egg. Vitreum, Vitrum Vomitione urgente Vitr. Glass. Vom. urg. Vomiting being severe. Note.—For the dangerous abbreviations, see ante, page 443, under the title Pre- scription Writing. Attention is particularly directed to the accentuation of words commonly mispronounced ; as, for example, acdtas, atropa, chimaphila (kima), chloridum, codeia, conium, enema, iodidum, radlcis, ricinus, sinapis, syrupus, eczema, umbilicus, abdomen, bromidum, pare- sis. Pronunciation. The Verbs used in prescription writing are nearly all in the imperative mood, giving directions to the compounder, and having their object in the accusative case. Such are— Verbs. Adde, add. Cola, strain. Divide, divide. Extende, spread. Fac, make. Filtra, filter. Macera, macerate. Misc'e, mix. Recipe, take. Signa, write. Solve, dissolve. Tere, rub. A few verbs are found in the subjunctive mood, taking their subject or predicate in the nominative case. The most usual are— Fiat, let be made. Fiant, let be made. Coletur, let be strained. Coloretur, let be colored. Sumatur, let be taken. Bulliat, let boil. Capiat, let take. Detur, let be given. Dividatur, let be divided. Sit, let it be. 700 PARTICIPLES—GENITIVE CASE ENDINGS. Participles. Participles or Verbal Adjectives are occasionally used, and should agree with their respective nouns in gender, number and case. Such are the following, viz.:— Dividendus, —a, —um, to be divided. Sumendus, -a, -um, to be taken. Adhibendus, -a, -um, to be administered. Those in the first column require the noun following to be in the accusative case,— those in the second column require the ablative case. Prepositions. Ad, to, up to. Cum, with. In. into Pro, for. Supra, upon. Sine, without. Ana, of each,—governs the genitive case. Bene, well. Bis, twice. Dein, thereupon. Et, and. Gradatim, gradually. Guttatim, by drops. In dies, daily. Da, give. Sundry Words and Phrases, in most frequent use. Non, not. Numerus, number. Octarius, a pint. Semel, once. Simul, together. Statim, at once. Ter, thrice. Quater, four times. Ad salurandum, to saturation. Numero, to the number of. Quantum sufficiat, as much as necessary. Pro re nata, according to need. In partes-cequales, into equal parts. Redactus in pulverem, let be pulverized. Secundum artem, according to art. ATon Repetatur, let it not be repeated. GENITIVE CASE ENDINGS, ETC. Nom. Gen. Exceptions. a ae Cataplasma, Enema, Physostigma, Aspidosperma and Gargarysma, all have the genitive in -atis. Coca is unchanged, though the genitive Cocae is written by some authorities. Folia is plural, gen. Foliorum. us urn os on i Rhus, Rhois; Flos, Floris; Bos, Bovis; Limon, Limonis; Erigeron, -ontis. Fructus, Cornus, Quercus, Spiritus, Haustus, Potus, do not change, being of 4th declension. as atis Asclepias,-adis; Mas, Maris. is idis Pulvis, -eris ; Arsenis, —itis ; Phosphis, -itis; Sulphis, —itis, and all salts ending n -is, have genitive in -its. 0 onis Mucilago, -inis; Ustilago,-inis ; Solidago,-inis. i -lis Fel, Fellis ; Mell, Mellis ; Sumbul, Sumbuli. Words which do not change in the Genitive. en ps rs r X inis pis rtis ris cis *Amyl. Catechu. Digitalis. Kino. Azedarach. *Coca. Fructus. Matico. Berberis. Cundurango. Haustus. Quercus. Buchu. Cornus. Hydrastis. Sassafras. Cannabis. Curare. Jaborandi. Sago. Sinapis. Potus. Spiritus. * But some authorities give Apiolum,-i; Sumbul, -i ; Amyl, Amylis ; Coca,-ae. HYPODERMIC FORMULAE. 701 HYPODERMIC FORMULAE. Apomorphine. R. Apomorphinae Muriat.. . .gr.j. Div. in pulv. xvj. One to four in of water as required. Aqua-puncture. R. Aquae Destiilatae, . . . . §j. Sig.— 3 ss- 3 j as an injection. Arsenic. R. Liq. Potassii Arsenitis, . . q. s. Sig.—rqjj-x, hypodermically. R. Liq. Arsen, et Hydr. Iodidi, q. s. Sig.—TTpv-xx, hypodermically. Amyl Nitrite. R. Amyli Nitrit., 3 j. Sig.—rrpiij-v at a dose, which may be repeated in y2 an hour if necessary. Atropine. R. Atropinae Sulphatis, . . . gr. ij. Aquae Destiilatae, . . . . §j. Solve. Sig.— For hypodermic use, trpiij = gr- SO’ l»Uj = gr- TZTP Caffeine. R. Caffeinae Citratis, . . . . gr. xxiv. Aquae Destiilatae, . . . . §j. Solve. Sig.—trpxx contain gr. j. Carbolic Acid. R. Ac. Carbol. Purif., . . . . gr. x. Aquae Destil., M. Sig.—hbviij contain gr. *4 °f the acid, which may be given up to gr. ij or iij. Chloral. R. Chloralis Flydratis, . . . z iv. Aquae Destil., M. Sig.—rtpxxx contain gr. xv of Chloral Hydrate. Chloroform. R. Chloroformi Purif., . . . Sig.—trpv-xv can be used as one deep injection. (See ante, page 623.) The spirit is safer, in somewhat larger doses. Coniine. R . Coniinae Hvdrobromat, . gr. j. Aquae Destillat., 5jj. M. Sig.—trpx contain gr. ?C. Cocaine. R. Cocainae Hydrochlorat., . gr. v. Aquae Destiilatae, .... gj. Solve. Sig.— contain gr. ss. Curare. R. Curarae (Merck), . . . . gr. j. Acidi Acetici rt^v. Aquae Destiilatae, . . . ad rt^c. M. et filtra. Sig—rt\x contain gr. j1^. R. Curarinae Sulphat., . . . . gr. j. Aquae Destillat., ss. M. Sig.—tTLiv contain gr. -fo. Daturine. R . Daturinae, gr. ss. Aquae Destil., Solve. Sig.— contain gr. Dose, rrpiv-x. Digitaline. R. Digitalinae, gr. ss. Alcoholis, Aquae Destil., aa^ij. Solve. Sig. — ti\_iv contain gr. Dose, tr^iv-viij. Duboisine. R. Duboisinae Sulphat., . . . gr. j. Aquae Destil., gj. M. Sig.—nyv contains gr. T^. Ergot and Ergotine. R. Extr. Ergotae Fluid., . . . 3 ss. Filtra. Sig.—Dose, rt\^x. R. Extracti Ergotae (Squibb), . ’7t). Aquae Destillat., Solve et filtra. Sig.—trpx contain gr.j. Dose, n^x-xx. Eserine. R. Eserinae Flydrochlor., . . gr. j. Aquae Destil., giv. Solve. Sig.—Tthiv contain gr. 702 HYPODERMIC FORMULAS. Hydrocyanic Acid. R. Acidi Hydrocyan. Dil., q. s. Sig.—nyv, a maximum dose. Hyoscyamine. R. Hyoscyaminae, gr. j. Ac. Sulphur. Dil., .... Trpv. Aquas Destil., %)■ M. Sig.— contain gr. Mercury. R . Hydrarg. Chlor. Corr., . . gr. j. Aquae Destillat., §]■ M. Sig.—rqx contain gr. R . Hydrarg. Chlor. Corrosivi, Ammonii Chloridi, . . aagr. iij. Misce et solve in— Aquae Destillatae, .... 3 jss. Dein adde— Albuminis Ovi, 3JSS- Aquae Destillatae, . . . . 3v* Filtra, et adde— Aquae Destil., . . . q. s. ad 3 x. Sig-—contains gr. . Dose, n\,iij-x. R . Hydrarg. et Sodii Iodidi, . gr. iij. Aquae Destillatae, .... 3 iijss. Solve. Sig.—Tt\x contain gr. Dose, rrpx every second day. Morphine. R. Morphinae Sulphatis. . . . gy. xvj. Aquae Destillatae, . . . . Solve et filtra. Sig.—rqyijss contain gr. %. (Magendie's.) R. Morphinae Sulphatis, . . . gr. xvj. Acidi Carbolici, TT\^iij. Aquae Destillat., Solve et filtra. Sig.—rrpvijss contain gr. (.Antiseptic, Magendie's.) Morphine and Atropine. R. Morphinae Sulphatis, . . . gr. xvj. Atropinae Sulphatis, . . . gr. ss. Acidi Carbolici, ,TD*j- Aquae Destillat., 3j Solve et filtra. Sig.—rtpvijss contain gr. 1( of Morphine Sulph., and gr. of Atropine Sulphate. (Potter.) R . Morphinae Sulphatis, . . . gr. xxiv. Atropinae Sulphatis, . . . gr. j. 01. Amygdalae Amar., . . gtt. j. Aquae Destillat., 3 ij. Solve. Sig.—trpx contain gr. of Morphine Sulphate, and gr. of Atropine Sulphate. (Didama's Solution.) Pilocarpine. R. Pilocarpinae Nitratis, . . . gr. xvj. Aquae Destillat., . . . . M. Sig.—rt\v contain gr. 14. Potassium Iodide. R. Potassii Iodidi, 3j. Aquae Fontanae, 3 iv. Solve. Sig.—Dose, trpvj-xx. Quinine. R. Quininse Disulph., . . . . gr. 1 (50). Ac. Sulphurici Dil., . . . rt\jc(ioo). Ac. Carbolici trpv (5). Aquae Fontanae, 3;j. Solve. Sig.— 3j contains gr. vj. (Lente). Is irritant. (B.) R . Quininae Hydrobrom., . . gr. xlviij. Aquae Destillat., . . . . giv. Solve.- Sig.—rrpxx contain gr. iv. R. Quininae Bimur. Carbamidat., Aquae Destillatae, . . . aa 3 iv. Solve. Sig.—trpx contain gr. v. Strychnine. R. Strychninae Sulphat., . . . gr. j. Aquae Destillatae, . . . . 25j. Solve sine alcohol. Sig.—Trpx contain gr- tV R. Strychninae Sulphatis, . . gr. j. Aquae Destillatae, .... npccl. Solve. Sig.—rt\y contain gr. 510. Dose, rrpv-viij. Notes.—Solutions for hypodermic use should be neutral in reaction, neither acid nor alkaline; and freshly prepared, especially solutions of the alkaloids, which develop a penicillium, which grows at the expense of the alkaloid. Aqua Fontana, if filtered, is a better menstruum than Aqua Destillata which has been kept for a week, and frequently exposed to the atmosphere. To run the least risk of producing a sore at the point of CHLORODYNE. 703 injection, use very fine needles, and deliver the injection into the areolar tissue beneath the skin, instead of into the skin, as lay parties generally do for themselves. I have given injections of Morphine and Atropine to a dying girl 3 and 4 times daily for two months, and never produced a sore. Always force out all fluid, and wipe the needle-point dry between the fingers, before returning it to the case; the sebaceous matter on the fingers keeping it free from rust. There is an area of several inches square, on the upper and exterior aspect of the thigh, just below the great trochanter of the femur, which is remarkably insensible, being sparingly supplied with cutaneous nerves. (See Fig. 307, Gray’s Anatomy, loth English edition.) An injection delivered in this area will not be felt by the patient. Avoid puncturing a vein; if you do so, watch the patient and pre- pare an injection containing gr. of Atropine Sulphate, to administer if dangerous symptoms arise. Never, except under special circumstances, administer the salts of Mor- phine or Atropine hypodermically to children less than 15 years of age. CHLORODYNE. A COMPARISON OF ITS INGREDIENTS, ACCORDING TO TEN FORMUL/E THEREFOR, THE QUANTITIES BEING CALCULATED FOR EACH FORMULA TO A FOUR-OUNCE MIXTURE, OR n\, 1920. Articles. Quantity of each article in a Siv mixture as per the formula of Squire, P.* Smith, Edw.f u JV 53 c a rC u U. S. Disp. Nat’l Disp. d 0 •a Q Oh' is Bartholow. Gilman. Brit Phar.ff Morphine Muriate, . . . gr. I l6 16 32 33/4 14 16 T 1 454 4 Chloroform, iri 236 192 240 372 375 207 240 247 62 240 Chloral, Ether, m 59 96 120 62 60 Cannabis Indica, Tinct., . in 248 250 207 20 Cannabis Indica, Extr., . gr. 32 Hydrocyanic Acid, 2 p. c., m 118 192 5° 5° 42 90 123 62 120 Ol. Menthse Pip , . . . . m 2 6 l6 IO 8 7 7 2 2 Capsicum, Fluid Extr., . m 4 Capsicum, Tinct., .... m 290 37 7 120 62 Capsicum, Oleo-res., . . m 4 Alcohol, m 236 810 994 IOIO 690 247 495 240 Hydrochloric Acid, . . . m 126 62 3° Sugar, Burnt, gr. 20 Glycvrrhizae, Extr., . . . gr. 147 154 24O Acacia, Mixture, .... HI 384 Tragacanth, Mucil., . . . m 9°3 Theriaca, or Syr. Eusci, . m 236 760 150 247 24O Syrup., in 760 992 744 q.s Glycerin, m 1033 818 760 495 Aqua, m 126 128 240 Total No. of Minims, . . 1920 1920 1920 1920 1920 1920 1920 1920 1920 1920 Adult Dose, rt\ 5-10 5-3° 3-10 5-5 5-30 •5-30 5—5 60 5-10 Morphine in ll\xv, .... gr- 1 T3S Vs Ys Y* Y 1 15 Ys T5S 35 33 Note.—See ante, page 169, for remarks on this preparation, and the number of formula; representing it. * Author of “ A Companion to the Br. Pharmacopoeia.” fSee Hartshorne’s “ Essentials,” 5th ed., p. 625. j Made by Eli Lilly & Co., Indianapolis. ** Parke, Davis & Co., Detroit. If 2d ed., page 430. ff Tinct. Chloroformi et Morphinae, B. P. 704 PATENT MEDICINES. PATENT MEDICINES. Note.—These formulae have been published from time to time in various journals and formularies, and are supposed to represent the preparations designated. The name of the author is appended in each case when known. Alcoholic Strength of Quack Bitters. Hostetter, 43-20 Drake Plantation, 3°-24 Rush, 34-20 Peruvian, 22.40 Hoofland, 20.85 Oxygenated 19.23 California Wine Bitters, .... 18.20 Walker’s Vinegar Bitters, 7.20 Ayer’s Sarsaparilla. Alcohol, fl. oz. 3. Fluid Extr. of Sarsaparilla, fl. oz. 3. Fluid Extr. of Stillingia, . fl. oz. 3. Fluid Extr. of Yellow Dock, fl. oz. 2. Fluid Extr. of Podophyllum, fl. oz. 2. Sugar, oz. 1. Iodide of Potassium, . . grs. 90, Iodide of Iron, grs. 10. Mix. Ayer’s Ague Cure. This, according to Churchill’s analysis, is alleged to consist of a syrupy tincture of Peruvian Bark with Aromatics, each bottle holding six fluid ounces, and each fluid ounce containing 3.2 grains of amorphous Cinchona alkaloids, 3 grains Cinchonia, 0.7 grain Cinchonidia, 0.8 grain Quinia, and I grain of Quinidia. Ayer’s “Vita Nuova.” Cocaine, gr. 8. Pepsin (golden scale), . . gr. 48. Port Wine, gall. 1. (Boston Herald.) Brandreth’s Pills. R. Podophylli Radicis, . . gr. x. Extracti Podophylli, . . gr. x. Extr. Phytolaccse Baccse, gr. xxx. Pulv. Caryophylli, . . . gr. x. Cambogise, gr. ij—v. Ol. Menthae Piperitae, . . tt\fij. Croci, . . gr. ij. Misce, fiat masse, et div. in pil. xxiv. [Hager.) Ayer’s Cherry Pectoral. R. Morphnne Acetat., . . . . gr. iij. Vini Antim. et Potass. Tartrat., Vini Ipecacuanhae, . . aacpij. Tinct. Sanguinariae . . . zij. Syr. Pruni Virginian., . . 3 iij. Castoria is a mixture of Senna, Pumpkin-seed, Anise, Levant Wormseed, Rochelle Salts, Sodium Bicarbonate, Sugar, Oil Gaultheria, Oil Peppermint, and Water. (.Deutsch Am. Apothek. Zeil.) Ayer’s Pills. Consist of Colocynth, Gamboge and Aloes, coated with Starch and Sugar. Ayer’s “ Recamier Balm.” Zinc Oxide, lbs. 5. Glycerin, dr. 2. Alcohol, oz. 2. Mercuric Chloride, . . oz. 4. Distilled Water, .... qts. 64. (Boston Herald.) “ Double Chloride of Gold.” For drunkenness and the opium habit. The composition is said to be as follows:— R. Chloride of Ammonium, . gr. 1. Aloin, gr. 2. Compound Tincture of Cinchona. . . . . . fl. S 3. Water, sufficient to make, fl. 3 4. Ayer’s “ Recamier Cream.” Rice Flour, oz. 48. Zinc Oxide, oz. 60. Glycerin, oz. 640. Cocoa Butter, oz. 48. Lard, . . oz. 48. Mercuric Chloride, . . . oz. 4 Make 32 pints. (Boston Herald.) Ely’s Cream Balm consists of Vaseline, I ounce; Thymol, 3 grains; Carb. Bismuth, 15 grains; Oil Win- tergreen, 2 minims. The directions are to dip the little finger into the balm and insert up the nostrils, giving two or three full in- halations. (Medical Record.) PATENT MEDICINES. 705 Hamburg Tea. R. Senna? Foliorum, pt. viij. Mannse, pt. iv. Coriandri, pt. j. Laville’s Gout Mixture. Calcium Chloride, Chinoi- din, each grm. 5- Extract Colocynth, . . . grm, 2.5 Water, grm. 85. Alcohol, grm. 100. Spanish Wine, grm. 800. Made into a solution. A pill of very complicated composition is used in connec- tion with the gout remedy. (Hager.) See also page 185, ante. Hamlin’s Wizard Oil. R. Spt. Camphorae, £j. Spt. Ammonite, Olei Sassafras, .... aa ss. Olei Caryophylli, 3 ij. Chloroformi, Olei Terebinthinae, . . aa gss. Alcoholis, ...... ad £ v. Morrison’s Pills. Powdered Colocynth, . . . gr. 3. Powdered Gamboge. . . . gr. 6. Powdered Aloes, gr. 9. Cream of Tartar, gr- 12. Syrup enough for 12 pills. Serious re- sults are often produced by large doses of these pills. Helmbold’s Buchu. Said to resemble the genuine. Short Buchu, oz. 9. Uva Ursi, oz. 4j^. Licorice root, dr. 10. Macerate in 9 pints of boiling water, strain and add— Caramel, oz. 2. Molasses, oz. 8. Mix well and add— Cubeb (fluid extract) . . . oz. 5. Alcohol, . pts. 2. Peppermint Oil, oz. 1. Water, sufficient to make . pts. 12. (LiHard's Prac. Hints and Formula.) Orange Blossom. Zinc Sulphate, gr. 60. Alum, gr- 15- Oil Almond Exp., . . . . gr. 90. Extract Hyoscyamus, . . . gr. 1. White Wax, gr. 30. Oil Theobroma, gr. 180. Made into oblong suppositories, one inch long, one and a half wide and half an inch thick, weighing 32 grains each. Perry Davis’s Pain Killer. R. Tinct. Capsici, 5 j. Spt. Camphorae, ]fij. Guaiaci Resinae, Sss. Alcoholis, 3 iij. Tinct. Myrrhte, q. s. ad coloret. Holloway’s Pills. R Aloes, powdered, gr. 36. Jalap, powdered, Ginger, powdered, Myrrh, powdered, of each, gr. 18. Mix. Pierce’s Favorite Prescription. R. Sabina?, Cinchonas, Agarici Albi, .... aa £ij. Cinnamomi, gr. xv. Coq. in aq. suff., ut ft. decoct. viij. Deinde cola, et adde— Sacchari Albi, j^ss. Acaciae gj- Solve, et addantur— Tinct. Opii Deodorat., Tinct. Digitalis, ... aa 3 ss. 01. Anisi, gtt. viij, in Alco- holis, |jss. Misce. (Hager.) Hostetter’s Bitters. R. Sacchari Albi, Aurantii Corticis, Calami, Cinchona?, Gentiante, Calumbae, aa ft j. Rhei Pulv., .... . . . iv. Cinnamomi, 5 ij. Caryophylli, gj. Alcoholis Diluti, C ij. (Med. Bulletin, 1884.) 706 PATENT MEDICINES Pierce’s Golden Discovery. R. Ext. Lactuci, zj. Mellis ff). Tinct. Opii Deodorat., . . 3 ss. Alcoholis Diluti, 3 iij. Aquae, iij. [Hager.) St. Jacob’s Oil — Continued. Another, perhaps more nearly correct:— Gum Camphor, oz. I. Chloral Hydrate, . . . . . oz. i. Chloroform, oz. I. Sulphuric Ether, oz. I. Tinct. of Opium, oz. ]/2. Oil of Origanum, oz. y. Oil of Sassafras, oz. y2. Alcohol, gal. ]/2. Dissolve the Gum Camphor in the Oils and Alcohol, then add the other ingredients. Squibb says that it is a weak Aconite Liniment, also containing Ether, Alcohol, Turpentines, red coloring matter, and water. (Ephemeris, p. 114.) Radam’s “Microbe-Killer.” Oil of Vitriol (impure), . . dr. 4. Muriatic Acid (impure), . . dr. 1. Red Wine, oz. x. Water, gall. 1. {Eckels.) Radway’s Ready Relief. R. Tinct. Capsici, Aquae Ammoniae, Alcoholis, aa t^j. Linimenti Saponis, .... iij. M. (Hager.) Swift’s Specific “ S. S. S.” Fluid Extr. of Smilax Sarsaparilla, 16 parts. Fluid Extr of Stillingia Sylvatica, 16 parts. Fluid Extr. of Lappa Minor, . . 16 parts. Fluid Extr. of Phytolacca Decan- dra, 16 parts. Tinct. of Xanthoxylum Carolini- anum 8 parts. (Registered Pharmacist.) Stearns’ New Idea gives the following : Stillingia, Pokeroot and Sar>aparilla, with Nitrate of Potash and a small quantity of Iron and enough Alcohol to preserve it. Radway’s Resolvent. R. Vini Zingiberis, Vini Cardamomi, ... aa iij. Sacchari Albi, q. s. M. (Hager.) Sage’s Catarrh Remedy. R . Sabs Culinaris(Sodii Chlor.), partes xx. Pulv. Camphorse, .... part. j. Acidi Carbolici, part. j. M.—To be dissolved in water and either injected or sniffed up the nose. Tamar Indien. According to the Report de Pharmacie, the formula for this preparation is as fol- lows :— Tamarind (pulp), 450; powd. Sugar, 40; powd. Sugar-of milk, 60; pure Gly- cerin, 50 (all parts). Mix and evaporate to the consistence of a soft extract, then add powd. Anise, 10 ; Ess. Lemon, 3 ; Tar- taric Acid, 3 (all parts). Mix and divide into 100 boluses. Roll in the lollowing mixture: Cream of Tartar, 5 ; White Su- gar, 35 ; Sugar-of milk, 35 ; Tragacanth, 2 ; Tartaric Acid, 2 ; powd. Red Sandal, 25 (all parts). Dry and put up in tin foil. (.American Druggist.) R. Pulv. Hydrastis Canadensis, partes v. Pulv. Indigo, part. y. Pulv. Camphorse, Acidi Carbolici, . . . aa partes ij. Sodii Chloridi, partes L. M. (New Remedies.) Sanford’s Catarrh Cure. According to an analysis made by Prof. A. B. Lyons for the New Idea, this prepa- ration is composed of distilled extract of Witch-hazel, containing a little Alcohol and Glycerin and some Morphine. The pro- portions of the constituents were not de- termined. (Nat. Druggist.) St. Jacob’s Oil. Said to be composed as follows :— Sulphuric Ether oz. 3. Oil of Turpentine, . . . . oz. 50. Oil of Origanum, oz. 3. Oil of Lavender, oz. 1. Alkanet Root, sufficient to color. Thompson’s Eye-Water. R. Sulphate of Copper, . . . gr. 10. Sulphate of Zinc, . . . . gr. 40. Rose-water, pints 2. Tincture of Saffron, .... dichm. 4. Tincture of Camphor, . . . drchm. 4. Mix and filter. THE TREATMENT OF POISONING. 707 Van Buskirk’s Sozodont. R. Saponis Albi, Alcoholis, 34 Aquae g vj Glycerin i, gij. Olei Gaultheriae, Olei Caryophylli, Olei Menthae Piperitae, aa q. s. ad saporem grat. Cocci Cacti, q. s. ad coloret. Walker’s Bitters—Continued. Sodii Sulphatis, 3 j. Acacias, . 15 ij. Spt. Anisi, 10 p. c., . . . 5jij. Alcoholis, 3jj. M. Dose 3 ij. (Eberbach.) Warner’s Safe Kidney and Liver Cure. It is said to be made after a formula of which the following is a close approxima- tion:— R. Hepatica (herb), . . . . oz. j. Boiling Water, pt. j. Make an infusion; strain and dissolve in it: — Extract of Taraxacum, . . oz. Nitrate of Potassium, . . gr. 320. Cool and add [the following mixture] : — Alcohol, fl. oz.2j^. Glycerin, fl.oz. 1)^. Ess. of Gaultheria, . , . drops 40. Water enough to make one pint. This formula is furnished by a correspond- ent of the Dentsche-Americanische Apothe- ker Zeitung (in No. 5 of 1884). [Am. Druggist.) R. Calcis Praecipitat., Magnesia Carbonatis, Iridis Florent. Radicis, aa p. aeq. M. et trit. [Hoffmann.) Walker’s Vegetable Vinegar Bitters. R. Aloes Socotrin., gij. Guaiaci Resinae, . . . . g iv. Sassafras Mucil., . . . . gj. Aceti, 5pj. Aquae, q. s. Coque, et ft. decoctum, ad §xix, deinde cola, et addantur— THE TREATMENT OF POISONING. The most energetic poisons are Hydrocyanic Acid, some reptile poisons, Strychnine, and Nicotine. (See pages 67, 288, 381.) Those usually selected for criminal purposes are Arsenic, Colchicum, and Tartarized Antimony, the symptoms of which resemble those of natural disease. General Principles of Treatment. Jeaunel's General Antidote.—R. Liq. Ferri Sulphatis (sp. gr. 1.45) 5ijss; Magnesiae Calcinat. Jjij; Carbonis Animalis 3 j; Aquae xx. The ingredients should be kept separate—the solution of the sulphate in one ves- sel, the others together. When needed, the former should be added to the latter and violently agitated. Dose, §jss to Jiij. This is a perfect antidote to Arsenic, Zinc, Digi- taline, etc. It delays the action of salts of Copper, Morpuine and Strychnine, and si ghtly influences compounds of Mercury. It is valueless for Cyanide of Mercury, Tartar Emetic, Hydrocyanic Acid, Phosphorus, or the caustic Alkalies. Bellini, of Florence, considers the Iodide of Starch a valuable antidote to alkaline Sulphides, earthy Sulphides, vegetable and caustic Alkalies, and Ammonia. In the first two cases, he considers it superior to all other antidotes. A fresh mixture of the Sulphide of Iron, Ma nesia, and the Sulphide of Sodium, is a perfect antidote for salts of Copper, the Bichloride of Mercury (Corr. Sub.), and the Cyanide of Mercury. If the nature of the poison is unknown, a harmless yet in most cases effectual antidote is: R. Magnesiae, Carbonis Ligni, Ferri Oxidi Hydrati, aa partes sequales; Aquae q. s. Give ad libitum. Castile Soap, dissolved in 4 times its bulk of hot water, drunk by the cupful, is one of the best remedies in many cases, especially poisoning with metals, corrosive acids or cor- rosive vegetable substances. It is injurious in cases of alkali poisoning. Albumen. White of egg, dissolved in water, is especially useful for metallic substances. 708 THE TREATMENT OF POISONING. Vinegar, for alkalies, and many narcotics. Coffee, made strong (black), in general anti- doting narcotic poisons. Camphor, the principal antidote to all vegetable poisons, espe- cially the corrosive. Milk, Oil, Mucilaginous Substances, for corrosive acids, and alkalies. Charcoal, for Arsenic, Corrosive Sublimate, etc. Emetics.—Zinc Sulphate is the best(R.); gr. v-3ss; is non-nauseating. Apomor- phine, gr. hypodermically, when narcosis prevents administration by stomach. For children, Antim. Tart. gr. a little sweetened water. Use but little water in mixing the antidotes. Antidote Bag, designed by Martindaleof London, contains the following-named articles, labeled with directions for use, viz.— Dialysed Iron. Syrup of Chloral. Chloroform. Spt. Chloroformi. Spt. Ammonias Aromat. Oil of Turpentine. Acetic Acid. Tinct. Digitalis. Amyl Nitrite. Zinc Sulphate. Ipecacuanha. Potassium Bromide. Calcined Magnesia. Tannic Acid. Also a Hypodermic Syringe and Solutions therefor of— Morphine Acetate. Atropine Sulphate. Apomorphine. Pilocarpine Nitrate. Strychnine Nitrate. Acids. Alkalies, for those least irritating. Magnesium Oxide, Slaked Lime, chalk, or magnesia; plaster from wall, with water, milk, oil, white of egg. Bland mucilaginous and oily fluids, and poultices (R.). Acetic.— Magnesia, or its carbonates. Arsenious; see Arsenic. Carbolic.—Stomach-pump; a strong solution of the official Syrup of Lime. Magnesium or Sodium Sulphate, up to iij, to form a sulpho-carbolate, is a very efficient antidote. Atropine is a good physiological antagonist (B.). Characteristic symptoms, very dark, black urine. When used locally to excess, apply a strong solution of Sodium Carbonate; also as a wash for the mouth, if necessary. Carbonic; see Car. Hydro- cyanic (Dilute).—rrLxl have killed. Ammonia, in any form ; cold douche ; Calcium or Sodium Chloride, gtt. xxx-xl, in water; Aqua Chlori is the antidote. Inhalations of Chlorine or Ammonia; artificial respiration. Muriatic, Nitric, or Sulphuric.—Albu- men, Carbonate of Magnesium, Calcium, Potassium, or Sodium, Chalk, Soap, or whiting, in milk; Oil. No water in Sulphuric cases. Oxalic.—Calcium Carbonate the antidote (R.); Magnesium Oxide (R.). Prepared Chalk, plaster from ceiling, or common whiting, made into a creamy paste with a little water. Bland mucilaginous drinks, and poultices to the abdomen. Avoid potash or soda, and all alkaline carbonates. “ Salts of Lemon,” or of “Sorrel,” is Potassium Oxalate, used for removing ink stains; it should be treated as Oxalic Acid. Aconite (compare Belladonna). Stimulants, emetics, Castor-oil or other purgatives; powdered animal Charcoal, in water; coffee. Bland fluids, and poultices, for abdominal irritation. Digitalis, to restore heart’s action (Fothergill). Alcohol. [Compare Alcoholism and Delirium Tremens in Part III.] Cold water smartly sprinkled over face, or cold douche from a height on the head (R.). Stomach- pump ; warmth to cardiac and gastric regions, and extremities. Artificial respiration. Alkaloids. Tannic Acid, holds a high place (P.). Alkalies. Dilute Acids, especially Vegetable Acids; fixed oils (R.). Vinegar unites with them, producing innocuous acetates (L.). Alum. Ammonium, or Potassium Carbonates, etc. Ammonium. (Common Sources of Danger, Spt. of Hartshorn, Smelling Salts, Liquor Ammoniae kept for cleaning purposes by housekeepers.) Vinegar, Lemon-juice, Orange-juice, followed by demulcents. If vapor has been inspired, inhale Acetic or Hydrochloric Acid. Antimony. Alkalies, Tannin, or strong tea and coffee (R.). Astringent infusions; Magnesium and Sodium Carbonates; milk; large draughts of warm water; emesis by tickling; Magnesia in milk, especially for Chloride of Antimony. Tannic Acid especially valuable (P ) Arsenic (Arsenious Acid). Gr. ij have been fatal. Magnesium Bicarbonate, or other alkalies (R.). Charcoal 5 ss, or more (R.). Magnesium Oxide (R.). Emesis by Zinc Sulphate 3 j (avoid tartar emetic), or by feather tickling. Albumen. Oil and Lime-water mixed (Taylor), before and after emesis. Milk or other bland fluids to aid emesis in THE TREATMENT OF POISONING. 709 washing stomach. Castor-oil after emesis. Linseed tea and Magnesia. Dialysed Iron is a good antidote, especially for chronic poisoning. After free emesis, the Ferri Oxidum Hydratum (add Liq. Ammon, to Tinct. of Iron) ; Ferri Subcarbonale just as good; ij followed by 01. Ricini (Leale); or Hydrated Magnesia; or Magnesia and sugar (Carl), as antidotes. Poultices and fomentations over abdomen. Common sources of danger are arsenical wall-papers, arsenic mistaken for “salts” or “magnesia,” or adulterated confec- tionery; Paris Green (Aceto-Arsenite of Copper) taken with suicidal intent. Barium. Fixed oils; Calcium, Magnesium, Potassium, or Sodium Sulphates. Belladonna, or Atropine. (Compare Aconite'). Opium a direct antidote, gtt. iij-v or more. Brandy, astringent infusions, Coffee. Cold to head, electricity, flagellation, pepper. Alkalies, especially Magnesium Bicarbonate, in poisoning by alkaloids (R.). Ammonia, breathed into air-passages (R.). Charcoal, % ss or more necessary (R.). Phy- sostigma possibly (R.). Bees and Insects. Aq. Ammoniae, solution of Sodium Bicarb., or Chloride, or Car- bolic Acid, applied to the wound ; or ffbxv of a 2 per cent, solution hypodermically, Liq. Ammon. Acetatis internally. [Compare Stings, in main Index, Part III.] Cannabis Indica. Stimulation by Brandy, evacuation of stomach, Strychnine and Faradic Electricity are antagonistic, also Lemon-juice freely. Camphor. Stimulants, as wine, and Opium. Cantharis. Emesis. No oils, but oleaginous injections into bladder. Warm bath, Camphor, Milk copiously, Broths, Enemata of demulcents, Opium. Chloral. Strychnine, the antidote (R.). Hot bath, or pack, frictions, stimulants, arti- ficial respiration. Coffee, fresh air, warmth over cardiac region. In fact, the treatment of narcoti-m. Chlorine. After emesis with warm water, give milk, white of egg, flour and water, or Lime-water; Aqua Ammonite. Chloroform, or Ether. Fresh air, cold effusions, flagellation, coffee, electricity, arti- ficial respiration. Amyl Nitrite, as antidote (Schuller). Atropine, hypodermically as antagonist to Ether (Amidon in N. Y. Med. Record, May 2d, 1885); is equally efficient in chloroform narcosis, as I have found by experience (Potter). Invert patient, draw tongue well forward with forceps, then compress and relax chest; the position to be maintained until breath and pulse are good (Nelaton). Ice in rectum. Faradization of respiratory muscles. If swallowed, use stomach-pump, then Ammonia and warmth. Liq. Ammon. injected ( n\_x-xl aq.) into veins,—Bartholow says unsuccessfully. Colchicum. Treatment same as for Aconite. Conium. Alcohol, etc.; external warmth after evacuation from stomach. Copper. Albumen, gluten, milk, sugar, Potassium Ferrocyanide. No vinegar. In absence of eggs, give a thin paste of flour and water. Creasote. Mucilage, Oil, are antidotes. Ammonia when great depression. Digitalis. The treatment is similar to that for Aconite. Emetics, brandy, horizontal position; galvanism, in bad cases. Fish. Capsicum, Chloroform, Potassium Chlorate freely; Liq. Ammon. Acet., Opium. Gamboge. Potassium or Sodium Carbonate, or Magnesium in milk; mucilaginous drinks, Opium. Gases. Carbonic Acid.—Galvanism, Oxygen inhaled ; artificial respiration indis- pensable. Ammonia inhalations. Sponge with brandy or alcohol and water. Open air, horizontal position, clothing removed, cold douche, hot water to feet, stimulants, frictions. Subsequently, warm bed, open windows; Condy’s fluid about room ; stimulants sparingly ; cold acid drinks ad libitum. Sulphuretted Hydrogen.—Chlorine Gas, well diluted with common air. Gelsemium. Galvanic current, stimulants, Brandy and Cayenne Pepper, warm baths, frictions, hot bricks to feet. Glass, coarse or in powder.—Much bread in crumbs to envelope it, then emetics. Gold. Ferric Sulphate, Mucilage. Hyoscyamus. See Belladonna. Iodine. Starch or flour given in tepid water; white of egg and milk; free emesis, so long as liquid rejected tinges blue a solution of starch. Sodium Bicarbonate. 710 THE TREATMENT OF POISONING. Iron. Carbonates of Ammonium and Sodium ; Magnesia; Mucilaginous drinks. Lead. Albumen, milk; alkalies especially Magnesium Bicarbonate (R.). Lukewarm drinks, or Sulphates of Sodium or Magnesium, or freshly precipitated Ferric Sulphate (R.). Promote vomiting; stomach-pump (R.). Sulphuric Acid and Magnesium Sulphate, for the constipation. The cachexia is much relieved by a combination of Sulphate of Quinine, Sulphate of Iron, and dilute Sulphuric Acid (B.). Potassium Iodide, gr. xv-xx 3 or 4 times each day (B.); as afier eliminative, in chronic cases (R-). When great pain at defecation give Extr. Belladon., gr. fg, Rhei, gr. ij, in pill twice daily (Da Costa). Alum, the most effective agent for the colic. [See Colic for formula.] Or to a pint of boiling milk add 90 grs. of alum, powdered ; separate the curd, and sweeten with sugar. Sig.— A wineglassful every hour or two (B.) Electricity, in the paralysis (dropped wrist), a slowly interrupted current until it causes reaction. Cure to be completed by the faradic current (B.). Strychnine, in paralysis, gives good results (B.). Sulphides, as baths, in chronic form (R ). Marked Diagnostic Signs.—Drop-wrist (paralysis of extensor muscles) ; dark-blue line around edges of gums. Lime. Calcium Chloride. Albumen, mucilaginous drinks, oils, milk, flour, and water. No acids. Mercury. Gr. iij of Corrosive Sublimate have proved fatal. Albumen, Yolk-of egg, vegetable astringents, gluten, flour, milk; Potassium Iodide, as after-treatment. The Hydrated Protosulphide of Iron, if given within twenty minutes, is Slid to be a chemical antidote. Potassium Iodide, converts the metal into soluble combinations (B.). Bismuth, locally in salivation (B ). Sodium Sulphite, locally aquae (B.). Tannic Acid, locally, as gargle in salivation. R. Acidi Tannici, gj, Mel. Rosse f, ij, Aquae % vj. M. Gargle (B.). Belladonna, to diminish secretion in ptyalism, v-x drops of tincture every 4 to 6 hours (B.). Hyoscyamine, for tremor, gr. gradually to TV (Oulmont). Alkalies, Bicarb, of Magnesium best (R.). Baths, simple or sulphurous (R.). Charcoal, or more necessary in poisoning by Corrosive Sublimate (R.). Cod-liver Oil, in chronic cases (B.). Nitric Acid, gtt. ij of the dilute acid in water ter die; also gargles of lukewarm water, acidulated with same (R.). Sulphurous Acid, int. and as gargle (R.). Mezereum. Albuminous and mucilaginous drinks ; milk, oils, and fats; albuminous enemata; cool poultices to abdomen; Opium. Mushrooms. Emetics, if soon after ; Purgatives, if some time has elapsed. After general treatment, Stimulants, unless inflammatory symptoms present themselves. Poul- tices to abdomen. Tannic Acid has been recommended. Opium or Morphine. Common Sources of Danger.— Soothing Syrups for quieting of children. (The American Journal of Pharmacy estimates the loss from this cause at 150,000 every year.) Paregoric. Overdosing with Cough-mixtures. Treatment.—Vegetable astringents ; strongest, hot black Coffee. Cold douche, flagel- lation, artificial respiration, persevered in for hours. Belladonna, Hyoscyamus or Stramo- nium. Faradism of phrenic nerves; Stimulants. Comp. Tinct. Iodine. Emetics by mouth are usually useless, may be given as enemata; or Apomorphine, gr. to as emetic (hypoder. must be administered before narcosis has set in (B.). Stomach- pump probably best, after which Vegetable Acids, to contract the narcotism. Cream of Tartar and water, Vinegar and water, Lemon-juice, etc., every ten minutes (R.). Atropine, gr. x/i~Ys hypodermically (R.); gr. TJ-0- every 15 minutes up to three doses (B.); in large amounts till pupil dilates, a successful antagonist (R.). No one is warranted in omitting Belladonna (P.). Amyl Nitrite, inhaled, has proved eminently successful in a case in which Belladonna or its alkaloid proved useless to restore the patient. Ammonia, as intravenous injection for failure of heart’s action from Opium and Chloroform narcosis, etc. (B.) ; breathed into air-passages (R.). Potassium Bromide, controls the disagreeable cerebral effects and vertigo resulting from Opium (R., B.). Water, hot water and ice alternately to nape of neck, in stupor of Opium-narcosis(B.). Copper Sulphate, as emetic, prompt and effective (B). Zinc Sulphate, gr. vj as emetic, well diluted with water (B.). Effeivesccnt Emetics, effective but dangerous (B.). Caffeine, hypodermat. (B., P.). Heat, alternately with cold (B.). Charcoal, 3 ss or more (R ). Phosphorus. Emesis by Cupric Sulphate; Magnesia in Linseed-tea ; Carbo Animalis; mucilaginous drinks; Liquor Calcis. Avoid all oleaginous mixtures. Poultices to epigas- trium. Sulphate of Copper, the best emetic, combining to form the less active phosphide (B.). Turpentine emulsion with hydrated Magnesia, freely (B., R.); vrpxxx in mucilage, every hour, excellent (P.). 7"ransfusion, has been employed to repair blood (B.). THE TREATMENT OF POISONING. 711 Physostigma. Minimum fatal dose, grain iT2ff. Chloral, the antidote (R.), if admin- istered very early. Belladonna, gr. to Atropinae, hypodermically repeated until effects are evident. The nine-thousandth of a grain of Atropine, injected five minutes before giving a minimum fatal dose of physostigma, prevents its fatal effects (R.). Picrotoxine, or Cocculus Indicus. Chloral, the antidote (B.). Potassium Salts. Potassium Bromide. Nervotis Stimulants—Brandy, Opium. Potassium Nitras (Saltpetre),—No chemical antidote. Emetics and stomach-pump, demulcent drinks, Opium, milk, aromatics, emollient enemata. Quinine. Emetics and cathartics, Opium, Coffee, Brandy, or wine, diuretics and sudo- rifics as after-eliminatives. Reptiles. (Compare Stings.) Ligate limb above wound; cleanse thoroughly, and cauterize with mineral acids or strong Carbolic. The wound should be forcibly sucked by a person with perfect mucous surface. Internally, Arsenic, when rapid prostration (R.) ; Ammonium, diaphoretics, Sodium Bisulphate, Whiskey, largely. Agave Ameri- cana. R. Potass. Iodidi gr. iv, Hydrarg. Chlor. Corr. gr. ij, Bromi gv, Aquae %j; gtt. x in of Brandy; repeat if necessary (Hammond). Ammonia, by intra-venous injec- tion, is shown to be unavailing by Brunton and Fayrer (B.). Rhus (Poison Oak or Ivy),—Carbolic Acid, locally, a 5 per cent. sol. Sulphide of Potassium, baths, to C xx. Lobelia, as infusion, ad Oj, a good application locally. Grindelia, the fluid extract, I part to 10 of water, as lotion; may be used undiluted. Cocaine, a 10 per cent, oleate, or a 5 per cent, solution in water, as a local application, promptly relieves the symptoms. Acetate of Lead, tjij, Ammonii Chloridi (crude) 3 ss, Aquae % viij, as lotion on cloths constantly wetted therewith, used with uniform success (Burns). Soapsuds and water, hot, frequent washing with this the surest, speediest, and best treatment (Couch). Silver Nitrate. Alkalies, especially the Magnesium Bicarbonate (R.). Sodium Chlo- ride, largely diluted, effects a double decomposition, precipitating the silver as the harmless insoluble chloride (R.). The resulting irritation may be allayed by milk, which should serve as food until the stomach is restored. Silver, Metallic. Albumen, Milk. Stramonium. See Belladonna. Strychnine or Nux Vomica. Fatal dose of strychnine gr. for adult, gr. for child. Chloral, the antagonist, especially when given soon. Physostigma, as an anti- dote (R ). Chamomile Oil, remarkably subdues reflex excitability in frogs after poison- ing by Strychnine or Brucine (P.). Tobacco, a good antagonist. The Stomach-pump, if available before tetanic symptoms. Animal Charcoal, largely; Tannin freely ; Solution of Iodine. Chloroform Inhalations, injections of Curare, or Urethan, or Methyl and Ethyl compounds of Strychnine, Brucine, or Theba'ine. Artificial respiration; fats; Nitrite of Amyl, inhaled; Magnesia (R.). Tube in oesophagus, and flexible catheter into larynx (R.). Veratrum Viride has cured a bad case; a teasp. was given at once, then gtt. ij every 10 minutes (R.). Ice to spine. Tobacco enemata. Lobelia, Potassium Bromide, Monobromated Camphor, hot bath. Valerian mitigates the spasms (P.). Ctirare, warmly recommended, but its claims are doubtful (P.). Nicotine, many cases prove its curative power (P.). Tin. Albumen, Ammonium and Sodium Carbonates, Milk. Tobacco. Strong Coffee and Brandy; warmth and friction; artificial respiration. Vegetable Poisons. Generally albuminous or mucilaginous drinks, oils, etc. Stimu- lants, Opium, ice ; cool poultices and fomentations to abdomen. Veratrum Viride. Digitalis, Opium, Stimulants. Zinc. Albumen, mucilaginous drinks, milk, Tannin. Potassium and Sodium Carbo- nates, if given early. Soapsuds given freely. Warm water in copious draughts. 712 FORMS OF BRIGHT’S DISEASE. DIFFERENTIAL DIAGNOSIS. Forms of Bright’s Disease. Compared with Acute Nephritis and with each other. Acute Nephritis. (1) Acute Bright’s Disease. Acute Parenchy. Nephritis. Chronic Bright’s Disease. Clinical Phenomena. (2) Chron. Parenchy. Nephritis {Large White Kidney). (3) Fatty Kidney. (4) Amyloid or Waxy Kidney. (5) Chron. Interstitial Nephritis {Cirrhotic Kidney). f Quantity, Normal or — — or + Normal or — Normal or + Normal or + . Reaction, Acid. Acid. Acid. Acid. Acid. Acid. | Color, Wine yellow. Dark smoky. Brown yellow. Pale. Pale. Clear. Sp. Gr., Normal or — High. - I.OI 5-I.O3O —,above 1.010 — I.OIO Urea, H Normal. - - Normal or — Normal, j Chlorides, Normal. - - - - Normal. Albumen {per cent.), . . . iff i 1 to 6 % to 2 1 to 6 tV to Vt of globulin. TO tO /2 Casts, Hyaline and Epithel. Blood Epithel. Hyaline. Granular Hyaline. No blood. Fatty. Few and hyaline. Very few. Sediment (macroscopical), Mucus. Blood. Brown cells. Urates. Kidney epithel’m. Blood Lymph. Free oil. Seldom any. Seldom any. Dropsy, Seldom. Great, especially of face. Never absent. Great. Trifling. In last stages. J Uraemia, . .' Often great. Not marked. Rare. Rare. Great. Other Symptoms, Stiff joints. Sacral pain. Lassitude. Fever. Tempera- ture low. No fever. Inflam, of serous membr’s. Cardiac hyper. Face pale, puffy. Cardiac hyper. Emacia- tion, sal- low face, enlarged liver and spleen, thirst, diarrhoea. Retinitis. Tense, quick pulse, j Hyper, of heart. Prognosis, Favorable. Recovery or No. 2. Recovery (?)or No.3. Always fatal. Depends on con- stitutional disease present. Unfavor- able, but course perhaps long. Note.—The signs -f- and — respectively denote a specific gravity greater than 1.024, or less than 1.018 in the line entitled Sp. Gr. DIFFERENTIAL DIAGNOSIS. Cancer Cancerous (Malignant) Tumors. Are of constitutional origin. Have no cyst, but invade and convert the surrounding tissues. Cancer material is short-lived from rapid deterioration, but is rapidly reproduced. Severe increasing pain. Extend to remote parts, reappearing chiefly in lymphatic glands. Cancerous cachexia of general health. Recur after extirpation, fatal in end. Non-malignant Tumors. Origin, some local error of growth. Limited by a cyst; may compress, but do not invade adjacent tissues. Have uncertain period of increase, after which may remain stationary. Usually no pain. Are local, have no disposition to spread. Impair functions of parts pressed on. Do not recur. Scirrhus. Is hard. Appears mostly on female breast. Hard kernel, movable under skin. Becomes fixed to adjoining structures, which it puckers. Single and grows slowly. Course slow—2-4 years. Never in the young. Encephaloma. Is soft and brain-like. Most frequently on the limbs. At first deeply seated, hard to recognize. Spreads through loose textures, which it pushes aside and distends. Has numerous tumors, grows rapidly. Generally fatal in 1—2 years. Often in the young, even at birth. Carditis. Endocarditis. Blowing sound. Excited heart action. Slight if any increase of percussion dulness. Impulse strong. Sounds normal, or more distinct, except at site where murmur is heard. Pericarditis. Friction sound. Excited heart action. Marked increase in effusion stage. Wavy and feeble. Feeble and muffled; no blowing sounds. Cerebral. Concussion. Patient can be roused; pupils act. Breathing seldom stertorous. Urinary action normal. Symptoms appear closely after accident. Compression. Complete insensibility ; motionless pupils. Breathing usually stertorous. May be either retention or incontinence. Frequently do not. Chancre and Chancroid. Chancre. Commences about 3d week after coitus. First as a papule, abrasion, or crack. Generally indurated (rarely not). Develops slowly. Discharge slight, unless irritated. Is soon limited and seldom phagedenic. Edges sloping, not undermined. Scanty serous secretion. Sore remains solitary, and cannot be multi- plied. Followed by numerous buboes, rarely sup- purating, never furnish inoculable pus. Chancroid. In 24 hours to 3 days. First as a red spot, then a pustule, then a suppurating sore. Not on an indurated base. Develops rapidly. Suppurates profusely. Tends to invade surrounding tissues, or be- come phagedenic. Edges undermined. Discharge is pus and copious. May be transplanted at will, and is seldom, single. A single bubo may appear and suppurate. DIFFERENTIAL DIAGNOSIS. Cholera Asiatic. Preceded by painless diarrhoea. Not directly from error in diet. First pain shooting down thighs. Prostration rapid and overwhelming, and out of ratio to evacuations. Rapid reduction of surface temperature; high temperature in cavities. Evacuations like rice-water from first. Cramps commence in extremities. Veins congested ; tongue, lips, and extremi- ties livid purple. Urine albuminous. Simple. Seizure sudden. Generally is from error in diet. First pain, abdominal colic. Prostration gradual, less marked than the vomiting and purging. Gradual reduction of surface temperature; internal temperature normal. Discharges bilious, causing burning and smarting pain ; only colorless at very last. Cramps commence in abdomen. Not so. Not so. Croup and Diphtheria Croup. Premonitory hoarse, metallic cough, with- out illness. A child’s disease. Tenacious mucus, covers the swollen mem- brane. A local disease. Diphtheria. Premonitory illness, shivers, fevers, sore throat, without cough. Attacks adults as well. Distinguished by a false membrane. A blood poison ; great general depression. Epilepsy and Hysteria. Epilepsy. Sudden, complete loss of consciousness. Livid face, frothy saliva escapes, eyelids half open, eyeballs rolling, teeth grind- ing, tongue biting; more or less insensi- bility of pupils to light. Countenance is distorted. Patient shows no feeling. Aura epileptica. Short paroxysm, followed by heavy coma- tose sleep and dull intellect. Frequently occurs at night. Not necessarily of uterine connection, though a paroxysm often occurs at the menstrual period. Hysteria. Gradual and partial or apparent. Face flushed, or complexion unaltered, no froth on lips, eyelids closed, eyeballs fixed, no grinding of teeth, or biting of tongue ; pupils react readily. Is not. Sighs, or laughs, or sobs. Globus hystericus. Longer paroxysm, not sleepy, but usually wakeful and depressed in spirits. Rarely occurs at night. Often connected with uterine or menstrual disorders. Gout. Chiefly affects small joints, especially the metatarsal joint of the great toe. From 35-50 years; rarely before puberty. Most frequent in men, and result of idle, intemperate and luxurious life. Is strongly hereditary. Chalk stones (urate of soda) in ext. ear, on tops of fingers, or elsewhere. Uric acid in the blood, absent from urine. A fit often affords temporary relief. Is confined to temperate zone. Gout and Rheumatism Rheumatism. Large joints chiefly implicated. Generally in young adults. Affects both sexes equally, and equally the poor and the rich. But slightly so. Not so. Lactic acid in the blood. Quite the contrary. Is ubiquitous—prevails in all climates. DIFFERENTIAL DIAGNOSIS. 715 Hematemesis and Hemoptysis. If from the stomach, the blood is of a dark color, and is vomited. Often mixed with food, not froth. Preceded by nausea and stomach distress, and blood is passed with the stools. Hematemesis. If from the lungs, it is bright red, and generally coughed up. Generally frothy, mixed with sputa. Preceded by pain in the chest and dyspnoea. No blood in the stools. Hemoptysis. Pleurisy and Pneumonia. Pleurisy. Pneumonia. Sharp pain, friction sound, dry cough, im- paired chest motion. In stage of effusion, obliteration of inter- costal spaces, enlargement of the side, viscera displaced. Dulness, with enfeebled or absent respira- tion, voice, and fremitus. Sputa frothy, rarely any rales. Febrile symptoms slight usually. Temperature irregular, rarely high. Dull pain, crepitant rale, cough followed by expectoration. In stage of hepatization none of these signs are present. Dulness, with marked bronchial respira- tion, distinct thoracic voice, increased vocal fremitus. Sputa rusty color, rales common. Febrile symptoms severe. Sudden elevations and falls, high tempera- ture not uncommon. Tubercular. First symptom, a dry, short cough. No exciting cause apparent. Hereditary cases are of this class. Frequently preceded by enlarged or sup- purating glands, or other evidence of scrofula. Voice changes from tubercular deposit. Phthisis ATon- Tubercular. First stage follows catarrh, bronchitis, or some other acute disease. Is referable to some exciting cause, as cold, inflammation, or inhaling of heavy dust. Not hereditary. No evidence of scrofula. No change of voice. Exanthemata. Scarlet Fever. Incubation I day to weeks. Fever, great heat of skin, and frequent pulse, un- abated during eruption. Brilliant stare. Eruption on second day, not rough, first on neck and chest, spreads rapidly, white streak on pressure with nail. Measles. Incubation, 7-14 days. Same fever rather increased by eruption. Liquid watery eye. On fourth day, on face, rough, spreads gradually, streak lasts short time. Small-pox. Incubation, 6-20 days, Average 10. Fever often violent, bound- ing pulse, pain in loins, greatly relieved by erup- tion. Usually on third day, at first, on lips and forehead, spreading rapidly. 716 DIFFERENTIAL DIAGNOSIS. Scarlet Fever. Uniform, or large patches, interspersed raised spots and some vesicles, rash scarlet, on its seventh day very complete desquama- tion in large patches. Sore throat, rarely coryza or bronchitis. “Raspberry” tongue, red. Cerebral symptoms frequent and grave. Temperature may be 1050- 1220 to 10th day, subsides gradually, falls on 5th, 10th, and 15th days. No secondary fever. Pneumonia rare, pleurisy more frequent. Sequelae : Bright’s disease, dropsy, deafness, conjunc- tivitis, phthisis, chronic diarrhoea ; glandular en- largements. Measles. Crescentic patches, last about 5 days, and then partial desquamation, scales very fine. Coryza and bronchitis very constant, rarely sore throat. Tongue coated, may be red at edges. Not so. io3°-io6 before eruption, remains high for 1-2 days after, then falls suddenly. None. Pneumonia a frequent com- plication. Sequelae: chronic bronchitis, phthisis, conjunctivitis. Small-pox. Papular, then vesicular, finally pustular ; pustules maturate on 8th day of eruption. Sore throat often and dry cough. Coated and swollen, may be red at edges. Cerebral symptoms are fre- quent. Before eruption often io6°, then rapidly sinks to ioo° in 36 hours; rises during secondary fever. Always secondary fever. Pneumonia not a very fre- quent complication. Sequelae: chronic diarrhoea, glandular enlargements, various eye diseases. Typhus Fever. Attacks quickly, incubation 9 days. Occurs at any age. Rare among the higher classes, except those exposed. Mulberry eruption on 4th or 5th day, on extremities, lasts till close. Brain chiefly affected ; bowels are often but little so; abdomen natural, evacuations dark, but never bloody (these are occa- sionally reversed). Contracted pupils, dusky face. Pulse and temperature rise to 120 and 105° till 3d day, high for 6 days, then fall. Lasts 2-3 weeks. Relapses rare. Death from coma, or congestion of the ! lungs, in 1st or 2d week. Arises from destitution, over-crowding, bad ventilation, is contagious, and generally epidemic. Post-mortem : not constant, most frequent are dark blood and enlarged spleen, soft heart. Typhus and Typhoid Typhoid (Enteric) Fever. Commences slowly, incubation about 13 days. Most common in youth and childhood, rarely after 40. As common among the rich as the poor. Rose eruption, few, on abdomen, and in successive crops, which fade and disap- pear. Bowels chiefly affected, evacuations ochre- color and watery, sometimes hemorrhage, or even ulceration, abdomen tumid. Dilated pupils, cheeks flushed. Pulse and temperature rise and fall inde- pendently, and without uniformity, but both are usually high to 15th day. Lasts 4-6 or more weeks. Relapses frequent. Death from asthenia, pneumonia, hemor- rhage, or perforation of intestine, in or after 3d week. Bad drainage, poisoned drinking water, putrid animal matter, want of ozone, certain electrical conditions; is not con- tagious, often sporadic. Post-mortem : morbid Peyer’s patches, en- larged mesenteric glands, ulcerated mucous coat of intestines; enlarged and soft spleen, ulcerated pharynx. TEMPERATURE IN DISEASE. 717 Yellow and Bilious Fevers. Yelloto P'ever. Short duration; ends in 3-7 days. Incubation 5-9 days. A disease of one paroxysm, terminating in recovery or collapse. Very severe nausea and vomiting, early epigastric tenderness. Black vomit. Hemorrhages from various parts. Tongue clean, or slightly coated. Pulse variable, slow at end. Injected and humid eye. Supr&-orbital pain, pain in back and in calves of legs. Rarely delirious, mind clear generally. Urine albuminous, usually suppressed. Rapid convalescence, no sequelae. Little muscular prostration. High mortality, epidemic. Treatment unsatisfactory. Autopsy: inflamed or congested stomach, enlarged yellow liver, filled with oil globules, muscular fibres of heart are often disintegrated. Bilious Remittent. Lasts 9 days or more. Incubation may extend to months. A disease of several paroxysms, with in- tervening remissions. These symptoms are not so severe nor so early. Bilious vomiting. No hemorrhagic tendency. Tongue heavily coated. Pulse quick to convalescence. Eye natural. Headache, sense of fullness in head, often no loin or leg pains. Delirium frequent, mind dull. Not so. Slow convalescence, tedious sequelae. Greater muscular prostration. Slight mortality, endemic. Very amenable to treatment. Autopsy : stomach congested, rarely in- flamed, liver olive or bronze hue, not fatty. Vomiting Cerebral. Little or no nausea, vomiting continues after stomach is emptied. No tenderness or pressure over the liver or stomach. Pulse infrequent and hard. Tongue clean, breath sweet, conjunctivae normal or injected, and headache primary. Generally obstinate constipation. No salivation. Gastric or Hepatic. Nausea relieved by discharge, returns when food is taken. Liver and stomach are tender, pressure pro- duces inclination to vomit. Pulse frequent and weak. Tongue furred, breath offensive, conjunc- tivse often yellowish, and headache sec- ondary as to time. Griping abdominal pain, diarrhoea and clay-colored stools. Increased salivation. NOTES ON TEMPERATURE IN DISEASE. Temperature, average normal, of adults, 98.6° F.; of children, 990; of the aged 98.8°. Diurnal variation i° to 1.50 F., highest from 9 A. M. to 2 p. m. Above 108° F. is a fatal sign, which issue may be averted by cold baths, reduced by ice from 96° to about 6o° F. (A). The clinical thermometer placed in the mouth, axilla or rectum, and retained in situ for five minutes, should go hand in hand with Aconite in the treatment of inflam- mations (R). [For antipyretics see the articles Fever, Inflammation, in part III, also the list of these agents on page 42.] Clinical Thermometry is one of the principal means of positive diagnosis. The ther- mometer should be self-registering, certified, and accurately marked according to the Fahrenheit scale. The most reliable temperature is that in recto, or in the vagina; less so in the axilla and folds of skin, and still less reliable in the mouth. A correct reading of the thermometer cannot be obtained in less time than five to seven minutes. (Da Costa.) The Average Normal Temperature of the body is 98.6° ; which, like the pulse, will 718 TEMPERATURE IN DISEASE. vary somewhat in individual cases ; as a general practical result, it is agreed that in tem- perate regions the normal temperature at completely sheltered parts of the surface of the human body amounts to 98.4° Fahr., or a few tenths more or less; and a rising above 99 50, or a depression below 97.30 F., are sure indications of some kind of disease, if the increase or depression is persistent. The temperature is increased at the prime of life, is raised and depressed temporarily by the influence of diet, stimulants, exercise, etc. The minimum diurnal temp, is observed at 2 A. M., the maximum at 4 to 6 P. M. Any rise above 99.50, or fall below 97.3°, if persistent, indicates disease; on the other hand, a normal temperature does not always indicate good health. The greatest recorded range of temperature in disease is 50.40 ; the minimum is 71.6° in a case of sclerema neonatorum (Quain’s Diet.), the maximum 1220, In severe and fatal cases it rarely exceeds 107°, and rarely falls below 920, even in fatal collapse. It may rise 3°-4° after death, as ob- served in a case of typhoid fever in which death occurred with a temperature of 107°, which increased shortly afterwards to 110.50. A temperature of 107° indicates malig- nancy, and where met with for two consecutive days in typhus, scarlatina, measles, pneu- monia, pyaemia, meningitis or rheumatism, death may be expected shortly. In relapsing, remittent and intermittent fevers, and in the initial chill of an abortion, the temperature may reach 107° without indicating great danger. During the last hours of life, in many diseases, the temperature rises to iog0-iii°; for example, in tetanus, sun-s'roke, typhus, etc. With a temperature of 96°, collapse is imminent. Abnormally High Temperatures reported in the British Med. Jour., by Dr. Donkin. In these eight cases all but one were in females, and none proved fatal. Pain was a prominent symptom in all. No. X, 111.6° ; convalescing from enteric fever. No. 2, 108°; no organic lesions : ovarian pain. No 3, 115.8° ; great abdominal pain and excitement. No. 4, hi0; convalescing from enteric fever. No. 5, 1130; enteric fever and double pneumonia. No. 6, 1X2°; synovitis. This was the only male. No. 7, 1120; painful stump, with necrosis. No. 8, 1170 ; pyonephrosis. A High Average Temperature (above 104°), is found in severe pneumonia, scarlatina, remittent, typhus, typhoid and relapsing fevers, pyaemia, etc. A Moderate High Tem- perature (1020 and above), is seen in peritonitis, acute rheumatism, pericarditis, pleurisy, dysentery, cerebro-spinal meningitis, catarrhs, etc. A temperature of ioo° and above is found in chronic affections, incipient inflammations, and mild fevers. When, in efferves- cence, the heat increases rapidly, it will, in defervescence, decline proportionately fast, and vice versa. Beware of a grave affection when the temperature is of a continuous type. A distinct interval between morning and evening temperature is a favorable sign. A slow and gradual increase indicates typhoid fever ; in rheumatism and anomalous fevers the increase is more rapid, and still more so in acute inflammatory disease, pneumonia, angina, pleurisy, typhus, scarlatina, rubeola, etc. It is usually very rapid in intermittent fever, febricula, and ephemeral fevers. A rapid effervescence and slow defervescence indicates some complication of disease; the revet se order indicates great danger. When the tem- perature begins to fall from the evening to the morning, it is an indication of improvement; while a rise of temperature from the evening to the morning is a sure indication that the patient is worse. Stability of temperature from morning to evening is a good sign, but from evening to the morning, unfavorable. A Decrease of Temperature below the normal heat is rare. It occurs sometimes transitorily, announcing thereby a favorable crisis, by preceding the return to a normal temperature. It is also met with occasionally during the morning remission of remittent fever; also during the apyrexia of intermittents; in acute collapse, preceded or not by fever ; in chronic wasting diseases ; and sometimes, also, on the approach of death, especially in typhus fever. In Phthisis, the temperature is higher in the evening than in the morning; later, higher at early bedtime than at noon, and high tjgain at dusk. This is a valuable and delicate test of the progress of tuberculization. In Typhoid Fever, the accession is by a rise of one degree each day, with the diur- nal variation. If the evening temperature does not exceed 103.50, the disease will probably be mild; but a temperature of 105° in the evening indicates a severe type and much danger. A sudden reduction to 950 in the third week denotes intestinal hemor- rhage ; a lingering temperature of ioi°-i02° in the fourth and fifth weeks indicates non- cicatrization of the intestinal ulceration. In Scarlatina, the rise of temperature is rapid, 104.70 may be reached in a few hours. It seldom rises above 105° and never above 106° ; is continuous until the eruption begins to fade, when remissions take place, unless complications arise. In Measles, 103° is the usual temperature, with daily variations, increasing with the OBSTETRICAL MEMORANDA. 719 eruption and catarrhal symptoms. A high temperature lasting beyond the tenth day denotes complications. In Diphtheria, the temperature by the end of the third day will, in uncomplicated cases, not exceed I03°-I04°. It falls temporarily with the exudation. Defervescence in the severe, favorable cases, is from the twelfth to the fourteenth day; in the milder cases not before the sixth. In some fatal cases it occurs early, from the third to the fourth day. In asthenic cases, the temperature of the surface falls, while that of the interior remains high — ioo° in the axilla, and 103° in the rectum. During convalescence, the temperature is low, and readily depressed, but may be raised by intercurrent maladies. Any increase after the first five days, or a continuous high temperature after the first ten days, is unfavorable. A sudden rise may indicate complications. Co-Relation of Pulse and Tetnperature.—As a general rule the co relation of pulse and temperature may be stated as follows, namely : an increase of temperature of one degree above 98° F. corresponds with an increase of ten beats of the pulse per minute, as in the following table :— Temperature of 98° corresponds with a pulse of 60. “ 990 “ “ 70. “ ioo° “ “ 80. “ IOI° “ “ 90. “ 102° “ “ IOO. “ 103° “ “ IIO. “ IO40 “ “ 120. “ IO50 “ *• I30. “ 1060 “ “ 140. OBSTETRICAL MEMORANDA. Pregnancy.—Duration about 275 days; usually reckoned as about 280 days from the first day of the last menstruation. The extremes of 405 cases at the Hfttel Dieu were 6 months, and 11 months 8 days. Many rules for the calculation of the date when labor may be expected are given; as good a one as any is to count backward three calendar months from the last day of the last menstruation, then add 7 days to obtain the date of expected confinement (Nsegele). The French law makes a child illegitimate if born within 200 days after marriage, or over 300 days after the husband’s death. Evidences of pregnancy may include : suppression of the menses; nausea and vomit- ing, morning sickness ; salivation ; changes in the appearance of the breasts and nipples ; changes in the position of the uterus, which descends during the first two months, rising from the third month, until, at the fifth, its fundus is level with the umbilicus, at the eighth nearly to the sternum, settling down at the ninth month; oedema of limbs; neck of uterus becomes shortened, the os patulous. The most positive signs are quickening, if the statements of the women are credible; ballottemeni; and above all, the pulsations of the foetal heart. Labor. Preliminary Signs.—Abdominal tumor sinks lower, occasional uterine pains and contractions, freer respiration, discharge of glairy fluid from vagina, frequent desire to urinate, hemorrhoids, oedema of legs. Essential Signs.—Paroxysmal pains, at regular intervals; os uteri generally low, neck effaced, os affected by each pain (easily ascertained by keeping finger on it). Dilatation of os uteri, requiring longer to acquire the size of a half-dollar, than from thence to completion. Shiverings and vomiting, tremblings and fainting, especially at complete dilatation. Head Positions (4).—Right (lst),or left (5) occipito-anterior, forehead backwards; right (3d), or left (4th) occipito-posterior, forehead forwards. Order of their comparative frequency; xst, 3d, 2d, 4th. The 3d rotates into the 2d, the 4th into the 1st. Facial Positions (4).—Right (1st), or left (2d) mento-posterior, forehead forwards; right (3d), or left (4th) mento-anterior, forehead backwards. The 2d rotates into the 3d, and the 1st into the 4th. Pelvic, or Breech Positions (4).—Left dorso-anterior (ist), left trochanter forwards; right dorso-anterior (2), right trochanter forwards; left dorso-posterior (3), right tro- chanter forwards; right dorso-posterior (4), left trochanter forwards. Order of their comparative frequency, ist, 2d, 4th, 3d. 7 20 OBSTETRICAL MEMORANDA. Shoulder Positions.—Varieties (2); dorso-anterior, and dorso-posterior, the former occurring twice as often as the latter. In each variety the head may lie in either iliac fossa; the presenting shoulder being, in dorso-anterior position, the left if the head is in the right fossa; in dorso-posterior position, the left if the head is in the left fossa, and vice versa. AVERAGE PELVIC DIAMETERS, As usually given. Prof. E. Wallace gives— Antero- Posterior. Oblique. Transverse. Antero- Posterior. Oblique. T ransverse Brim, 4% in. 4.8 in. 5.2 in. 4 0 in. —5.0 in. + 5.0 in. Cavity, .... 47 “ 5.2 “ “ aK “ A% “ aK “ Outlet, .... 5.0 “ 4.2 “ 4.2 “ 4.0 “ 4.0 “ Circumferential measurement of the brim—about 17 inches. DEVELOPMENT OF THE FCETUS. [Entries in the column headed “ Month ” refer to the end of each month,] Month. Name. Length in inches. Weight. Appearance. ISt Ovum one-twelfth Appears as a gray gelatinous mass. 2(1 Embryo 1.2 60 grains. Extremities apparent; points of ossifica- tion appear. 3<* (f to y/2 310 “ Neck, eyes, fingers, nails begin to form; sexes distinct. 4tk Foetus (>y2 to iy2 9 oz. Iiair, fat; muscles capable of contrac- tion. 5th 8 to 10 IO to 12 OZ. Eyebrows, skin, scrotum; nails nearly solid. 6th “ 11 to 12 • i lb. Pupillary membrane formed, lips closed. 7th to 14 2% lbs. Eyelids open, testes begin to descend, foetus is viable. 8th *• 15 to 17 4 to 5 fts. Skin red, smooth, covered with down. 9th “ 19 to 24 7 to libs Testes near scrotum, left often therein. DIAMETERS OF THE FCETAL SKULL AT TERM. Diameter. Where measured. Inches. Fronto-mental, Apex of forehead to chin, .... 3% Occipito-mental, Occipital protuberance to point of chin, . . slA-slA Occipito-frontal, Occiput to centre of forehead, . . 4^-5 Sub-occipito-bregmatic, . . Midway between occiput and foramen mag- num to centre of ant. fontanelle, .... 3X Cervico-bregmatic, .... Ant. margin of foram. mag. to centre of an- terior fontanelle, 3X Bi-parietal, Between the parietal protuberances, .... 3X~4 Bi-temporal, Between the ears, 3X [Compare the articles in Part III, entitled—Abortion, After-pains, False-pains, Hemorrhage Post-Partum, Labor, Lactation, Pregnancy, Puerperal Disorders, Vomiting of Pregnancy, etc.] ASPHYXIA AND APNCEA. 721 From Drowning.—Remove the person from the water as rapidly and gently as possible, turn the face downwards for a moment, and depress the tongue, in order that water, mucus, etc., may be removed from immediately over the entrance of the windpipe. Give the patient plenty of fresh air, fully exposing neck and chest to the breeze, unless inclement. Turn gently on the face, one forearm being under the forehead, and raise the body up that the water may have free discharge from the mouth. Place the patient upon the side *and apply stimulants (ammonia, etc.) near the nostrils ; or the cold douche, in order to excite respiration. The above measures being ineffectual, convey the body to the nearest convenient spot, strip it carefully and dry it, and place it on a warm bed, with head and shoulders slightly raised, and at once employ one of the following methods, known as Silvester’s and Marshall Hall’s. Silvester's Method.—Pull the tongue forward, to prevent obstruction to entrance of air into the windpipe; produce expansion of the chest by drawing the arms from the sides of the body and upwards until they almost meet over the head. Then bring the arms down to the sides again, causing the elbows almost to meet over the pit of the stomach, and thus producing contraction of the chest. This imitation of the act of respiration should be continued at the rate of fifteen or sixteen times a minute, as in health. Marshall Hall's Method.—The person should be placed flat on the face, gentle inter- mittent pressure being made with the hands on the back, the body turned on the side, or a little beyond, then on the face, and the same pressure, etc., continued as at first. The whole body must be worked simultaneously. The same number and frequency of these artificial processes of respiration should be employed as in the other method. The Michigan Method.—Lay the body face down, the head upon the arm, and stand astride it; grasp it then about the shoulders and armpits, and raise the chest as high as you can without lifting the head quite off the arm, and hold it about three seconds; then replace the body upon the ground, and press the lower limbs downwards and upwards, with slowly-increasing force, for ten seconds; then suddenly let go, to perform the lifting process again. Whichever process be employed, the effort to restore the temperature of the body must be maintained, the body being well rubbed in an upward direction with the hands, with warm flannels, etc.; bottles of hot water, hot bricks, etc , being applied to the stomach, the axillae, the soles of the feet, etc., stimulants and beef tea being judiciously adminis- tered when restoration is about taking place. The attempts at resuscitation must be per- severed in for several hours, if necessary. Laryngotomy or tracheotomy, with or without catheterization, or forced insufflations of air or oxygen, have proved successful, as also electro-puncture (Garratt). In artificial inflation, always press the larnyx and trachea against the vertebral column, so as to close the oesophagus and thus prevent the air entering the stomach. After Long Submersion is Recovery Possible ?—According to Harley (p. 881), dogs kept under water i y2 minutes always died, if water had entered the lungs. If it had not, the trachea being plugged, they survived a submersion of 4 minutes. When persons rise after sinking they usually get some air, and less speedily come into a state from which recovery is impossible. The greatest period between the last inspiration and the stoppage of the heart is 4 minutes. Some think that no recovery has been made after complete cessation of the heart’s action. We infer that after complete submersion for 5 minutes recovery is improbable, unless the person had been previously choked, or in a fainting state, so that no water entered the lungs. But in Anderson’s case, the patient had been under water at least 15 minutes, and in Garratt’s the time was variously estimated at from 15 to 60 minutes. When is a Case Hopeless ?—Harley says (p. 892): “ If the eyes are open, the pupils dilated, the conjunctiva insensible, the countenance placid, the skin cold, frothy mucus round the nostrils and mouth, no attempt at respiration, and the heart’s action inaudible (when the ear is applied to the chest), the case is hopeless.” Signs of Death.—The following have been suggested as methods of deciding whether death has occurred :— (a) Tie a string firmly about the finger. If the end of the finger becomes swollen and red, life is not extinct (b) Insert a bright steel needle into the flesh. If it tarnishes by oxidation in the course of half an hour, life may be considered not extinct. ASPHYXIA AND APNCEA. 722 CLINICAL EXAMINATION OF THE URINE. (*:) Inject a few drops of Liquor Ammoniae under the skin. During life a deep red or purple spot is formed. (d) Moisten the eye with Atropine. During life the pupil will dilate. (,e) Look at a bright light or at the sun, through the fingers held closely side by side. During life the color is pink; after death a dead white. (f) After death a dark spot is said to form gradually on the outer side of the white of the eye, from drying of the sclerotic, so that the dark choroid shows through. (£■) Putrefaction is an absolute sign of death. Better delay for it than run any risk of burying alive. From Foreign Bodies in Air Passages.—If round and smooth, invert the patient and strike on the back : laryngotomy: tracheotomy. Of the New-Born.—Clean the mucus out of nostrils and throat; catheterize the trachea, and suck up the mucus. “ Marshall Hall’s Method:” by placing child on abdo- men, then bringing into lateral posture, repeating slowly and deliberately. “ Schultze’s method : ” by placing the thumbs upon the anterior surface of thorax, the indices in the axillae, and the other fingers along the back, the face of the child being from you ; rotate the child, by swinging upwards, so that the inferior extremities turn over towards you, In a moment re-rotate to the original position. Do not support head or legs in the for- ward rotation; their bending upon or towards the abdomen gives a forced expiration. CLINICAL EXAMINATION OF THE URINE. Note.—Use morning urine, or a sample of all passed during the 24 hours. Pale (and copious), 1.030 . . indicates Sugar. Pale (and copious), below 1.018 “ Hysteria and convulsions, Of urine and froth, very yellow nervous disease. or greenish, “ Bile, Rhubarb. Bright yellow to crimson, . . . “ Santonin, Dark, odor of violets, “ Turpentine. Color - High (scanty), sp. gr. -J- . . . “ Fever, Uric Acid Dia- thesis. High (scanty), sp. gr. — ... “ A grave symptom of Bright’s Disease. Dark, muddy, smoky, “ Blood, strong Coffee. Black, “ Putridity, disintegrated Blood, Tar, Creasote. “ Cystine, Sugar, etc. Fragrant, Smell Fetid, “ Alkalinity. Of violets, “ Turpentine. Quantity (in 24 hours). Normal about 50 fl. oz., from which there may be consider- able variation either way, according to the quantity of sweat, the fluidity of food used, etc. Specific Gravity. If possible, take the mixed urine. Normal is about 1.018, i. 'j 81.00 90.00 120.00 300 19.40 f 3 iv 108.00 120.00 160,00 360 23-5° f ?v i35-oo 150.00 200.00 420 27.20 f.3vj 162.00 180.00 240.00 480 5 j 960 3 ij 1000 I1': X vi % viij 31.10 62.20 64.79 124.40 186.60 248.80 f 3 Vllj 216.00 240.00 320.00 * Lighter than water are tinctures, spirits, compound spirit of ether, sweet spirits of nitre, fixed and volatile oils. .(Ether Fortior, f5j = grams 2.80. f Same as water are waters, liquids, decoctions, infusions, most fluid extracts, and tinctures made with dilute alcohol. I Heavier than water are syrups, glycerin, a few fluid extracts, and chloroform. Of the latter f5j = grams 5.50. INDEX. Note.—This Index has been arranged with the object of enabling instant reference to- be made to the mention of every article of the Materia Medica, every drug, official or unofficial, and each preparation, derivative or constituent thereof, which is treated of in the first part of the book, every article, preparation or operation discussed in the pharma- ceutical portion, and every disease or other title contained in the therapeutical section.. Many of the entries are only made once, but double and even treble entries are made for every item which seemed of sufficient importance to warrant such repetition. Salts are each placed but once in the Index, under their English names and the titles of their acid factors, thus, Acetate of Potassium. A basic view of the salts under their basis titles is seen in the section on Materia Medica, but as no such view of the Allyl, Ethyl, Methyl, Propyl and similar compounds exists in the book, these are each indexed twice, under both the acid and basic portions of their names, as Cetyl Palmitate and Palmitate of Cetyl. Plants are indexed under both English and Latin names, except where the technical- name of the plant corresponds in part with the official drug-title, in which case the one entry serves for both. Thus the entry Conium answers for the plant Conium macula turn, as well as for the official drug; but the drug ATux Vomica and the plant Strychnos Nux- vomica receive separate index entries. Alkaloids are each entered once only and under their chemical termination, ine; their salts following the same rule as other salts. Glucosides and similar principles (except such as are acids) are indexed under their chemical termination, in. Preparations are indexed under their Latin names where the reference is to the class,, as Infusa, 422; but the several individual preparations are placed under their English titles, thus, Infusion of Digitalis, 199; the reference being to the Infusum Digitalis,, page 199. Abbreviations, their use, 443 Table of, 443, 691 Abdominal Plethora, 480 Abies, 315 Abies balsamea, 384 canadensis, 315 excelsa, 315 Abietic Anhydride, 385 Abortion, 48, 480 Abrus, 55 Abscess, 481 of the Liver, 590 Absinthe, 56 Absinthium, 56 Abstract of Aconite, 76 of Belladonna, 126 of Conium, 186 of Digitalis, 199 Abstract of Hyoscyamus, 248 of Ignatia, 250 of Jalap, 258 of Nux Vomica, 288 of Podophyllum, 320 of Senega, 363 of Valerian, 394 Abstracta, 429 Acacia, 56 Catechu, 159 Aceta (see also Vinegars), 428 Acetanilide, 56 Acetate of Copper, 194 of Ethyl, 79 of Iron, 215 of Iron and Ammonium, 217 of Lead, 317 of Morphine, 293 730 INDEX, Acetate of Potassium, 322 of Sodium, 369 of Zinc, 4Q3 Acetic Ether, 79 Acetous Preparations, 428 Acetum, 58 Acid Abietic, 334 Abric, 55 Acetic, 58 Aconitic, 76 Agaric, 83 Aloetic, 90 Anemonic, 328 Angelic, 380, 390 Arabic, 56 Arsenious, 116 Artanthic, 277 Benzoic, 129, 179 Boracic, 59 Boric, 59 Brassic, 367 Calumbic, 145 Camphoric, 147 Camphretic, 147 Capronic, 114 Caprylic, 114 Carbazotic, 72 Carbolic, 60, 179 Solutions of, 60 Gauze, 60 Carminic, 183 Caryophyllic, 156 Caryophyllinic, 156 Catechuic, 159 Catechu-tannic, 159 Cathartic, 364 Cathartogenic, 364 Cerotic, 160 Cetraric, 161 Cevadic, 396 Chelidonic, 162, 353 Chromic, 62 ■Chrysammic, 90 Chrysophanic, 174, 344 Cinnamic, 124, 129, 376 Citric, 266 Coca-tannic, 208 Copaibic, 189 Cresylic, 60 Cubebic, 193 Ergotic, 204 Ergotinic, 204 Erucic, 367 Eugenic, 284 Euonic, 213 Euphrastic, 214 Filicic, 121 Fluoric, 63 Gallic, 63, 223 Gallo-tannic, 74 Gambogic, 146 Gelsemic, 224 Acid Gentesic, 226 Gentianic, 226 Glycyrrhizic, 228 Guaiac, 232 Guaiaconic, 232 Guaiarec, 232 Gurjunic, 234 Gynocardic, 161 Hydriodic, 252 Hydrobromic, 65 Hydrochloric, 65 Hydrocyanic, 67 Hypopicroloxic, 310 Igasuric, 288 Ipecacuanhic, 256 Juglandic, 259 Kinic, 177 Kinotannic, 177, 261 Kinovic, 177 Kinovo-tannic, 177 Lactic, 69, 292 Lactucic, 263 Linoleic, 268 Lobelic, 269 Lupulinic, 238 Maizenic, 402 Malic, 126 Mastichic, 277 Meconic, 292 Melassic, 347 Methyl-salicylic, 224 Mezereinic, 281 Muriatic, 65 Myristic, 285 Nitric, 70 Nitro-hydrochloric, 65, 70 Nitro-muriatic, 65, 70 Oleic, 71, 290 Ophelic, 164 Oxalic, 48, 487 Palmaric, 334 Palmitic, 290 Phenic, 60 Phosphoric, 71 Phytolaccic, 309 Picric, 72 Picrotoxic, 310 Pjnic, 334 Piperonylic, 191 Podophyllinic, 320 Polygonic, 321 Protocatechuic, 320 Prussic, 67 Punico-tannic, 230 Pyrogallic, 63, 179 Pyroligneous, 315 Quercitannic, 74, 332 Rhatania-tannic, 74, 262 Rheotannic, 336 Rheumic, 336 Ricinoleic, 340 Sabadillic, 396 INDEX, 731 Acid, Salicylic, 179, 349 Salicylous, 349 Salicyluric, 350 Sanguinarinic, 353 Scheele’s, 67 Sclerotinic, 204 Silvic, 334 Sphacelinic, 205 Strychnic, 288 Sulphuric, 72 Sulphuric, Aromatic, 72 Sulphurous, 73 Succinic, 91 Tannic, 74, 223 Tannic and Iron, 453 Tartaric, 75 Thebolactic, 292 Tiglinic, 390 Toxicodendric, 339 Tropic, 126, 247 Valerianic, 380, 393 Vanillic, 395 Veratric, 396 Viburnic, 399 Xylic, 60 Acids, their action, 36, 65 Acidity, 481 Acipenser Huso, 249 Acne, 482 Aconine, 76 Aconite, 75 Aconitine, 76 Aconitum, 75 Cammarum, 76 Chinense, 76 ferox, 76 Japonicum, 76 Napellus, 76 Acorin, 143 Acorus Calamus, 143 Acrinyl, Sulpho-cyanate, 367 Acrolein, 227 Addison’s Disease, 483 Administration of Medicines, 20 Adynamia, 483 Adeps, 78 Benzoinatus, 78 Hither, 78 Hither, Acetic, 79 After-pains, 484 Agalactia, 484 Agaricin, 83 Agaricus albus, 83 chirurgorum, 83 muscarius, 84 Agave Americana, 90 Ague, see Intermittent Fever, 598 Ailanthus glandulosa, 85 Albau, 234 Albumin, 400 Albuminate of Iron, 217 of Mercury, 244 Albuminuria, 484 Alcohol, 85 Caustic, 369 Phenylic, 60, 87 Alcoholic Preparations, 423 strength of Bitters, 704 Alcoholism, 87, 485 Aldehyde, 87 Proto-catechuic, 395 Alder bark, 64, 89 Alder, Black, 327 Alder, Buckthorn, 221 Ale, 86 Alkalies, their action, 36 Alkaline Mineral Waters, 109 Alkaloids, 409 Allium cepa, 89 porrum, 89 sativum, 89 Allspice, 313 Allyl Sulphide, 119 Sulpho-cyanide, 367 Almond, 67, 97 Alnus, 64, 89 Aloe socotrina, 89 Aloes, 89 Alopecia, 486, 673 Alstonia scholaris, 202 Alteratives, 41 Uterine, 48 Althaea officinalis, 91 Alum, 91 Alum, Ammonio-ferric, 217 Alum root, 64 Alumen, 91 Alumen Exsiccatum, 91 Aluminium, 92 Amanita Muscaria, 84 Amaurosis, 486 Amber, 377, 385 Amblyopia, 30, 486 Amenorrhcea, 486 Amido-benzene, 179 Ammonia, 93 Ammonia-alum, 91 Ammoniated Mercury, 240 Ammoniacum, 93 Ammonium, 93 Amorphous Bodies, 415 Amygdala, 97 Amara, 67, 97 Dulcis, 97 Amygdalin, 67, 97 Amyl Chloride, 81 Hydrate, 87 Hydride, 81 Nitrite, 98 Amylene, 81 Hydrate, 164 Amylic Alcohol, 87 Amylum, 100, 348 Iodatum, 100, 252 732 INDEX, Anaemia, 488 cerebral, 512 Anaesthesia, 80, 171, 489 Local, 209 Anaesthetics, 25, 27, 80, 81, 171 Local, 25 Mixtures, 79 Modes of using, 171 Anacyclus Pyrethrum, 330 Analgesics, 27 Anamirta paniculata, 310 Anaphrodisiacs, 47 Anaphrodisiac Pills,'468 Anasarca, see Dropsy, 540 Andira Araroba, 174 Anemone, Meadow, 328 patens, 328 pratensis, 328 Pulsatilla, 328 Anemonin, 328 Aneurism, 489 Angelate of Butyl, 101 Angina.—See Croup, Laryngitis, Pharyn- gitis, Throat, Tonsillitis, etc, Angina Pectoris, 489 Anhidrotics, 46 Anilin, 179 Anilin Red, 222 Anise, 100 Star, 100 Anodynes, 25, 27 Local, 25 Ant-acids, 36 Antagonists, 52 List of, 53, 451 Anthelmintics, 40 Anthemis, 101 Anthrax.—See Carbuncle, 507 Antibilious Pills, 469 Antidote, Jeaunel’s, 707 Antidote-bag, 708 Antidotes, 52, 707 Anti-emetics, 37 Anti-fat, 222 Antifebrin, 56 Antilithics, 45 Antimonial Powder, 102 Antimony, 102 Sulphurated, 102 Antiperiodics, 43 Antiphlogistics, 43 Antipyretics, 42 Antipyrine, 104 Antiseptic Fluid, 389 Antiseptics, 51, 389 Antisialics, 35 Antispasmodics, 28 Antizymotics, 51 Anus, Fissured, 490 Prolapse of, 647 Aperients, 38, 468 Aphonia, 490 Aphrodisiacs, 47 Aphthae, 491 Apiin, 106 Apiol, 106 Apis mellifica, 160, 278 Apnoea, 721 Apocynin, 107 Apocynum, 107 t Apomorphine, 107, 292 Apoplexy, 491 Apotheme, 429 Appetite, 491 Approximate Measures, 438 Aqua, 108 Bulliens, 108 Carbonata, 108 Communis, 108 Destillata, 108 Fervens, 108 Fluvialis, 108 Fontana, 108 Marina, 108 Pluvialis, 108 Aquae (see also Water of), 419 Aqueous Preparations, 419 Arabin, 56, 391 Arbor Vitae, 385, 388 Arbutin, 162, 180, 223, 393 Arctostaphylos glauca, 393 Uva-ursi, 392 Argentum, 112 Argol, 322 Argyria, 113 Aristolochia reticulata, 365 Serpentaria, 365 Aristolochine, 365 Arnica, 114 Arnicin, 114 Aromatic Fluid Extract, 183 Aromatic Powder, 183 Aromatic Sulphuric Acid, 72 Arseniate of Iron, 217 of Sodium, 116 Arsenic, 116 Arsemte of Bromine, 117 of Copper, 117, 709 of Potassium, 116 Arsenium, 116 Artemisia Absinthium, 55 maritima, 355 Arterial Transfusion, 21 Artanthe elongata, 277 Asafoetida, 119 Asagraea officinalis, 396 Ascarides.—See Worms, 688 .Ascites, 492 Asclepias, 120 Ash, Flowering, 276 Prickly, 401 Asparagin, 91, 213, 228 Asphyxia, 721 Aspidium, 121 INDEX. 733 Aspidosperma Quebracho, 331 Aspidospermine, 331 Asthenia.—See Adynamia, Convalescence, Atrophy. Asthenopia, 492 Asthma, 492 Astigmatism, 494 Astragalus gummifer, 391 Astringents, 42, 50, 64, 468 Intestinal, 39 Powder, 472 Urinary, 45 Atheroma, 494 Atrophy, 494 Atropine, 126 and Morphine, 299, 702 Atrosin, 126 Aurantiin, 121 Aurantium, X2I Aurum, 122 Ava-kava, 261 Avena Sativa, 123 Ayer’s Ague Cure, 704 Cherry Pectoral, 704 Pills, 704 Recamier Balm, 704 Cream, 704 Sarsaparilla, 704 Vita Nuova, 704 Azedarach, 123 Azoturia.—See Urinary Disorders, 680 Azulen, 278 Basilicon Ointment, 334 Bassorin, 391 Baths, Formulae, 462 Bay-berry, 284 Bay Rum, 284 Bear-berry, 392 Bed-sores, 495 Beer, 86 Belladonna, 125 Beliadonnine, 125 Benne Oii, 366 Benzene, 128, 179 Benzin, 128 Benzoate of Ammonium, 94, 129 of Lithium, 129, 268 of Sodium, 129 Benzoin, 129 Benzoinated Lard, 129 Benzol, 128, 179 Benzyl Cinnamate, 124 Berberine, 129, 145, 246, 320, 401 Muriate of, 129, 246 Berberis, 129 Bergamium, 130 Bergamot, Oil of, 131 Bergaptene, 130 Beta-naphthol, 286 Beta vulgaris, 347 Bhang, 150 Bibliography and References, 479 Bicarbonate of Potassium, 322 of Sodium, 369 commercial, 369 Bichloride of Ethene, 81 of Ethylene, 169 of Mercury, 239 of Methylene, 170 Bichlorinated Chloride of Methyl, 168 Bichromate of Potassium, 62 Bile, Agents affecting the, 40 Biliary Solvents, 45 Biliousness, 495 Bilious Remittent Fever, 717 Bind weed, 237 Biniodide of Mercury, 240 Bird-lime, 400 Bismuth, 131 Bismuth Mixture for Children, 457 Bisulphate of Quinine, 177 Bisulphide of Carbon, 81, 154 Bisulphite of Sodium, 73 Bitartrate of Potassium, 323 Bites and Stings, 667 Bitters, Action of the Simple, 146 Alcoholic Strength of, 704 Bittersweet, 203 Black-berry, 64, 343 Bark, 343 Black Draught, 364 Drop, 293 Paste, 571 Bladder, Inflammation of, 529 Balanitis, 494 Baldness.—See Alopecia, 486, 673 Balm, 279 of Gilead, 384 Balnea, 462 Balneum Maris, 108 Vaporis, 108 Balsam of Copaiba, 189 of Fir, 384 Friar’s, 129, 376 of Peru, 124 of Tolu, 124 Balsamodendron Myrrha, 285 Balsamum Dipterocarpi, 233 Peruvianum, 124 Tolutanum, 124 Bandoline, 197 Baptisia, 125 Baptisin, 125 Barberry, 129 Bark, Cuprea, 176 Peruvian, 176 Tincture of, 177 Barley, 273 Barosma, 137 Barosmin, 137 Basham’s Mixture, 217 734 INDEX Bladder, Irritable, 496 Paralysis of, 496 -wrack, 222 Blende, 403 Blepharitis, 496 Blistering Cerate, 151 Blisters, 49 Blood-root, 352 Blood-stains, 666 Blue Flag, 257 Mass, 239 Ointment, 239 Pill, 239 Boiling, 411 Boils, 496 Boldine, 132 Boldo, 132 Boldus, 132 Bolus, 463 Bone Diseases, 497 Boneset, 213 Borate of Quinine, 178 of Sodium, 59 Borax, 59 Boro-citrate of Magnesium, 59 Boro-glyceride, 59 Bos-taurus, 214 Bots, 124 Bougies, Formulae for, 475 Boxwood, 301 Brain Disorders.—See Cerebral Anaemia, Cerebral Concussion, etc. Fever.—See Meningitis,Cerebro-spinal Meningitis, Typhoid Fever, Typhus Fever. Brandreth’s Pills, 704 Brandy, 86 Brayera, 132 Breasts.—See Abscess, Lactation, Mastitis, Nipples. Breath, P'etid, 497 Bright’s Disease, Acute, 497 Chronic, 498 Diagnosis, 712 Bromide of Ammonium, 94, 133 of Arsenic, 117 of Calcium, 133 of Ethyl, 79 of Iron, 133, 215 of Lithium, 133, 268 of Methyl, 81 of Potassium, 133 of Sodium, 133 of Zinc, 133 Bromidrosis, 559 Bromine and Bromides, 133 Bromism, 134 Bronchiectasis, 499 Bronchitis, Acute, 499 Capillary, 500 Chronic, 501 Bronchocele.—See Goitre, 569 Bronchorrhoea, 502 Broom, 360 Brown Mixture, 228 Brucine, 237, 250, 288 Bruises, 503 Bryonia, 135 Bryonin, 136 Bubo, 503 Buchu, 137 Helmbold’s, 705 Buckthorn, 158, 221 Bulimia, 491 Bunion, 504 Burdock, 264 Burnett’s Disinfectant, 51, 403 Burns, 504 Bursitis, 504 Butternut, 259 Butyl Angelate, 101 Butyl chloral Hydrate, 168 Chloride, 81 Hydride, 81 Valerianate, 101 Buxine, 301 Buxus sempervirens, 301 Cacao-butter, 387 Cachets, 471 Cachexiae, 504 Cadmium, 137 Caffea, 138 Caffeine, 138 Cajuput Oil, 142 Cajuputene Bihydrate, 142 Cajuputol, 142 Calabar Bean, 307 Calabarine, 307 Calamine, 403 Ointment, 405 Calamus, 143 Calcination, 412 Calcium, 143 Calculi, Biliary, 505 Renal, 505 Solvents of, 45 Vesical, 505 Calendula, 145 Calomel, 240 C.alumba, 145 Calx, 143 Chlorata, 172 Sulphurata, 378 Cambogia, 146 Camellia Thea, 138, 139 Camp Fever.—See Typhus, 677 Camphor, 147 Baldrian, 393 Bergamot, 131 Carbolated, 148 -Chloral, 148 INDEX. 735 Camphor-Cymol, 147 Monobromated, 147 Peppermint, 280 Salicylated, 148 Canadian Hemp, 107 Cancer, 506 Diagnosis of, 713 of Uterus, 681 Cancrum Oris, 507 Cane Sugar, 347 Cannabene, 149 Cannabin, 149, 165 Cannabis, 149 Americana, 149 Indica, 149 sativa, 149 Cantharides, 151, 229 Cantharidin, 151 Cantharis, 151 Capsicin, 153 Capsicum, 153 Capsules, 469 Caraway, 156 Carbo, 154 Animalis, 154 Purified, 154 Ligni, 154 Carbolate of 254 Carbon, 154 Bisulphide, 154 Dioxide, 81, 348 Monoxide, 81 Tetrachloride, 170 Carbolate of Iodine, 252 Carbonei Bisulphidum, 154 Carbonate of Ammonium, 94 of Calcium, Precipitated, 143 of Iron, 215 Saccharated, 2x5 of Iron and Manganese, 275 of Lead, 317 of Lithium, 268 of Magnesium, 271 of Potassium, 322 of Sodium, 369 Dried, 369 of Zinc, Precipitated, 403 Carbonated Mineral Waters, 108 Carbonization, 412 Carbuncle, 507 Carcinoma.—See Cancer, 506 Cardamom, 155 Cardiac Disorders.—See Heart. Sedatives, 33 Stimulants, 33 Tonics, 33 Cardialgia.—See Pyrosis, 653 Carduus, 155 Carica Papaya, 300 Caries, 508 Carminatives, 37 Dewees’, 272 Carmine, 183 Caroval, 196 Carron Oil, 144, 268 Carthamus tinctorius, 193 Caruen, 156 Carum, 156 Caruol, 156 Caryophyllin, 156 Caryophyllus, 156 Casca Bark, 157 Cascara Amarga, 157 Sagrada, 158 Cascarilla, 158 Cascarillin, 158 Cassia acutifolia, 364 elongata, 364 Fistula, 158 Castanea, 64, 159 vesjca, 159 Castor Oil, 340 Emulsion; Formula, 524 Castoria, 704 Catalepsy, 508 Cataplasmata, 477 Cataract, 508 Catarrh, Acute Nasal, 509 Broncho pulmonary.—See Bronchitis, Bronchorrhcea. Chronic Nasal, 510 Duodenal, 541 Epidemic.—See Influenza, 597 Gastric.—See Gastritis, Chronic, 566 Genito-urinary.—See Bladder, Catarrh of, Cystitis, Endometritis, Gonor- rhoea, Lbucorrhoea, etc. Intestinal.—See Dysentery, Jaundice, etc. Summer.—See Hay Fever, 573 Catechol, 180 Catechu, 64, 159 Cathartics, 38 Catharto-mannite, 364 Caulophyllin, 159 Caulophyllum, 159 Caustic, Lunar, 112 Potash, 322 Soda, 368 Caustics, 49 Cedar, Oil of, 354 Red, 346 Celandine, 162 Cellulose, 229, 348 Centaurea benedicta, 156 Cephaelis Ipecacuanha, 256 Cephalalgia, 575 Cera, 160 Cera Alba, 160 Flava, 160 Cerata, 433, 475 Cerate of Camphor, 147 of Cantharides, 151 of Cantharides Extract, 151 736 INDEX Cerate of Cetaceum, 161 of Lead Subacetate, 318 of Resin, 334 of Sabine, 346 Cerates, 433, 475 Compounding of, 475 Ceratum, 160, 433 Cerebellum, Agents affecting, 28 Cerebral Anaemia, 512 Compression, Diagnosis, 713 Concussion, 512 Diagnosis, 713 Congestion, 512 Depressants, 26 Excitants, 26 Softening, 512 Vomiting—Diagnosis, 717 Cerebro-spinal Fever, 615 Cerium Oxalate, 160 Cerolein, 160 Cetaceum, 161 Cetin, 161 Cetraria, 161 Cetyl Palmitate, 161 Cevadilla, 396 Cevadilline, 396 Cevadine, 396 Chalk, Prepared, 143 Chalybeate Waters, 109 Chamomile, 101 German, 278 Chamomilla, 278 Chancre, 513 Diagnosis of, 713 Chancroid, 513 Diagnosis of, 713 Change of Life—See Climacteric, 518 Chapped Hands and Lips, 513 Charcoal, 154 Chartae (see also Papers), 434 Chartuke, 471 Chaulmoogra Oil, 161 Chelerythrine, 162 Chelidonine, 162 Chelidonium, 162 Chelidoxanthin, 162 Chelsea Pensioner, 470, 659 Chemical Incompatibility, 448 Chenopodium, 162 Cherry-laurel, 67, 68 Cherry, Wild, 327 Chestnut, 159 Chestnut-leaves, 64 Chest-pains, 513 Chian Turpentine, 384 Chicken-pox, 514, 684 Chilblains, 514 Chidren, Dosage for, 22 Chimaphila, 162 Chimaphilin, 162 China, Pride of, 123 Chininum Amorphum Boricum, 178 Chinoidin, 178 Chinoline, 163, 179 Chiratin, 164 Chiretta, 164 Chittem Bark, 158 Chloral, 164 Analogues of, 164 Butylic, 168 Hydrate, 164 Chloralamid, 165 Chloral-habit, 167 Chlorate of Potassium, 322 of Sodium, 369 Chloride of Ammonium, 94 of Amyl, 81 of Arsenic, 85 of Butyl, 81 of Calcium, 143 of Cocaine, 208 of Ethene, 81 of Ethyl, 81 of Ethylidene, 170 of Gold, 122 of Gold and Sodium, 122 Double, 704 of Iron, 215 of Lime, 172 Mercur-ammonium, 240 of Mercury, Corrosive, 239 Mild, 240 of Methane, 81, 170 of Methyl, 81, 170 of Sodium, 369 of Zinc, 403 Chlorinated Waters, 108 Chlorine, 172 Chlorine-water, 172 Chlorodyne, 169 Formulae for, compared, 703 Chloroform, 80, 168 Commercial, 169 Methylic, 169 Purified, 169 Chlorosis, 514 Chlorum, 172 Chocolate, 387 Choking, 515 Cholagogues, 39 Pills, 4.68 Purgatives, 38 Cholera Asiatica, 515 Infantum, 515 Simplex, 516 Diagnosis of, 714 Cholera Mixture (Squibb), 293, 515 Cholesterin, 400 Chondodendron tomentosum, 301 Chondrus, 174 Chordee, 517 Chorea, 517 Choroiditis, 518 Chrysarobin, 174 INDEX, 737 Chrysophan, 336 Churrus, 150 Cigarettes, Formulae for, 493 Ciliary Excitants, 33 Cimicifuga, 174 Cimicifugin, 175 Cinchona, 176 Flava, 176 Rubra, 176 Cinchonidine, 177 Cinchonine, 177 Cinchonism, 181 Cinnabar, 240 Cinnamein, 124 Cinnamomum, 182 Camphora, 147 Cinnamon, 182 Cinquefoil, 636 Circulation, Agents affecting, 33 Circumcision, 639 Cissampeline, 301 Cissampelos Pareira, 301 Citrate of Bismuth, 131 of Bismuth and Ammonium, 131 of Caffeine, 138 of Cocaine, 208 of Iron, 215 of Iron and Ammonium, 217 of Iron and Quinine, 217 of Iron and Strychnine, 217 of Lithium, 268 of Magnesium, Granulated, 272 of Potassium, 322 Citrates, 266 Citrine Ointment, 240 Brown, 240 Citron, 266 Citrullus Colocynthis, 185 Citrus acris, 266 Aurantium, 121 Bergamia, 131 Limonum, 266 medica, 266 vulgaris, 121 Clarification, 415 Classification of Medicines, 23 Claviceps purpurea, 204 Clavus.—See Headache, 575 Clemen’s Solution, 1x7 Climacteric Disorders, 518 Cloves, 156 Club-moss, 270 Clysters, 461 Cnicin, 156 Cnicus benedictus, 156 Coca, 130, 208 Cocaine, 208 Cocaine-habit, 209 Cocculus Indicus, 310 Coccus, 183 Coccyodynia, 518 Cochineal, 183 Cocoa, 140 Codamine, 292 Codfish, 282 Codeine, 292, 294 Cod-liver Oil, 282 Emulsion, 282 Coffee, 138 Cohosh, Black, 173 Blue, 159 Colation, 414 Colchiceine, 184 Colchicine, 184 Colchicum, 184 Coldness, 518 Colic, Hepatic, 520 Intestinal, 518 Lead, 5x9 Renal, 520 Colic-root, 201 Collodia, 427 Collodion, 229 with Cantharides, 151, 229 Flexible, 229, 427 Styptic, 74, 229, 427 Colloids, 416 Collunarium, 461 Collyrium, 460 Formulae for, 460 of Four Sulphates, 460 Colocynth, 185 Colocynthein, 185 Colocynthin, 185 Colocynthis, 185 Colocynthitin, 185 Cologne-water, 86 Colophony, 334, 385 Columbo, 145 Coma, 520 Combination, Principles of, 441 Comminution, 412 Compounding Medicines, 434 a Mixture, 456 Condylomata, 520 Condy’s Fluid, 51 Confectio Damocratis, 470 Confection of Rose, 342 of Senna, 364 Confectiones, 431,470 Formulae for, 470 Conhydrine, 186 Coniine, 186 Conium, 186 Conjunctivitis, Catarrhal, 520 Diphtheritic, 521 Gonorrhoeal, 521 Granular, 521 Phlyctenular, 522 Purulent, 522 Conspergative, 463, 464 Constipation, 523 Constituents of Drugs, 408 Convalescence, 524 INDEX, Convallamarin, 188 Convallaria Majalis, 187 Convallarin, 188 Convolvulin, 258, 359 Convolvulus Scammonia, 359 Convulsions, 524 Infantile, 525 Puerperal, 650 Copaiba, 189 Emulsion, 459 Copaifera Langsdorffii, 189 Copper, 194 Cordial, Cascara, 158 Coriander, 190 Coriandrum, 190 Corneal Opacities, 525 Corneitis.—See Keratitis, 603 Corn, Indian, 402 Silk, 402 Smut, 402 Cornin, 190 Corns, 525 Cornus, 190 Cornutin, 205 Corpulence.—See Obesity, 626 Corrosive Sublimate, 239 Coryza.—See Catarrh, Acute, 509 Coto Bark, 190 Cotoin, 190 Cosmoline, 304 Cotton, 229 Iodized, Formula for, 581 Cotton-seed Oil, 229 Couch grass, 392 Cough, 526 Mixtures, Formulae for, 527, 597, 638 Counter irritants, 49 Court Plaster, 249 Coxalgia, 527 Coxe’s Hive Mixture, 102, 360 Crab Lice.—See Pediculi, 635 Cramp Bark, 399 Cramps.—See Trismus, Spasmodic Affec- tions. Cranberry Tree, 399 Cranesbill, 64, 226 Cream, Cold, 342 of Tartar, 323 Creasol, 191 Creasote, 61, 191 Creolin, 192 Creta Praeparata, 143 Crocus, 192 Croton-chloral, 165, 168 Croton Eluteria, 158 Oil. 390 Tiglium, 390 Croup, Catarrhal, 528 Membranous, 528 Diagnosis, 714 Cryptopine, 292 Crystallization, 415 Cubeba, 193 Cubeben, 193 Cubebene, 193 Cubebin, 193 Cuca, 208 Cucumber, Squirting, 203 Cucumber Tree, 273 Cucurbita Pepo, 302 Cucurbitine, 302 Culver’s Root, 265 Cuprea Bark, 176 Cuprum, 194 Ammoniatum, 194 Curare, 196 Curarine, 196 Cutaneous Irritants, 49 Cyanide of Mercury, 240 of Potassium, 67 of Silver, 113 Cyanosis, 529 Cydonin, 197 Cydonium, 197 Cymene, 389 Cynips Gallae tinctoriae, 223 Cypripedin, 197 Cypripedium, 197 Cystitis, Acute, 529 Chronic, 529 Cysts, 531 Damiana, 197 Dandelion, 383 Dandruff.—See Pityriasis, 642 Daphne Mezereum, 281 Daphnin, 281 Datura Stramonium, 374 Tatula, 198 Daturine, 198, 374 Deafness, 531 Death, Signs of.—See Asphyxia, 721 Debility.—See Adynamia, Anaemia, Con- valescence. Decantation, 414 Decocta, 422 Decoction of Cetraria, 161 of Chimaphila, 163 of Dulcamara, 203 of Granatum, 230 of Haematoxylon, 235 of Hydrangea, 239 of Inula, 251 of Prinos, 327 of Quercus, 332 of Quillaia, 333 of Rumex, 344 of Sarsaparilla, Compound, 357 of Stillingia, 373 of Viola Tricolor, 400 of Viscum, 400 of Xanthoxylum, 401 Decoloration, 415 INDEX. 739 Deer, Musk, 283 Deflagration, 412 Deliquescence, 416 Deliquescent Salts, List of, 466 Deliriants, 26 Delirium, 531 Tremens, 531 Delphinine, 372 Delphinium Staphisagria, 372 Dementia, 532 Paralytica, 533 Demulcents, 51 Dengue, 533 Dentition, 533 Dentifrices, 34 Deodorants, 52 Depressants, Cerebral, 26 Hepatic, 40 Renal, 44 Respiratory, 30 Uterine, 48 Desiccation, 411 Destructive Metamorphosis, 42 Dew berry, 343 Dewees’ Carminative, 119,272 Dextrin, 348 Dextrose, 347 Diabetes Insipidus, 534 Mellitus, 534 Diachylon Ointment, 318 Plaster, 318 Diagnosis, Differential, 712 Dialysis, 416 Dialysed Iron, 217, 417 Diaphoretics, 46 Diarrhoea, 535 Diastase, 273 Pancreatic, 300 Dichloro-methane, 170 Diffusate, 416 Digestive System, Agents affecting, 34 Digitalein, 199 Digitalin, 199 Digitalis, 198 Digitonin, 199 Digitoxin, 199 Diluents, 46, 455 Dioscorea, 201, 399 Dioscorein, 201 Diospyros, 64 Dioxide of Carbon, 81, 348 Diphtheria, 537 Diagnosis of, 714 Dipsomania.—See Alcoholism, Delirium Tremens. Discutients, 42 Disinfectants, 51 Burnett’s, 52, 403 Condy’s, 52 Labarraque’s, 51, 172 Dislocations, 563 Dispensatories, 407 Dispensing, 434 by Physicians, 434, 445 Displacement, 417 Distillation, 411 Dry, 411 Fractional, 411 Disulphide of Iodine, 378 Dita Bark, 202 Ditaine, 202 Ditamine, 202 Diuretics, 43 Formulae for, 541, 680 Dizziness.—See Vertigo, 685 Dobell’s Nasal Wash, 462, 511 Dock, Yellow, 344 Dog-wood, 190 Jamaica, 314 Domestic Measures, 438 Donovan’s Solution, 117 Dorema Ammoniacum, 93 Dosage of Medicines, 54 of Opium, 294, 297 Dover’s Powder, 256 Fluid, 256 Drastic Purgatives, 38 Draught, 459 Black, 364, 459 Effervescing, 459 Drink, 459 Imperial, Formula, 460 Drops, 438 Table of Drops to a Drachm, 438, 726 Dropsy, 540 Drosera, 202 Drowning.—See Asphyxia, 721 Drugs, Their Constituents, 408 Drug-experimentation, 19 Duboisia, 202 Duboisine, 202 Dulcamara, 203 Dulcamarin, 203 Duodenal Catarrh, 541 Dutch Liquid, 169 Dyscrasise.—See Cachexias, 504 Dysentery, 541 Dyspepsia, 544 Dysphagia, 546 Dysmenorrhcea, 543 Dyspnoea, 546 Dysuria, 547 Ear, Agents affecting it, 30 Earache, 630 Eau Sedative, 94, 147 Ebullition, 411 Ecballium Elaterium, 203 Ecbolics, 47, 48 Ecboline, 204 Ecchymosis, 547 Ecgonine, 208 740 INDEX, Eclampsia, 650 Ecthyma, 547 Ectropium, 547 Eczema, 547 Efflorescence, 416 Efflorescent Salts, List of, 466 Egg, Yolk of, 400 Eights, The Three, 670 Elaterin, 203 Elaterium, 203 Elder, 352 Elecampane, 251 Electuaria, 431, 470 Electuary for Piles, 470 Elixir of Orange, 122 of Opium, 293 of Vitriol, 72 Elixiria, 426, 459 Elm, Slippery, 392 Elutriation, 413 Ely’s Cream Balm, 704 Emaciation, 549 Embrocation, 461 Emetics, 36 General or Systematic, 37 Local, 37 Emetine, 256 Emissions, 550 Emmenagogues, 47 Formulae for, 487 Pills, 468 Emollients, 50 Emphysema of Lungs, 550 Emplastra, 433, 476 Empyema, 550 Emulsification, 457 Emulsin, 67 Emulsion of Cod-liver Oil, 282, 459 of Copaiba, 459 Pancreatic, 300 Emulsions, 457 Natural, 457 Encephaloma.—See Cancer, 506 Diagnosis of, 713 Endarteritis.— See Atheroma, 494 Endocarditis, 551 Diagnosis of, 713 Endometritis,' 551 Enema of Tobacco, 381 Enemas, Formulae for, 462, 552 Enemata, 461, 552 Enteralgia.—See Colic, Intes., 518 Enteric Fever.—See Typhoid, 676 Enteritis, 552 Entropium, 547 Enuresis, 552 Epididymitis, 553 Epilation.—See Tinea Circin., 673 Epilepsy, 553 Diagnosis of, 714 Epispastics, 49 Epistaxis, 555 Epsom Salt, 271 Epulis.—See Teeth, 671 Equinia.—See Glanders, 568 Erections, 550 Ergot of Rye, 204 of Corn.—See Ustilago, 402 Ergota, 204 Ergotine, 204 Ergotinine, 204 Ergotism, 205 Ericolin, 223, 393 Erigeron, 207 Eriodyction, 207 Errhines, 32 Eructations, 544, 562 Eruptions caused by Drugs, 555 Erysipelas, 555 Erythema, 557 Erythrophleine, 157 Erythrophloeum Guinense, 157 Erythroretin, 336 Erythroxylon, 140 Escharotics, 49 Eserine, 307 Essence of Lemon, 266 of Nutmeg, 285 of Peppermint, 280 of Spearmint, 281 Ethene, 81 Chloride, 81 Dichloride, 81 Ether, 78 Acetic, 79 Chloric, 169 Chlorinated Muriatic, 170 Hydrobromic, 79 Hydriodic, 79 Methylic, 81 Petroleum, 128 Ethereal Oil, 79 Preparations, 427 Ethics, 724 Ethyl Acetate, 79 Alcohol, 85, 87 Bromide, 79, 81 Carbamate, 166 Chloride, 81 Hydrate, 87 Hydride, 81 Iodide, 79, 253 Nitrite, 79 Oxide, 78 Ethylate of Sodium, 369 Ethylene Bichloride, 169 Ethylidene Chloride, 170 Eucalyptene, 212 Eucalyptol, 212 Eucalyptolen, 212 Eucalyptus, 212 Eugenia caryophyllata, 156 Pimenta, 313 Eugenin, 156 INDEX. 741 Eugenol, 156 Euonymin, 213 Euonymus, 213 Eupatorin, 213 Eupatorium, 213 perfoliatum, 213 purpureum, 214 Euphrasia, 214 Evaporation, 410 Spontaneous, 411 Exanthemata, Diagnosis of, 715 Excipients, 430, 455 for Emulsions, 458 for Pills, 464 Excitants, Cerebral, 26 Ciliary, 33 Excoriation.—See Intertrigo, 600 Excretion.—Agents affecting, 43 Exhaustion, 557 Exogonium purga, 258 Exophthalmos, 558 Exostosis, 558 Expectorants, 32 Explosive Compounds, 449 Expression, 417 Exsiccation, 412, 416 Extemporaneous Pharmacy, 434 Preparations, 453 Prescriptions, 439 Extract of Aconite, 76 of Aloes, Watery, 90 of Arnica-root, 115 of Baptisia, 125 of Belladonna, Alcoholic, 126 of Cannabis Indica, 149 of Cinchona, 177 of Colocynth, 185 of Colocynth, Compound, 185 of Colchicum-root, 184 of Conium, Alcoholic, 186 of Convallaria, 188 of Damiana, 198 of Digitalis, 199 of Duboisia, 202 of Ergot, 205 of Eriodyction, 207 of Euonymus, 213 of Gentian, 226 of Glycyrrhiza, 228 Pure, 228 of Hsematoxylon, 235 of Hellebore, 236 of Hyoscyamus, Alcoholic, 248 of Iris, 257 of Juglans, 259 of Krameria, 262 of Leptandra, 265 of Malt, 273 of Mezereum, 281 of Nux Vomica, 288 of Opium, 292 of Physostigma, 308 Extract of Pi chi, 310 of Pinus Canad., 316 of Podophyllum, 320 of Polygonum, 321 of Quassia, 331 of Quebracho, 332 of Rheum, 336 of Rhus Toxicodendron, 339 of Stramonium, 374 of Taraxacum, 384 Extracta, 428 Extracta Fluida.—See Fluid Extracts, 423 Extractive, 429 Eye-bright, 214 Eye Diseases, 558 Ointments.—Formulae for, 521 Sensibility, Agents affecting it, 29 Water, Formulae for, 521 Eyelids, 559 Fabiana imbricata, 310 Face, 559 Face-ache.—See Neuralgia, Tic Doulou- reux, 622,672 Fainting.—See Syncope, 668 False Pains, 559 Farcy, 568 Fat.—See Obesity, 626 Fatigue.—See Exhaustion, 557 Favus.—See Tinea Favosa, 673 Febricula.—See Fever, Simple, 561 Febrifuge, 178 Feet, 559 Fehling’s Solution, 194 Fel Bovis, 214 Inspissatum, 214 Purificatum, 214 Felon.—See Onychia, 627 Fennel, 221 Fermentation, Lactic, 348 Fern, Male, 121 Ferrier’s Snuff, Formula, 510 Ferro-cyanide of Potass., 67 Ferrum, 215 Dialysatum, 217, 417 Reductum, 215 Ferula galbaniflua, 222 Narthex, 119 Scorodosma, 119 Sumbul, 380 Fever, 560 Bilious Remittent, Diagnosis, 717 Cerebro-spinal, 615 Hay, 573 Hectic, 580 Intermittent, 598 Miliary, 618 Milk.—See Lactation, 604 Pernicious.—See Intermittent Fever, Remittent Fever. 742 INDEX Fever, Puerperal, 651 Relapsing, 654 Remittent, 655 Diagnosis of, 717 Rheumatic, 656 Scarlet, 660 Diagnosis of, 715 Simple, 561 Spotted.—See Typhus Fever, also Meningitis, Cerebro-spinal. Surgical, 668 Traumatic.—See Surgical Fever, 668 Typhoid, 676 Diagnosis of, 716 Typho-malarial.—See Typhoid, 676 Typhus, 677 Diagnosis of, 716 Yellow, 689 Diagnosis of, 717 Ficus (Fig), 221 Filix Mas, 121 Filtering-paper, 414 Filtration, 414 Fir, Balsam of, 384 Scotch, 316 Silver, 384 Firs, 315 Fish-berries, 310 Fistula, 562 Fits.—See Apoplexy, Convulsions, Epi- lepsy, Hysteria, Syncope. Flatulence, 562 Flavoring Agents, 456 Flax-seed, 267 Flea-bane, 207 Fleming’s Tincture of Aconite, 76 Flooding.—See Hemorrhage Post-partum, Menorrhagia and Metrorrhagia. Fluavil, 234 Fluid Extract of Aconite, 76 of Ailanthus, 85 of Arnica-root, 115 Aromatic, 183 of Aurantium Amarum, 122 of Baptisia, 125 of Belladonna, 126 of Berberis, 130 of Brayera, 132 of Buchu, 137 of Calamus, 143 of Calumba, 145 of Cannabis Indica, 149 of Capsicum, 153 of Cascara Amarga, 157 of Cascara Sagrada, 158 of Castanea, 159 of Chimaphila, 163 of Chirata, 164 of Cimicifuga, 175 of Cinchona, 177 of Cocculus, 310 of Coffee, Green, 138 Fluid Extract of Colchicum-root, 184 of Colchicum-seed, 184 of Conium, 186 of Convallaria, 188 of Corn-silk, 402 of Cornus, 190 of Coto, 191 of Cotton-root, 229 of Cubeb, 193 of Cypripedium, 197 of Damiana, 198 of Digitalis, 199 of Drosera, 202 of Dulcamara, 203 of Ergot, 205 of Eriodyction, 207 of Erythroxylon, 208 of Eucalyptus, 213 of Eupatorium, 214 of Frangula, 221 of Gelsemium, 224 of Gentian, 226 of Geranium, 226 of Ginger, 406 of Glycyrrhiza, 228 of Gossypium, 229 of Granatum, 230 of Grindelia, 230 of Guarana, 233 of Hamamelis, 235 of Hellebore, Black, 236 of Hydrangea, 239 of Hydrastis, 246 of Hyoscyamus, 248 of Ipecacuanha, 256 of Iris, 257 of Jaborandi, 312 of Krameria, 262 of Lactucarium, 263 of Leptandra, 265 of Liquorice, 228 of Lobelia, 269 of Lupulin, 238 of Manaca, 274 of Matico, 277 of Mezereon, 281 of Nux Vomica, 288 of Orange, Bitter, 122 of Pareira, 301 of Phytolacca, 309 of Pichi, 310 of Pilocarpus, 312 of Pink-root, 372 of Piscidia, 314 of Plantago, 317 of Podophyllum, 320 of Poke-root, 309 of Polygonum, 321 of Prunus Virginiana, 328 of Quassia, 331 of Quebracho, 332 of Rhatany, 262 INDEX, 743 Fluid Extract of Rheum, 336 of Rhubarb, 336 of Rhus Aromatica, 338 of Rhus Glabra, 338 of Rose, 342 of Rubus, 344 of Rumex, 344 of Sabina, 346 of Sanguinaria, 353 of Santalum, 354 of Sarsaparilla, 357 Compound, 357 of Savine, 346 of Scilla, 359 of Scutellaria, 362 of Senega, 363 of Senna, 364 of Serpentaria, 365 of Spigelia, 372 of Stigmata Maydis, 402 of Stillingia, 373 of Stramonium, 374 of Sumach, Smooth, 338 Sweet, 338 of Taraxacum, 384 of Tonga, 391 of Triticum, 392 of Ustilago, 402 of Uva-ursi, 393 of Valerian, 394 of Veratrum Viride, 396 of Viburnum, 399 of Wild Cherry, 328 of Witch-hazel, 235 of Xanthoxylum, 401 of Zingiber, 406 Fluid Extracts, 423 Flushing-heats, 563 Fly-agaric, 84 Fceniculum, 211 Foetal Development, 720 Skull, its Diameters, 720 Fomentation, 460 Food, Horlick’s, 273 Mellin’s, 273 Foods, 41 Foreign Bodies, 563 Formulae, Hypodermic, 701 Formyl Iodide, 252 Fotus, 460 Fowler’s Solution, 116 Fox-glove, 198 Fractures, 563 Franciscea uniflora, 274 Frangula, 221 Frangulin, 221 Frankincense, 385 Franklinite, 403 Fraxin, 276 Fraxinus Ornus, 276 Freckles, 563 Friar’s Balsam, 129, 376 Fuchsin, 222 Fucus Yesiculosus, 222 Furuncle.—See Boils, 496 Fusel Oil, 87 Fusion, 412 Gaduin, 282 Gadus Morrhua, 282 Galactagogues, 49 Galbanum, 222 Galla, 64, 223 Galena, 317 Gallipots, 476 Gall-stones.—See Calculi, Biliary, 505 Gallus Bankiva, 400 Gamboge, 146 Gangrene, 564 of Lungs, 610 Garcinia Hanburii, 146 mangostana, 276 Gargarysma, 460 Gargles, Formulae for, 460, 539, 639, 672 Garlic, 89 Gaseous Preparations, 477 Gastralgia, 564 Gastric Dilatation, 565 Gastric Fever.—See Fever, Simple,—Ty- phoid Fever, Gastritis. Gastric Pain, 37 Sedatives, 37 Tonics, 35 Ulcer, 567 Vomiting, Diagnosis, 717 Gastritis, Acute, 565 Chronic, 566 Gastrodynia, 564 Gaultheria, 223 Gaultherilene, 224 Gauze of Thymol, 389 Gelatin, 249 Capsules, 469 Gelsemine, 224 Gelsemium, 224 Generative System, Agents affecting, 47 Genitive Case-endings, 700 Gentian, 225 Gentianin, 225 Gentopicrin, 225 Geranium, 64, 226 Gin, 86, 259 Ginger, 405 Glanders, 568 Glandular Enlargements, 568 Glass, Soluble, 366 Glauber’s Salt, 369 Glaucoma, 568 Gleet, 568 Glonoin, 98 Glossitis, 569 Glottis, CEdema of, 569 Gluco-pepsin, 303 744 INDEX, Glucose, 347 Glucosides, 407 Glycerin, 227 Preparations, 428 Glycerita, 428 Glycerite of Carbolic Acid, 60 of Tannin, 74 of Starch, 100 of Yolk of egg, 400 Glyceryl, 290 Trinitrate, 98 Glycocholate of Sodium, 214 Glycogen, 348 Agents affecting production, 40 Glyconin, 400 Emulsion of, 282 Glycyrrhetin, 228 Glycyrrhiza, 228 Glycyrrhizin, 228 Glycyrrhizinum Ammoniatum, 228 Gnoscopine, 292 Goa-powder, 174 Goitre, 569 Gold, 122 Double Chloride of, 704 Golden Seal, 246 Gonorrhoea, 570 Gossypii Radicis Cortex, 229 Gossypium, 229 Goulard’s Cerate, 318 Extract, 318 Gout, 572 Diagnosis of, 714 Granatum, 64, 230 Granular Lids.—See Conjunctivitis, Oph- thalmia. Granulation, 416 Granule, 463 Grass, Ribbed, 317 Gravel-root, 214 Graves’ Disease.—See Exophthalmos, 558 Gray Powder, 239 Griffith Mixture, 215 Pills, 215 Grindelia, 231 Guarana, 140, 233 Guaranine, 140, 233 Guaiac, 232 Lignum, 232 Resina, 232 Guaiacol, 191 Gum Arabic, 56 Gumboil.—See Gums, 573 Gum-tree, Blue, 212 Gums, 573 Gun-cotton, 229 Gunjah, 150 Gurjun Balsam, 233 Gutta, 234 Gutta-percha, 234 Guttse (Drops), 438 Gynocardia odorata, 161 Hair, 573 Hair-tonic, 573 Hair Washes, Formulae, 573 Haller’s Dictum, 19 Hamamelin, 234 Hamamelis, 64, 234 Hamburg Tea, 705 Hamlin’s Wizard Oil, 705 Hands.—See Chapped Hands, 513 Hashish, 150 Haustus, 459 Haw, Black, 399 Hay ah, 157 Hay-fever, 573 Haematics, 41 Haematoxylin, 235 Haematoxylon, 64, 234 Head-ache, Bilious Sick, 575 Congestive, 575 Nervous, 576 Heart, Fatty, 578 Dilated, 578 Diseases, 577 Hypertrophied, 578 Palpitation, 578 Valvular Disease, 579 Heartburn.—See Pyrosis, 653 Heart’s-ease, 399 Hectic Fever, 580 Hedeoma, 236 Helenin, 251 Hellebore, 236 American, 395 Swamp, 395 White, 396 Helleborein, 236 Helleborin, 236 Helleborus, 236 Hematemesis, 580 Diagnosis of, 715 Hematocele, Pelvic, 580 Hematuria, 581 Helmbold’s Buchu, 705 Hemeralopia, 581 Hemicrania, 582 Hemiopia, 583 Hemiplegia, 583 Hemlock, 186 Hemlock Spruce, 315 Hemoptysis, 583 Diagnosis of, 715 Hemorrhage, 584 Intestinal, 585 Post-partum, 585 Hemorrhagic Diathesis, 584 Hemorrhoids, 586 Hemostatics, 50 Hemp, 149 American, 149 Canadian, 107 Indian, 149 Henbane, 247 INDEX. 745 Hepar Sulphuris, 378 Hepatalgia, 587 Hepatic Abscess, 590 Congestion, 588 Cirrhosis, 587 Depressants, 40 Diseases, 589 Stimulants, 39 Vomiting, Diagnosis, 717 Hepatitis, 590 Hernia, 590 Herpes, 590 Zoster, 591 Hesperidin, 121, 266 Heuchera, 64 Hiccough, 591 Hip-joint Disease, 527 Hippocratic Oath, 724 Hive Mixture, 102, 360 Syrup, 102 Hives.—See Urticaria, 681 Hoang Nan, 237 Hoarseness.—See Aphonia, 490 Hoffman’s Anodyne, 79, 83 Hoff’s Malt Extract, 273 Holloway’s Pills, 705 Homatropine, 126 Honduras Bark, 157 Honey, 278 Clarified, 278 of Rose, 278, 343 Honeys (Mellita), 421 Hong-Pang-Chong, 337 Hooper’s Female Pills, 468 Hope’s Mixture, 537 Hop tree, 339 Hops, 238 Hordeolum.—See Eyelids, 559 Hordeum distichum, 273 Plorehound, 277 Horlick’s Food, 273 Hostetter’s Bitters, 705 Housemaid’s Knee.—See Bursitis, 504 Humulus, 238 Hunger.—See Appetite, 491 Hunyadi Water, 524 Huxham’s Tincture of Bark, 177 Hydragogue Purgatives, 38 Hydrangea, 239 Hydrargyrism, 242 Hydrargyrum, 239 Ammoniatum, 240 cum Creta, 239 Hydrastin, 246 Hydrastine, 246 Hydrastis, 246 Hydrate of Aluminium, 92 of Amyl, 87 of Amylene, 164 of Butyl-chloral, 168 of Chloral, 165 of Ethyl, 87 Hydrate of Magnesium, 271 of Methyl, 87 of Potassium, 322 of Sodium, 368 of Terpine, 385 Hydrated Oxide of Iron, 216 with Magnesia, 216 Hydrated Silicate of Magnesium, 360 Hydride of Amyl, 81 of Butyl, 81 of Ethyl, 81 Hydriodic Ether, 79, 83 Hydrobromate of Coniine, 186 of Hyoscine, 165, 248 of Quinine, 177 Hydrobromic Ether, 79, 82 Hydrocele, 592 Hydrocephalus, 592 Hydrochlorate of Apomorphine, 107 of Cocaine, 208 of Quinine, 177 Carbamide, 178 of Morphine, 293 of Narcotine, 294 of Oxy-ethyl-chinoline-hydride, 179. of Pilocarpine, 312 of Rosanilin, 222 Hydrocotarnine, 292 Hydrocotyle, 247 Hydrogen, Sulphuretted, 378 Peroxide, 385 Hydro-naphthol, 286 Hydrophobia, 592 Hydroquinone, 179, 180, 393 Hydrothorax, 593 Hygrine, 208 Hygroscopic Bodies, 4x6 Hyoscine, 165, 247 Hyoscyamus, 247 Hyoscyamine, 247 Hyperidrosis, 636 Hypnone, 165 Hypnotics, 27, 165 Hypochondriasis, 593 Hypodermic Formulae, 701 Hypodermic Injections, 22, 702 Hypophosphite of Calcium, 305 of Iron, 216, 305 of Potassium, 305 of Sodium, 305 Hypophosphites, 305 with Iron, Syrup of, 305 Hyposulphite of Sodium, 73 Hysteria, 593 Diagnosis of, 714 Ice, no Iceland Moss, 161 Ichthyocolla, 249 Ichthyol, 378 Ichthyosis, 594 746 INDEX Icterus.—See Jaundice, 601 Igasurine, 288 Ignatia, 250 Ignition, 412 Ileus.—See Intestinal Obstruction, 600 Ilex Paraguayensis, 140 Illicium, 250 Anisatum, 100 Impetigo, 594 Impotence, 595 Incineration, 412 Incompatibility, 448 Chemical, 448 Pharmaceutical, 448, 450 Rules for avoiding, 452 Therapeutical, 451 Indian Tobacco, 269 Indigestion.—See Dyspepsia, 544 Indigo, Wild, 125 Inflammation, 595 Influenza, 597 Infusa, 422 Infusion of Arnica, 115 of Brayera, 132 of Buchu, 137 of Cardamom, 155 of Caraway, 156 of Cascarilla, 158 of Cinchona, 177 of Cloves, 156 of Convallaria, 188 of Digitalis, 199 of Gentian, Compound, 226 of Hops, 238 of Jequirity, 55 of Juniper, 259 of Linseed, 268 of Lobelia, 269 of Pareira, 301 of Quassia, 331 of Sassafras, 358 of Senna, Compound, 364 of Spigelia, Compound, 372 of Tansy, 383 of Tar, 316 of Wild Cherry, 328 of Uva-ursi, 393 Infusions, 422 Ingluvin, 303 Inhalation of Thymol, 389 Inhalations, Formulae for, 477 Injection Brou, 462 of Morphine, Hypodermic, 294 Injections, 461 Formulae, 22, 462, 702 Injuries.—See Bruises, Burns, Ecchymosis, Fractures, Sprains, Wounds. Inoculation, 22 Inosit, 347 Insanity, 532 Insolation.—See sunstroke, 668 Insoluble Salts, 449 Insomnia, 598 Intemperance.—See Alcoholism, Delirium Tremens. Intermittent Fever, 598 Intertrigo, 600 Intestinal Astringents, 39 Intestinal Diseases.—See Colic, Constipa- tion, Diarrhoea, Duodenitis, Dysentery, Enteritis, Hemorrhoids, Hernia, In- testinal Obstruction, Intussusception, Typhlitis, Tabes Mesenterica, Worms. Intestinal Obstruction, 600 Parasites.—See Worms, 688 Intussusception, 600 Inula, 251 Inulin, 114, 251 Iodide of Ammonium, 94, 252 of Arsenic, 116 of Cadmium, 137 of Ethyl, 79 of Formyl, 252 of Iron, 216 Saccharated, 216 and Manganese, 218 of Lead, 317 of Manganese, 274 of Mercury, 240 Green, 240 Red, 240 of Potassium, 252 of Silver, 113 of Sodium, 252 of Sulphur, 378 of Zinc, 403 Iodides, 252 Iodine, 251 Iodism, 253 Iodized Cotton, 581 Phenol, 252 Starch, 252 Iodol, 252 Iodoform, 252 Iodum, 251 Ipecacuanha, 256 Iridin, 257 Iris, 257 Irish Moss, 174 Irisin, 257 Iritis, 601 Iron, 215 Dialysed, 217, 417 Pills, 468 and Tannic Acid, 453 Irritability, 601 Irritants, Cutaneous, 49 Ischuria.—See Urinary Disorders. Isonandra Gutta, 234 Iso-naphthol, 286 Itch.—See Scabies, 659 Itching.—See Lichen, Prurigo, Pruritus, Pediculi, Scabies, Urticaria, etc. Ivy, Poison, 338 INDEX, 747 Jaborandi, 311 Jaborine, 311 Jalap, 258 Jalapin, 258, 359 James’ Powder, 102 Jamestown Weed, 374 Japaconitine, 76 Jasmine, Yellow, 224 Jateorrhiza Calumba, 145 Jaundice, 601 Jequirity, 55 Jervine, 396 Joint Affections, 602 Juglans, 259 Juniperin, 259 Juniper, 259 Juniperus communis, 259 Sabina, 346 Virginiana, 346 Kairine, 179 Kairoline, 179 Kalium, 322 Kalmia latifolia, 279 Kamala, 260 Kavahin, 261 Kava-kava, 261 Kawin, 261 Kefir, 263 Keratitis, 603 Kidneys, Diseases of.—See Albuminuria, Bright’s Disease, Calculi, Diabetes, Dropsy, Hematuria, Lithsemia, Ne- phritis. Kino, 64, 261 Kinoin, 261 Kino-red, 261 Kinovate of Calcium, 177 Kinovin, 177 Komb6 arrow-poison, 375 Koussin, 132 Kousso, 132 Krameriaj 64, 261 Kumyss, 86, 262 Kurung Oil, 321 Labarraque’s Solution, 51, 172 Labor, 603, 719 Positions in, 719 Signs of, 719 Lac Sulphuris, 378 Lactate of Iron, 216 Lactation, 604 Lactopeptine, 303 Lactophosphate of Calcium, 305 Lactose, 348 Lactuca virosa, 263 Lactucerin, 263 Lactucin, 263 Lactucarium, 263 Ladies’ Slipper, 197 La Fayette’s Mixture, 189 Lallemand’s Specific, 572 Lanolin, 263 Lanthopine, 292 Lapathin, 344 Lappa, 264 Larch, 83 European, 83, 385 Lard, 78 Benzoinated, 78 Oil, 78 Larix Europsea, 385 Laryngismus Stridulus, 604 Laryngitis, 605 Laryngotomy, 606 Latin Phrases and Terms, 691, 700 Laudanine, 292 Laudanosine, 292 Laudanum, 292 Laurel, Mountain, 279 Laurocerasus, 67 Lavandula, 264 Lavender, 264 Water, 265 Laville’s Anti-gout Remedy, 185, 656, 705 Laxatives, 38 Powder, 472 Lead, 317 Colic, 519 Plaster, 318 Sugar of, 317 Water, 318 and Laudanum, 460 White, 317 Leek, 89 Legal’s Disease, 624 Lemon, 266 Juice, 266 Peel, 266 Lentigo.—See Freckles, 563 Leopard’s Bane, 114 Leprosy, 606 Leptandra, 265 Leptandrin, 265 Lettuce, 263 Leucocythmmia, 606 Leucoline, 163 Leucoma.—See Corneal Opacities, 525 Leucorrhoea, 607 Levigation, 413 Levulose, 347 Lice.—See Pediculi, 633 Lichen, 607 Lichenin, 161 Licoperdon giganteum, 265 Lignum Vitae, 232 Lily-of-the Valley, 187 Lily, Water, 290 Lime, 143, 144, 266 748 INDEX. Lime, Chlorinated, 172 Sulphurated, 378 Water, 144 Limon, 266 Limonis Cortex, 266 Succus, 266 Linimenta, 427, 460 Liniment, Aconite, 76 Ammonia, 93 Anodyne, 461 Army, 561 Belladonna, 126 Camphor, 147 Cantharides, 151 Chloroform, 169 Compound, 169, 461 Croton, 391 Lead Subacetate, 318 Lime, 144 Mustard, Compound, 367 Soap, 357 Stokes’, 461 Turpentine, 384 Liniments, Formulae for, 461 Linseed, 267 Linum, 267 Lips.—See Chapped Lips, 513 Lip-salve, Red, 388 Liquid-ambar orientalis, 376 Liquids, Normal, 424 Liquores (See Solution of), 420 Liquorice Root, 228 Wild, 55 Lithaemia, 608 Litharge, 318 Lithium, 268 Lithontriptics, 45 Liver.—See Hepatalgia, etc., 587 Liver of Sulphur, 378 Lixiviation, 417 Lobelacrin, 269 Lobelia, 269 Lobelin, 269 Lobeline, 269 Lochia.—See Labor and Puerperal Disor- ders, 603, 651 Lock-jaw.—See Tetanus, 671 Locomotor Ataxia, 608 Log-wood, 64, 234 Lotion, 460 Black, of Mercury, 241 Yellow, of Mercury, 241 Loxopterygium Lorentzii, 332 Lozenges, 431, 469 Lugol’s Solution, 252 Lumbago, 609 Lumbrici.—See Worms, 688 Lungs, Diseases of, 609 Gangrene of, 610 Lupulin, 238 Lupuline, 238 Lupus, 610 Lycopodium, 270 Lyctonine, 76 Lymphangeitis, 611 Mace, 285 Oil of, 285 Maceration, 417 Macis, 285 Macrotin, 175 Magendie’s Solution, 294 Magenta, 222 Magma, 415 Magnesia, 271 Ponderosa, 271 Magnesium, 271 Magnolia, 273 Magnolin, 273 Maize, 402 Malaria, 611 Male Fern, 121 Mallotus phillipinensis, 260 Malt, 273 Extract, HofPs, 273 Maltum, 273 Mammary Abscess, 481 Manaca, 274 Mandrake, 320 Manganese, 274 Oxide, 274 Manganum, 274 Mangifera indica, 276 Mango, 276 Mango-fruit, 276 Mangosteen, 276 Mania, 612 Puerperal, 652 Manna, 276 Mannit, 276 Manzanita, 393 Marasmus. — See Atrophy, Emaciation, Tabes Mesenterica. Marc, 423 Marginal Shield Fern, 121 Marigold, 145 Marjoram, Wild, 300 Marrubiin, 277 Marrubium, 277 Marsh-mallow, 91 Mass of Copaiba, 189 of Ferrum Carbonate, 215 of Mercury, 239 Massse, 430 Mastic, 277 Mastiche, 277 Mastichin, 277 Mastitis, 612 Mastodynia, 613 Masturbation.—See Emissions, Spermator- rhoea, 550, 664 Mate, 140 INDEX, 749 Materia Medica, 17, 55 Matico, 277 Matricaria, 278 Chamomilla, 278 May Apple, 320 McMunn’s Elixir of Opium, 293 Meadow Anemone, 328 Saffron, 184 Measles, 613 Diagnosis of, 715 False.—See Roseola, 659 Measures, Approximate, 438 Domestic, 438 and Weights, 435, 726 Meconidine, 292 Meconoiosin, 292 Meconin, 292 Medicines, Administration of, 20 Classification of, 23 Meerschaum, 367 Mel, 278 Despumatum, 278 Rosae, 278 Melaleuca Cajuputi, 142 Melancholia, 614 Puerperal, 652 Melia Azedarach, 123 Melissa, 278 Mellin’s Food, 273 Mellita, 421 Meningitis, Cerebral, 614 Cerebro-spinal, 615 Spinal, 615 Tubercular.—See Hydrocephalus, 592 Menispermin, 279, 310 Menispermum, 279 Cocculus, 310 Menopause.—See Climacteric, 5x8 Menorrhagia, 616 Menstrual Disorders, 617 Menstruum, 417 Mentagra, 617 Mentha Piperita, 279 Viridis, 280 Menthol, 280 Mercurial Ointment, 239 Plaster, 239 Mercuric Chloride, 239 Iodide, 240 Mercurio-vegetal, 274 Mercurous Chloride, 240 Iodide, 240 Mercury, 239 Ammoniated, 240 with Chalk, 239 Mesenteric Disease.—See Tabes Mesen- terica, 670 Metabolism, Agents affecting, 41 Meta-dihydroxy-benzene, 334 Methane, 81 Methene Chloride, 81 Methyl Alcohol, 81 Methyl Bromide, 81 Chloride, 170 Bichlorinated, 168 Coniine, 186 Creasol, 191 Ether of Protocatechuic Aldehyde, 39? Hydrate, 87 Salicylate, 224 Terchloride, 168 Methylal, 166 Methylene Bichloride, 170 Methylic Alcohol, 87 Ether, 81 Methysticin, 261 Metric Prescriptions, 437 System of Weights, etc., 436 Table for Converting, 727 Metritis, Acute, 617 Metrorrhagia, 617 Mezereon, 281 Mezereum, 281 Microbe-killer, 706 Migraine, 582 Miliary Fever, 618 Milk.—See Agalactia, Lactation. Milk Fever.—See Lactation, 604 Mindererus, Spirit of, 94 Mineral Waters, 109 Mint, 279 Miscarriage.—See Abortion, 480 Mistletoe, 400 Misturas, 421, 453 Mixture, Almond, 97 Ammoniac, 93 Asafetida, 119 Bismuth, 457 Chalk, 143 Chloroform, 169 Copaiba, Compound, 189 Coxe’s Hive, 102, 360 Ferro-saline, 218 Gentian, Alkaline, 226 and Senna, 226 Iron, Aromatic, 218 and Ammon. Acetate, 217 Iron, Compound, 215 Iron, Laxative, 218 Laville’s, 185, 656 Liquorice, Compound, 228 Magnesia and Asafetida, 119, 272 Neutral, 323 Quinine, 455, 457 Potassium Citrate, 323 Rhubarb and Soda, 336 Mixtures, 421, 453 Compounding of, 456 Substances suitable to, 454 Moccasin-plant, 197 Molasses, 348 Mole.—See Naevus, 619 Mollities Ossium —See Bone Diseases, Rachitis, 497, 653 750 INDEX Monoxide of Carbon, 81 Monsel’s Solution, 216 Moonseed, Canadian, 279 Morbilli.—See Measles, 613 Morphine, 293 and Atropine, 299, 702 Habit, 628 Morrhuse Oleum, 282 Morrison’s Pills, 146, 705 Moschus, 283 Mosquitoes, 667 Motor Depressants, 24 Excitants, 24 Mouth Diseases.—See Aphthae, Cancrum Oris, Gums, Parotitis, Ptyalism, Stom- atitis, Toothache, Tongue. MouthWashes, Formulae, 573 Mucilage of Acacia, 56 of Cydonium, 197 of Elm, 392 of Sassafras-pith, 358 of Tragacanth, 391 Mucilagines, 421 Mullein, 398 Mumps, 634 Muriate —See Hydrochlorate, of Berberine, 130 of Cocaine, 208 Muscae Volitantes, 618 Muscarine, 84 Muscular Disorders.—See Atrophy, Cho- rea, Hydrophobia, Laryngismus, Lum- bago, Myalgia, Pleurodynia, Rheum- atism, Tetanus, Torticollis. Musk, 283 Mustard, 367 Black, 367 Flour of, 367 Oil of, 367 White, 367 Myalgia, 618 Mydriasis, 127 Mydriatics, 28 Myelitis, 618 Mykose, 204 Myopia, 619 Myotics, 29 Myrcia, 284 Myrica, 64 cerifera, 160 Myricin, 160 Myristica, 284 Myristicol, 285 Myronate of Potassium, 367 Myrosin, 367 Myroxylon toluifera, 124 Pereirae, 124 Myrrh, 285 Myrrhin, 286 Myrrhol, 286 Myrtle, 64 Myrtol, 503 Naevus, 619 Nails, Ingrowing, 619 Napelline, 76 Naphthaline, 179, 286 Naphthol, 286 Narceine, 292 Narcotics, 26 Narcotine, 292 Nasal Affections, 619 Injections, Formulae, 539 Natrium, 368 Nausea, 620 Necrosis, 620 Nectandra, 301 Nervous Affections, 620 Exhaustion, 621 Nervousness, 621 Nervous System, Agents affecting, 24 Neuralgia, 622 Ovarian, 631 Neutral Mixture, 323 Nicotiana Tabacum, 381 Nicotianin, 381 Nicotine, 381 Nightshade, Black, 203 Deadly, 125 Woody, 203 Night-mare, 625 Night Sweats.—See Hectic Fever, Per.-pl ration, Phthisis. Nipples, Sore, 625 Fissured, 625 Nitrate of Ammonium, 94 of Iron, 216 of Lead, 317 of Mercury, 240 of Muscarine, 84 of Potassium, 323 of Silver, 112 Fused, 112 of Sodium, 369 Nitre, 323, 369 Chili, 369 Sweet Spirit of, 79 Nitrite of Amyl, 98 of Ethyl, 79, 98 of Potassium, 98 of Sodium, 98 Nitro-benzene, 179 Nitro-benzol, 97 Nitro-glycerin, 98 Nitrous Ether, 79, 82 Oxide, 81 Nodes, 625 Normal Liquids, 424 Norwood’s Tincture, 396 Norway Spruce, 315 Nucin, 259 Nutgall, 64, 223 Nutmeg, 284 Nux Vomica, 287 Nyctalopia, 581 INDEX. 751 Nymphsea, 64 Odorata, 290 Nymphomania, 625 Oak-bark, 64, 332 Black, 333 Oak, Dyer’s, 223 Poison, 338 White, 332 Oat, 123 Obesity, 626 Obstetrical Memoranda, 719 Odontalgia, 626 (Esophagus, Affections of, 627 Official Operations, 410 Preparations, 419 Officinal.—See Preface. Oil of Allspice, 313 of Almond, Bitter, 98 Expressed, 98 of Amber, 377, 385 of Anise, 101 of Anthemis, 101 of Aurantium Cortex, 122 Flores, 122 of Bay, 284 Benne, 366 of Bergamot, 131 of Cade, 259 of Cadinum, 259 of Cajuput, 142 of Caraway, 156 of Carum, 156 Carron, 144, 268 Castor, 340 of Caryophyllus, 156 of Cedar, 354 Chaulmoogra, 161 of Chenopodium, 162 of Cinnamon, 183 of Cloves, 156 Cod-liver, 282 of Copaiba, 189 of Coriander, 190 of Cotton-seed, 229, 290 Croton, 390 of Cubeb, 193 of Erigeron, 207 Ethereal, 79 of Eucalyptus, 212 of Fennel, 221 of Gaultheria, 223 of Gossypium-seed, 229, 290 of Hedeoma, 236 of Hemlock, 316 of Juniper, 259 Kurung, 321 Lard, 78 of Lavender, 265 Flowers, 265 Oil, of Lemon, 266 of Linseed, 267 of Linum, 267 of Mace, 285 of Mentha Piperita, 280 of Mentha Viride, 281 of Mirbane, 97 of Morrhua, 282 of Mustard, Volatile, 367 of Myrcia, 284 of Myristica, 285 of Neroli, 122 of Nutmeg, 285 Olive, 290 of Orange-flowers, 122 of Orange-peel, 122 of Origanum, 300 of Pennyroyal, 236 of Pepper-mint, 280 Phosphorated, 304 of Pimenta, 3x3 of Pinus Sylvestris, 316 of Pix Liquida, 315 of Pongamia, 321 of Ricinus, 340 of Rose, 342 of Rosemary, 343 of Rue, 345 of Ruta, 345 of Sabina, 346 Salad, 290 of Sandalwood, 354 of Santal, 354 of Sassafras, 358 of Scotch Fir, 316 of Sesamum, 366 of Sinapis, Volatile, 367 of Spearmint, 281 of Spruce, 316 Sweet, 290 of Succinum, 377, 385 of Tabacum, 381 of Tanacetum, 383 of Tansy, 383 of Tar, 315 of Terebinthina, 384 of Theobroma, 387 of Thuja, 385, 388 of Thyme, 389 of Tiglium, 390 of Turpentine, 384 of Valerian, 394 of Wintergreen, 223 Wood, 233 Oils, Expressed, 417 Fixed, 417 Ointment, 160 Basilicon, 334 Belladonna, 126 Boracic, 59 Calamine, 405 Carbolic Acid, 60 752 INDEX. Ointment, Chrysarobin, 174 Citrine, 240 Diachylon, 318 Gallic Acid, 63 Gall, 223 Hamamelis, 235 Iodine, 252 Iodoform, 252 Lead Carbonate, 318 Iodide, 318 Mercurial, 239 of Mercury, Ammoniated, 240 Nitrate, 240 Red, 241 Oxide, Red, 240 Yellow, 240 Mezereum, 281 Nutgall, 223 Petroleum, 304 of Pix Liquida, 316 of Potassium Iodide, 252 of Rose-water, 342 of Staphisagria, 372 Stramonium, 374 Sulphur, 378 Alkaline, 378 of Tannic Acid, 74 Tar, 316 Thymol, 389 Veratrine, 396 White Precipitate, 240 Witch-hazel, 235 of Zinc Oxide, 403 Ointments, 432, 475 Compounding, 475 Formulae for, 476 Olea Europsea, 290 Oleaginous Preparations, 427 Oleata, 71, 428 Oleate of Aconitine, 71, 76 of Aluminium, 71 of Arsenic, 71 of Atropine, 71 of Bismuth, 71 of Cocaine, 208 of Copper, 71 of Iron, 71 of Lead, 71, 318 of Mercury, 71, 240 of Morphine, 71, 294 and Mercury, 71 of Quinine, 71 of Silver, 71 of Strychnine, 71 of Veratrine, 71, 396 of Zinc, 71 Oleates, 71, 428 Olein, 290 Oleoresina, 427 Oleoresin of Aspidium, 121 of Capsicum, 153 of Cubeb, 193 Oleoresin of Lupulin, 238 of Pepper, 314 of Zingiber, 406 Oleoresins, 427 Onion, 89 Onychia, 627 Operations, Official, 410 Ophelia Chirata, 164 Ophthalmia, 627 Opisthotonos.—See Tetanus, 671 Opium, 291 Denarcotized, 292 Habit, 628 Opodeldoc, 357 Orange, 121, 266 Blossom, 705 Orchitis, 630 Ordeal Bark, 157 Origanum, 300 Otalgia, 630 Otitis, 630 Otorrhoea, 631 Ovarian Neuralgia, 631 Tumors.—See Cysts, 531 Ovaritis, 631 Ovis Aries, 366 Oxalate of Cerium, 161 of Iron, 216 Oxaluria, 632 Ox-gall, 214 Oxide of Antimony, 102 of Calcium, 143 of Ethyl, 78 of Iron, Hydrated, 216 with Magnesia, 216 of Lead, 318 of Magnesium, 271 of Manganese, Black, 274 of Mercury, Red, 240 of Mercury, Yellow, 240 of Propyl, 282 of Silver, 113 of Zinc, 403 Oxidizers, 450 Oxy-benzene, 60 Oxymel, 279, 421 Oxytocics, 48 Oyster-shell, 143 Ozaena, 632 Pagliari’s Styptic, 585 Pain, 632 Chest, 513 Gastric, 37 Pains, False, 559 Paints, 477 Palmitate of Cetyl, 161 Palmitin, 290 Pan coast’s Styptic, 585 Pancreas, Agents affecting, 40 INDEX, 753 Pancreatin, 300 Pancreopepsin, 303 Pannus.—See Corneal Opacities, 525 Pansy, 399 Papain, 300 Papaiva, 300 Papaver Somniferum, 291 Papaverine, 292 Papaw Milk, 301 Paper of Cantharides, 151 of Mustard, 367 of Potassium Nitrate, 323 Papers (Chartre), 434 Papine, 293 Parachinanisols, 179 Paraconii'ne, 186 Paracoto Bark, 191 Paracotoin, 191 Paraldehyde, 166, 301 Paralysis, 633, 665 Paramenispermin, 310 Paramorphine, 292 Paraphimosis.—See Phimosis, 639 Paraplegia.—See Paralysis, 633 Parasiticides, 52 Paregoric, 293 Pareira, 301 Parigenin, 357 Parillin, 357 Paris Green, 117, 709 Paronychia, 627 Parotitis, 634 Parsley, 106 Parrish’s Chemical Food, 305 Participles, 700 Parvule, 463 Paste, Black, 571 Pastilles, 431, 469 Pasque-flower, 328 Patent Medicines, 704 Paullinia curare, 196 Paullinia sorbilis, 233 Pearson’s Solution, 116 Pectin, 332 Pediculi, 635 Pelletierine, 230 Pellitory, 330 Persian, 330 Pelosine, 301 Pelvic Diameters, 720 Pemphigus, 635 Pencils, 474 Penis.—See Chancre, Chancroid, Chordee, Gleet, Gonorrhoea, Phimosis, Urethra. Pennyroyal, 236 Pennywort, 247 Pepo, 302 Pepper, Black, 313 Cayenne, 153 Water, 321 Peppermint, 279 Pepsin, 302 Pepsin, Liquid, 303 Saccharated, 303 Pepsinum, 302 Peptogenic Milk Powder, 303 Perchloride of Iron, 215 Percolation, 417 Pericarditis, 635 Diagnosis of, 713 Periostitis, 636 Peritonitis, 636 Puerperal, 652 Permanganate of Potassium, 274 Pernicious Fever.—See Intermittent Fever, Remittent Fever. Peroxide of Hydrogen, 385 Perry Davis’s Pain-Killer, 705 Persimmon, 64 Perspiration, 636 Pertussis, 637 Peruvian Bark, 176 Petrolatum, 304 Petroleum Ether, 128 Ointment, 304 Petroselinum sativum, X06 Peumus Boldo, 132 Phseoretin, 336 Phagedena.—See Chancre, Chancroid, Gangrene, Ulcers. Pharmaceutical Incompatibility, 448, 450 Rules, 447 Pharmaceutists.—Their objectionable prac- tices, 444 Pharmacology, 17 Pharmacopoeias, List of, 407 Pharmacy, 17, 407 Extemporaneous, 434 Official. 410 Rules for neophytes, 447, 452 Pharyngitis, 638 Phaseo-mannit, 347 Phenacetine, 180 Phenol, 60, 179 Iodized, 252 Salicyl, 350 Sodique, 60 Pheno-resorcin, 180 Phenyl-acetamide, 57 Phenylic Alcohol, 60, 179 Phimosis, 639 Phlebitis, 639 Phlegmasia Alba Dolens, 639 Phlegmon, 640 Phlorol, 191 Phosphate of Ammonium, 94 of Calcium, Precipitated, 305 of Iron, 216 of Iron and Manganese, 218 of Sodium, 305 Phosphates, 304 Syrup of the, 305 Phosphide of Zinc, 305 Phosphites, 304 754 INDEX, Phosphorus, 304 Photophobia, 640 Phthisis, 640 Diagnosis of, 715 Physeter macrocephalus, 161 Physiological Antagonists, 451 Physostigma, 307 Physostigmine, 307 Phytolacca, 309 Pichi, 310 Picraena excelsa, 330 Picrates, 72 Picroglycion, 203 Picropodophyllin, 320 Picrotoxin, 310 Pierce’s Favorite Prescription, 705 Golden Discovery, 706 Pigmenta, 477 Piles, 586 Pill of Aloes, 90 of Aloes and Asafetida, 90, 119 of Aloes and Iron, 90 of Aloes and Mastic, 90 of Aloes and Myrrh, 90 of Antimony, Compound, 102 of Asafetida, 119 Blue, 239 Compound Cathartic, 185 of Galbanum Comp., 119,223 of Iodide of Iron, 216 of Iron, Compound, 215 Lady Webster’s, 90 of Mercury, 239 of Opium, 292 of Phosphorus, 304 of Rhubarb, 336 of Rhubarb, Compound, 336 Tanjore, 667 Pill-masses, 430, 463 Pills, 430, 462 Coated, 466 Compressed, 467, 469 Excipients for, 463 Formulae for, 468 Process of making, 463 Official, 430 Substances suitable for, 465 Pilocarpine, 311 Pilocarpus, 311 Pilulae, 430, 462 Pimenta, 313 Pimpinella Anisum, 100 Pimples.—See Acne, 482 Pine, Prince’s, 163 Yellow, 384 Pines, 315 Pinipicrin, 388 Pinites Succinifer, 377, 385 Pink, Carolina, 372 Pink-root, 372 Pinus, 315 Australis, 384, 385 Pinus, Palustris, 315 Sylvestris, 316 Taeda, 385 Piper, 313 angustifolium, 277 methysticum, 261 Piperine, 314 Pipsissewa, 162 Piscidia, 314 Piscidin, 314 Pissenlit, 383 Pistaceae Terebinthus, 384 Pistacia Lentiscus, 277 Pitch, 315 Burgundy, 313 Canada, 315 Hemlock, 315 Pityriasis, 642 Fix, 315 Pix Liquida, 315 Planat’s Tincture, 310 Plantago, 317 Plantain, 317 Plaster Adhesive, 334 Ammoniac, 93 with Mercury, 93 Arnica, 115 Asafetida, 119 Belladonna, 126 Capsicum, 153 Carbolic Acid, 60 Diachylon, 318 Galbanum, 223 Ichthyocolla, 249 Iron, 216 Lead, 318 Mercurial, 239 Opium, 293 Pitch, Burgundy, 316 Pitch with Cantharides, 151, 316 Pitch, Canada, 316 Resin, 334 Soap, 357 _ Strengthening, 216 Warming, 316 Plasters, 433, 476 Formulae for, 476 Preparation of, 433 Plethora, 643 Abdominal, 480 Pleurisy, 643 Diagnosis of, 715 Pleurisy root, 120 Pleuritis, 643 Pleurodynia, 644 Pleuro-pneumonia, 644 Plum, 327 Plumbum, 317 Plummer’s Pills, 102 Pneumonia, 644 Diagnosis of, 715 Podophyllin, 320 INDEX, 755 Podophyllitoxin, 320 Podophyllum, 320 Poison Ivy, 338 Oak, 338 Sumach, 338 Poisoning by Acids, 66 Acid, Acetic, 708 Arsenious, 118, 708 Carbolic, 61, 708 Chromic, 63 Gallic, 64 Hydrocyanic, 68, 708 Mineral, 66, 708 Oxalic, 708 Sulphuric, 708 Sulphurous, 73 Tannic, 74 Aconite, 76, 708 Agaricus, 84 Alcohol, 88, 708 Alkalies, 370, 708 Alum, 708 Ammonia, 95, 708 Antimony, 103, 708 Arsenic, 118, 708 Atropine, 127, 709 Barium, 709 Be;s, 709 Belladonna, 127, 709 Bromides, 134 Camphor, 148, 709 Cannabis Indica, 150, 709 Cahtharis, 152, 709 Chloral, 167, 709 Chlorine, 172, 709 Chloroform, 81, 170, 709 Cinchona, 181 Cocaine, 210 Cocculus Indicus, 311, 710 Colchicum, 184, 709 Conium, 186, 709 Copper, 195, 709 Creasote, 709 Curare, 196 Cyanide of Pot., 68 Digitalis, 200, 709 Duboisine, 202 Ergot, 206 Ether, 81 Fish, 709 Gamboge, 709 Gas, Carbonic Acid, 709 Sulphuretted Hydrogen, 709 Gelsemium, 225, 709 Glass, 709 Gold Salts, 123, 709 Hyoscyamus, 249, 709 Insects, 709 Iodine, 253, 709 Ipecacuanha, 256 Iron, 709 Lead, 319, 709 Poisoning by Lime, 144, 710 Lobelia, 270 Mercury, 244, 710 Mezereum, 710 Muscarine, 84 Morphine, 297, 710 Mushrooms, 710 Nitrites, 99 Nux 289, 711 Oak or Ivy, 339 Opium, 297, 710 Phosphorus, 306, 710 Physostigma, 308, 710 Picrotoxin, 311, 710 Pilocarpine, 312 Potassa, 324 Potassium Salts, 324, 7x0 Pulsatilla, 329 Quinine, 181, 710 Reptiles, 400, 710 Resorcin, 334 Rhus, 339, 711 Sanguinaria, 353 Silver Salts, 113, 711 Snakes, 400 Sodium, 370 Stramonium, 374, 711 Strychnine, 289, 711 Sulphites, 73 Sulphur, 378 Sulphuretted Hydrogen, 379 Sumach, 339 Tin, 711 Tobacco, 382, 711 Turpentine, 386 Vegetable Poisons, 711 Veratrum Viride, 397, 7x1 Zinc Salts, 404, 711 Poisoning, 52, 707 Antidotes and Antagonists, 53 Indications for Treatment, 53 General Principles, 707 Poisonous Compounds, 450 Poisons, Energetic, 707 Poke-berry, 309 Poke, Indian, 395 Poke-root, 309, 395 Polygala Senega, 363 Polygonum Hydropiperoides, 321 Polyporus fomentarius, 83 Polypus, 645 Polyuria.—See Diabetes Insipidus, 534 Pomade de Bareges, 643 Pomegranate, 64, 230 Pond’s Extract, 235 Pond Lily, 64 Pongamia, 321 Poppy, White, 291 Porphyrization, 413 Porphyroxine, 292, 353 Porrigo Capitis.—Tinea Tonsurans, 673 Porter, 86 756 INDEX, Port Wine, 86 Potassa, 322 Alum, 91 cum Calce, 322 Sulphurata, 378 Potassio Cupric-Tartrate, 194 Potassium, 322 Potato, 203 Potentilla Sarmentosa, 636 Potus, 459 Poultices, 477, 646 List of Br. official, 477 Powder of Aloes and Canella, 90 Antimonial, 102 Aromatic, 183 Chalk, Compound, 143 Dover’s, 256 Effervescing, Comp., 323 Gray, 239 Ipecac and Opium, 256, 293 Jalap, Compound, 258 James’, 102 Kino, Compound, 261 Liquorice, Compound, 228, 364 Morphine, Compound, 293 Opium, 292 Rhubarb, Compound, 336 Seidlitz, 323 Tullo’s, 293 Powders, 431, 470 Formulae for, 472 Substances suitable to, 471 Precipitant Solutions, Table of, 449 Precipitate, White, 240 Precipitation, 415 Pregnancy, Disorders of, 646 Signs of, 719 Vomiting of, 686 Premna tatiensis, 391 Preparations, Acetous, 428 Alcoholic, 423 Aqueous, 419 Ethereal, 427 Extemporaneous, 453 Gaseous, 477 Glycerin, 428 Liquid, 453 Official, 419 Oleaginous, 427 Solid, 428, 462 Prepositions, 700 Prescriptions, 439 Analysis of, 439 Blanks for, 443 Filling of, 445 Metric, 437 Renewals, 444 Tonic, 484, 488, 622 Prescription Writing, 442 Latin Words used in, 691 Prickly Heat.—See Lichen, 607 Prince’s Pine, 162 Prinos, 327 Proctitis.—See Rectum, 654 Prolapsus Ani, 647 Uteri, 647 Pronunciation, 699 Propyl Oxide, 282 Propylamine, 1x5 Prosopalgia.—See Neuralgia, Odontalgia, Tic Douloureux. Prostate, Hypertrophied, 647 Prostatitis, 647 Prostatorrhoea, 647 Protectives, 51 Protiodide of Mercury, 240 Protopine, 292 Prune, 327 Prunum, 327 Prunus domestica, 327 Laurocerasus, 67 serotina, 327 Virginiana, 327 Prurigo, 648 Pruritus, 648 Pseud aconitine, 76 Pseudo-jervine, 396 Pseudo-morphine, 292 Pseudotropine, 247 Psoriasis, 649 Ptelea trifoliata, 339 Pterocarpus marsupium, 261 santaiinus, 354 Pterygium, 650 Ptosis, 650 Ptyalism, 650 Puccine, 353 Puerperal Convulsions, 650 Disorders, 651 Fever, 651 Mania, 652 Melancholia, 652 Peritonitis, 652 Puff-ball, 265 Pulmonary Sedatives, 31 Pulsatilla, 328 Pulse, 652 Pulveres, 431, 470 Pulverization, 413 Pumpkin-seed, 302 Punica Granatum, 230 Purgatives, 38 Purging Agaric, 83 Cassia, 158 Purpura, 652 Pustule, Malignant, 653 Pustules.—See Ecthyma, Eruptions, Im- petigo, Pustule Malignant. Pustulants, 49 Pyaemia, 653 Pyrethrine, 330 Pyrethrum, 330 Roseum, 330 Pyridine, 179, 381 INDEX. 757 Pyrocatechin, 179, 180 Pyrogallol, 63, 179 Pyrol, 252 Pyrophosphate of Iron, 216 of Sodium, 305 Pyrosis, 653 Pyroxylin, 229 Quassia, 330 Surinam, 330 Quassin, 330 Quebrachine, 331 Quebracho, 331 Queen’s Delight, 373 Root, 373 Quercin, 332 Quercitrin, 333 Quercus Alba, 64, 332 Lusitanica, 223, 333 Tinctoria, 333 Quicksilver, 239 Quillaia, 333 Quince-seed, 197 Quinetum, 178 Quinicine, 179 Quinidine, 177 Quinine, 177 Mixture, 457 Quinoidin, 178 Quinquinine, 178 Quinsy.—See Tonsillitis, 674 Rabies.—See Hydrophobia, 592 Rachitis, 653 Radam’s Microbe-killer, 706 Rad way’s Ready Relief, 706 Resolvent, 706 Raspail’s Eau Sedative, 94, 147 Raspberry, 344 Recamier Balm, etc., 704 Rectum, Absorption by, 20 Diseases of, 654 Ulceration of, 654 Red Gum.—See Strophulus,‘668 References and Bibliography, 479 Refrigerants, 35 Relapsing Fever, 654 Remittent Fever, 655 Diagnosis of, 717 Renal Depressants, 44 Renewals of Prescriptions, 444 Repercolation, 418 Resin, 334, 385 Cerate, 334 of Copaiba, 189 of Jalap, 258 Plaster, 334 of Podophyllum, 320 Resin of Scammony, 359 Resina, 334, 385 Resinae, 430 Resolvents, 42 Resorcin, 61, 179, 334 Respiration.—See Bronchitis, Croup, Dysp- noea, Emphysema, Pneumonia, etc. Respiration, Agents affecting, 30 Artificial, 721 Respiratory Depressants, 30 Stimulants, 30 Restoratives, 41 Retina, Affections of, 655 Rhamnoxanthin, 221 Rhamnus Frangula, 221 Purshiana, 158 Rhaphidophora vitiensis, 391 Rhatanine, 262 Rhatany, 64, 261 Rheum, 336 Rheumatic Arthritis, 655 Rheumatism, Acute, 656 Chronic, 657 Diagnosis of, 714 Gonorrhoeal, 659 Muscular, 659 Rhinacanthin, 337 Rhinacanthus, 337 Rhinitis.—See Catarrh, Acute Nasal, also Nasal Affections. Rhoeadine, 292 Rhubarb, 336 Rhus Aromatica, 337 diversiloba, 339 glabra, 338 pumila, 339 radicans, 338 \ Toxicodendron, 338 venenata, 339 Ricinus communis, 340 Rickets.—See Rachitis, 653 Rigors.—See under Fever, 560 Ring-worm, 673 Roasting, 412 Rochelle Salt, 323 Rosa centifolia, 342 Damascena, 342 Gallica, 64, 342 Rosanilin, 222 Rose, 64, 342 Attar of, 342 Cabbage, 342 Pale, 342 Red, 64, 342 Roseine, 222 Rosemary, 64, 343 Roseola, 659 Rosin, 334 Rosmarinus, 343 Rottlera, 260 tinctoria, 260 Rottlerin, 260 758 INDEX, Rubefacients, 49 Rubeola.—See> Measles, 6x3 Rubijervine, 396 Rubini’s Tincture, 147 Rubus, 64, 343 Canadensis, 343 Idaeus, 344 occidentalis, 344 trivialis, 343 strigosus, 344 villosus, 343 Rue, 345 Rules for Incompatibility, 452 for Pharmaceutists, 447 Rum, 86 Bay, 284 Rumex, 344 Rumicin, 344 Rupia.—See Pemphigus, 635 Ruta, 345 Russian Spirit, 658 Rye, 204 Sabadilla, 396 Sabina, 346 Saccharine, 347 Saccharum, 347 Lactis, 348 Sacred Bark, 158 Safflower, 193 Saffron, 192 American, 182 Meadow, 184 Saffron-tea, 192 Sage, 352 Sage’s Catarrh Remedy, 706 Salicin, 349 Salicylate of Cinchonidine, 178 of Cocaine, 208 of Lithium, 298, 349 of Methyl, 224 of Phenol, 350 of Physostigmine, 308, 349 of Sodium, 349 Saligenin, 349 Saline Mineral Waters, 109 Purgatives, 38 Salipyrin, 350 Saliva, Agents affecting, 35 Salivation, 35, 242, 650, 710 Salix, 349 Salol, 350 Salt, common, 369 Epsom, 271 Glauber’s, 369 Rochelle, 323 Salt-petre, 323 Chili, 369 Salt-rheum.—See Eczema, 547 Salts, Deliquescent, List of, 466 Salts, Efflorescent, List of, 466 Salve, Red Lip, 388 Salvia, 352 Salviol, 352 Sambucus, 352 Sandal-wood Oil, 354 White, 354 Yellow, 354 Sanford’s Catarrh Cure, 706 Sanguinaria, 352 Sanguinarine, 352 Sanitas, 385 Santalum Album, 354 citrinum, 354 Rubrum, 354 Santonica, 355 Santonin, 355 Santoninate of Sodium, 355 Sapo, 356 Animalis, 356 Medicatus, 356 Mollis, 356 Viridis, 356 Sapogenin, 363 Saponification, 356 Saponin, 159, 333 Sarcinse, 659 Sarcocele.—See under Cancer, Testicles. Sarothamnus Scoparius, 360 Sarsaparilla, 357 Sassafras, 358 Medulla, 358 Swamp, 273 Sassy Bark, 157 Saunders, Red, 354 Savine, 346 Sayre’s Method for Chloroform, 171 Scabies, 659 Scald-head.—See Eczema, Tinea. Scalds, 504 Scammonium, 359 Scammony, 359 Scarlet Fever, 660 Diagnosis of, 715 Scheele’s Acid, 67 Green, 117 Sciatica, 661 Scilla, 359 Scillin, 359 Scillipicrin, 359 Scillitin, 359 Scillitoxin, 359 Scirrhus.—See Cancer, 506 Diagnosis of, 713 Sclererythrin, 204 Scleroderma, 662 Scleromucin, 204 Scleroxanthin, 204 Scoparin, 360 Scoparius, 360 Scorbutus.—See Scurvy, 663 Screaming.—See Nightmare, 625 INDEX, 759 Scrofulosis, 662 Scudamore’s Mixture, 572 Scurvy, 663 Scutellaria, 362, 399 Scutellarin, 363 Sea-sickness, 663 Seborrhoea, 663 Sea-wrack, 222 Secale cereale, 204 Secaline, 402 Sedatives, 24, 37 Cardiac, 33 Gastric, 37 Pulmonary, 31 Urinary, 45 Uterine, 468 Vascular, 34 Vesical, 45 Seidlitz Powder, 323 Senega, 363 Senegin, 363 Senna, 364 Sennacrcfl, 364 Sennapicrin, 364 Separation, 415 Septicaemia, 653 Serpentaria, 365 Serpent-bites.—See Poisoning by Reptiles, also Stings. Sesamum, Oil of, 366 Sevum, 366 Shampoo Mixtures, 642 Sheep, 366 Sherry Wine, 86 Shingles.—See Herpes Zoster, 591 Sialogogues, 35 Sickness at Stomach.—See Nausea, Sea- sickness, Vomiting. Siddhi, 150 Silicate of Magnesium, 366 Hydrated, 367 of Potassium, 323, 366 of Sodium, 366 Silicious Mineral Waters, 109 Silver, 112 Sinalbin, 367 Sinapine, 367 Sinapis, 367 Alba, 367 Nigra, 367 Singultus.—See Hiccough, 591 Sinigrin, 367 Sinistrin, 359 Skin, Agents affecting, 49 as an Absorbent, 21 Skin Diseases.—See Acne, Boils, Burns, Carbuncles, Chapped Hands and Lips, Chilblains, Condylomata, Ecchymosis, Ecthyma, Eczema, Elephantiasis, Eruptions, Erysipelas, Erythema, Freckles, Herpes, Herpes Zoster, Ich- thyosis, Impetigo, Intertrigo, Lichen, Lupus, Mentagra, Nsevus, Onychia, Pemphigus, Phlegmon, Pityriasis, Prurigo, Pruritus, Psoriasis, Roseola, Scabies, Scleroderma, Seborrhoea, Strophulus, Syphilis, Tinea, Ulcer, Urticaria, Wart, Wen. Skull-cap, 362 Sleep, Abnormal.—See Delirium, Insom- nia, Nightmare, Somnambulism. Slippery Elm Bark, 392 Small-pox, 684 Diagnosis of, 715 Smart-weed, 321 Smell, Agents affecting, 30 Smilacin, 357 Smilax, 357 Snake-root, Black, 174 Virginia, 365 Sneezing, 664 Agents producing, 32 See also Catarrh, Hay Fever, Influ- enza. Soaloin, 90 Soap. 356 Bark, 333 Curd, 356 Green, 356 Insoluble, 356 of Lead Monoxide, 356 of Lime, 356 Soft, 356 Soda, Caustic, 368 Chlorata, 172 Chlorinated, 172 Soda-water, 108, m Sodium, 368 Solanine, 203 Solanum Dulcamara, 203 Solid Preparations, 428, 462 Soluble Substances, 454 Solution, 413 Aids to, 454 Circulatory, 414 of Aluminium Benzoate, 93 of Ammonium Acetate, 94 of Arsenious Acid, 116 of Arsenic and Mercuric Iodide, 1x6 of Arsenite of Bromine, 117 of Arsenite of Potassium, 116 of Carbolic Acid, 108 Clemen’s, 117 Donovan’s, 117 Fehling’s, 194 Fowler’s, 116 of Gutta-percha, 234 of Iodine, Compound, 252 of Iron Acetate, 215 of Iron Citrate, 215 of Iron Chloride, 215 of Iron Nitrate, 216 of Iron and Quinine Citrate, 217 of Iron Subsulphate, 216 760 INDEX, Solution of Iron Tersulphate, 217 of Lead Subacetate, 318 of Lead Subacet., Dilute, 318 of Lime, 144 of Lime, Chlorinated, 172 of Lime, Saccharated, 144 Labarraque’s, 172 Lugol’s, 252 Magendie’s, 294 of Magnesium Citrate, 272 of Mercuric Nitrate, 240 of Morphine Sulphate, 294 of Opium, Compound, 293 Pancreatic, 300 Pearson’s, 116 of Pepsin, 303 of Potassa, 322 of Potassium Arsenite, 116 of Potassium Citrate, 323 of Potassium Silicate, 366 of Soda, 368 of Soda Chlorinated, 143 of Sodium Arseniate, 116 of Sodium Silicate, 366 of Thymol, 389 of Zinc Chloride, 403 Solutions (Liquores), 420 Hypodermic, 702 Precipitant, Table of, 449 Stock, 447 Solvents, 414 Somnal, 371 Somnambulism, 664 Sores, 678 Sorghum, 347 Sorrel, 344 Sozodont, 707 Spanish Flies, 151 Sparteine, 360 Spasmodic Affections, 664 Spearmint, 28 r Specific Gravity and Volume, 439 Table of, 725 Spermaceti, 161 Spermatorrhoea, 664 Spigelia, 372 Spina Bifida, 665 Spinal Concussion, 665 Congestion, 665 Inflammation.—See Meningitis, Mye litis. Irritation, 665 Paralysis, 665 Softening, 665 Spirit of Ammonia, 93 of Ammonia, Aromatic, 93 of Ammonia, Fetid, 119 of Anise, 101 of Camphor, 147 of Chloroform, 169 of Cinnamon, 183 of Ether, 79, 83 [ Spirit of Ether, Compound, 79,83 of Nitrous Ether, 79, 83 of Gaultheria, 224 Grain, 85, 87 of Hedeoma, 236 of Juniper, 259 of Juniper, Compound, 259 of Lavender, 265 of Lemon, 266 of Mentha Piperita, 280 of Mentha Viride, 281 of Mindererus, 94 of Myrcia, 284 of Myristica, 285 of Nutmeg, 285 of Orange, 122 of Pennyroyal, 236 of Peppermint, 280 Potato, 87 Proof, 86 Rectified, 86 Russian, 658 of Spearmint, 281 of Turpentine, 384 Wood, 87 Spirits (Spiritus), 426 Spleen, Affections of, 666 Spongia Usta, 662 Spotted Fever.—See Typhus Fever, Men ingitis Cerebro-spinal Sprains, 666 Spruces, 315 Spunk, 83 Squama?.—See Ichthyosis, Pityriasis, Pso- riasis Squaw-root, 160 Squibb’s Mixture, 293, 5x5 Squill, 359 St. Ignatius’ Bean, 250 St. Jacob’s Oil, 76, 706 St. Mary’s Thistle, 156 Stains, 666 Stammering, 666 Staphisagria, 372 Star Anise, loo, 250 Starch, roo, 348 Iodized, 100, 252 Statice, 64 Stavesacre, 362 Sterility, 666 Sternutatories, 32 Stigmata Maydis, 402 Stillingia, 373 Stimulants, 23 Cardiac, 33 Hepatic, 39 Local, 25 Pancreatic, 40 Respiratory, 30 Vascular, 34 Stings, 667 Stock Solutions, 447 INDEX. 761 Stomach Diseases.—See Dyspepsia, Gas- tralgia, Gastric Ulcer, Gastritis, etc. Stomachics, 35 Stomatitis, 667 Stone.—See Calculi, 505 Storax, 376 Strabismus, 668 Straining, 414 Stramonium, 374 Strangury.—See Cystitis, Dysuria Stricture.—See Rectum, Urethral Stric- ture of Urethra, 679 Strophanthin, 375 Strophanthus, 375 Strophulus, 268 Struma.—See Scrofulosis, 662 Strychnine, 237, 250, 288 Strychnos Ignatii, 250 Gaultheriana, 237 Nux-Vomica, 287 Sturgeon, 249 Stye.—See Eyelids, 559 Styptic Collodion, 74 Styptics, 50, 585 Styracin, 376 Styrax, 376 Benzoin, 129 Styrol, 376 Subacetate of Lead, 318 Subcarbonate of Bismuth, 131 Subchloride of Mercury, 240 Subiodide of Bismuth, 132 Sublimation, 411 Subnitrate of Bismuth, 131 Substances best given alone, 453 difficult to combine in pill, 465 suitable for mixtures, 454 suitable for pills, 465 suitable for powders, 471 unsuited to pill-form, 466 Subsulphate of Iron, 216 of Mercury, Yellow, 240 Succinum, 377, 385 Sudorifics, 46 Suet, 366 Sugar, 347 Beet, 347 Cane, 347 Diabetic, 348 Fruit, 348 Grape, 348 of Lead, 317 of Milk, 348 Starch, 348 in Urine, Tests for, 723 Sulphate of Aluminium, 92 of Aluminium and Ammonium, 91 of Aluminium and Potassium, 91 of Ammonium, 94 of Atropine, 126 of Cadmium, 137 Sulphate of Cinchonidine, 178 of Cinchonine, 178 of Copper, 194 of Duboisine, 202 of Hyoscyamine, 248 of Iron, 216 of Iron, Dried, 216 of Iron, Precipitated, 216 of Iron and Ammonium, 217 of Magnesium, 271 of Manganese, 274 of Morphine, 293 of Potassium, 323 of Quinidine, 178 of Quinine, 177 of Sodium, 369 of Sparteine, 360 of Strychnine, 288 of Tetra-hydromethyl-chinoline, 179. of Zinc, 403 Sulphide of Allyl, 119 of Antimony, 102 of Antimony, Purified, 102 of Calcium, 378 of Hydrogen, 378 of Mercury, Red, 240 Sulphite of Magnesium, 73, 271 of Potassium, 73 of Sodium, 73 Sulpho-carbolate of Sodium, 61, 62 Sulpho-cyanate of Acrinyl, 367 Sulpho-cyanide of Ally], 367 Sulphonal, 166 Sulphur, 377 Liver of, 378 Lotum, 377 Milk of, 378 Precipitated, 378 Sublimed, 377 Washed, 377 Sulphurated Antimony, 102 Lime, 378 Potassa, 378 Sulphuretted Hydrogen, 378 Sulphurous Mineral Waters, no Sumach, Poison, 338 Smooth, 338 Swamp, 339 Sweet, 337 Sumbul, 380 Sun-dew, 202 Sunstroke, 668 Suppositoria, 432, 473 Suppositories, Formulae, 475 Official in Br. Phar., 474 of Tannic Acid, 74 Suppuration, 668 Surgeon’s Agaric, 83 Surgical Fever, 668 Svapnia, 292 Swallowing.—See Dysphagia; Oesopha- gus, Disorders of. 762 INDEX Swamp Sassafras, 273 Sweet Bay, 273 Flag, 143 Gum, 376 Swift’s Specific, S.'S. S., 706 Sycosis, 668 Sydenham’s Laudanum, 293 Syncope, 668 Synovitis, 669- Syphilis, 669 Syrup of Acacia, 56 of Allium, 89 of Almond, 97 of Althaea, 91 of Amygdala, 97 of Citric Acid, 266 of Garlic, 89 of Ginger, 406 of Hydriodic Acid, 252 of Hypophosphites, 305 of Hypophos. with Iron, 305 of Ipecacuanha, 256 of Iron Bromide, 215 of Iron Iodide, 216 of Iron and Mang. Iodide, 218, 274 of Iron and Mang. Phosphate, 218 of Iron, Quinine and Strychnine Phosphates, 305 of Krameria, 262 of Lactophosphate of Calcium, 305 of Lactucarium, 263 of Lemon, 266 of Lime, 144 of Manganese Iodide, 274 of Orange, 122 of Orange-flowers, 122 of Phosphates, Compound, 305 of Prunus Virginiana, 328 of Rhubarb, 336 of Rhubarb, Aromatic, 336 of Raspberry, 344 of Rose, 343 of Rubus, 344 of Rubus, Aromatic, 344 of Rubus Idseus, 344 of Sarsaparilla, 357 of Sarsaparilla, Comp., 337 of Scilla, 356 of Squill, 359 of Squill, Compound, 102, 360 of Senega, 363 of Senna, 364 of Stillingia, Comp., 373 of Tar, 316 of Tolu, 125 of Wild Cherry, 328 of Zingiber, 406 • Syrupi (Syrups), 420 Tabacum, 381 Label Lie Nitroglycerini, 98 Tabes Mesenterica, 670 Table of Drops, etc., in 439, 726 of Latin Words, Phrases, etc., 691 of Metric Conversion, 727 of Precipitant Solutions, 449 of Specific Gravities and Volumes, 725 Tables of Differential Diagnosis, 7x2 of Weights and Measures, 435, 726 Tablets, 431 Compressed, List of, 469, 470 Hypodermic, List of, 470 Tag Alder, 89 Tamarind, 382 Tamar-Indien, 364, 706 Tamarindus, 382 Tanacetin, 383 Tanacetum, 383 Tanjore Pill, 667 Tannate of Cannabin, 149, 151, 165 of Pelletierine, 231 Tannin, 74 and Iron, 453 Tansy, 383 Oil of, 383 Tea of, 383 Tapeworm, 121, 231, 688 Tar, 315 Tar-water, 316 Taraxacerin, 383 Taraxacin, 383 Taraxacum, 383 Tartar, Crude, 322 Emetic, 102 Tartra-borate of Potassium, 59 Tartrate.of Antimony and Potas., 102 of Chinoline, 163 of Iron and Ammonium, 217 of Iron and Potassium, 217 Potassio-Cupric, 194 of Potassium, 323 of Potassium, Acid, 323 of Potassium and Sodium, 323 Tartrates, 75 Taste, Agents affecting, 30 Disordered, 671 Taurocholate of Sodium, 214 Tseniafuges, 40 Taeniae.—See Worms, 688 Tea, 139 Flaxseed, 268 German Breast, 57 Saffron, 193 Tansy, 383 Worm, 371 Teeth, 671 Agents affecting, 34 Teething.—See Dentition, 533 Temperature of the Body, 717 Tenesmus.—See Dysentery, 541 Terchloride of Methyl, 168 Terebene, 385 Terebinthene, 385 INDEX. 763 Terebinthina, 384 Canadensis, 384 Terpine, 385 Terpinol, 385 Tersulphate of Iron, 217 Testa Praeparata, 143 Testicles, 671 Testing, 417 Tests for Morphine, 294 Tetanus, 671 Tetrachloride of Carbon, 81, 169 Tetra-iodo-pyrol, 252 Tetter.—See Herpes, Pityriasis, Psoriasis. Thalline, 179 Thebaine, 292 Theine, 138, 141 Theobroma Cacao, 140, 387 Theobromine, 141, 387 Therapeutical Incompatibility, 461 Therapeutics, 17, 479 Applied, 18, 479 Empirical, 18 Natural, 17 Rational, 18 Special, 479 Theriaca, 348 Thermometer, Clinical, 717 Thimble berry, 344 Thirst, 672 Agents allaying, 35 Thistle, Blessed, 156 Thompson’s Eye-water, 706 Thorn-apple, 374 Thorough-wort, 213 Throat.—See Aphonia, Croup, Diphtheria, Laryngitis, Pharyngitis, Scarlet Fever, Tonsillitis, etc. Sore, 672 Thrush.—See Aphtha;, 491 Thuja, 385, 388 Thujetin, 388 Thujin, 388 Thus Americanum, 385 Thyme, Garden, 389 Thymene, 389 Thymol, 389 Thymus vulgaris, 389 Tic Douloureux, 672 Tiglii Oleum, 390 Tincture of Aconite, 76 of Ailanthus, 85 of Aloes, 90 of Aloes and Myrrh, 90 of Arnica-flowers, 115 of Arnica-root, 115 of Asafetida, 119 of Aurantium Amarum, 122 of Aurantium Dulce, 122 of Baptisia, 125 of Belladonna, 126 of Benzoin, 129 of Benzoin, Compound, 129, 376 Tincture of Berberis, 130 of Bryonia, 136 of Calendula, 145 of Calumba, 145 of Camphor, 147 of Cannabis Indica, 149 of Cantharides, 151 of Capsicum, 153 of Cardamom, 155 of Cascarilla, 158 of Catechu, Compound, 159 of Chirata, 164 of Chloroform and Morphine, 169, 294 of Chloroform, Compound, 169 of Cimicifuga, 175 of Cinnamon, 183 of Cinchona, 177 of Cinchona, Compound, 177 of Cocculus, 310 of Colchicum, 184 of Conium, 186 of Coto, 191 of Crocus, 193 of Cubeb, 193 of Digitalis, 199 of Duboisia, 202 of Eucalyptus, 212 of Euphrasia, 214 of Galls, 223 of Gelsemium, 224 of Gentian, Compound, 226 of Ginger, 406 of Guaiac, 232 Ammoniated, 232 of Hemp, Indian, 149 of Hops, 238 of Humulus, 238 of Hydrastis, 246 of Hyoscyamus, 248 of Ignatia, 250 of Iodine, 251 of Ipecac and Opium, 256, 293 of Iron Acetate, 215 of Iron Chloride, 215 of Kino, 261 of Krameria, 262 of Lavender, Compound, 265 of Lobelia, 269 of Lupulin, 238 of Matico, 277 of Musk, 284 of Myrrh, 286 of Nitro-glycerin, 98 Norwood’s, 396 of Nutgall, 223 of Nux Vomica, 288 of Opium, 292 of Opium, Camphorated, 293 of Opium, Compound, 293 of Opium, Deodorized, 292 of Opium and Ipecac, 293 764 INDEX, Tincture of Orange Peel, Bitter, 122 of Orange Peel, Sweet, 122 of Phosphorus, 304 of Physostigma, 308 of Phytolacca, 309 of Pulsatilla, 328 of Pyrethrum, 330 Pyrexialis, 178 of Quassia, 331 of Quebracho, 332 of Rhubarb, 336 of Rhubarb, Aromatic, 336 of Rhubarb, Sweet, 336 of Rhus Toxicodendron, 339 of Sanguinaria, 353 of Serpentaria. 365 of Soap, Green, 357 of Squill, 359 of Stillingia, 373 of Stramonium, 374 of Strophanthus, 375 of Sumbul, 380 of Thuja, 388 of Tolu, 125 of Valerian, 394 of Valerian, Ammoniated, 394 of Vanilla, 395 of Veratrum Viride, 396 of Viscum, 400 of Zingiber, 406 Tincturse, 425 Tinea Circinata, 673 Decalvans, 673 Favosa, 673 Sycosis.—See Mentagra, 617 Tonsurans, 673 Tobacco, 381 Indian, 269 Symptoms.—See Nervousness, 621 Toe-nails.—See Nails, 619 Tolene, 125 Toluene, 347 Tomato, 203 Tonga, 391 Tongine, 391 Tongue, 674 Tonics, 41 Cardiac, 33 Formulae, 484, 488, 622 Gastric, 35 Hair, 486 Nerve, 622, 630 Pills for Women, 469 Uterine, 48 Vascular, 34 Vesical, 45 Tonsillitis, 674 Tonsils, Enlarged, 674 Ulcerated, 675 Toothache.—See Odontalgia, 626 Toothrash.—See Strophulus, 668 Torrefaction, 412 Torticollis, 675 Torulse.—See Sarcinse, 659 Tracheitis.—See Croup, 528 Trachoma.—See Conjunctivitis Granular, Ophthalmia, 522, 627 Tragacantha, 391 Traumaticine, 234 Traumatic Fever, 668 Treacle, 348 Tree of Heaven, 85 Tri-chlor-aldehyde, 164 Tricophytosis Capitis.—See Tinea, 673 Trimethylamine, 114, 115, 238 Trinitrophenol, 72 Trinitrate of Glyceryl, 98 Trinitrin, 98 Trismus, 675 Triticin, 392 Triticum, 392 Vulgare, 100 Trituration, 413 of Elaterinum, 204 Triturationes, 432, 472 Triturations, Advantages of, 472 Formulae, 473 of Mercury, 240 Troches, 431, 469 of Ammonium Chloride, 94 of Catechu, 159 of Chalk, 143 of Cubeb, i93 of Ginger, 406 of Ipecac, 256 of Iron, 216, 395 of Krameria, 262 of Liquorice and Opium, 2.28, 293 List of, 469 of Magnesia, 272 of Morphine and Ipecac, 256, 294 of Peppermint, 280 of Potassium Chlorate, 322 of Santonin, 355 of Sodium Bicarbonate, 369 of Sodium Santoninate, 355 of Tannic Acid, 74 of Zingiber, 406 Trochisci, 431 Tropeius, 126 Tropical Fruit-Laxative, 364 Tropin, 126 Trypsin, 300 Tubercular Meningitis.—See Hydroceph- alus, Acute, 592 Tuberculin, 641 Tuberculosis.—See Phthisis, Scrofulosis, 640, 662 Tully’s Powder, 293 Tumors, 675 Diagnosis of, 713 Uterine, 683 Turnera aphrodisiaca, 197 Turpentine, 384 INDEX 765 Turpentine, Canada, 384 Chian, 384 Oil of, 384 Venice, 385 Turpeth Mineral, 240 Tympanites, 675 Typhlitis, 676 Typhoid Fever, 676 Diagnosis of, 716 Typho malarial Fever.—See Typhoid Typhus Fever, 677 Diagnosis of, 716 Ulcers and Sores, 678 of Rectum, 654 Stomach, 567 of Tonsils, 675 of Uterus, 683 Ulmus, 392 Umbellifcron, 222 Umbrella-tree, 273 Unguenta, 432, 475 Unguentum, 160, 432 Uraemia, 679 Urea, Agents affecting, 40 Urethane, 166 Urethra, Stricture of, 679 Urethral Injections, 569, 571 Urethritis, 679 Urginea Sciila, 359 Uric Acid Diathesis.—See Lithaemia, 608 Urinary Astringents, 45 Disorders, 680 Sedatives, 45 Urine, Acidifiers of, 45 Alkalinizers of, 44 Examination of, 722 Urticaria, 681 Ursone, 223, 393 Ustilago, 402 Uterine Alteratives, 48 Cancer, 681 Congestion, 681 Depressants, 48 Diseases, 682 Displacements, 682 Hypertrophy, 681 Prolapse, 647 Tonics, 48 Tumors, 683 Ulceration, 683 Uva Ursi, 392 Uvula, 683 Vaccination, 683 Vaginismus, 683 Vaginitis, 684 Valerene, 393 Valerian, 197, 393 Valerianate of Ammonium, 94, 395 of Butyl, 101 of Iron, 217 of Quinine, 177 of Zinc, 395, 403 Valerianates, 394 Valerol, 238, 393 Vallett’s Mass, 215 Van Buskiik’s Sozodont, 707 Vanilla, 395 Vanillin, 395 Vao, 196 Vapores, 477 Vaporization, 410 Vapors, 477 Varicella, 684 Varicocele, 684 Varicosis, 684 Variola, 684 Diagnosis of, 715 Vascular Sedatives, 34 Stimulants, 34 Tonics, 34 Vaseline, 304 Vegetable Drugs, their Constituents, 408 Veins.—See Phlebitis, Phlegmasia, Vari- cosis. Veins, Transfusion by, 20 Veloutine, 182, 207 Vellarine, 247 Venous Medication, 20 Veratralbine, 396 Veratrine, 396 Veratroidine, 396 Veratrum Album, 396 Sabadilla, 396 Viride, 395 Verbascum, 398 Verbs, 699 Vermicides, 40 Vermifuges, 40 Vertigo, 685 Verucca.—See Warts, 687 Vesical Tonics, 45 Sedatives, 45 Vesicants, 49 Viburnin, 399 Viburnum, 399 Compound, 399 Opulus, 399 Prunifolium, 399 Vienna Paste, 322 Villate’s Solution, 195 Vina (See also Wines), 426 Vinegar, 58 Bitters, 707 of Lobelia, 269 of Opium, 293 of Sanguinaria, 353 of Squill, 359 Vinegars (Aceta), 428 766 INDEX Vinum, 86 Album, 86 Aromaticum, 86 Official (See Wine of —) Portense, 86 Rubrum, 86 Xericum, 86 Viola cucullata, 400 Tricolor, 399 Violine,'399 Viscin, 400 Viscum, 400 Visions, Agents producing, 29 Vitellin, 400 Vitellus, 400 Vitriol, Elixir of, 72 Volkmann’s Antiseptic Fluid, 389 Vomiting, 685 of Pregnancy, 686 Diagnosis of, 717 Vulva, Eczema, etc., of, 687 Vulvitis, 687 Wade’s Bougies, 475 Wafers, 471 Wahoo, 213 Walker’s Vinegar Bitters, 707 Warburg’s Tincture, 178, 182 Warming-plaster, 120 Warner's Safe Cure, 707 Warts, 687 Wash, 460 Black, 241 Mouth, 573 Yellow, 241 Washing, 414 Waste, Agents promoting, 42 Wasting.—See Atrophy, Emaciation, 494, 549 Wasting Diseases, 349 Water, 108 Almond, Bitter, 97 of Ammonia, 93 of Ammonia, Stronger, 93 Anise, 101 Camphor, 147 Carbolic Acid, 60 Carbonated, 108 Cherry-laurel, 69 Chlorine, 172 Cinnamon, 183 Creasote, 191 of Crystallization, 416 Distilled, 108 Elder-flower, 352 Fennel, 221 Hunyadi, 524 Laurel, 67 Orange-flower, 122 Peppermint, 280 Water, Rose, 342 Soda, 108 Spearmint, 281 Tar, 316 Water-lily, 290 Water-pepper, 321 Waters (Aquae), 419 Mineral, 109, 112 Nomenclature, 108 Wax, 160 Wax Myrtle, 64 Weakness.—See Adynamia, Exhaustion, 483,557 Weights and Measures, 435, 726 Apothecaries’, 436, 726 British Pharmacopoeial, 436 Metric, 436, 727 Wen, 688 Whiskey, 85 White-leg.—See Phlegmasia, 639 White-swelling.—See Joints, Synovitis, 602, 669 Whitlow.—See Onychia, 627 Whooping-cough, 637 Willow, 349 Wine, 86 of Aloes, 90 of Antimony, 102 Aromatic, 86 of Cocaine, 208 of Colchicum-root, 184 of Colchicum-seed, 184 of Ergot, 205 of Ipecac, 256 of Iron, Bitter, 217 of Iron Citrate, 215 of Opium, 293 Port, 86 of Quebracho, 332 Red, 86 of Rhubarb, 336 Sherry, 86 of Tar, 316 of Tobacco, 381 White, 86 Wines (Vina), 86, 426 Winter-berry, 327 Wintergreen, 223 Witch-hazel, 64, 235 Wood Oil, 233 Woorara, 196 Words and Phrases, Latin, 691 Sundry, 700 Worms, 40, 688 Worm-grass, 372 Wormseed, 162 Levant, 355 Worm Tea, 371 Wormwood, 56 Wounds, 689 Writer's Cramp.—See Spasmodic Affec- tions, 664 Xantho-puccine, 246 Xanthoxyline, 401 Xanthoxylum, 401 Xeroderma.—See Ichthyosis, 594 INDEX. 767 Yerba Santa, 207 Yolk of Egg, 400 Zea Mays, 402 Zincite, 403 Zincum, 403 Zingiber, 405 Zona.—See Herpes Zoster, 591 Yam, Wild, 201 Yellow Fever, 689 Diagnosis of, 717 CATALOGUE No. 1. 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Allen, Harlan, Harte, Van Harlingen. Local Thera. Biddle, nth Ed. Cl. 4.25; Sh.' 5.00 Burnet. Food and Dietaries. 1.75 Field. Cathartics and Emetics.$i.75 Headland. Action of Med. 3.00 Jaworski. Carlsbad Salts. 2.00 Mays. Therap. Forces. 1.25 Theine 50 Napheys’ Medical. - Surgical. - - Ott. Action of Medicines. 2.00 Potter’s Compend. 5th Ed. 1.00 , Handbook of. 4.00 ; Sh. 5.00 Waring’s Practical. 4th Ed. 3.00 THROAT AND NOSE. Cohen. Throat and Voice. .50 Greenhow. Bronchitis. 1.25 Hutchinson. Nose & Throat. 1.25 Journal of Laryngology. 3.00 Mackenzie. The CEsophagus, Naso-Pharynx, etc. - 3.00 Pharmacopoeia. - 1.25 Murrell. Bronchitis. - 1.50 Potter. Stammering, etc. 1.00 Woakes. Post-Nasal Catarrh. 1.50 Deafness, Giddiness, etc. TRANSACTIONS AND REPORTS. Penna. Hospital Reports. 1.25 Power and Holmes’ Reports. 1.25 Trans. College of Physicians. 3.50 Amer. Surg. Assoc. 3.00 Assoc. Amer. Phys. 3.50 URINE & URINARY ORGANS. Acton. Repro. Organs. 2.00 Beale. Urin. & Renal Dis. 1.75 Urin. Deposits. Plates. 2.00 Holland. The Urine, Milk and Common Poisons. 4th Ed. 1.00 Legg. On Urine. - - .75 MacMunn. Chem. of Urine, 3.00 Marshall and Smith. Urine. 1.00 Ralfe. Kidney and Uri. Org. 2.75 Schnee. Diabetes. - 2.00 Thompson. Urinary Organs. 3.50 Surg. of Urin. Organs. 1.25 Calculous Dis. 3d. Ed. 1.00 Lithotomy. - - 3.50 Prostate. 6th Ed. 2.00 Thornton. Surg. of Kidney. 1.75 Tyson. Exam, of Urine. 1.50 Van Niiys. Urine Analysis. 2.00 VENEREAL DISEASES. Hill and Cooper’s Manual. 1.00 VETERINARY. Armatage. Vet. Rem. 1.25 Ballou. Anat. and Phys. 1.00 Tuson. Vet. Pharm. 2.50 VISITING LISTS. Lindsay and Blakiston’s Regular Edition. Send for Circular, - - 1.00 to 3.00 Perpetual Edition. 1.25 Monthly Ed. Plain, .75; Tucks, 1.00 WATER. Fox. Water, Air, Food. 4 00 Frankland. Analysis of. 1.00 Leffmann & Beam. Exam.of. 1.25 MacDonald. Examination of. 2.75 WOMEN, DISEASES OF. Byford’s Text-book. 4th Ed. 5.00 — Uterus. - 1.25 Doran. Gynaec. Operations. 4 50 Edis. Sterility. - - 1.75 Lewers. Dis. of Women. 2.25 Morris. Compend. Ulus. 1.00 Tilt. Change of Life. - 1.25 Winckel, by Parvin. Manual of. Illus. Clo.,3.00: Sh. 3.50 From PROF. J. M. DaCOSTA. *11 find it an excellent work, doing credit to the learning and discrimination of the author.” A New Medical Dictionary A compact, concise Vocabulary, including all the Words and Phrases used in medicine, with their proper Pronunciation and Defini- tions. BASED ON RECENT MEDICAL LITERATURE. BY GEORGE M. GOULD, A.B., M.D., Ophthalmic Surgeon to the Philadelphia Hospital, Clinical Chief Ophthalmological Dept. German Hos- pital, Philadelphia. It is not a mere compilation from other dictionaries. The definitions have been made by the aid of the most recent stan- dard text-books in the various branches of medicine. It includes Small 8vo, Half Morocco, as above, with Thumb Index, $4.25 Plain Dark Leather, without Thumb Index, 3.25 SEVERAL THOUSAND NEW WORDS NOT CONTAINED IN ANY SIMILAR WORK. IT CONTAINS TABLES of the ABBREVIATIONS used in Medicine, of the ARTERIES, of the BACILLI, giving the Name, Habitat, Characteristics, etc.; of GAN- GLIA, LEUCOMAINES, MICROCOCCI, MUSCLES, NERVES, PLEXUSES, PTOMAINES, with the Name, Formula, Physiological Action, etc.; and the COMPARI- SON OF THERMOMETERS, of all the most used WEIGHTS AND MEASURES of the world, of the MINERAL SPRINGS OF THE U. S., VITAL STATISTICS, etc. Much of the material thus classified is not obtainable by English readers in any other work. OPINIONS OF PROMINENT MEDICAL PAPERS. “ One pleasing feature of the book is that the reader can almost invariably find the definition under the word he looks for, without being referred from one place to another, as is too commonly the case in medical dictionaries. The tables of the bacilli, micrococci, leucomai'nes and ptomaines are excellent, and contain a large amount of information in a limited space. The anatomical tables are also concise and clear. . . . We should unhesitatingly recom- mend this dictionary to our readers, feeling sure that it will prove of much value to them.”—American Journal of Medical Science, Sept. 1890. “Asa handy, concise and accurate, and complete medical dictionary it decidedly claims a very high place among works of this description. In fact, taking handiness and cheapness into account, we certainly think this is the general practitioner’s model dictionary, and we cordially recommend it to our readers. The definitions are for the most part terse and accurate, and the derivations up to modern lights.”—British MedicalJournal, London, Sept. 1890. JMay be obtained through all Booksellers. Sample pages free. P. BLAKISTON, SON & CO.’S jyjedical and Scientific publications, No. 1012 Walnut St., Philadelphia. ACTON. The Functions and Disorders of the Reproductive Organs in Childhood, Youth, Adult Age and Advanced Life, considered in their Physiological, Social and Moral Relations. By Wm. 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Harlan, m.d., late Professor of Diseases of the Eye in the Philadelphia Polyclinic and College for Graduates in Medicine ; Surgeon to the Wills Eye Hospital, and Eye and Ear Department of the Penn- sylvania Hospital. Richard H. Harte, m.d., Demonstrator of Osteology, University of Pennsylvania ; Assistant Surgeon, University Hospital, and Arthur Van Harlingen, m.d., Professor of Diseases of the Skin in the Philadelphia Polyclinic and College for Graduates in Medicine; late Clinical Lecturer on Dermatology in Jefferson Medical College; Dermatologist to the Howard Hos- pital. In One Handsome Compact Volume. Nearly Ready. ALLEN. Commercial Organic Analysis. A Treatise on the Modes of Assaying the Various Organic Chemicals and Products employed in the Arts, Manufactures, Medicine, etc., with Concise Methods for the Detection of Impurities, Adultera- tions, etc. Second Edition. Revised and Enlarged. By Alfred Allen, f.c.S. Vol. I. Alcohols, Ethers, Vegetable Acids. Starch, etc. Out of Print. Vol. II. Fixed Oils and Fats, Hydrocarbons and Mineral Oils, Phenols and their Derivatives, Coloring Matters, etc. Out of Print. Vol. III.—Part I. Acid Derivatives of Phenols, Aromatic Acids, Tannins, Dyes, and Coloring Matters. 8vo. Cloth, $4.50 ANDERSON. A Treatise on Skin Diseases. With special reference to Diagnosis and Treatment, and including an Analysis of 11,000 consecutive cases. By T. McCall Anderson, m.d., Professor of Clinical Medicine, University of Glasgow. With several Full-page Plates, two of which are Colored Lithographs, and nu- merous Wood Engravings. Octavo. 650 pages. Cloth, $4-5°; Leather, $5.50 ARCHIVES OF SURGERY. Edited by Jonathan Hutchinson, f.r.s. Colored Illustrations. Published Quarterly. Per Vol. #3.00 ARLT. Diseases of the Eye. Clinical Studies on Diseases of the Eye. Including the Conjunctiva, Cornea and Sclerotic, Iris and Ciliary Body. By Dr. Ferd. Ritter von Arlt, University of Vienna. Authorized Translation by Lyman Ware, m.d., Surgeon to the Illinois Charitable Eye and Ear Infirmary, Chicago. Illustrated. 8vo. Cloth, $2.50 ARMATAGE. The Veterinarian’s Pocket Remembrancer; being Concise Directions for the Treatment of Urgent or Rare Cases, embracing Semeiology, Diagnosis, Prognosis, Surgery, Therapeutics, Toxicology, Detection of Poisons by their appropriate tests, Hygiene, etc. By George Armatage, m.r.c.v.s. Second Edition. 32010. Boards, $1.25 6 P. BLAKTSTON, SON Different Figures. In Two Handsome Octavo Volumes. 1600 pages. « Vol. I, Nearly Ready. Vol. II, Ready Septembe *** The first American edition of this book, which was published in one rath unwieldy volume, was completely exhausted within eighteen months. In printing t second, it has been thought best to follow the style adopted by the English publishe and issue it in two volumes. In this form it will be much handier for reading and refi ence. Dr. Gowers has devoted a great deal of time and work in the revising; ma sections have been rewritten, and the new matter will amount to about 100 pages, inclu ing an important chapter on Multiple Neuritis, of which no good account exists, anc number of new illustrations. SPECIMEN OF ILLUSTRATIONS—FLEXOR CONTRACTION OF LEGS IN MYELITIS OF THE DORSAL REGION. A large number of the illustrations are original, having been made from special dra ings or from photographs of cases; they not only serve to illustrate the text, but will found of great value in the diagnosing of obscure cases. PRESS NOTICES OF FIRST EDITION. “ It may be said, without reserve, that this work is the most clear, concise and complete text-book up diseases of the nervous system in any language. And when the large number of such works which 1 appeared in Germany, France and England within the past ten years is considered, this implies high praise — The American Journal of Medical Science. “ Taken as a whole, it promises to be the most useful work on diseases of the nervous system which ■ possess.”—The Dublin Journal of Medical Sciences. “ The student and practitioner will find in it a true friend, guide and helper in his studies of the disea: of the nervous system. It is a most complete manual, presenting a thorough reflex of the present state knowledge of the diseases of the nervous system. The care and thought that have been bestowed on its p duction are evident on every page. In the presence of such ability, learning and originality, criticism can 01 take a favorable direction. The style and manner are accurate, studied and adequate—never diffuse. T illustrations call for special notice. 1 hey are numerous, new and original. No better manual on nerve diseases has been presented to the medical profession.”—The London Lancet. “ Gowers’ manual is herewith recommended to the general and to the special student. It is not t detailed for the former, while for the specialist it is explicit enough as a first-class book of reference. It is, the whole, an admirable treatise.”—The Journal of Nervous and Mental Diseases, New York. BY THE SAME AUTHOR. Diseases of the Brain. Lectures on Diagnosis of Diseases of the Brain, delivered University College Hospital. Second Edition. Illustrated. 8vo. Cloth, $2.1 NOW READY FOR 1891. 40TH YEAR. HE PHYSICIAN’S VISITING LIST (LINDSAY & BLAKISTON’S.) Almanac for 1891 and 1892; Table of Signs to be used in keeping accounts; Marshall Hall’s Ready :hod in Asphyxia; Poisons and Antidotes, revised for 1890; The Metric or French Decimal System of ights and Measures; Dose Table, revised and rewritten for 1891; List of New Remedies for 1891; Aids diagnosis and Treatment of Diseases of the Eye; Diagram Showing Eruption of Milk Teeth, Dr. Louis RR; Posological Table; Disinfectants and Disinfecting; Examination of Urine, Dr. J. Daland, based n Tyson's “ Practical Examination of Urine ”; Incompatibility, Dr. S. O. L. Potter ; A New Complete ile for Calculating the Period of Utero-Gestation; Sylvester’s Method for Artificial Respiration, Illustrated; gram of the Chest; Blank Leaves, suitably ruled, for Visiting Lists, Monthly Memoranda, Addresses of :ents and others; Addresses of Nurses, their references, etc.; Accounts asked for; Memoranda of Wants; itetric and Vaccination Engagements; Record of Births and Deaths; Cash Account, etc.; Special Pencil 1 Rubber Tip. This Visiting List is published in November of each year. CONTENTS. SIZES AND PRICES. REGULAR EDITION. 25 Patients weekly. Tucks, pockets and Pencil, $1.00 50 “ “ “ 1.25 75 “ “ " i-5° OO M tl 2.00 ~ ■' 3.00 INTERLEAVED EDITION. 25 Patients weekly. Interleaved, tucks and Pencil, 1.25 » ■■ - 3“ PERPETUAL EDITION, without Dates. No. I. Containing space for over 1300 names, with blank page opposite each Visiting List page. Bound in Red Leather cover, with pocket and Pencil, #1.25 No. 2. Containing space for 2600 names, with blank page opposite each Visiting List page. Bound like No. 1, with Pocket and Pencil, • . 1.50 MONTHLY EDITION, without Dates. No. 1. Bound, Seal leather, without Flap or Pencil, gilt edges, 75 No. 2. Bound, Seal leather, with Tucks, Pencil, etc., gilt edges, 1.00 SPECIAL SIZES AND BINDINGS MADE TO ORDER. Nothing can seem better fitted to meet the purpose for ch they are designed than these Visiting Lists of >srs. Blakiston, and the forty years of patronage they e enjoyed must have convinced public and publisher e of their value. We not only have the convenient mgement for keeping visiting accounts, but a fund of ful information of all kinds, embracing dose tables, ghts and measures, posological tables, disinfectants, lary analysis, poisons and antidotes, etc., all arranged ready reference in a well bound leather book that can ill times be carried in the coat pocket. These books complete, comprehensive, and convenient.”—The 'sician and Surgeon, Ann Arbor, Mich. It has long been known to the profession, and needs no her notice than to say that it maintains the standard xcellence acquired by its predecessors.”—New Orleans dical and Surgical Journal. This oldest and best known of the Visiting Lists les with the new year unchanged in form, and with h alterations in contents only as were called for by jnt therapeutic advance. In compactness, neatness, 1 completeness it is a marvel.”—American Practitioner '■ News, Louisville. This is the thirty-ninth year of the publication of this t, compact, and universally-acknowledged-to-be the t of its kind published. It has stood the test of time i finds ready sale from a simple announcement that it is dy ”—The Medical Brief, St. Louis. The best endorsement I can give of my appreciation the Lindsay & Blakiston Visiting List is, that I have n using it from its first issue and find it is the best in .”—O. F. Poiter, M.D., St. Louis. PRESS NOTICES OF EDITION FOR 1891. “ This is the eleventh year that we are using this Visit- ing List in our practice, and we can truly say that we could not wish for anything better. It has saved us many times its cost, and, besides, has furnished a permanent and pleasing record of our daily work during the years that have passed.”—Canada Medical Record. Dear Sirs:—We received the Visiting List for 1891. It is the finest of all. We had five (5) sent us, from the same number of firms, and must acknowledge it is the smallest, neatest and most compact, as any physician can place it in his side pocket with ease, while, if you have noticed or seen the others, they will require the tailor to enlarge the coat pocket. Very truly yours, N. W. Medical Journal, Minneapolis, Minn. “ The fact that this Visiting List has been published an- nually for forty years is sufficient guarantee of its excellence and popularity. In addition to the visiting list proper, it contains easily-accessible suggestions upon many of the emergencies that may arise in a physician’s practice, and when he is too far from home to learn from his text-books the antidote for a poison that may have been swallowed, or the proper method of resuscitating a half-drowned per- son. True, he should know these things, but who does not occasionally forget, when he most wishes to remember? There are also dose-tables, tables of the metric system, a list of new remedies for 1890, rules for examining urine, a table for calculating the period of pregnancy, and other equally useful information. The arrangement for entering patients, visits, consultations, etc., is exceeding simple, and the whole makes a thin, compact, and easily-carried volume.”—Medical News, Philada., January jd, 1891. *** P. Blakiston, Son & Co. wish to announce that the edition for 1892, which is now being mufactured, will contain several improvements that will, without making any radical changes, :atly enhance its usefulness, compactness and durability, SURGERY. A COMPLETE PRACTICAL TREATISE, WITH SPECIAL REFERENCE TO TREATMENT C. W. MANSELL MOU LLIN, M.A., M.D.. OXON., FELLOW OF THE ROYAL COLLEGE OF SURGEONS; SURGEON AND LECTURER ON PHYSIOLOGY TO THE LONDON HOSPITAL, ASSISTED BY VARIOUS WRITERS ON SPECIAL SUBJECTS. FIVE HUNDRED ILLUSTRATIONS. 200 OF WHICH ARE ORIGINAL WITH THIS WORK ROYAL OCTAVO. 1190 PAGES. Royal 8vo. Handsome Cloth, $7.00; Leather, Raised Bands, $8.00. Extract from the Preface.—“ Modern Surgery has advanced with such rapid strides, and in so n different directions, that it is almost impossible within the space of a single volume to give more thai epitome of its main principles. I have therefore touched but lightly upon controversial matters, and endeavored to make this book a practical one, in the hope that it may be of greater service to students general practitioners. With this object, I have given special attention to the question of Treatment; ai have included under the head of each organ a brief description of the malformations to which it is liable, the various operations that may be performed under it, instead of relegating them to chapters by themse The General Pathology of Surgical Diseases is dealt with in Part I; that of Injuries in Part II. In Part the Diseases and Injuries of Special Structures and Organs are considered more fully. Throughout, I endeavored to enforce the idea that the chief aim and object of Surgery at the present day is, to assist tissues in every possible way in their struggle against disease. “ Of the five hundred illustrations, nearly two hundred were (with four exceptions) drawn from ori specimens by my brother, Dr. J. A. Mansell Moulin (to whom I am also indebted for the article on Dis of the Female Generative Organs), or myself. “ I have to express my thanks to Mr. J. Hutchinson, junior, for his chapters on Diseases of the Skin Eye; to Mr. T. Mark Hovell, for that on Diseases of the Ear and Larynx; and to Mr. F. S. Eve, for on Tumors.” OUTLINE OF CONTENTS. I. Injury and Repair. II. Diseases due to Non-infective Organisms. PART I.—GENERAL PATHOLOGY OF SURGICAL DISEASES. PART II—GENERAL PATHOLOGY OF INJURIES. III & IV. Diseases due to Infective Organisms. V. Tumors. I. The General Effects of Injury. II. The Local Effects of Injury. I. Diseases of the Skin. II. Injuries and Diseases of Blood-vessels. III. Injuries and Diseases of Lymphatics. IV. Injuries and Diseases of Nerves. V. Injuries and Diseases of Muscles, Tendons, etc. VI. Injuries and Diseases of Bones and Joints. VII. Injuries and Diseases of the Head. VIII. Injuries and Diseases of the Back. IX. Injuries and Diseases of the Eye. X. Injuries and Diseases of the Face and Nose. XI. Injuries and Diseases of the Mouth and Jaws. XII. Injuries and Diseases of the Tongue, Salivary Glands and Tonsils. XIII. Diseases of the Ear and Larvnx. XIV. Injuries and Diseases of the Neck and Throat. PART III—DISEASES AND INJURIES OF SPECIAL STRUCTURES. XV. Diseases of the Thyroid. XVI. Injuries and Diseases of the Pharynx (Esophagus. XVII. Injuries and Diseases of the Chest. XVIII. Injuries and Diseases of the Abdomen. XIX. Injuries and Diseases of the Rectum. XX. Injuries and Diseases of the Kidney. XXI. Injuries and Diseases of the Bladdei. XXII. Diseases of the Prostate. XXIII. Injuries and Diseases of the Urethra. XXIV. Injuries and Diseases of the Male Organs. XXV. Diseases of the Female Generative Organ; XXVI. Diseases of the Breast. XXVII. Amputations. XXVIII. Anaesthetics. SAMPLE PAGES SENT FREE UPON APPLICATION