HANDBOOK OK MATERIA MEDICA, PHARMACY, AND THERAPEUTICS. POTTER. NOTICES OF THE PRESS OF PREVIOUS EDITIONS OF DR. POTTER’S HANDBOOK. From the American Journal of the Medical Sciences. “ The author has very skilfully steered his course between the pessimism that marks a system of therapeutics based solely on the results given by experiments and observations in the chemical and physiological laboratories, and the optimism of hasty empirical general- izations upon meagre clinical data, and upon this we consider that the greatest claim can lie made, that this book is a safe one for the junior practitioner. , . . The author, then, has fully attained the purpose which he set before him at the commencement.” From the Medical Record. 11 This is an old and valued friend which needs no commendation, much less an introduction. It ought to be in the library of every physician and student. It is the most convenient and most concise work on therapeutics and materia medica in the English language, and is at the same time thoroughly reliable. Though necessarily largely a compilation, nevertheless there is much that is original, the author being one of the most prominent of American therapeutists. The contents embrace the essentials of practical materia medica and therapeutics, the amount of pharmacy that every physician should possess, one of the best sections on prescription-writing ever written, besidts a great mass of interesting and valuable material relating to the subject of the work Both diseases and remedies are arranged alphabetically, making the book unusually con- venient. The section on applied therapeutics includes, besides the writer’s own views, the recommendations of fifty authors. All in all, the book is an exceedingly useful one.” 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. . . . Under the head of prescription writing considerable attention is paid to the subject of in- compatibilities, 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 alpha- betically 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 suit- able 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. 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 discrimination 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 cata- logue of drugs, but is a digest of modern therapeutics, and as such will prove of immense use to its possessor.” From the Pacific 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.” *** The price of this book is $4.00 in cloth binding, or $5.00 in full leather. Thumb Index in each copy. 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., M.R.C.P.Lond., PROFESSOR OF THE THEORY AND PRACTICE OF MEDICINE IN THE COOPER MEDICAL COLLEGE OF SAN FRANCISCO: VISITING PHYSICIAN TO ST. LUKE'S HOSPITAL*. AUTHOR OF “QUIZ-COMPENDS” OF ANATOMY AND MATERIA MEDICA, UAN INDEX OF COMPARATIVE THERAPEU- TICS,” AND “A STUDY OF SPEECH AND ITS DEFECTS.” FORMERLY A. A. SURGEON, U. S. ARMY, AND BRIGADE-SURGEON, N. G. OF CALIFORNIA. FOURTH EDITION. REVISED.' PHILADELPHIA: P. BLAKISTON, SON & CO., 1012 Walnut Street. 1893. Copyright, 1892, By P. BLAKISTON, SON & CO. Press of Win. F. Fell, a Co., 1220-24 SANSOM ST., PHILADELPHIA. TO MY WIFE WHOSE UNFAILING AND DEVOTED CARE AND PATIENT ENCOURAGEMENT, DURING THE PAST FOURTEEN YEARS, HAS SUPPORTED THE AUTHOR IN EVERY EXIGENCY. OF HIS PROFESSIONAL LIFE. PREFACE TO THE FOURTH EDITION. The exhaustion of the third edition in thirteen months from the date of its publication, is ample proof of the continued favor which this book has received from teachers, students and practitioners of medicine. For this appreciation of his work, by those for whose use he designed it, the author returns his sincere thanks, and begs also to hereby express his gratitude to the numerous reviewers, whose kind words of commendation have so constantly encouraged him. In the present edition several new remedies receive such consideration as their merits seem to justify ; particularly Aristol, Chloralamid, Diuretin, Phenacetine and Piperazine. Briefer mention is made of less important agents, such as Antikamnia, Phenolid, Exodyne, Exalgine, Salipyrin, Hypnal, etc. Many articles have been re-written, others expanded and corrected, and the entire text has received a thorough revision. At the same time every care has been taken to preserve intact the characteristic features of the book, which have proven so important a factor among the elements of its success. SAM’L O. L. POTTER. 330 Sutter St., San Francisco, January, 1893. 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 with a corres- ponding degree of appreciation. The fact that quite a number of new PREFACE. 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 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, PREFACE. 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 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 PREFACE. 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. TABLE OF CONTENTS. PAGE INTRODUCTION 17 Materia Medica, 17 Pharmacy, 17 Empirical Therapeutics, 18 Rational Therapeutics, 18 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 Apparatus, 47 Agents acting on the Cutaneous Surface, 49 Agents acting on Microbes, Ferments, etc., 51 Agents acting upon each other, 52 Dosage of Medicines, 54 PART I.—MATERIA MEDICA AND THERAPEUTICS, 55 Abrus to Zingiber 55-414 PART II.—PHARMACY AND PRESCRIPTION WRITING, ... 415 Constituents of Vegetable Drugs, 416 Official Operations, 418 Official Preparations 427 Extemporaneous Pharmacy 442 Weights and Measures, 443 Metric System, 444 Approximate or Domestic Measures, 446 Specific Gravity and Specific Volume, 447 Prescriptions 447 Analysis of a Prescription, 447 Principles of Combination, .... 449 Prescription Writing, 450 Abbreviations, 451 Prescription Blanks, 451 Renewals, 452 Filling a Prescription, 453 Stock Solutions, 455 Rules for the Pharmaceutical Student, 455 TABLE OF CONTENTS. PAG K Incompatibly Chemical Incompatibility, 456 Pharmaceutical Incompatibility, 458 Therapeutical Incompatibility, 459 Rules for Avoidance of Dangers 460 Extkmporaneous Preparations and Formula, 461 Excipients for Mixtures, 46 Excipients for Emulsions, 466 Excipients for Pills, PART III.—SPECIAL THERAPEUTICS, 487 References and Bibliography 487 Abdominal Plethora to Yellow Fever, 488-702 APPENDIX 7o3 Latin Terms, Phrases, etc., used in Prescriptions, 703 Verbs, Participles, Prepositions, etc., 711 Genitive Case-endings, 712 Hypodermic Formulae, 713 Chlorodyne, Comparisons of Ten Formulae therefor, 715 Patent Medicines 716 The Treatment of Poisoning, 720 Tables of Differential Diagnosis, 725 Notes on Temperature in Disease, 730 Clinical Thermometry, 730 Obstetrical Memoranda, 732 Signs of Pregnancy, 732 Signs of Labor 732 Average Pelvic Diameters, 733 Development of the Foetus, 733 Diameters of the Foetal Skull at Term, 735 Asphyxia and Apncea, 734 Clinical Examination of the Urine, 735 Ethics, the Hippocratic Oath, etc., 737 Table of Specific Gravities and Specifig Volumes 738 Table of Drops in, and Weights of, a Fluid-drachm of Various Liquids, 739 Table of Weights and Measures 739 Table for Converting Apothecaries’ Weights and Measures into Grams, 740 Table of Prescription Doses and Quantities, 741 INDEX 743 ERRATA. Page 80, line 10 from bottom, “ Nitrate ” should read “ Nitrite.” “ 81, “ 8 “ “ insert “ almost ” before “ always.” “ 106, “ 29, “ Uvae ” should read “ Uva.” “ 164, running title, “ Oxalis " should read “ Oxalas ” “ 187, “ “ “ Cinchona ” should read “ Cinnamomum.” “ 187, line 11 “ 213, “ 17 from bottom, “ 234, “22, “ Veloutine ” should read “ Velatine." “ 463, “ 23 from bottom, ' “ 245, “ 19 “ “ after “ Subchloride,” insert “ of Mercury.” “ 245, “ 23 “ “ after “ Bichloride,” insert “ of Mercury.” “ 309, “ 19 “ “ should read—“ It is said to have broken a glass when stirred therein with water. “ 311, " 3, “ xx ” should read “ xv.” INTRODUCTION. Pharmacology, (phannakon, 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 char- acteristics, chemical properties, modes of preparation and administration, 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 a 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 spontaneous 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 dis- orders. 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 sys- tematic treatment than it receives. 17 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 condition. This division is the portion of the subject which is taught separately and systematically 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 Col- chicum 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 unscien- tific 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 would tend to a minimum degree of accuracy in a science which, in the very nature of things, can never be an exact one;—though un- doubtedly such methods will always prevail to some extent. Rational Therapeutics embraces the use of remedies for reasons based on a knowledge (i) 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 leading idea in every revolt against empirical therapeutics in the past. Humor- alism, Chemicism, Solidism, Stimulism, Galenism in the 2d century, Par- acelcism 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 (circa 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, qum respiratio, qusenam excretiones, attendendum. Inde adductum phenominorum in sano obviorum, transeas ad experimenta in corpore segroto.” INTRODUCTION. 19 11 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 ; such as upon the pulse, the temperature, the respiration, the excretions. Having thereby adduced their obvious phenomena in 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 t)f 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 profes- sional 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 differences due to the action of drugs in different doses on the human organism in health and disease. [Compare pages fij, 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 blood-vessels and the lacteals. When the stomach is empty and its mucous membrane healthy, crystalloidal substances in solu- tion pass through the walls of its vessels with great rapidity. Colloidal substances (fats, albumen, gum, gelatin, etc.) require to be digested and emulsified before they can be absorbed. The Rectum will absorb many substances applied in the 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 dan- gerous one. The injection intravenously of Saline Solutions in the col- lapse 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, Hvdro- cyanic-acid poisoning, Opium narcosis, Chloroform asphyxia, etc., are the instances admitted in practice. 20 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 circulation, an occurrence which may cause 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 externa/, 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. Aconitine (crystals), . . . gr.y^yj. Apomorphine Muriate, . . . gr. Atropine Sulphate, . . . gr. -fa. Atropine Sulphate, . . . gr. jfa. Cocaine Hydrochlorate,. . . gr. Conine Hydrobromate, . . . gr. Colchicine, gr. fa. Corrosive Sub. and Urea, . . gr. fa. Digitalin (Soluble), .... gr. jfa. Gelsemine Muriate,. . . . gr. fa. Hyoscine Hydrobromate, . . gr. x