HANDBOOK OF 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 be 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 : “ 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.” From the Australasian Medical Gazette : “ We have pleasure in commending the fourth edition of this excellent work to our readers. It is a monument of persistent industry. There is no better book in the English language for the student and practitioner. . . . Dr. Potter’s book is thor- oughly practical, and Part III contains an enormous amount of information, for which the student ought to be grateful. . . . The chapter on prescriptions is especially well done, in fact the best we have seen.” From the Journal of the American Medical Association : “ Dr. Potter has embodied many original ideas in the preparation of this work, some, if not all of which will prove of very great value to the reader.” From the Medical Bulletin : “The author’s statements are concise, exact, compact, and his diction faultless; no one, perhaps, in this country at least, excels him in the perspicuity of his condensations and the completeness of his work in respect to the many details involved in authorship.” 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 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. 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 catalogue of drugs, but is a digest of modern therapeutics, and as such will prove of immense use to its possessor.” *#*The price of this book is $4.50, net, in cloth binding, or $5.50, net, in full leather ; for which it will be delivered free to any address. Thumb Index in each copy. 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 PRINCIPLES AND PRACTICE OF MEDICINE AND CLINICAL MEDICINE IN THE COLLEGE OF PHYSICIANS AND SURGEONS OF SAN FRANCISCO ; MEDICAL SUPERINTENDENT OF ST. MARK’S hospital; AUTHOR OF THE “QUIZ-COMPENDS OF ANATOMY AND MATERIA MEDICA," “ AN INDEX OF COMPARATIVE THERAPEUTICS," SEVERAL ARTICLES in poster’s “practical therapeutics," and “ speech and its defects;" formerly a. a. surgeon u. s. army, and BRIGADE-SURGEON N. G OF CALIFORNIA. SIXTH EDITION. FULLY REVISED AND GREATLY ENLARGED. PHILADELPHIA: P. BLAKISTON, SON & CO. 1012 WALNUT STREET. i897- Copyright, 1897, By P. BLAKISTON, SON & CO. Press of Wm. f. Fell & Co. 1220-24 SANSOM ST. PHILADELPHIA. TO MY WIFE WHOSE DEVOTED CARE AND PATIENT ENCOURAGEMENT, DURING THE PAST NINETEEN YEARS, HAS SUPPORTED THE AUTHOR IN EVERY EXIGENCY OF HIS PROFESSIONAL LIFE. PREFACE TO THE SIXTH EDITION. This edition is one-eighth larger than its immediate predecessor, and is almost a new book, although retaining the general plan and the special features which have proved so acceptable in previous editions. The text has again been subjected to a thorough and critical revision, has been largely rewritten, and is greatly expanded by the introduction of new matter. Ninety-seven pages have been added, containing forty-six new articles and one hundred and seventy rewritten ones, besides many hundred sentences incorporated into the original text. In the section on Materia Medica, etc., there have been inserted thirty- three new articles, including those on Cactus, Carbonic Acid, Formalin, Oil of Myrtle and Oxygen ; also briefer notices of new preparations and remedies, such as Aseptol, Aseptolin, Borine, Bromelin, Dulcin, Ferratin, Kola, Lactophenin, Lycetol, Lysidin, Malakin, Migranin, Trikresol, Tannigen, Solanum, etc. Serum-therapy has achieved such importance during the past two years that it cannot be ignored in any work which professes to keep abreast of the progress in therapeutics. The author has deemed this subject worthy of full though concise treatment, under the new titles Toxins, Antitoxins and Animal Extracts, in the first part of the book, and has inserted brief cross-references thereto under the appro- priate disease-headings in the section on therapeutics. The list of rewritten articles in the first part includes those on Ace- tanilid, Antipyrin, Aurum, Bismuth, Boric Acid, Caffea, Calcium, Can- nabis, Chloral, Chloroform, Chlorine, Cinchona, Cod-liver Oil, Creosote, Duboisia, Grindelia, Hyoscyamus, Iodine, Magnesium, Nux Vomica, Opium, Paraldehyde, Phenacetin, Phosphorus, Physostigma, Pilocarpus, Pulsatilla, Sassafras, Sodium, Strontium and Tobacco. Besides these, the articles on Alcohol, Carbolic Acid and Digitalis were entirely re- written for the fifth edition and may be ranked equally as new matter. In the section on Therapeutics, new articles are inserted on Abasia, Acne Rosacea, Actinomycosis, Chyluria, Collapse, Tubercular Laryngitis, Tubercular Meningitis, Tubercular Peritonitis, Acute Tuberculosis, Tuber- culous Affections and Myxcedema. One hundred and nineteen articles in this portion of the book have been rewritten, and the text of the sec- tion has been everywhere expanded by the incorporation of many hundred IX X PREFACE. items from recent authorities, current medical literature and the author’s personal experience in practice. In the Appendix the article on The Treatment of Poisoning has been carefully revised and enlarged, with the object of bringing the contained information into available shape for rapid reference in emergencies. The List of Latin Words and Phrases has been increased by the addition of five pages, and is believed to be the most complete list of this kind now published. The Index has been entirely recast and considerably in- creased in size, and contains the name of every substance mentioned in the text. Having been called upon for a sixth edition of this book within ten years after its first appearance, the author feels that he may be pardoned for assuming that his efforts have met with an unusual degree of appre- ciation on the part of his profession. He believes that his object, as set forth in the preface to the first edition, has been accomplished in so far that the book has taken rank as a reliable working companion to teach- ers, practitioners and students of medicine. Having enjoyed for a decade the pleasure of seeing the glow of professional favor upon his work, he is encouraged to strive for the continuance thereof, as long as he may be permitted to labor to that end. Sam’l O. L. Potter. College of Physicians and Surgeons, San Francisco, January, 1897. EXTRACTS FROM THE PREFACE TO THE FIRST EDITION. The author’s intention has been to produce a book which would em- brace 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 fram- ing of Prescriptions as might elucidate what to many is a very difficult problem. Furthermore, he has tried to present as much information 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. PREFACE. XI 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 consider- ation 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 therapeutically, 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 will be found mention also of the Ethyl, Sodium and Potassium Nitrites, 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 Classification is placed before the Materia Medica, in order to supplement such deficiencies in grouping as are inevitable in an alpha- betical 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 are also noted, and all the compounds into which it enters are 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 antagonists, antidotes and incompatibles, if any; and a concise summary of its thera- peutical 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. Pharma- copoeia 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 prac- tical 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 XII PREFACE. for themselves a practical acquaintance with their professional weapons which cannot but make them better physicians and more accurate pre- scribes. In this section of the book Prescription Writing receives full consideration, and many standard formulae are given as samples of pre- scriptions of each kind in extemporaneous use. In the third part the subject of Special Therapeutics is treated of elab- orately, 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. 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 Brunton, Ringer, Wood, Phillips, Waring and Bartholow, in their latest editions; as well as of the writer’s verbatim notes of two courses of didactic and clinical lectures delivered by Professors Da Costa and Bar- tholow in the Jefferson Medical College and Hospital and in the auditorium of the Pennsylvania Hospital. On page 566 will be found a full list of the authorities referred to by initials in the section on Special Therapeu- tics. The Appendix contains numerous Tables, comprising diagnostic hints, Latin terms and phrases, formulae for hypodermic use, metric equivalents, and specific gravities and volumes; also Notes on temperature in disease, on the use of the clinical thermometer, the treatment of poisoning, and the examination of urine; also Formulae representing 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. 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 now- adays constitute much over one-fourth part of the officinal stock, it is a wilful debasement of our professional weapons, as well as an inexcusable misnomer, to apply the shop-title to them any longer. Cooper Medical College, San Francisco, December, 1886. TABLE OF CONTENTS. PAGE INTRODUCTION i7 Materia Medica, 17 Pharmacy, 17 Therapeutics, 17 Empirical Therapeutics, 18 Rational Therapeutics, 18 Constituents of Vegetable Drugs, 20 Alkaloids, 21 Glucosides, 22 Resins, . . 22 Administration of Medicines, 23 Transfusion, 25 The Hypodermic Method, 25 Dosage of Medicines, 28 Average Adult Doses of Official Preparations, 29 Classification of Medicines, 30 Stimulants and Sedatives, 31 Agents acting chiefly on the Nervous System, 31 Agents acting on the Organs of Special Sense, 37 Agents acting on Respiration, 39 Agents acting on the Circulation, 41 Agents acting on the Digestive System, 42 Agents acting on Metabolism 49 Agents acting on Excretion, 52 Agents acting on the Generative Apparatus, 55 Agents acting on the Cutaneous Surface, 57 Agents acting on Microbes, Gases, Ferments, etc., 59 Agents acting upon each other, 61 Antidotes and Antagonists, 61 Physiological Antagonism, 62 Table of Antagonistic Poisons, 64 PART I.—MATERIA MEDICA AND THERAPEUTICS, 65 Abrus to Zingiber (alphabetically arranged), 65-492 PART II.—PHARMACY AND PRESCRIPTION WRITING, ... 493 Pharmacopceias and Dispensatories, ... 493 Weights and Measures, 494 Metric System, 496 Approximate or Domestic Measures, 497 Specific Gravity and Specific Volume, 498 XIII XIV TABLE OF CONTENTS, PAGE Prescriptions, 499 Analysis of a Prescription, 499 Procedure in Writing a Prescription, 500 Use of Latin in Prescriptions, 503 Principles of Combination, 505 Metric Prescriptions, 506 Abbreviations, 508 Renewals of Prescriptions, 508 Prescription Blanks, 510 Incompatibility 511 Chemical Incompatibility, 511 Pharmaceutical Incompatibility, 513 Therapeutical Incompatibility, 514 Rules for Avoidance of the Dangers of Incompatibility, 514 Extemporaneous Pharmacy 516 Filling a Prescription, 517 Stock Solutions, 518 Rules for the Pharmaceutical Student, 518 Official Pharmacy, 519 Official Operations, 519 Pharmaceutical Operations, 519 Preparations, 527 Official Preparations, 527 Pharmaceutical Preparations, 527 Aceta to Vina, 528-565 Excipients for Emulsions, . 533 Excipients for Mixtures, 544 Excipients for Pills, 549 PART III.—SPECIAL THERAPEUTICS, 566 References and Bibliography, 566 Abasia and Astasia to Yellow Fever, . 567-815 APPENDIX, 816 Latin Terms, Phrases, etc., used in Prescriptions 816 Latin Numerals, 828 Latin Verbs, Participles, Prepositions, etc., 829 Genitive Case-endings, 829 Hypodermic Formulae 830 Chlorodyne, Comparisons of Ten Formulae therefor, 832 Patent Medicines, 833 Tables of Differential Diagnosis, 837 Forms of Bright’s Disease, 837 Cancer, 838 Carditis, Endo- and Peri-, 838 Cerebral Concussion and Compression, 838 Chancre and Chancroid, 838 TABLE OF CONTENTS. XV PAGE Cholera, 839 Croup and Diphtheria, 839 Epilepsy and Hysteria, 839 Gout and Rheumatism, 839 Hematemesis and Hemoptysis, . . . 840 Phthisis, Tubercular and Non-tubercular, 840 Pleurisy and Pneumonia, 840 Scarlet Fever, Measles and Smallpox, 840 Typhus and Typhoid 841 Vomiting, Cerebral and Gastric, 842 Yellow P'ever and Bilious Remittent, 842 Notes on Temperature in Disease 842 Clinical Thermometry, 842 Temperature in Phthisis, 844 Temperature in Typhoid Fever, 844 Temperature in Scarlatina, 844 Temperature in Measles, 844 Temperature in Diphtheria, 844 Co-relation of Pulse and Temperature, 844 Clinical Examination of the Urine, 844 Deposits in Urine, 846 Necessary Apparatus, 846 The Treatment of Poisoning, 847 Antidotes and Antidotal Measures, .... 847 Antagonists and Antagonistic Measures, 851 Poisons, their Antidotes and Antagonists, 851 Tables. Table of Specific Gravities and Volumes, 862 Table of Drops and Weights of a Fluidrachm, 863 Table of Weights and Measures, 863 Table of Metric Conversions, 864 Table of Equivalent Weights and Measures, Inside of Cover. Table of Prescription Doses and Quantities, Inside of Cover. INDEX, 865 EXPLANATION. Numerals unqualified, under the subtitles Preparations in Part I, denote grammes for solids and cubic centimeters for liquids. For Signs and Abbreviations used, see pages 495 to 497. ERRATA. Page 95, line 14 from bottom,—for “ Five ” read “ Four,” Page 207, line 23 from bottom,—for “ Tincture” read “ Tinctura.” Page 239, line 4,—for “ Pyridin ” read “ Pyridine. ” Page 263, line 23,—for “ Paulinia ” read “ Paullinia Page 289, line 6,—for “ Urson” read “ Ursone.” Page 456, lines 18 and 25,—for “ Karst” read “ Kast.” Page 465, line 6 from bottom,—for “ Pistacece ” read “ Pistacia." Page 813, line 19,—strike out the comma after “ Emulsi.” Page 844, line 10,—for “ 104.70” read “ 104° ”; and in the following line after the word “hours” insert “ and 105° by the second day.” Page 845, line 1 from bottom,—before “Morphine” insert ‘‘Glycerin (see page 292).” XVI 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 for the poison. 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 divi- sions, viz. :— Natural Therapeutics, including the operations of the Vis Medica- trix Naturae,—the modes and processes of healing which occur indepen- 17 18 INTRODUCTION. dently 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 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 ex- cept 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. Applied Therapeutics embraces the application by Art of agents for- eign 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 sub- ject 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 pro- fessional 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, inde- pendently of physio-pathological reasoning (Hartshorne). It was neces- sarily 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 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 undoubtedly such methods will always prevail to some extent. Rational Therapeutics embraces the use of remedies for reasons based on a knowledge of (i) the pathological conditions present in the subject, and (2) 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- INTRODUCTION. 19 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 {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 quas inde contingunt affectiones, quis pulsus, quis calor, quse respiratio, qusenam excretiones, attend- endum. Inde adductum phenominoruin in sano obviorum, transeas ad experimenta in corpore aegroto. ” “ 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 experi77ient 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 labors, the present generation sees the development of an idea, announced nearly 140 years ago, but now inspiring the minds of teachers and students all over the civilized world. Medical Colleges are recognizing physio- logical drug-experimentation as a part of their regular curricula; labora- tories 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, Liebermeister, 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 com- ponent principles of vegetable drugs, are being subjected to the same rigid observation, as is 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 graduat- ing ordeal until he has mastered the essential characteristics of the physio- 20 CONSTITUENTS OF VEGETABLE DRUGS. logical 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, namely—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. 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 con- tents of the dispensatories, plus the entire literature of the “new reme- dies,” and every symptom in the ten quarto volumes of the largely dis- credited 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 in 1755, cultivated to some extent by Alexander in 1768, Crumpe in 1793, Thommassini, Curtis, etc.,—urged by John Hunter, Sir Thomas Watson, Dr. King Chambers, and many other lumi- naries of the medical profession,—the scientifically guarded proving of drugs on the human organism has lain, like the similar work of Jenner, neglected these many years, waiting for another Koch to re-inaugurate the work. CONSTITUENTS OF VEGETABLE DRUGS. The Constituents of Vegetable Drugs may be classified as Soluble and Insoluble, the first group containing those ingredients which may be extracted by suitable menstrua, the second such as resist the action of all ordinary solvents. The Soluble Constituents comprise both Inert and Active Princi- ples, the inert being chiefly starch, gum and pectin, which may be readily CONSTITUENTS OF VEGETABLE DRUGS. separated by water. The active principles are alkaloids, acids, salts, glucosides and other neutral principles, volatile oils, resins, etc. Some few of these may be extracted by Water alone (e. g., Morphine), and in some cases the addition of acids or alkalies to the water will effect the chemical solution of many ingredients which are insoluble in water alone. As a rule, however, Alcohol is the most generally applicable of all simple solvents, but from its hardening the cell-membranes instead of softening them it prevents the osmosis of their contents. Drugs subjected to alco- holic or ethereal menstrua should have their cells thoroughly broken or torn, so that the solvent may be brought into actual contact with the principles contained in them. The degree of disintegration required depends upon the size of the cells, ducts, tubes, intercellular spaces, etc., in which the active principles are enclosed. A very finely powdered state is however open to objection from the packing of the particles together into an almost impenetrable mass when treated by the solvent. The average size of vegetable cells is about of an inch, while resin cells and other cavities are larger, averaging perhaps about inch. The Pharmacopoeia prescribes in each instance the degree of fineness of the powdered drug employed in making certain of its preparations, or its bruising, slicing, etc., when such operations will answer. [Compare the article on Comminution in Part II.] 21 Alkaloids are active, nitrogenous principles existing in plants, from which they are extracted by chemical art. They are organic bases, com- bining with acids to form crystalline salts without the production of water. They are regarded as compound ammonias, that is to say, one or more atoms of H in ammonia (NH3) are in them replaced by various radicals; and they may be considered to be products of albuminous decomposition in the plant-cells during the process of growth. Like ammonia, they all contain N, with C and H; most of them also contain O, though a few are devoid of the latter element, and occur as oily liquids, namely—Nico- tine, Coniine, Sparteine, Piperidine, Lupuline, Lobeline, Muscarine and Pilocarpine. Alkaloids are alkaline in reaction, the solid ones (except Berberine) are colorless; they are sparingly soluble or insoluble in water, but readily soluble in alcohol; while their salts are more soluble in water than in any other liquid. Their solutions are intensely bitter. They are easily decomposed by alkalies or alkaline carbonates; and are precipitated from their solutions by a solution of Iodine in Potassium Iodide, by Po- tassio-mercuric Iodide, and by Picric, Phospho-molybdic and Phospho- tungstic Acids. They generally have a powerful physiological action. They are closely related to Pyridenc, and some of them may be synthet- ically prepared from pyridene bases. The names of alkaloids terminate in Latin in —ina, in English in —ine. 22 CONSTITUENTS OF VEGETABLE DRUGS. Of the alkaloids 15 are official, under either their own names or those of their salts, besides Veratrine, which is described as a mixture of alka- loids. Of the official salts of alkaloids there are 10 Sulphates, 6 Hydro- chlorates, 3 Hydrobromates and 1 each Bisulphate, Acetate, Salicylate and Valerianate. The official alkaloids are as follows, viz. :— Apomorphina, (Apomorphine). Atropina, (Atropine). Caffeina, (Caffeine). Cinchonina, (Cinchonine). Cinchonidina, (Cinchonidine). Cocaina, (Cocaine). Codeina, (Codeine). Hyoscina, (Hyoscine). Hyoscyamina, (Hyoscyamine). Morphina, (Morphine). Physostigmina, (Physostigmine). Pilocarpina, (Pilocarpine). Quinina, (Quinine). Quinidina, (Quinidine). Strychnina, (Strychnine). Veratrina, (Veratrine). Unofficial but Important Alkaloids, are the following, viz.:— Aconitina, (Aconitine). Berberina, (Berberine). Brucina, (Brucine). Colchicina, (Colchicine). Coniina, (Coniine). Curarina, (Curarine). Duboisina, (Duboisine). Emetina, (Emetine). Gelsemina, (Gelsemine). Homatropina, (Homatropine). Muscarina, (Muscarine). Pelletierina, (Pelletierine). Glucosides are organic compounds belonging to the group of Neutral Principles existing in plants; which, when acted upon by acids or certain ferments, split up into Glucose and other substances (alcohols, aldehydes, phenols), different in each case. Few, if any, of these compounds, con- tain any N,—but among them are some very active agents. The official glucosides number six, and like other neutral principles, are designated by titles which end, in Latin in —inum, in English in —in, viz. :— Chrysarobinum, (Chrysarobin). Elaterinum, (Elaterin). Glycyrrhizinum, (Glycyrrhizin). Picrotoxinum, (Picrotoxin). Salicinum, (Salicin). Santoninum, (Santonin). The most important unofficial glucosides are Digitalin, Digitalein and Digitoxin, the active principles of Digitalis. Besides these, there are several other substances recognized by pharma- copoeial names which terminate in —inum, —in, but which have no re- lationship to the group of Glucosides. Among them are the following :— Aloinum, (Aloin),—a neutral principle from Aloes. Benzoinum, (Benzoin),—a balsamic resin from Slyrax Benzoin. Cannabinum, (Cannabin),—a resin from Cannabis Indica. Chinoidinum, (Chinoidin),—a mixture of alkaloids from Cinchona. Glycerinum, (Glycerin),—a liquid and sweet principle obtained by the decomposi- tion of vegetable or animal fats or fixed oils. Juniperinum, (Junipenn),—a principle from Juniper. Lupulinum, (Lupulin),—the glandular powder of the Hop plant. Piperinum, (Piperin),—a neutral principle obtained from Pepper. Also Benzin, Naphtalin, Pancreatin, Pepsin, Pyroxylin, Chinolin, Resorcin, Antipy- rin, Phenacetin, Kairin, Thallin, Piperazin, and other organic compounds, which are not derived from the vegetable kingdom. Resins are brittle, amorphous, solid exudations from trees; charac- terized by being insoluble in water but soluble in alcohol, and by soft- ADMINISTRATION OF MEDICINES. ening or melting when heated and solidifying again on cooling. They are oxidized terpenes, consist of an acid or a mixture of acids, and dis- solve in alkalies, forming a kind of soap. They may be obtained from oleo-resins, as turpentine, by simple distillation, the volatile oil passing over and the resin remaining behind; or by heating the part of the plant in which they are contained, as in the case of guaiacum resin. [Com- pare the title Resina, in Part II.] 23 Gum-resins are natural mixtures of gum and resin. When they are rubbed up with water the gummy matter dissolves and the resin is suspended in the form of an emulsion. [Compare the title Emulsa, in Part II.] The Insoluble Constituents of vegetable drugs are Cellulose, Lignin and Sclerogen, which make up the cell-walls of vegetable sub- stances, and are extremely intractable. ADMINISTRATION OF MEDICINES. Medicines may be introduced into the circulation by various routes, including the mouth, the stomach, the rectum, the respiratory tract, the veins and arteries, the subcutaneous cellular tissue, and the integument itself. The Mouth is the usual receptacle for medicines intended for the stomach, but may itself be employed for the introduction of minute quan- tities of powerful agents. A drop of the tincture of Aconite placed on the tongue is quickly absorbed, and soon manifests that fact by its symp- toms. The small tablets used for hypodermic administration, if placed under the tongue, are readily conveyed into the system, and used in this way form a very convenient means of medication with alkaloids and other active principles. The Stomach is the most convenient organ for the absorption of medicines and the one most frequently employed. After having been swallowed the remedies 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 rapid- ity. Colloidal Substances (fats, albumen, gum, gelatin, etc.) require to be digested and emulsified before they can be absorbed. Iodine and Iodides should be given on an empty stomach, so that they may diffuse rapidly into the blood ; if administered during digestion the acid gastric juice and the starch of the food will alter their chemical constitution and 24 ADMINISTRATION OF MEDICINES. weaken their action. Acids should be given, as a rule, on an empty stomach, especially when they are intended to check the secretion of the acids of the gastric juice. Alkalies, of which Sodium Bicarbonate may be taken as the type, are given after meals to neutralize excessive acidity, and before meals to stimulate the acid gastric secretions. Silver Oxide and Nitrate should be administered after the digestive process is ended; if given during digestion, chemical reactions destroy or impair their special attributes and defeat the object for which they were prescribed. Metallic Salts (especially corrosive sublimate), also Tannin and pure Alcohol, impair the digestive power of the active principle of the gastric juice, and should only appear in the stomach during its period of inac- tivity. Malt Extracts, Cod-liver Oil, Phosphates, etc., should be given with or directly after food, so that they may enter the blood with the products of digestion. Bismuth should be given before meals, as it is usually employed for its local sedative action on the gastric mucous mem- brane. Potassium Perma7iganate should be given after meals, for on an empty stomach it would irritate the mucous membrane and might possi- bly produce ulceration thereof. Arsenic and other irritant and dangerous drugs (such as Copper, Zinc and Iron salts), should be given directly after food, except where local conditions require their administration in very small doses on an empty stomach. Morphine by hypodermic injec- tion should only be given when the patient is lying down, unless pre- viously habituated to its use. Pilocarpine, administered to produce sweating, should be given when the patient is in bed in a warm room. Ammonium Acetate acts as a diaphoretic when the recipient is warm in bed, but as a diuretic when the patient is in a cold room. Sulphonal should be given two or three hours before its hypnotic action is desired, as it is very slow of solubility and absorption. Under some circumstances it becomes necessary to introduce medicines directly into the stomach, as in cases of the patient’s inability to swallow through narcotic poisoning or other causes. The stomach-pump or the stomach-tube may then be employed to convey both food and medicine to that receptacle. In obstruction of the oesophagus, as from stricture or malignant disease thereof, it may become necessary to make an opening through the abdominal wall and the wall of the stomach itself. Nasal feeding, by the use of a soft catheter with a hard rubber funnel inserted into its end, is a very efficient method of conveying liquids into the stomach. The eye end of the catheter is oiled and passed gently along the floor of the nose and down the pharynx; the fluid being then poured into the funnel. In many cases, especially insane ones, the patient will so con- strict the muscles of the throat as to force the catheter into the mouth ; but if it is with- drawn until nearly out of the pharynx, the presence of the fluid as it drops down will excite swallowing, and the patient may be fed as well as if the tube was in the oesopha- gus. This method is particularly serviceable in cases of acute tonsillitis or other pain- ful affections of the mouth and palate, also after excision of the tongue, when swallowing is to be avoided as much as possible. 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 ADMINISTRATION OF MEDICINES. 25 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. Nutritive enemata must be small, not exceeding three or four fluid ounces, or they will not be retained. They become necessary in many cases, especially in cases of gastric ulcer, in order to afford rest to the stomach. It is often found advantageous to have the food predigested before being administered by the rectum, for which purpose Pancreatin is used. [Compare the articles entitled Injec- tiones and Suppositoria in Part II and Enemata in Part III.] 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. [Compare the article entitled Inhala- tiones, in Part II.] The Veins are only used as a route of medication in emergencies, when the other channels are not available, and where immediate action is necessary to the preservation of life, the operation being a highly 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, Hydro- cyanic-acid poisoning, Opium narcosis, Chloroform asphyxia, etc., are the instances admitted in practice. Arterial Transfusion has also been performed successfully in a number of cases, and is considered safer than venous transfusion when a large quantity of fluid has to be in- troduced 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 when powerful alkaloids are employed. Another is the avoidance of reactions between the drug and the secretions of the stomach, which may destroy the activity of the former, or seri- ously change its character. The medicines must be in solution, of neu- tral reaction and freshly prepared, the usual menstruum being distilled water; though filtered spring water will answer just as well, and much better than distilled water which has been standing several days, and ex- posed from time to time to the air. The solution is to be injected beneath 26 ADMINISTRATION OF MEDICINES. 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 sensitive nerve filaments. A few years ago the sight of a hypodermic syringe in a physician’s hand suggested an injection of mor- phine to the patient and to the patient’s friends, and many a physician has acquired the reputation of giving morphine on every possible occa- sion because he administered drugs by this method. It is therefore well to inform the patient that another drug is being so administered when such is the fact. In this age of toxin and antitoxin treatment the hypo- dermic syringe has become a necessity, as many of these agents are inert when given by the stomach. Whenever such preparations are employed their injection must be administered under strict aseptic conditions, ap- plied to the syringe and needle as well as to the site of the operation, and the contents of the syringe should be discharged very slowly into the tis- sues beneath the skin, giving time for the fluid to diffuse itself without rupturing the tissue. The classic practice of pinching up a fold of the integument before inserting the hypo- dermic needle is entirely wrong both in theory and in practice. It is never done by per- sons who habitually use this instrument on themselves, and they are admittedly the most expert of all operators in this line. It increases the liability to local soreness, and often produces bruises and ecchymoses which might be avoided by following the method de- scribed below. After nearly filling the syringe with the solution to be used, the needle, if separate, 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 ex- pelling air-bubbles and filling the needle itself. A site having been selected, where there is no danger of penetrating a vein or artery, the needle should be quickly inserted at a right angle with the surface, and carried on into the subcutaneous tissue for fully one-half its length. It should be held steadily and not moved around so as to avoid injuring the tissue. The piston should be pressed down slowly, and when the injection has been delivered the needle should be quickly withdrawn, and no attention paid to the few drops of solution which may follow it. The very finest needles should alone be used, except in cases where the patient is struggling and liable to break the needle off by his move- ments. The point of the needle should be perfect and its surface highly polished. It is far better to use a new needle every day than to risk one’s reputation for skill on a blunt- pointed and rough-surfaced instrument. The writer buys Green’s short and finest needles by the dozen and uses a new one on every patient. He has injected a strychnine solu- tion in this manner on some 300 patients during the last three years, three and four times daily in the same upper arm for a month in each case, without having produced any more serious result than a hypersemic zone around some punctures in a very few instances. If the solutions are freshly prepared with clean water, the needles sharp, clean and bright, and the injections delivered beneath the skin and not into it, there is no danger of pro- ducing abscesses or even indurations with the agents ordinarily employed in this manner. Compressed Tablets for hypodermic use are prepared by the prominent manufac- turers, and are furnished in glass tubes containing from 20 to 25 tablets each. The writer prefers those made by John Wyeth and Brother of Philadelphia, for many reasons. They are very small, are entirely free from any foreign material, are sufficiently soluble, and are put up in short tubes which can be carried in cases to fit the vest pocket. The tablets may be readily dissolved in a teaspoon at the bedside, or in the syringe itself if ADMINISTRATION OF MEDICINES. the instrument has a screw-hole large enough to admit the tablet before screwing on the needle. A regular line of Hypodermic Tablets includes the agents named in the follow- ing list, though many others are prepared by the manufacturing chemists. 27 List of Hypodermic Tablets. Aconitine (crystals), gr. x|x. Apomorphine Hydrochlorate, gr. fa. Atropine Sulphate, gr. tU> ?>V Caffeine, gr. Cocaine Hydrochlorate, gr. ]■. Coniine Hydrobromate, gr. Colchicine, gr. fa. Corrosive Sub. and Urea, gr. fa. Digitalin (soluble), gr. -j-fa. Duboisine Hydrochlorate, gr. yyy. Ergotin, gr. Gelsemine Hydrochlorate, gr. fa. Hyoscine Plydrobromate, gr. x^x, fa. Hyoscyamine, gr. fa. Morphine Sulphate, gr. J. Morphine & Atropine, No. I. Morphine Suiph., gr. Atropine Suiph., gr. Morphine & Atropine, No. 2. Morphine Suiph., gr. J. Atropine Suiph., gr. Tl Nitroglycerin, gr. , Physostigmine Sulphate, gr. yly. Picrotoxin, gr. Pilocarpine Hydrochlorate, gr. 4. Sodium Arsenate, gr. y1^. Sparteine Sulphate, gr. yL-. Strychnine Nitrate, gr. -fo, Strychnine Sulphate, gr. -fa, Tfa [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, Salts of Cocaine for local anaesthesia, and Carbolic Acid for deep-seated inflammations. The Integument is an active absorbent of crystalloidal substances when its epidermis or cuticle is removed, and many substances may be made to pass through the latter and produce their characteristic effects on the system. By this route there are four methods of introducing medica- ments into the circulation, viz. :—the Endermic, Enepidermic and Epi- dermic Methods and Inoculation. The Endermic Method obviates the difficulty of absorption through the cuticle by removing the latter with a blister, and then powdering the medicament over the surface of the denuded derma. Before the intro- duction of the hypodermic method this procedure was quite common, but it is rarely employed now, as it is both painful and unpopular. An ordinary Cantharides-plaster, followed by a poultice to raise the blister, may be employed ; but a quicker method is to place upon the skin a piece of lint soaked in Stronger Water of Ammonia, covering it with a watch-glass or a piece of oiled silk to prevent evaporation. The blister raises rapidly and should be removed with scissors, and the medicine in powder then placed on the raw surface. Morphine, Atropine, Quinine and Strychnine, are the agents generally used in this manner. The Enepidermic Method consists in placing the medicine in simple contact with the epidermis, no friction being used to hasten its penetra- tion. Chloroform and oleic acid solutions of the alkaloids pass by osmo- sis in this manner with comparative ease, but aqueous solutions act very slowly, and alcoholic ones with great difficulty if at all. Drugs are readily absorbed from the surface of hot, moist poultices, a fact to be remem- bered in directing such applications for children, as narcotic poisoning may follow the liberal use of opium in this manner. A good belladonna 28 DOSAGE OF MEDICINES. plaster will cause dilatation of the pupils and may produce the character- istic belladonna rash all over the body. The Epidermic Method or Inunction consists in the use of fric- tion to promote the passage of the medicament between the cells of the epidermis. Mercurial ointment, cod-liver oil, and other fats, oleates, etc., are rubbed into the skin of the armpits, the popliteal space, and other parts of the body, for their local and systemic effects. Oil inunc- tions are an excellent method of introducing fatty substances into children and persons who cannot take oils by the stomach. The inunction of castor oil will produce a purgative effect. Inoculation is the introduction of medicinal agents through the scraped or punctured skin by an operation similar to that employed for vaccination. 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, --j— = 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, Ipecacuanha, Calomel and other preparations of Mercury, also Squill, Rhubarb and several other purgatives. Pilocarpine has very little effect on children, though it readily induces perspiration and salivation in adults. 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 accumu- lated rubbish of ages, which has been called therapeutic 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- DOSAGE OF MEDICINES. 29 stones in the foundation. Drugs have widely differing actions on the human organism in health and in disease, according as they are adminis- tered in different doses, in different menstrua, and during different con- ditions 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 doc- trine now rule of “similars,” and avoided by the great mass of the med- ical profession, through dread of the bogy-name, “ irregular.” In the British Pharmacopoeia a minimum and maximum dose is stated for all the more important medicines, the quantities being intended to represent average doses in ordinary cases for adults. In the preface to that work it is however distinctly stated that these doses “ are not authoritatively enjoined ” and that “ the practitioner must rely on his own judgment and act on his own responsibility in graduating the doses of any thera- peutic agents which he may wish to administer to his patients.” As a matter of fact most British practitioners ignore the doses given in their pharmacopoeia, or at best con- sider them as mere indications. The German Pharmacopoeia has appended to it a table giving the maximum single dose and the maximum daily dose for a number of drugs and preparations, but they are of little value in practice except to catch an unwary physician in a legal proceeding for mal-practice. In the following pages an effort has been made, whenever possible, to indicate the different doses of active agents for different purposes, and the proper intervals for repetition in certain cases, as determined by the accumulated experience of clinicians, which is the only safe guide in this respect. The average doses of the official preparations should be memor- ized by the student, and the following rules will be found useful for that purpose. Average Adult Doses of Official Preparations. Acids (dilute), n\,x;—except Dilute Hydrocyanic Acid, the average dose of which is TT\,iij- Alkalies. Liquor Potassae, well diluted. Carbonates, gr. xv, Sodium Borate (Borax) gr. xx, Bicarbonates, gr. xxx. Alkaloids and their Salts, form three groups, (i) those of the Solanacese, etc., the average dose of which is gr. (2) those from Nux Vomica, gr. (3) those from Opium, gr. J-;—except Codeine, gr. j, Narcotine (which is not a narcotic), gr. iij, Quinine and the other Cinchona alkaloids, gr. x. Aquae (Waters), gj;—except Aqua Ammoniae, rt\x, Aqua Chlori, and Aqua Creosoti, 3 ij. Extracts, gr. v ;—except Ext. Physostigmatis, gr. y Ext. Aconiti, gr. J, Ext. Belladonnae, gr. jt, Ext. Colchici Radicis, gr. j, Ext. Colocynthidis, gr. j, Ext. Cannabis Indicae, gr. Ext. Opii, gr. Ext. Stramonii, gr. and Ext. Aloes, gr. iij. Fluid Extracts, tl\_x;—except the fluid extracts of Aconite, Tt\j, Belladonna, Colchicum-root, rt\_v, Colchicum-seed, rt\qj, Digitalis, TT\J, Nux Vomica, TTLij, Sanguina- ria, Tqjj, Squill, TTLij, Stramonium, TTLij, and Veratrum Viride, TTLij. Infusions and Decoctions, %j;—except Infusion of Digitalis, gij. Mixtures, j;—except the Mist. Glycyrrhizae Comp, (for children), 3 j, and Mistura Ferri Composita, 3 iij. Oils, Fixed, j ss;—except Oleum Phosplioratum, TTLiij, and Oleum Tiglii (Croton 0il)>."ij- ... Oils, Volatile, TTLij;—except Oleum Amygdalae Amarse, TTLss, and the Oils of Co- paiba, Erigeron, Cubeb, Eucalyptus, Juniper, Sandal-wood and Amber, of each TTLx. Pills, gr. v;—except those of Phosphorus, Ferrum Iodide, Opium, Blue Mass, and Compound Antimony, which are given in smaller doses. 30 STIMULANTS AND SEDATIVES. Powders, form two classes, (i) those given in grains, including Pulv. Antimonialis, gr. v, Pulv. Morphinse Comp., gr. x, Pulv. Ipecac, et Opii, gr. x, Pulvis Opii, gr. j, Pulv. Cretae Comp., gr. xx, and Pulv. Jalapae Comp., gr. xxx ; (2) those given in dose of 3j or more, including Pulv. Glycyrrhizse Comp., Pulv. Rhei Comp., and Pulv. Ef- fervescens Comp. Resins, gr. v;—except Resin of Podophyllum, the average dose of which is gr. ss, and Resin of Copaiba, gr. ij. Spirits, 3 ss or more, according to the amount of alcohol desired to be taken ex- cept Spirit of Camphor, and Spirit of Nitroglycerin (Spt. Glonoini), ttbiij. Syrups, 3 j ;—except Syrup of the Iodide of Iron, npx, and Compound Syrup of Squill, rrpx. Tinctures, sjss;—except the tinctures of Aconite, tt\j, Belladonna, rrpx, Can- tharides, trpv, Capsicum, rt\v, Colchicum-seed, rrpxx, Digitalis, Ttpx, Chloride of Iron, nvx, Gelsemium, Iodine, rrpv, Ipecac and Opium, Lobelia, rtpx, Nux Vomica, Ttpx, Opium, ttpxv, Physostigma, rrpx, Stramonium, npx, Strophanthus, rrpv; also the tinctures given in larger doses, namely, Hyoscyamus, % ij, and Camphorated Opium, 3 ij. It is well to remember that children bear the above dose of tincture of Belladonna without difficulty, and that tincture of Aconite should always be given in doses of a drop or less. Wines, 3 j;—except those of Antimony, Colchicum and Opium, the average dose of which is tr^x. Vinegars, number only 2, that of Opium, and that of Squill, TT\xxx. CLASSIFICATION OF MEDICINES. In the present state of knowledge respecting the actions and uses of 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 chiefly 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 compar- ing 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. Stimulants and Sedatives. These are general terras employed in various classifications with very little discrimination. AGENTS ACTING ON THE NERVOUS SYSTEM. 31 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 even briefly the organic action of any part of the system. All excessive stimulation reacts into depression, and most of the agents which stimulate the nerve centres at first will soon depress and finally paralyze them. In many cases the action is one of progressive stimulation primarily and progres- sive paralysis afterward, affecting the centres in the inverse order of their development, the highest or latest developed centres being affected first, the lowest or oldest ones last. These laws are well exemplified in the action of Alcohol upon the nervous system. [See the article entitled Alcohol in Part I.] Diffusible Stimulants are those which have a prompt but transient effect on the general system, such as Alcohol, Ammonia, Camphor, etc. Spinal Stimulants exalt the functions of the cord, as Strychnine, Picrotoxin, Ergot, Atropine, Phosphorus. Cardiac Stimu- lants 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. Respiratory Stimulants directly stimulate the respira- tory centre, as Ammonia, Strychnine, Apomorphine, Belladonna, etc. Vaso-motor Stim- ulants, as Alcohol, Chloroform, Ether (all three in very small quantities), Ammonia, Strychnine, Digitalis and Squill, acting on the vaso-motor centre; and the Nitrites, Bella- donna, Electricity, Volatile Oils, etc., acting as local dilators of the vascular system. Cerebral Stimulants, as Alcohol, Opium, Belladonna, Caffeine, Cocaine, Theine, Canna- bis, Chloroform, Ether, Tobacco, etc. Renal Stimulants, as the diuretic group. Stom- achic Stimulants, as the Aromatics, Volatile Oils, Vegetable Bitters, Mineral Acids, Nux Vomica, Mustard, Capsicum, etc. Hepatic Stimulants, as Nitro-muriatic and Nitric acids, and the cholagogue purgatives Podophyllum, Jalap, Leptandra, Euonymin, Iridin, etc. Intestinal Stimulants, as Mercurials, Elaterium, Colocynth, Jalap, Scammony, Podophyl- lum, etc., which affect the glandular apparatus,—and Belladonna, Physostigma, Nux Vomica, Rhubarb, Senna, Aloes, Frangula, Cascara, etc., which chiefly affect the mus- cular fibres and the intestinal nerves. Ctitaneous Stimulants, as the diaphoretic group, and the rubefacients Mustard, Capsicum, Turpentine, Ammonia, etc. 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 anesthetics. Local Sedatives include Aco- nite, Opium, Ice, etc. Puhtionary Sedatives, as Hydrocyanic Acid, Veratrine and the nauseants and emetics. Spinal Sedatives, as Physostigma, Gelsemium, Potassium Bro- mide. Sto?nachic Sedatives include Arsenic, Bismuth, Silver Nitrate, Sodium Bicarbon- ate. 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. 32 AGENTS ACTING ON THE NERVOUS SYSTEM. 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, Strychnine 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. Convallaria. Cimicifuga. Pilocarpine. Pyridine. Rhus Toxicodendron. Electricity. Motor Depressants lower the functional activity of the spinal cord and other parts of the motor apparatus and in large doses paralyze them. Drugs which depress the cerebral motor convolutions, the motor centres in the medulla, the motor nerve-trunks and nerve-endings, or the muscular contractility itself, produce impairment of the motor power, and in large doses may cause complete paralysis of the part or parts involved. Some act indirectly by reducing the spinal circulation, as Aconite, Digitalis and large doses of Quinine, others by a direct paralyzant action on the centres. The principal members of this class are comprised in the following list: — Curare. Physostigma. Conium. Gelsemium. Opium, Morphine, Apomorphine. Belladonna, Atropine. Stramonium. Hyoscyamus. Muscarine. Pulsatilla. Grindelia. Phytolacca. Pilocarpus. Quebracho. Aconite. Veratrum. Tobacco. Lobelia. Digitalis. Arnica. Ailanthus. Saponine. Sparteine. Ergot(at last). Quinine (large doses). Camphor. Alcohol (large doses). Plther (large doses). Chloroform (large). Chloral. Bromides. Potassium Salts. Many metallic Salts. Amyl Nitrite. Nitroglycerin. Hydrocyanic Acid. Potassium Cyanide. Methyl-strychnine. Many Methyl compounds. Ammonium Cyanide. Ammonium Iodide. Many compound Ammonias. Galvanism. Cold. 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. These last three 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, Carbolic Acid, and other agents, and the motor nerves by Conium, Methyl-Strychnine, etc., both actions resulting in paralysis of the limbs. Curare, 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. * In large doses. f In small doses. AGENTS ACTING ON THE NERVOUS SYSTEM. 33 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 cir- culation, as in inflammation. The principal members of this group are— Faradism. Heat. Cold. Alcohol. Ether. Chloroform. Carbolic Acid. Creosote. Mineral Acids. Ammonia. Volatile Oils. Acrid Essential Oils. Metallic Salts. Veratrine (at first). Cantharis (at first). Local Anaesthetics and Anodynes {An, without, Aistheysis, per- ception, 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 impair- ing 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 named in the following list. Local Anodynes. Acetanilid. Aconite, Aconitine. Belladonna, Atropine. Opium, Morphine. Carbolic Acid. Chloroform. Chloral. Veratrum, Veratrine. Volatile Oils. Oil of Turpentine. Galvanism. Local Anesthetics. Extreme Cold, Ice. Ether Spray. Ouabain. Cocaine. Antipyrin. Erythrophloein. Hydrocyanic Acid. Carbolic Acid. Creosote, Guaiacol. 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. Ammonia (inhaled). Coffee, Caffeine. Tea, Theine. Guarana, Guaranine. Coca, Cocaine. Tobacco. Strychnine. Acetic Acid (inhaled). V alerian. Ether. 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. Belladonna. Stramonium. Hyoscyamus. Turpentine. Alcohol. Chloral. Ether. Chloroform. Cannabis Indica. Lupulus (at first). Opium (at first). Nitrous Oxide Gas. 34 AGENTS ACTING ON THE NERVOUS SYSTEM. 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 dimin- ish 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, also Carbolic Acid. Narcotics (Narkay, stupor),—are agents which lessen the relation- ship of the individual to the external world. At first more or less exci- tant to the higher brain and stimulant to the mind and to all the bodily functions, the next stage of their action is one of profound sleep charac- terized by increasing stupor, and, if the dose has been sufficient, is followed by coma and insensibility (narcotism), and finally by death from paralysis of the medullary centres which govern the functions of organic life. Narcotics and stimulants are closely related, Alcohol and Opium being good illustrations, in the different stages of their action, of stimulation followed by narcosis. [Compare the sub-title Stimulants, ante, page 31, and the title Alcohol in Part I.] Narcotics, in proper medicinal doses, give us the power of lowering morbidly acute perception, of relieving pain and allaying irritation, nervous agitation and spasm, of inducing sleep, and of regulating the vital functions by rest—all of which are means of great therapeutical value. The chief narcotics are— Opium, Morphine. Belladonna, Atropine. Hyoscyamus. Stramonium. Cannabis Indica. Alcohol. Ether. Chloroform. Chloral Hydrate. Bromal Hydrate. Carbolic Acid. Hydrocyanic Acid. Oil of Turpentine. Other Essential Oils. Carbonic Acid Gas. Opium is the typical member of the group. Humulus (hops) and Lactucarium, (lettuce), are generally included among the narcotics, but their action is so feeble that they are seldom used for such purpose. Hypnotics (Heupnos, sleep),—are remedies which produce sleep. In this wide sense the term includes the narcotics and the general anaes- thetics, but it is usually restricted to those agents which, in the doses necessary to cause sleep, do not disturb the normal relationship of the mental faculties to the external world (Brunton). Another definition of Hypnotics is—that they produce sleep without suspending the conscious- ness of pain, Narcotics doing both. The Hypnotics may be subdivided and listed as follows:— (1) Pure Hypnotics,—which directly induce a sleep closely resem- bling the normal, without causing narcotic or other dangerous cerebral symptoms. The Bromides are the type of this subdivision, but the list AGENTS ACTING ON THE NERVOUS SYSTEM 35 is constantly growing smaller as experience reveals toxic powers in the action of its members. (2) Narco-hypnotics,—which induce sleep by direct depression of the cerebral functions and in larger doses are narcotic, suspending the con- sciousness of pain and producing coma. Opium is the type of this class. (3) Indirect Hypnotics,—which induce sleep by removing or sup- pressing any cause (not mental) which interferes therewith. Such are the non-narcotic analgesics,* acting against pain ; the respiratory stimu- lants,f relieving dyspnoea; the pulmonary sedatives,| relieving cough ; the motor depressants,§ restraining excessive motor activity; also the vascular and cardiac tonics,antagonizing cerebral hyperaemia and regu- lating the cardiac action. The principal members of each of the above sub-divisions are included in the following list. \ Pure Hypnotics. Bromides. Paraldehyde. Sulphonal. Trional. Tetronal. Urethane. Chloralamid. Cannabin Tannate. Na rco- hypn otics. Chloral Hydrate. Opium, Morphine, Narceine. Hyoscyamus, Hyoscine. Duboisine. Cannabis Indica. Humulus. Piscidia erythrina. Ether. Chloroform. Amylene Hydrate. Alcohol. Indirect Hypnotics. * Antipyrin. * Acetanilid. * Phenacetin. f Strychnine. i Hydrocyanic Acid. | Conium. | Gelsemium. IT Ergot. Digitalis. Chloral Hydrate is undoubtedly the most efficient of all hypnotics. Paraldehyde is one of the most reliable and safe, but its sleep is transient, lasting only a few hours. Sul- pho7ial and Trional are very efficient in some cases, but often fail entirely. Urethane is feeble and uncertain, and the same may be said of Humulus and some other agents which are not mentioned above. Piscidia is also somewhat uncertain in action, though its hypnotic and anodyne powers have proved very decided in many cases. Analgesics or Anodynes (An, without, Algos, pain, Odunay, pain), —are remedies which relieve pain either by direct depression of the centres of perception and sensation in the cerebrum, or by impairing 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 Ano- dynes have been described, and the list of General Anodynes includes the following-named agents, viz.— Opium, Morphine. Belladonna, Atropine. Cannabis Indica. Stramonium. Hyoscyamus. Gelsemium. Antipyrin. Acetanilid. Phenacetin. Phenocoll. Exalgin. 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 36 AGENTS ACTING ON THE NERVOUS SYSTEM. Ancesthetics are certain volatile substances, mostly belonging to the classes 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 this term is usually restricted to the effects of the volatile agents referred to above. The principal mem- bers of this group are— Ether (Ethyl Oxide). Methylene Bichloride. Ethylene Bichloride. Nitrous Oxide. Chloroform. Chlorinated Ethyl Chloride. Ethyl Bromide. Pental (Tri-methyl-ethylene). The list of General Anaesthetics also includes Alcohol and many substitution products derived from alcohols and ethers. [Compare the articles entitled Alcohol, AJther and Chloroform in Part I.] 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 codrdinating 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. Hydrocyanic Acid. Physostigma. Curare. Ammoniac. Castor. Musk. Galbanum. Sumbul. Ipecacuanha. 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. AGENTS ACTING ON ORGANS OF SPECIAL SENSE. 37 Agents Acting on the Organs of Special Sense. 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 muscle resulting in temporary loss of accommodation, the eye remaining focussed for distant objects, and the intra-ocular tension being increased. The principal mydriatics are the following named,— Atropine. Belladonnine (internally only). Hyoscyamine. Daturine. Duboisine. Homatropine. Gelsemine (locally only). Muscarine. Cocaine. Anaesthetics (at last). 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 ot 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. Cocaine acts by stimulating the terminations of the sym- pathetic. Ancesthetics produce mydriasis late in their action, which is central. Atropine, Duboisine and Homatropine are the mydriatics used by ophthalmologists. Myotics (Meuo, I close),—are agents which produce contraction of the pupil. The alkaloid Physostigmine (Eserine) is the chief local myotic, and the only one used in ophthalmic practice. It acts by stimulating the circular muscular fibres of the iris, at the same time contracting the cili- ary muscle so that the eye is accommodated for near objects only, and diminishing intra-ocular tension; in all of which it exactly antagonizes 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 during anaesthesia is a sign of failing respiratory power. The myotic action of Opium is ot central origin, probably paralysis of the local reflex excitability. The chief myotics are as follows:— Physostigma, Eserine. Opium, Morphine. Pilocarpus, Pilocarpine. Muscarine. Gelsemine (internally). Carbolic Acid (internally). Lobeline (internally). Nicotine (locally). Anaesthetics (at first). Accommodation is impaired or paralyzed by the following named drugs, acting upon the ciliary muscle, viz.— Atropine. Daturine. Hyoscyaniine. Homatropine. Physostigmine. Pilocarpine. Cocaine. Gelsemine. Intraocular tension is increased by Atropine (large doses), Hyoscyamine and Daturine ; and is decreased by Physostigmine and by Cocaine. Gelsemine paralyzes the external ocular muscles, especially the levator palpebrse and external rectus, by its action on the terminal nerve filaments. 38 AGENTS ACTING ON ORGANS OF SPECIAL SENSE. 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 injec- 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 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. Strychnine 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, Antipyiin and Salicylates produce hyper- aemia of the auditory apparatus, causing subjective noises, as humming, buzzing or ringing, which are very unpleasant. Hydrobromic 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. AGENTS ACTING ON RESPIRATION. 39 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 imme- diately after swallowing. Substances which are excreted from the system in the saliva (as Iodides) leave a very persistent after-taste. 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 position from which they were moved by the inspiratory effort. An Expiratory Centre must also exist for the initiation of forced expiration, as in the production of voice, cough, sneezing, etc. The chief Inspira- tory Nerves are the pulmonary branches of the vagus. The Expiratory Nerves are the nasal branches of the fifth, the superior and inferior laryn- geal, and the cutaneous nerves of the chest and abdomen. Agents Acting on Respiration. 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. Veratrine, Eserine, 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. Hydrocyanic Acid. Conium. Alcohol. Ether. Chloroform. Chloral. Saponin. Caffeine. Colchicine. Nicotine. Quinine. Camphor. Carbolic Acid. The eleven 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 40 AGENTS ACTING ON RESPIRATION. others by lowering the excitability of the vagus end-organs in the lungs, and of 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. Belladonna 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. Hydrocyanic Acid. Amyl Nitrite. Quebracho. Cannabis. Turpentine. Ethyl Iodide. Conium. Tobacco. Errhines and Sternutatories (En, in, Rhin, the nose; Sternu/o, I sneeze),—are agents which produce increased nasal secretion and sneez- ing, 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 respiratory centre, exciting the sudden and forcible expira- tory 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. Saponin. 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 of, 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 ex- pelling the mucus in the act of vomiting, in small doses by increasing osmosis from the inflamed mucous membrane. The members of this sub- division generally increase secretion and tend to lower the blood-pressure. The chief of them are the following named :— Antimony, Tartar Emetic. Ipecacuanha, Emetine. Pilocarpus (Jaborandi). Apomorphine. Quebracho. Alkalies. Potassium Iodide. Lobelia. Lobeline. 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— AGENTS ACTING ON THE CIRCULATION. 41 Ammonium Chloride. Ammonium Carbonate. Benzoin and Benzoic Acid. Balsams of Peru and Tolu. Wood Tar, and Tar. Oleum Pini Sylvestris. Acids. Squill. Garlic. Onion. Turpentine. Sulphur. Nux Vomica. Strychnine. Senega. Saponin. 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. 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. Agents Acting on the Circulation. 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. : — Alcohol. Ammonia. Atropine. Nitroglycerin. Orchitic Extract. Spermine. Hydrastinine. Cocaine. Ether. Chloroform. Heat. Continuous Galvanic Current. Counter-irritation. .Sparteine. Camphor. Aromatic Oil. 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. Sparteine. Squill. Erythrophloein. Caffeine. Saponin. Strophanthus. Strychnine. Helleborein. 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, Erythrophlceum, 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. 42 AGENTS ACTING ON THE DIGESTIVE SYSTEM. Cardiac Sedatives lessen the force and the frequency of the neart’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. Ouaba'in. Emetine. Senega, Saponin. Hydrocyanic Acid. Potassium Salts. Cold. Aconite, Veratrum, Muscarine, Pilocarpine, Saponin, and Hydrocyanic Acid are direct cardiac poisons, depressing the heart muscle and the cardiac motor ganglia; Mus- carine 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 inhibi- tion, 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 Alco- hol and Etheiy 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. Thyroid Extract. Belladonna. Stramonium. Hyoscyamus. Opium (at first). Hydrocyanic Acid. Chloral. Chloroform. Liq. Ammonii Acetatis. Ipecacuanha. Heat, as Poultices, etc. Tartar Emetic. 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. Strophanthus. Iron. Ergot. Opium (in small doses). Adrenal Extract. Strychnine. Lead and Silver. Hamamelis. 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 evaporating 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. Barium salts. Zinc salts. Hamamelis. Digitalis. Hydrastis. Sulphuric Acid. Opium. Lead salts. Cocaine (locally). Antipyrin. Agents Acting on the Digestive System. Dentifrices (Dens, a tooth, Frico, I rub),—are medicated powders or pastes employed to cleanse the teeth and gums. Chalk is the basis gener- AGENTS ACTING ON THE DIGESTIVE SYSTEM. 43 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 in- gredient, being an aromatic local stimulant and disinfectant. 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 be afterwards rinsed with a weak alkaline wash. Opium, Chloral, Cocaine, Carbolic Acid, Creosote, Potassium Chlorate, and Aconite are the agents used as local anodynes in tooth- ache from caries exposing a nerve filament. Chloral should never be used for this pur- pose, for 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 increase 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 principal 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. Ipecacuanha. Antisialics {Anti, against, Seealon, saliva),—are remedies which di- minish the secretions of the salivary glands. Atropine is the principal agent of this group, acting by paralyzing the terminations of the nerves of secretion. 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. Soda. Lime. Lithia. Magnesia. Insipid or nauseous articles of food or medicine. 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 appetite and promote gastric digestion. They include a number of sub- stances, dietetic and medicinal, some acting by stimulation of the pro- 44 AGENTS ACTING ON THE DIGESTIVE SYSTEM. duction 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 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 digestion-ferments, Pepsin, Ingluvin, Papain, also dilute HC1 acid; which may be used to supplement the gastric juice when deficient in quantity or quality. The juice of the Pineapple contains a very active digestive principle, and may be employed as an aid to digestion with excellent results. Pepsin acts in acid media, and is only applicable to gastric indigestion; Pancreatin acts in alkaline media, is destroyed by acids, and is only applicable to intestinal indigestion ; while Papain exercises its proteolytic power in either acid, alkaline or neutral solutions, and is equally applicable to either gastric or intestinal indigestion. 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 Sodas. Carbonates and Bicarbonates of Potas- sium, Sodium, Lithium, Magnesium and Ammonium. 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 named 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 Potassa 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. AGENTS ACTING ON THE DIGESTIVE SYSTEM. 45 Emetics (Eemeo, I vomit),—are agents which produce vomiting. They may be subdivided into two groups, (1) 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 : — 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. Ouabain. 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 Aluscarine, 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, when 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. Creosote. Ether. Ice. Opium. Hydrocyanic Acid. Silver Nitrate. Calomel 1 small Ipecac / doses. Hot Water. Cocaine. General Sedatives. Opium. Morphine. Hydrocyanic 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 IIP] 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. 46 agents acting on the digestive system. Carminatives (Carmino, I soothe),—aid the expulsion of gas from the stomach and intestines by increasing peristalsis, stimulating the circu- lation, 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, alco- hols or ethers, and are embraced in the following list: — Asafetida. Capsicum. Cardamom. Chloroform. Ether. Fennel. Ginger. Horse-radish. Mace. Mustard. Pepper. Spirits. Oil of Anise. Oil of Cajuput. Oil of Caraway. Oil of Cinnamon. Oil of Cloves. Oil of Coriander. Oil of Eucalyptus. Oil of Fennel. Oil of Peppermint. Oil of Spearmint. Oil of Nutmeg. Oil of Pimento. Oil of Valerian. Camphor. Serpentaria. Cathartics or Purgatives (.Kathairo, 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 exosmosis of serum from its vessels, and in large dose set up inflammation and symptoms of irritant poisoning. Jalap is a typical drastic. Saline Purgatives.—This group comprises the neutral salts of metals of the alkalies or alkaline earths. They stimulate the intestinal glands to increased secretion, and by their low diffusibility impede reabsorption, causing an accumulation of fluid in the intestinal tract, which, partly from the effect of gravity and partly by gentle stimulation of peristalsis excited by distention, reaches the rectum and produces a copious evacu- ation. Magnesium Sulpliate and Sodium Sulphate are the typical salines. They should be given in plenty of water and during active movement (as in walking) in order to produce their best effects. Hydragogue Purgatives (Hudore, water, Ago, I bring away),—in- clude the most active of the drastic and saline groups, those which remove a large quantity of water from the vessels. Elaterium is a typical hydra- gogue. Cholagogue Purgatives (Kohlay, bile, Ago, I bring away),—are AGENTS ACTING ON THE DIGESTIVE SYSTEM. 47 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. Cascara Sagrada. Physostigma. Ergot. Belladonna. Stramonium. Hyoscyamus. Almond Oil. Olive Oil. Soap. Taraxacum. Glycerin. Oatmeal. Bran Biscuit. Brown Bread. Simple Purgatives. Senna. Aloes. Rhubarb. Castor Oil. Rhamnus Frangula. Ox-gall. Calomel. Small doses of drastics, salines or cholagogues. Saline Purgatives. Magnesium Sulphate. Magnesium Citrate. Potassium Sulphate. Potassium Tartrate. Potassium Bitartrate. Sodium Sulphate. Sodium Phosphate. Sodium Chloride. Pot. et Sodium Tartrate. Manganese Sulphate. Drastics. Jalap. Gamboge. Colocynth. Elaterium. Scammony. Croton Oil. Cathartic Acid, hypoder- mically. Hydragogues. Elaterium. Gamboge. Potassium Bitartrate. Croton Oil. Salines in large doses. Cholagogues. 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. Constringents. Phosphoric Acid. Nitric Acid. Sulphuric Acid. Acetic Acid. Diluted. Tannic Acid. Vegetable Astringents. Alum. Zinc Oxide. Copper Sulphate. Persalts of Iron. Lead Acetate. Silver Nitrate. 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 indi- rectly 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 48 AGENTS ACTING ON THE DIGESTIVE SYSTEM. its secretion. The following list includes the principal drugs belonging to both groups :— Hepatic Stimulants. Ckolagogues. 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. 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 ad- visable to combine an hepatic stimulant with an intestinal stimulant which shall produce increased secretion from the intestinal mucous membrane and excite peristalsis. The glycogenic function of the liver, and the production of urea are stimulated by the following-named drugs :— Increasing Glycogen. Increasing Urea. Amyl Nitrite. Sodium Bicarbonate. Nitro-hydrochloric Acid. Arsenic. Antimony. Ammonium Chloride. Iron. Phosphorus. Hepatic Depressants are agents which lower the functional activity of the liver, reducing the quantity of bile secreted, and lessening the pro- duction of glycogen and urea. They are as follows, viz.: — Lessening Bile. Opium, Morphine. Many Purgatives. Lead Acetate. 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.:— AGENTS acting on metabolism. 49 Thread Worms (Oxyuris Vermicularis). Alum. Sulphate of Iron. Lime Water. Quassia. Eucalyptol. Sodium Chloride. Tannin. Veg. Astringents. Naphtalin. Round Worms (.Ascaris Lunibricoides). Santonica. Santonin. Spigelia. Chenopodium. Azedarach. Tape Worms (Tcenice, etc.'). Filix Mas. Kamala. Kousso. Granatum. Pelletierine. Pepo. Turpentine. Chloroform. Naphtalin. Senna. Calomel. with the above. Naphtalin. 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, also Ammonium Chloride and Sodium Chloride. Agents Acting on Metabolism. Restoratives,—are agents which promote constructive metamorpho- sis, including the Foods, Hsematics, 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, Sodium Chloride, etc. Haematics (.Haivia, the blood),—are medicines which augment the quantity of haematin in the blood, and thus restore the quality of that tissue by enriching its red corpuscles. They consist chiefly of Iron and Manganese and their compounds. Tonics (Tonnos, 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 Cimicifuga—on the nervous system, Phosphorus, Quinine and the Valerianates,—on muscular tissue, Tannin,—on the blood, Iron, Manganese, Cod-liver Oil, and other fats. 50 AGENTS ACTING ON METABOLISM. 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 : — 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 (Re- solvo, I unbind, Discutio, I dissipate),—agents which promote the absorp- tion of inflammatory products or other materials of morbid origin, appar- ently by stimulation of the lymphatic system. They include Mercury, Arsenic, Iodine, and Cadmium, as well as such local measures as Poulticing and Counter-irritation. Destructive Metamorphosis of the tissues is promoted by a num- ber of agents, most of which are classed as Alteratives or as Astringents, 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. Destructive Metamorphosis may be diminished by many substances, the following-named being the chief ones :— Alcohol. Glycerin. Oils and Fats. Salicin. Salicylates. Quinine. Resorcin. Chinolin. Cocaine. Antipyretics (Anti, against, Puretos, 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.:— AGENTS ACTING ON METABOLISM. I. Diminishing tissue-change. 2'. Reducing the circulation. 51 By Lessening the Projection of Heat, by or by Promoting the Loss of Heat, by 3. Dilating the cutaneous vessels, and producing in- creased radiation. 4. Producing perspiration, and its evaporation. 5. Abstracting heat from the body. The following list contains nearly all the antipyretics, the number fol- lowing each referring to its proper method of action, as enumerated above:— Quinine.1 Quinidine.1 Cinchonine.1 Cinchonidine.1 Berberine.1 Benzoic Acid.1 Carbolic Acid.1)3 Picric Acid.1 Salicin.1 Salicylic Acid.1 Sodium Salicylate.1)4 Quinine Salicylate.1 Methyl Salicylate.1 (Oil of Gaultheria.) Trimethylamin. 2 Salol.1 Acetanilid. C4 Antipyrin.1.4 Phenacetin. L4 Chinolin.1 Resorcin.1 Kairin. L4 Kairolin. L4 Hydroquinon.4 Thallin.1,4 Pyrocatechin.1 Pheno-resorcin.1 Eucalyptol.1 Thymol.1 Other Essential Oils.1 Alcohol. L3 Digitalis. 2 Aconite.2 Camphor.1 Antimonials. 2<4 Veratrine. 2 Colchicum. 2 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 doubtful (Brunton). The Body Temperature is raised by Belladonna (or Atropine) and by Cocaine, but not to such a degree as to constitute fever or enable them to be classed as pyretics. Tuberculin, various albumoses, and certain animal poisons, as that of shell fish, will also produce a rise of temperature. 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 respir- atory 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 re- turn. 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. 52 AGENTS ACTING UPON EXCRETION. 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 modes of action of the drug in the above synopsis: — 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 Theobromine.3 Broom.3 Squill.1,2 Nitrites.2 Colchicum. 3 Strychnine.1 Stigmata Maidis. L2 Alcohol. 2 Cantliarides.3 Turpentine.3 Juniper.3 Savine.3 Copaiba.3 Cubebs.3 Pepper.3 Matico.3 Kava.3 Guaiac.3 Parsley.3 Taraxacum.3 Jaborandi.3 Dulcamara.3 Bryonia.3 Stimulant Diuretics. Gin.2 Carrot.3 Fennel. 3 Mustard.3 Asparagus. 3 Uva Ursi.3 Buchu. 3 Sarsaparilla.3 Pareira.3 Chimaphila.3 Santonica. 3 Lobelia.3 Aconite.3 Tobacco. 1>3 Volatile Oils. 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, so also is Theobromine Sodio-salicylate (Diuretin). Dropsy from Renal Disease,—Diuretin, Broom, Nitrous Ether, Oil of Juniper, Digi- talis 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.] To Dilute the Urine,—Water is the best diuretic, and its most efficient form is Dis- tilled Water acidified with Carbonic Acid Gas. Renal Depressants,—are such agents as directly diminish the activity 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 AGENTS ACTING UPON EXCRETION. 53 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 of 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 Sodium Urate 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. Acidifiers of the Urine,—are Benzoic and Salicylic Acids and several of their salts, 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 ex- creted as neutral sulphates, chlorides, phosphates, etc. Salol is much quicker in its action upon the urine than is Ammonium Benzoate ; as or- dinarily in a day or so, under its administration, the urine in chronic cystitis loses its al- kalinity and foul odor, and becomes clear (Dr. Mansel Sympson). Vesical Sedatives,—are substances which lessen irritability of the bladder, relieving pain and increasing the desire to micturate. Opium, Belladonna, Hyoscyamus, Stigmata Maidis, Cannabis, etc., lessen the irritability of the nerves, Calcium Carbonate relieves that due to the presence of calculi; mucilaginous drinks, such as Barley-water or Lin- seed tea, also astringents like Buchu, Uva Ursi, Pareira, etc., diminish the irritation due to chronic cystitis, and antiseptics, as Copaiba, and Cubebs, also act in like manner, being carried by the urine to the bladder. 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, Zinc and Lead Acetates, Boracic Acid, Chloral and Zinc Chloride, etc., for a similar purpose. Copaiba is one of the most efficient agents for rendering the urine antiseptic, and should be more employed in cystitis and urethritis than it is. Oil of Eucalyptus is nearly as efficient, and Stigmata 54 AGENTS ACTING UPON EXCRETION. 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 bili- ary form are included in this arrangement for the sake of consistent clas- sification. 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. Calcium. Oxalate Calculi. Dilute Nitro-Hydrochloric Acid. Carbonated Water. Lactic Acid (for digestion). Uric Acid Calculi or Urates. Distilled Water. Potassium Salts. Lithium Salts. Potassium Tartraborate. Magnesium Citroborate. Piperazin. Tetraethyl - ammonium. Phosphatic Calculi. Ammonium Benzoate. Benzoic Acid. Dilute Nitric Acid. There is probably little or no solvent value to the agents recommended for biliary cal- culi. 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. Piperazin is, however, still more efficient in this respect, forming a piperazin urate which is seven times more solu- ble than lithium urate. 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. Wafer is the one true diluent, whatever form it may be disguised in, as teas, weak fluid foods, acid drinks, etc. Diaphoretics and Sudorifics (Deeaphorheeo, 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 energetic- ally, so that the perspiration stands in beads upon the surface, they are known as Sudorifics. They may be subdivided into the following groups, viz. : — 1. Simple Diaphoretics, which enter the circulation and are eliminated by the sudor- iferous 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 respective supposed modes of action as indicated above, viz.: — AGENTS ACTING ON THE GENERATIVE APPARATUS. 55 Taborandi.3 Pilocarpine.1, 3 Salicylic Acid.1 Salicylates.1 Ipecacuanha. 2 Tartar Emetic.2 Sulphur.1 Opium2, 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, Heedroce, sweat),—are agents which check perspiration. They may act— 1. By depressing the action of the sweat-glands. 2. By depressing the excitability of the sweat-centres 3. 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. Opium2 (small doses). Zinc Salts.3 Local Cold.3 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 respira- tory 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 Damiana is doubtful. Urtication and Flagellation of 56 AGENTS ACTING ON THE GENERATIVE APPARATUS. the nates produce priapism by irritation of the genital centre in the cord through the sen- sory 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,Vznus),—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. : — Bromides. 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 remedies which restore the menstrual function, either directly by stimu- lation 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.:— Direct Emmenagogues. Indirect Emmenagogues. Ergot. Quinine. Savine. Tansy. Digitalis. Cantharis. Pulsatilla. Asafetida. Alcohol. Indigo. Hydrargyrum Biniod. Caulophyllum. Rue. Apiol. Borax. Myrrh. Guaiacum. Polygonum Hydropip. Potass. Permanganate. Cimicifuga. Oxalic Acid. Hedeoma. Origanum. Viscum Flavescens. 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 may 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 congestion of the uterus producing reflex stimulation. The principal oxytocics are those enumerated in the following list, viz.: — Ergot. Ustilago. Savine. Potassium Permang. Hydrastis. Quinine. Borax. Cotton-root bark. Oil of Rue. Pilocarpine. Viscum Flavescens. Strong Purgatives. 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. agents acting on the cutaneous surface. 57 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. Copper Sulphate. 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 column as topical applications to the uterine cavity or cervix. Galactagogues (Galla, milk, Ago, I bring away),—are medicines which increase the lacteal secretion, as Ricinus, Tea, Anise, Fennel, Potas- sium Chlorate, etc. The value of many so-called galactagogues is ex- tremely 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 the article entitled Lactation in Part III.) Antigalactagogues decrease the secretion of milk. Belladonna is the typical and most potent agent for this purpose, and acts when given internally or applied locally. Antipyrin has given evidence of similar power, also Camphor locally, and Potassium Iodide internally. 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 sur- face, when they may cause exudation between the cuticle and the true skin Agents Acting on the Cutaneous Surface. 58 AGENTS ACTING ON THE CUTANEOUS SURFACE. (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 sudoriferous glands, giving rise to pustules. The following list embraces the principal agents and measures belong- ing to these groups, viz. :— 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(theconfinedvapor). Glacial Acetic Acid. Volatile Oil of Mustard. Heat / Boiling wMer. ' \ 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. 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 Glacial Acetic Acid.1 Carbolic Acid.1 Chromic Acid. 3 Arsenous 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.2 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. Creosote. 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. agents acting on microbes, gases, ferments. 59 Sulphuric Acid, Gallic Acid and Lead Acetate 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 (Stuphoh, I contract; ETaimah, blood ; Stahsis, a standing),—are agents which arrest hemorrhage, Styptics being those which are applied locally, and Hemostatics those which are admin- istered 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 prin- cipal members of this class are the following-named :— Styptics. Hemostatics. Acids. Alum. Antipyrin. Cautery. Collodion. Ferric Chloride. Ferric Sulphate. Silver Nitrate. 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. 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 be 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. 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. 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 Wooi. Agents Acting on Microbes, Gases, Ferments, etc. Antizymotics (Anti, against, Zeumohsis, fermentation),—are agents which arrest the fermentative processes, which depend upon the action of 60 AGENTS ACTING ON MICROBES, GASES, FERMENTS. unorganized ferments (enzymes), as diastase, ptyalin, pepsin, etc., or upon that of organized ferments, as the yeast-plant, bacteria, etc. The Anti- zymotics are usually subdivided into two groups, respectively entitled Antiseptics and Disinfectants. Antiseptics {Anti, against, Sayptekos, putrefaction),—prevent or retard septic decomposition, by destroying the bacteria which produce it, or by arresting their development. The chief antiseptics are named in the following list, the first column containing the most powerful ones, the middle column those which are moderately antiseptic, and the third col- umn the weakest members of the group. Strong. Corrosive Sublimate. Formalin. Oxygenated Water. Silver Nitrate. Gold Chloride. Zinc Chloride. Copper Sulphate. Iodine. Bromine. Chlorine. Potassium Permanganate. Carbolic Acid. Creosote. Chloroform. Thymol. Menthol. Hydronaphtol. Alum. Tannin. Acetanilid. Antipyrin. Moderate. Boric Acid. Chloral Hydrate. Ferrous Sulphate. Zinc Sulphate. Arsenic. Salicin. Quinine. Sodium Salicylate. Salol. Mercuric Iodide. Eucalyptol. Sulphurous Acid. Sulpho-carbolates. Bismuth Subgallate. Resorcin. Coffee. Feeble. Benzoic Acid. Sodium Borate. Calcium Chloride. Sodium Chloride. Barium Chloride. Strontium Chloride. Ammonium Chloride. Ammonium Sulphate. Alcohol (pure). Sodium Hyposulphite. Potassium Chlorate. Potassium Arsenate. Potassium Iodide. Manganese Chloride. Glycerin. The first four named are the most powerful. Corrosive Sublimate is probably the most powerful of all, but it is very poisonous. The best are those which act sufficiently on the microbes without injuring the tissues. Chlorine, Bromine and Iodine are too irritant for general use. Salol is the best intestinal antiseptic, though Naphtol will destroy micro- organisms in the stomach and intestines. We do not know any drugs which, taken internally or inhaled, will certainly destroy micro-organisms in the body, unless sufficiently concentrated to be fatal to the patient. Disinfectants destroy the specific germs of communicable diseases, and as most of these germs belong to the microbe class, many antiseptics are also disinfectants. They act in several modes, some as oxidizants, others by combining with albumen, others by chemical combination form- ing substitution-compounds, others by arresting molecular changes, and still others by altering the reaction of the media containing the germs. The principal disinfectants are those named in the following list:— Corrosive Sublimate. Formalin. Heat (230°-25o° F.). Potassium Permang. Zinc Sulphate. Hydrogen Dioxide. Creolin. Carbolic Acid. Zinc Chloride. Potassium Bichromate. Ferrous Sulphate. Calcium Chloride. Chlorinated Soda. Lysol. Chlorine. Iodine. Bromine. Lime (fresh). Sulphurous Acid. Nitrous Acid. Thymol. Camphor. Condy's Fluid is an aqueous solution of Potassium Permanganate, 2 parts in loo, or gr. 176 in % xx. Burnett's Fluid is a solution of Zinc Chloride, containing about 50 per AGENTS ACTING UPON EACH OTHER. 61 cent, of the salt, and equivalent to the official Liquor Zinci Chloridi. Labarraque's Solution is the official Liquor Sodse Chloratae. Sanitas is an aqueous solution of oxidized turpentine, containing Hydrogen Dioxide, Thymol, Camphor, etc. The popular idea of disinfecting the air of a room by burning sulphur, etc., is an ab- surdity, for the foul air is easily removed by simple ventilation. In disinfecting a room in which a case of contagious or infectious disease has been, the true aim is to kill the germs contained in the dust on ledges, or in the crevices between the boards, or adher- ing to the walls, and a dry gas is powerless for this purpose, which is best accomplished by using a Sublimate Solution of the strength of I in iooo, or by Lime washing, pro- vided that the lime be freshly burnt, and caustic, or by spraying with Formalin, or by dropping the latter on hot plates or sheets of metal. Deodorants,—are agents which destroy foul odors. The Volatile De- odorants are chiefly oxidizing and deoxidizing substances, acting chemic- ally 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 :— Formalin. Chlorine Gas. Sulphurous Acid Gas. Hydrogen Dioxide. Potassium Permanganate. Coffee, freshly roasted. Charcoal. Earth. Lime. Ferrous Sulphate. For removing the fetid exhalations emitted by the faeces, the following powder is a very efficient and cheap deodorizing and disinfecting agent. Zinc Sulphate, lbs. ij, Sul- phuric Acid, :$jss to 3 ijss, Essence of Mirbane, gj, Indigo Blue, gr. ij. About a des- sertspoonful of this salt is placed in the bed-pan or chamber utensil before it is used. Contact with urine or a liquid stool causes its prompt solution, deodorization is instanta- neous, the liquid excreta are at once sterilized, and the fetor is changed to a rather agree- able odor. 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. Sulphur Iodide. Iodine. Mercury. Ammoniated Mercury. Mercuric Chloride. Mercuric Nitrate. Mercuric Oxide. Carbolic Acid. Petroleum. Storax. Staphisagria, Balsam of Peru. Agents Acting upon Each Other. Antidotes are agents which affect a poison either physically or chem- ically, or both, so as to remove it from the body or alter its character by forming with it an insoluble or inert compound before its absorption, with the object of preventing its toxic action upon the organism. Anti- dotes do their work in the alimentary canal or in the respiratory passages, and are applicable to vegetable as well as mineral poisons, but are not available against poisons administered hypodermically. They include sundry chemical substances, also measures of various kinds, and may be divided into two classes : (i) Chemical or True Antidotes, which unite chemically with the poison, converting a soluble and absorbable substance into a compound which is more or less insoluble and non-absorbable, or 62 AGENTS ACTING UPON EACH OTHER. harmless though soluble; (2) Mechanical, or Antidotal Measures, which include such agents or measures as may remove the poison as such from the system or mechanically prevent its absorption. Thus, Tannic Acid is the antidote for poisoning by Digitalis, as it forms with the active toxic principles of the drug chemical compounds (tannates) which are almost insol- uble and therefore comparatively harmless. But as these tannates are not entirely inert, an antidotal measure, evacuation of the stomach, must be employed, by the administration of Zinc Sulphate or any other emetic, or by the use of a stomach-pump. Antagonists 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 upon the organism. Antagonistic action takes place in the blood and tissues, after the absorption of both the poison and the antagonist; it is available against poisons administered hypoder- mically as well as by other channels, and so far as drugs are concerned it is applicable chiefly to vegetable poisons or to those which produce their toxic effects after absorption. In most cases of poisoning by vegetable principles absorption has proceeded so far before professional assistance is obtained that the time for antidotes has passed, and reliance can be placed only upon the physiological antagonists and such antagonistic measures as may support vitality until the poison can be eliminated by the excretory organs of the body. There may be an exception to this rule in the case of Morphine, which, after making the round of the circu- lation, constantly returns in part to the stomach until finally eliminated, so that repeated washing of that organ with a solution of potassium per- manganate, or the ingestion thereof from time to time, may have a con- tinuous antidotal action on such portion of the poison as may have been absorbed. Antagonistic Measures include all such procedures as may tend to antagonize any remote effects of poisons, as artificial respiration, fara- dization of the respiratory muscles, constant motion or absolute repose, application of heat or cold, douching, etc. Thus, to refer again to the case of poisoning by Digitalis, the antagonists which will counteract the effects of such portion of the drug as may have been absorbed are the following : Aconite or Morphine against the cardiac action, the former for the effects of large doses, the latter for those of the long-continued use of the drug. Saponin and Senegin are the most complete antagonists against Digitalis, their counteraction extend- ing throughout nearly its entire range of action. Alcohol is also indicated, as a cardiac stimulant, and absolute Rest in the recumbent posture is an antagonistic measure of prime importance, by reason of the liability to sudden cessation of the lowered cardiac action on the assumption of the erect posture. In Part I of this book, under the several titles of the poisonous drugs, their most efficient Antidotes and Antagonists are mentioned; but these are more fully described, and are arranged in a form suitable for reference, under the caption The Treatment of Poisoning, in the Appendix. Physiological Antagonism means a balance of opposed actions on particular organs or tissues, excited by medicinal agents and measures or AGENTS ACTING UPON EACH OTHER. 63 by disease. It may extend throughout the whole or the greater part of the range of action of the opposing agents, or, as is usually the case, may be limited to a few points thereof. There is no instance in which the antagonism of two drugs is absolutely complete along their whole line of action. In a few cases it is nearly so, as with Morphine and Atropine (except as to narcotism), Digitalis and Saponin, and Atropine and Mus- carine, the latter being considered the most complete instance known. In most cases the antagonism extends only to certain definite spheres of action, and the antagonists therein may be synergists to each other in other spheres, as in the narcosis produced by both Morphine and Atro- pine. It may be local, affecting a single organ or function, or it may extend to a group of organs, to several associated functions, or over the distribution of the nerves proceeding from a single nerve-trunk (as the vagus) or controlled by a single nerve-centre. Antagonism implies a balance of functional disturbance, not an alteration of structure. Drugs are rarely antagonistic to each other in the same degree, but, by reason of differences in their mode and time of action, the action of one preponderates over that of the other, so that the latter will not counteract the former to the extent of averting a fatal result, though in the reverse order their counteraction may be most satisfactory. For ex- ample, while Chloral is the antagonist to Strychnine, opposing as it does the spinal action of the latter drug, the reverse is true to a very limited extent; and, while Atropine may prevent death from a lethal dose of Aconitine, Morphine or Bromal Hydrate, no one of these three will do so in atropine poisoning. Two mutually antagonistic principles may exist in the same plant, as the alkaloids Pilocarpine and Jaborine in pilocarpus, and the glucoside constituents of digitalis, one of which, Digitonin, antagonizes the actions of the other three, Digitalin, Digitoxin and Digitalein. Toxicological Antagonism is a very ancient idea in medicine. Mithridates of Pontus (B. C. 164-124) and other monarchs of the heathen world occupied themselves with the study of poisons and their antidotes and antagonists, established botanical gardens for the purpose of their investigation, and gave their names to what were supposed to be universal preventives against the results of poisoning. In the 16th century Prosper held that Theriaca (opium) was an antagonist to all poisons. From 1570 to 1677 many ob- servations were made and published on the treatment of belladonna poisoning by opium, and in 1810 the same matter was made the subject of an inaugural thesis by Lipp. The scientific investigation of drug action and antagonism was not possible until the discovery and isolation of the alkaloids, but followed immediately thereafter, and was begun in 1809 by Magendie upon the upas poison (nux vomica) and its newly discovered alkaloid, strychnine. In 1869 Schmeideberg and Koppe made their researches on muscarine and atropine, and Liebrich discovered chloral and proved the antagonism of strychnine against its action, the converse of which was shown by Bennett in 1875. ln Frazer published his investigations upon atropine and physostigma, and Preyer his on the antagonistic influence of atropine and hydrocyanic acid on respiration. In 1875 a com- mittee of the British Medical Association made an extended investigation and report on the antagonisms of several drugs, which was supplemented by the work of Vulpian on atropine and pilocarpine in the same year, that of Fothergill in 1877 on aconite, atropine and digitalis, and that of Iluseman on the antagonisms of chloral. Much good work 64 AGENTS ACTING UPON EACH OTHER. has also been done in England by Brunton and Ringer, and in the United States by Wood and Bartholow, on the same lines. The name of Brunton is unalterably associated with the antagonism between amyl nitrite and the spasmodic paroxysm of angina pectoris, a discovery in therapeutic antagonism which was made by him through the exercise of purely scientific reasoning, and which has since been applied to the similar paroxysm induced in poisoning by certain drugs, as cocaine. Bartholow has collected a list of 120 cases of poisoning by opium and belladonna, in which each poison was treated with the other as an antagonist, and in which only 15 proved fatal, a mortality of per cent. The following table, modified from Brunton, gives the antagonistic poisons, also their mutual antagonistic and lethal doses in each case in which they have been determined. The doses are expressed in grains or fractions of a grain per pound weight of the animal. ANTAGONIS- LETHAL TIC DOSE. DOSE. I. II. I. ii. — i- II. Aconitine and Atropine 1 7 “ “ Digitalin, skis f i “ “ Strychnine, viu 1 TZZ nihr Alcohol and Strychnine, 1 Atropine and Aconitine, 7 “ “ Chloral, 7 7 “ “ Hydrocyanic Acid, 7 “ “ Jaborandi, 7 “ “ Muscarine, 7 “ “ Morphine, 7 3 “ “ Pilocarpine, 7 “ “ Phytolaccine, 7 . . . “ “ Physostigmine, 7 25 “ “ Quinine, 7 Bromal Hydrate and Atropine, ■sixr 7 Chloral and Atropine, 7 7 “ “ Picrotoxin, 7 “ “ Physostigmine, 7 1 2o “ “ Strychnine, 7 Chloroform and Amyl Nitrite, 7 SiJTJ 7 Digitalin and Aconitine, 1 78^ “ “ Muscarine, 555 “ “ Saponin, Gelsemium and Opium, ........ 9 ZS 1 1 z 1 7CT “ “ Atropine, 3 3 7 • 3 7 Morphine and Caffeine, 1 1 z “ “ Chloroform, Muscarine and Atropine, Opium and Atropine, .... 7 “ “ Gelsemium, 7 “ “ Veratrum Viride, PART I. MATERIA MEDICA AND THERAPEUTICS. ABRUS, Jequirity (Unofficial),—is the seed of Abrusprecatorius, or Wild Liquorice, a plant of the nat. ord. Leguminosae, indigenous in India, but growing wild in most tropical countries. The seeds are small, hard, of a bright scarlet color, and contain some fixed oil, sugar, a prin- ciple resembling glycyrrhizin, Abric Acid, C12H24N30, and two proteid poisons, a paraglobulin and an albumose, the latter of which is named Abrin. Preparation. Infusum Abri, Infusion of Jequirity (Unofficial),—prepared by macerating three powdered seeds in g ss of cold water for twelve hours, adding 3 ss of boiling water, and filtering when cold. It should be used while fresh, as after two or three days it is worth- less, and is found in a short time swarming with bacteria. Another formula contains gr. ix 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. Sidney Martin has shown that the pro- teid poisons contained in Jequirity seeds are almost identical in their physiological and toxic properties with the similar principles found in snake venom, although less powerful. 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. 65 66 ABSINTHIUM ACETANILIDUM. ABSINTHIUM, Wormwood,—the leaves and tops of Artemisia Absinthium, a perennial garden herb of the nat. ord. Compositse, indigenous in Europe, but cultivated in the United States. It contains a volatile oil and a bitter principle, Absinthin. Dose, gr. xx-xl, in infusion. There are no official preparations, but of the formerly official Vinum Aromaticum, Absinthium constituted one per cent. Absinthe, the French liqueur, is an alcoholic solution of the oil, containing also extracts of Anise, Majoram 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, only as a stomachic tonic in dyspepsia. ACACIA, Gum Arabic,—is a gummy exudation from Acacia Sene- gal, a small tree of the nat. ord. Leguminosae, indigenous in Africa. It occurs in spheroidal tears of various sizes, breaking with a glassy, some- times iridescent fracture; insoluble in alcohol, but soluble in water, forming a thick and mucilaginous liquid. It consists of Arabin or Arabic Acid, C12H22Ou, combined with calcium, potassium, and magnesium. Mucilago Acaciae, Mucilage of Acacia,—has of Acacia 35, Water to 100 parts. It should not be prescribed with tinctures or spirits except in very small quantity. Dose, indefinite. Syrupus Acaciae, Syrup of Acacia,—has of the Mucilage 25, Syrup 75. Should be freshly made. Dose, indefinite. Acacia enters into the composition of Mistura Amygdalae, Mistura Glycyrrhizae Com posita, Pulvis Cretae Compositus, Trochisci Cretse, Troschisci Cubebm, 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. ACETANILIDUM, Acetanilid, (.Antifebrin).—Like the major number of the newest antipyretics, which are related either to Chinolm or to Phenol, Acetanilid is a derivative of Anilin, from which it is ob- tained by the action thereon of glacial acetic acid, substituting the organic radical Acetyle for an atom of hydrogen. Chemically, it has the name Acetanilid or Phenyl-acetamide, and the formula C6H5NHC2H30. The name Antifebrin is copyrighted by its original promoters for trade purposes, and therefore should be dropped from professional usage. Acetanilid is a white crystalline powder, of neutral reaction, and odor- less, but of slightly burning taste. It melts at 2350 F., and distils at 55 70 F., is freely soluble in alcohol, wine, etc., but very sparingly (1 in 200) in cold water, more readily in hot water. It is a neutral substance, being unaffected by hydrochloric or sulphuric acids, and ordinarily unaltered by alkalies. ACETANILIDUM. 67 The dose ranges from gr. ij to gr. x, repeated twice, and not exceeding gr. xxx in the 24 hours. As much as gj has been swallowed without ill effects supervening. It may- be administered in the very convenient form of compressed tablets ;—also in powders, or in dilute alcoholic solution. 2[j may be dissolved in 3; ivss of brandy, to which, if we add £vj each of simple syrup and water, we get a six-ounce mixture, of which a table- spoonful (gss) contains 5 grains of Acetanilid, a fair adult dose. As an antipyretic, gr. iij may be administered every f to *4 hour, until 12 or 15 grains have been given, which will usually be a sufficient quantity, especially if given at the acme of the febrile movement. Unofficial Derivatives and Allied Compounds. Acetanilid Compound (Aulde),—is a mixture containing Acetanilid 70, Caffeine 10, and Sodium Bicarbonate 20 per cent., and is put up in the form of compressed tablet triturates, each containing yz grain of the mixture. It is intended to replace the numer- ous proprietary preparations sold under fancy names and having acetanilid and caffeine as the active constituents. Dose, from 10 to 30 tablets. Agathin, Salicyl-aldehyde-a-niethyl-phetiyl-hydrazo?ie,—is a synthetic compound, which has been used extensively in Europe as an anti-neuralgic and anti-rheumatic rem edy. Dose, gr. v-x, two or three times a day, but from ss 1° 3jss must be given be- fore any effect is produced. Ammonol, Ammoniated Pkenylacetatnide,—a new antipyretic and analgesic, claimed to possess unusual stimulating and expectorant properties due to the loosely combined Ammonia in its composition. Its introduction has been confined to the distribution of circulars and samples to physicians by its proprietors. Dose, gr. v-xx. Analgen, Or(ho-oxy-ethyl-ana-mono-acetyl-amido-chinolin,—a. Chinolin derivative; was reformed by inserting benzoyl instead of the acetyl radicle, and re-christened QuiNAL- gen. (See below.) Analgesine,—a proprietary preparation, consisting of Acetanilid 60, Ammonium Chloride 20, Citrated Caffeine 10, Sodium Bicarbonate 10. Dose, gr. v-xv. Antikamnia,—is a proprietary preparation widely advertised as an antipyretic and analgesic. Analyses of several samples have been made by different chemists, all of which agree in finding the chief ingredients to be Acetanilid and Sodium Bicarbonate in varying proportions. By some observers Caffeine was detected, also Tartaric Acid, etc. The preparation is formulated by the latest analysis as a mixture of Acetanilid 70, Sodium Bicarbonate 20, and Caffeine 10 per cent. Dose, gr. v-xv, in powder or tablets. Antikol,—contains Acetanilid 75, Sodium Bicarbonate Tartaric Acid per cent. (Squibb). Dose, gr. v-xv. Another “ Antikol" is advertised by its manufacturer to consist of Acetanilid, Quinine Bisulphate, Sodium Bicarbonate, and Caffeine Citrate, the latter in the proportion of 10 per cent. Antinervin, Salbrotnalide (Salicylbromalide),—is a mixture of Acetanilid 2, wi'h 1 part each of Salicylic Acid and Ammonium Bromide (Ritsert). Dose, gr. v-xv. Antipyrinum, Antipyrin (Phenazone),—is described under its own title. Caffenol,—is a mixture of similar character to the above, and contains Acetanilid and Caffeine. Dose, gr. v—xv. Exalgin, Methyl-acetanilid,—is a crystalline compound allied to Acetanilid, occur- ring in acicular needles, readily soluble in dilute alcohol, less so in warm water, and with difficulty in cold water. Dose, gr. j-v, in wine, or other dilute alcoholic mixture. Alcohol g ss, and Water g) form a permanent solution with gr. xvj of Exalgin. Its name, derived from ef, out of, d/lyof, pain, denotes its principal therapeutic action. Exodyne is a mixture of Acetanilid 90, Sodium Salicylate 5, and Sodium Bicarbonate 5- The name (from ’eg, out of, od'vvr), pain) sufficiently states its claims to medicinal virtue. Dose, gr. iij-x. Febrinol, Methyl-ara-acet-phenetidin,— so called by its proprietors, is a mixture of Acetanilid and other inert substances, advertised at one half the price of similar coal-tar preparations. Malakin, Salicyl-para-phenetidin,—is a combination of Phenacetin and Salicylic Acid, and is described under SALICINUM. Migranin,—is a double Citrate of Antipyrin and Caffeine, and is described under Antipyrinum. 68 ACETANILIDUM. Neurodin, Acetyl- para-oxy-phenyl-urethane,—an analgesic, antineuralgic and anti- rheumatic remedy. Its antipyre tic action is too sudden for it to be used as a general anti- pyretic. Its action is uncertain and much inferior to that of phenacetin or antipyrin (Lippi). Dose, gr. v—xxv. As much as §jss has been taken in 24 hours without ill effects. Phenacetin, Methacetin and Phenocoll,—are closely allied to Acetanilid, both chemically and medicinally, and are described under the title Phenacetinum, et seq. Phenatol,—contains Acetanilid, Sodium Carbonate, Bicarbonate, Chloride and Sul- phate, also Caffeine. Dose, gr. v-x. Phenolid,—is a mixture of Acetanilid 58, and Sodium Salicylate 43, and competes with the above as a panacea. Dose, gr. v-xv. Pyretine,—contains Acetanilid, Caffeine, Sodium Bicarbonate and Chalk, in varying proportions. Dose, gr. v-x. Quinalgen, Ortho-ethoxy-ana-mono-benzoyl-amido-quinoline,—is a derivative of Quin- oline (Chinolin), and is a reformation and renaming of the preparation named Analgen (see above). It is described under Chinolinum. Dose, gr. vij-xv, up to gr. xlv daily. Salfene and Kaputin are Acetanilid mixtures, the latter being simply colored acetan- ilid. Thermodin, Acetyl-para-ethoxy-phenyl-niethane,—is closely allied to Neurodin (see above), which it resembles in all respects except that it has a smaller dose, which is gr. v—x. Physiological Action. Acetanilid is strongly analgesic, somewhat hypnotic and antispasmodic, a moderately efficient antipyretic, also a decided antiseptic and local anaesthetic. It lessens the reflex action of the spinal cord, and inhibits the sensibility of the sensory nerves. It raises arterial tension somewhat, and slows the heart in a corresponding degree, quiet sleep often following. Compared with the action of Antipyrin, the effect of Acetanilid on the body-temperature is manifested more slowly (1 hour against hour), but lasts a longer time (6 against 2 hours). It is markedly diuretic, and somewhat diaphoretic ; is a cerebral, muscular and vaso-motor stimulant, and leaves no ill after-effects;—while Antipyrin is powerfully diaphoretic, a cerebral sedative, and produces great depression. Furthermore, Ace- tanilid frequently produces nearly the same degree of reduction of body- temperature as Antipyrin, with the ingestion of but yih the dose; and, like the latter agent, it has little or no effect on the normal temperature, and its continued use begets tolerance of its action. Its antipyretic action is, however, less reliable than that of Antipyrin, and corresponds, in degree and in duration, to the size of the dose. There is neither vomiting nor diarrhoea afterwards, but there is a tendency, in some 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 of animals poisoned thereby are found in a state of acute fatty degeneration. 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-elements. ACIDUM ACETICUM. 69 Therapeutics. Besides being a fairly efficient antipyretic, Acetanilid has marked anal- gesic and antispasmodic powers; and these, together with its great ad- vantages of a small dose, comparative efficiency and safety, and the absence of the severe rigors and cardiac depression which mark the chinolin de- rivatives, combine to make it an agent of 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 sequelae, especially periostitis of the ribs, gangrene of tissues, etc. For the pains of loco- motor ataxia, and in those of rheumatic origin, sciatica, lumbago, etc., it is a most efficient remedy. In acute rheumatism, influenza and scarlet fever it is highly praised ; and in acute bronchitis doses of four grains every two hours have often arrested the attacks within twenty-four hours. In epilepsy, it is being tried, with the view of moderating reflex excita- bility. Added in minute proportion to aqueous solutions for hypodermic use, it is said to preserve them from decomposition more efficiently than any other agent hitherto employed for that purpose. It acts very well with children, when used in proper doses; but in all cases, overdosing must be avoided, both as to quantity and repetition. Acetanilid is now extensively employed in surgical practice as a dry dressing for wounds, burns, scalds, and other injuries involving breach of the tissues. Dusted in fine powder over the surface of a wound it promotes healing, prevents suppuration, relieves pain, and is odorless, unirritant and non-toxic, though a few cases of very young children are reported in which its topical application to wounds caused cyanosis and symptoms of collapse. It has also been used with much benefit as an application to mucous patches and rectal ulcers. Antinervin attracted much attention, during the epidemic of influenza in Scotland, as an analgesic and antipyretic. It relieved the pains in the back and head, reduced the fever and produced copious perspiration, without being followed by unfavorable sequela;. It has proven to be of great benefit in acute rheumatism, and may be used with advan- tage in all abnormal excitement of the nervous system, either against neuralgia or as a general nerve sedative. The best way to prescribe it, is as an extemporaneous mixture, containing the proper proportions of its ingredients, viz. :—Acetanilid 50, Salicylic Acid 25, and Ammonium Bromide 25 per cent., mixed secundum artem, and administered in doses of gr. v-xv every two hours until relief is obtained. Exalgin resembles Acetanilid and Antipyrin in its antipyretic and analgesic powers. Compared with the latter it is less efficiently antipyretic, but more powerful as an anal- gesic and antiseptic. In overdose it is highly dangerous, having produced symptoms resembling those of angina pectoris, also toxic effects resembling those of carbolic acid, with delirium, dyspnoea, cyanosis, and renal disturbances. It has been used with most excellent results in neuralgias ; also in chorea. In the latter affection daily doses of 3 grains were sufficient. ACIDUM ACETICUM, Acetic Acid,—is a liquid composed of 36 per cent, of absolute Acetic Acid, HC2H302, and 64 per cent, of water. 70 ACIDUM BORICUM. It is a clear, colorless liquid, of a distinctly vinegar odor, a purely acid taste, and a strongly acid reaction ; 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 absolute Acetic Acid, solid below 590 F., above that temperature a colorless liquid. Is strongly escharotic and only used locally. Acidum Aceticum Dilutum, Diluted Acetic Acid,—consists of Acetic Acid 10, Dis- tilled Water 50 parts, contains 6 per cent, of absolute Acetic Acid, and has a sp. gr. of 1.008. Dose, 3j-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 two official Aceta (Vinegars). Physiological Action and Therapeutics. 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, produc- ing 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 anthel- mintic, and the vapor inhaled causes reflex contraction of the vessels and raises the blood-pressure. Lately, investigations into its germicidal powers have given it high rank among germ-destroyers, a solution containing 7 per cent, of this acid proving as efficient as mercuric chloride. 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. 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 (Boracic) Acid, H3B03,—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, in 15 of alcohol and in 10 of glycerin. Its aqueous solubility is increased by the addition of hydrochloric acid or borax. It is produced from Borax by the action of sulphuric acid; also by the purification of the native acid. Dose, gr. y-xv. There are 2 official Borates, viz. :— acidum boricum. Sodii Boras, Sodium Borate (Borax), Na2B+07 -)- 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 the Death Valley region, California, and various other parts of the world. Dose, gr. v-xxx. Glyceryl Borate, Boroglycerin,—official in the following preparation,— Glyceritum Boroglycerini, Glycerite of Boroglycerin (Glycerite of Glyceryl Borate, Solution of Boroglyceride),—prepared by heating together Boric Acid 310 and Glycerin 460, until reduced to 500 grammes, then adding an equal weight of Glycerin. 71 Unofficial Preparations. Boroglyceridum, Boroglyceride,—is a solid chemical compound, prepared by heating together Boric Acid and Glycerin. It is soluble in water, but is generally used in solu- tion with glycerin, as the above official glycerite. 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 i, White Wax i, 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, Magnesium Borocitrate,—prepared extemporaneously thus ; R. Magnesii Carbonatis Acidi Citrici gij, Sodii Biborat. 5jij, Aquae Bullientis l|viij. A tablespoonful three or four times daily as a solvent of uric acid calculi. Potassii Tartra-boras, Potassium Tartraborate,—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 I, Potassii Bitartras 4, Water 10 parts. Dose, gr. xx, largely diluted with water, three or four times a day. Sodium Tetraborate is a new preparation (or salt ?) obtained by heating together equal parts of Boric Acid, Borax and Water. The resulting compound is neutral, and is supposed to be an entirely new salt. It was introduced to furnish a more soluble form of Boric Acid, and may be used wherever the latter is indicated, but it has the disadvan- tage of forming hard crusts upon dressings, which irritate abraded surfaces. It has long been known that the addition of Borax to Boric Acid in aqueous solution greatly increases the solubility of the acid,—and the above may explain the observed fact. Borine,—is a proprietary antiseptic preparation, advertised to be “ composed of the active constituents of Benzoin, Wintergreen, Meadowsweet, Golden Rod, Witch Hazel, combined with the stearoptenes of Wild Thyme, Eucalyptus, Peppermint and Boracic Acid.” What the stearopten of Boracic Acid is the advertisers do not say. It is in- tended chiefly for external use, diluted, I part to 1—4 of water; but may be used inter- nally in doses of 3 j—ij - Listerine,—is a proprietary preparation, advertised to be “the essential antiseptic constituent of Thyme, Eucalyptus, Baptisia, Gaultheria, and Mentha Arvensis, in com- bination. Each fluid-drachm also contains two grains of refined and purified Benzo- boracic Acid,”—whatever the latter may be. It is chiefly intended for external use, but may be given internally, in doses of 55 j three or more times a day (as indicated), either full strength, or diluted with water, or in combination with other drugs. Boric Acid is an efficient antiseptic, disinfectant and deodorant, arrest- ing fermentation and putrefaction, and very destructive to all low organ- isms. A solution of i in 133 arrests the activity of bacteria. It is feebly acid and but slightly irritant, and is used in the form of a dusting powder as a surgical dressing for its antiseptic and unirritating qualities. Its lotion and ointment have been successfully employed in ulcers, eczema, Physiological Action and Therapeutics. 72 ACIDUM CARBOLICUM. burns and scalds, pruritus ani, fetid perspiration, wounds, tinea tonsurans, and tinea circinata. Sodium Borate is a powerful antiseptic and disinfectant, as it also de- stroys low vegetable organisms. It removes the epidermis when locally applied, has power to increase uterine contraction, and aids the solution of Benzoic and Boric Acids. It is employed as a wash to remove the epidermis from the skin, and as a sedative lotion in acne, freckles, chlo- asma, leucorrhoea, aphthae, etc., also to allay itching in urticaria, psoriasis, impetigo, and in pruritus pudendi, scroti et ani. It has been used inter- nally in amenorrhoea, dysmenorrhoea, puerperal fever, and puerperal convulsions, for its supposed specific action on the uterus ; and has been found beneficial in epilepsy, though far inferior to potassium bromide in efficacy and far more dangerous in toxic effects. It is apparently of most service in cases where the bromides fail and in those in which the epilepsy is associated with gross organic disease. When administered in large doses Borax produces certain toxic symp- toms to which the term Borism is applied. These include intestinal dis- turbance, nausea, vomiting and anorexia, also dryness of the skin, with redness and even inflammation of the mucous membranes. There is great general weakness, the hair is dry and falls out, and there is an erup- tion on the skin, which may assume the forms of seborrhoeic eczema, reddish patches which desquamate like psoriasis, or papules attended with much itching. In severe cases albumen may appear in the urine, and oedema of the face and extremities may occur, so that whenever this drug is given in full doses a careful watch should be kept upon the state of the urine (Fere). Boro-glyceride in aqueous solution (1 to 40), or as the official Glycerite, 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 pre- servative of milk and food against putrefactive changes, and is entirely harmless. An elegant cosmetic cream may be made by dissolving Boric Acid in Glycerin, and then incorporating it with White Wax and Almond Oil. ACIDUM CARBOLICUM, Carbolic Acid, Phenol (Phenic Acid, Phenyl Alcohol), C6H5OH,—occurs in Castoreum, in the urine of man and of herbivorous animals, and in the products of the dry distillation of various organic substances, such as resin, bones, wood and coal. It is obtained by the fractional distillation of coal-tar, and subsequently purified ; occurring in colorless, interlaced, needle-shaped crystals, of characteristic, aromatic odor, deliquescent on exposure to damp air, and acquiring a reddish tint with age and light. When copiously diluted with water it has a sweetish taste, and a slightly burning after-taste. It is soluble in about 15 of water, very soluble in alcohol, ether, chloroform, benzol, glycerin, oils and carbon disulphide; almost insoluble in benzin. ACIDUM CARBOLICUM. Is melted by gentle heating, and liquefied by the addition of about 8 per cent, of water. Dose, gr. ij, well diluted. Acidum Carbolicum Crudum, Crude Carbolic Acid,—is obtained as above stated, but by a lower degree of heat; and contains various other constituents of coal-tar besides Phenol, chiefly Cresol (Cresylic Acid) and Xylic Acid, in varying proportions. Is used as a disinfectant. 73 Peculiarities about Carbolic Acid are that the addition of about 8 per cent, of water liquefies it, while a further addition of water produces a turbid mixture, until about 15 parts of water to I of the acid is reached, when a stable and clear solution is formed. One volume of the liquefied acid, containing 8 per cent, of water, forms with one volume of Glycerin a clear mixture, which is not rendered turbid by the addition of 3 volumes of water (absence of Creosote and Creosol). Hitherto described as neutral to litmus paper, it is now officially given a faintly acid reaction. Its claims to be considered an acid are, however, very feeble, as, though it com- bines with salifiable bases, it is incapable of neutralizing the alkalies, and its combinations are decomposed by the feeblest acids (carbonic, etc.), sometimes, it is asserted, even by water. Chemically, it is considered to be the Hydroxyl (HO) derivative of Benzene (C6Hfi), which would ally it to the alcohols ; but as it does not yield the same products on oxidation (yielding finally oxalic instead of acetic acid), it is taken as the type of a class called phenols, which are simple HO derivatives of the aromatic hydrocarbons. [For the chemical theory of the Benzene derivatives see the sub-title Substitutes for Quinine, under the title CINCHONA.] Carbolic acid is converted by concentrated sulphuric acid into Sulpho-carbolic Acid, C6H5HS04; by nitric acid into several substitution-products, the most important of which is Picric Acid. The reddish tint which it acquires with age and light, does not impair its pro-erties; but is unaccounted for satisfactorily, though supposed to be due to the presence of Aurin and Rosolic Acid, impurities which form a red compound by the ab- sorption of COa and oxygen. Carbolic Acid coagulates albumen and collodion, Creosote does not. Official Preparations. Unguentum Acidi Carbolici, Ointment of Carbolic Acid,—strength 5 Per cent. Carbolic Acid 5, Unguentum 95. For external use. Glyceritum Acidi Carbolici, Glycerite of Carbolic Acid,—has of Carbolic Acid I, in Glycerin 4. Dose, trpv-x in water. Should be diluted with an equal quantity of water for external use. Sodii Sulpho-carbolas, Sodium Sulpho-carbolate, NaS03C6H4(0II) +2H20,—is pre- pared by dissolving Carbolic Acid in an equal part of strong Sulphuric Acid, thus form- ing sulpho-carbolic acid, which is neutralized with barium carbonate, and then treated with water and sodium carbonate, forming a solution of Sodium Sulpho-carbolate, which is evaporated to crystallization. It occurs in transparent, rhombic prisms, soluble in 5 of water, less freely in alcohol and in glycerin. Dose, gr. x-xxx. Sulpho-carbolates of Ammonium, Magnesium, Potassium and Sodium crystallize in tufts of acic.ular crystals, more or less white ; Sulpho-carbolate of Copper, in transparent, light blue, interlacing prisms; of Iron, in small brown, micaceous crystals ; of Zinc, in transparent, rectangular, colorless plates. That of Sodium is the only one official. Aqua Acidi Carbolici, Carbolic Acid Water,—has of the Glycerite g x to Aqua; Oj. Dose .^j-iv. Carbolic Acid Solutions, —for antiseptic surgery, are : — 5 per cent, in Water, as a spray or wash. Is decidedly irritant. 2]/2 per cent, in Water, for sponges, hands, or as a lotion. 5 per cent, or less in Olive Oil, as a special dressing. Carbolic Acid Gauze, is Gauze medicated with Carbolic Acid I, Resin 5, Paraffin 7, and is used as a surgical dressing. Unofficial Preparations. 74 ACIDUM CARBOLICUM. Carbolic Acid Plaster,—an unofficial plaster composed of Carbolic Acid 25, Shellac 75, coated with Gutta-percha dissolved in Carbon Disulphide. Phenol Sodique,—is composed of Carbolic Acid, gr. 188, Caustic Soda, gr. 31, Distilled Water, jijiv. Phenol-camphor,—has of Carbolic Acid and Camphor, equal parts. A colorless, refractive liquid ; soluble in alcohol, ether, chloroform and oils ; insoluble in water or glycerin. Used as a local anaesthetic, chiefly for toothache. In the proportion of Carbolic Acid I, Camphor 3, an application to false membrane in diphtheria, and as subcutaneous and intrapulmonary injections in phthisis. Phenol Iodatum, Iodized Phenol,—a mixture of Iodine and crystallized Carbolic Acid. (See under Iodum.) 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. Phenosalyl,—is a clear, syrupy liquid, consisting of a mixture of Carbolic, Salicylic and Benzoic Acids, melted together and dissolved in Lactic Acid. It is very soluble in water, has a pleasant and non-persistent odor, and is used in a 1 per cent, solution as an antiseptic application. Aseptol,—is the trade name of'a 33.3 per cent, solution of Sozolic or Ortho-phenol- sulphonic Acid, which is formed when Carbolic Acid is dissolved in concentrated Sul- phuric Acid. Aseptol occurs as a syrupy liquid which crystallizes in small deliquescent needles, decomposes when distilled and is very soluble in water, also in alcohol and in glycerin. It has a faint odor of carbolic acid, and is asserted to be antiseptic but not poisonous nor irritant, and hence of especial value in abdominal and ophthalmological surgery. In spite of these allegations it is probably toxic, and at any rate has been shown, by a careful series of comparative experiments, to have not more than one-third the anti- septic power of carbolic acid. It has been recommended for internal use as a substitute for Salicylic Acid, on account of its greater solubility. It has been employed in concentrated solution for the treatment of pharyngitis and diphtheritic laryngitis. Externally it is used so diluted as to contain from 3 to 10 per cent, of the active principle. Aseptolin,—is a solution containing about per cent, of absolute Carbolic Acid and 0.02 per cent, of a new pilocarpine salt named Pilocarpine-phenyl-hydroxide. It is intended for hypodermic use only, in one daily dose of tl\l-ccl for adults, injected into the abdominal parieties or into the muscles of the back. Creosotum, Creosote,—is a similar product, obtained from wood-tar. It consists of a mixture of phenols, chiefly Guaiacol (C7H802), and Creasol (C8H]0O2) ; and by the action of nitric acid is converted into oxalic acid principally, while Carbolic Acid is con- verted into picric acid by that reagent. Creosote does not coagulate albumen or collodion, Carbolic Acid does. Creosote is described under its own title. Resorcinum, Resorcin, C6II602,—is also a phenol, obtained from certain resins by the action of fusing alkalies, and is described under its own title. Creolin (Unofficial),—was the first form in which the cresols were presented in a liquid condition for use in medicine. It is a coal-tar product, occurring as a dark-brown, alkaline, semi-fluid substance, of the consistence of honey. It forms a white cloud when added to water, with which, however, 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 Oint- ments to 5 per cent., and Creolin Gauze is prepared of 10 per cent, strength of the drug. Dose, in capsules. Lysol (Unofficial),—one of the latest disinfectants and antiseptics, is a saponified product of coal-tar, chiefly composed of the cresols; and occurs as a clear, brown, oily liquid, mixible readily with water, and forming clear solutions with glycerin, alcohol, chloroform and various other fluids. It is employed as a local application only, gener- ally in a 1 per cent, solution. Trikresol (Unofficial),—is a mixture of the three isomeric cresols, respectively named the ortho-, meta- and para-methyl phenols, and also contains the hydroxyl group, which seems to be a characteristic constituent of antiseptics and germicides. It occurs as a white liquid, of creosote-like odor, sp. gr. 1,042 to 1,049, and soluble in water to the Allied Products and Derivatives ACIDUM CARBOLICUM. extent of 2.55 per cent. Its solutions are clear and do not impart any sensation of numb- ness to the fingers. It is a powerful germicide in solutions of I per cent, strength, which are said to be as efficient as a 5 per cent, solution of carbolic acid. Trikresol Water (1 part to 1000) is used as a menstruum for the ordinary collyria employed in ophthal- mological practice. Saprol, Disinfection Oil (Unofficial),—is a dark brown, oily mixture, highly inflam- mable, and composed of the crude cresols in a great excess of the liquid hydrocarbons obtained from the refining of petroleum. It floats on water and yet gives up its soluble constituents as disinfectants to the offending fluid, leaving the remainder as an oily film on the surface to hinder the escape of disagreeable odors, and the spread of infecting spores. It is a cheap disinfectant, and can be employed on a large scale in barracks, prisons, schools, etc., if no light or fire is brought into proximity with it. Sewage treated with it still retains its value as a manure ; and so small a quantity as one per cent, of it will effect- ually sterilize urine and fecal matter impregnated with micro-organisms like the bacilli of cholera and typhoid fever (Laser). Solutol and Solveol (Unofficial),—are disinfectants of the same class as the preced- ing, both being soluble forms of the insoluble Cresol (Cresylic Acid). Solutol is an alka- line solution of Sodium Cresylate in an excess of Cresol, and is not suited for surgical use, by reason of its caustic alkalinity ; but is of marked utility in the preservation of the cadaver, and for general and copious use in disinfecting water-closets, sinks, infected bed-clothing, sputa and deleterious discharges of all kinds. Solveol differs from Solutol in containing Sodium Cresotate instead of sodium cresylate, is devoid of the causticity so characteristic of the latter substance, and is also free from the greasiness of Creolin and Lysol. It is a dark-colored, nearly odorless liquid, of neutral reaction, soluble in water in all proportions. It is especially applicable to surgical uses, a ]/2 percent, solution being employed for dressings, being more active (it is claimed) antiseptically, than a 2 per cent, solution of carbolic acid. 75 Physiological Action Carbolic Acid is a powerful antizymotic and antiseptic, a good disin- fectant, somewhat antipyretic, also a local anaesthetic, and a depressant of the cardiac, respiratory, cerebral and spinal functions. It is destructive to all low forms of life, rapidly destroying all organized ferments, both animal and vegetable. On unorganized ferments (enzymes), such as pepsin and ptyalin, it does not act so readily, but in large doses it like- wise destroys their activity ; and is an efficient parasiticide against certain vegetable parasites which infest the skin. The foregoing is true of the liquefied acid and its aqueous and glycerin solutions, but not of its solu- tions in oils, which have no antizymotic properties. Applied to the skin in weak or moderately strong solutions, it produces local anaesthesia, with a sensation of numbness, which lasts for several hours. Applied in concentrated form, it is irritant and superficially escharotic, with burning pain of brief duration, and produces at the point of application a white spot, changing to red if the acid is soon removed. It does not vesicate, but if the application be prolonged, a white eschar or slough results, from the coagulation of the albumen of the tissue, and this is bordered by a red zone of inflammation. Taken internally, the concentrated acid has the same effect on the mucous membranes as on the skin, producing white, superficial eschars, after burning pain of short duration, in the mouth, gullet and stomach. To the latter viscus it is a powerful irritant, and causes a violent gastritis. 76 ACIDUM CARBOLICUM. In medicinal doses, when acted upon by the gastric secretions, it is con- verted into a sulpho-carbolate, and is so diluted by the contents of the stomach that it loses its antizymotic power, and hence is of no value as an internal antiseptic remedy. In the blood it probably circulates as an alkaline carbolate, in medicinal doseshaving no effect upon the circu- lation or respiration. Its antipyretic power is incapable of being utilized, requiring a dosage which would be dangerous. A toxic dose paralyzes the vaso-motor centre in the medulla before markedly affecting the heart. The blood-pressure and body-temperature fall; the respiration, at first accelerated by stimulation of the vagi, is quickly depressed and ultimately paralyzed ; cardiac inhibition is stimu- lated, the heart being first slowed and then depressed. The anterior cornua of the spinal cord are first stimulated, producing convulsions; and subsequently depressed, causing suspension of reflexes, impaired motility and sensibility, and finally paralysis of both motion and sensation. The cerebrum is profoundly depressed, producing stupor deepening into coma, with minutely contracted pupils. Death occurs, in most cases, by par- alysis of respiration ; in a few, by paralysis of the heart. Carbolic Acid is readily absorbed, and rapidly diffused ; many fatal cases having resulted from its external use in undiluted form. A single vaginal injection of a moderately weak solution has produced very severe constitutional results. It is partly oxidized in the blood, and partly eliminated by the lungs and kidneys. It imparts to the urine a peculiar smoky or olive-green color, which is not due to blood, and may be seen after moderate doses, or even as a result of its absorption from dressings. When ingested in a large dose, the acid itself may appear in the urine; but the smoky color is due to the presence of its intermediate oxidation products, viz., pyrocatechin (only in alkaline urine), and hydrochinon, also salts of sulpho-carbolic acid and glycuronic acid. In poisoning thereby the sulphates are absent from the urine. A case of poisoning by Carbolic Acid shows white, corrugated eschars in the mouth and fauces, if the drug has been swallowed in concentrated form. These eschars are also found on the mucous lining of the oesopha- gus and stomach, at the autopsy. The patient has complained of an intense, burning sensation along the same tract, immediately after the ingestion of the poison, and soon passes into a state of collapse ; the skin being cold and clammy, the pupils contracted, respiration becomes more and more feeble and shallow; the urine, if not entirely suppressed, is of a dark-green color; reflexes are then abolished, stupor and coma supervene, and finally the breathing ceases. The blood, after death, is dark in color, and coagulates imperfectly; and fatty degeneration of the liver and kidneys may be found. When poisoning occurs by absorption, an early symptom is the peculiar, smoky color of the urine. There may ACIDUM CARBOLICUM. 77 be pain in the lumbar region, indicating renal irritation, and slight rest- lessness or cerebral disturbance; after which come the impairment of respiration and stupor. A toxic dose of Carbolic Acid, taken internally, is one of the most rapidly acting poisons known, sometimes equalling Prussic Acid in this respect. The symptoms develop almost immediately, and death may occur in a very few minutes; but usually the patient lives from one to ten hours; rarely over two days. In some cases, a great amendment has occurred, with restoration of consciousness, but after some hours sudden and fatal collapse has supervened. The minimum fatal dose is not deter- mined, but §ss has frequently caused death ; and doses as small as npvj have given rise to dangerous symptoms. Cases of suicidal and accidental poisoning by this drug are very frequent, by reason of the facility with which it may be obtained for use as a disinfectant. If the case is seen shortly after ingestion, Apomorphine may be administered hypoder- mically, as a rapidly acting emetic; but, in any case, the stomach should be washed out freely. The chemical antidote is any soluble sulphate to form the harmless sulpho-car- bolates; as Magnesium Sulphate J$j, or Sodium Sulphate 3 ss, dissolved in ]/z pint of water. Even if several hours have elapsed since the ingestion of the poison, the sulphates should be used, as their antidotal action proceeds in the blood current. In one case where 3 ss of the 95 per cent, acid had been taken, nearly 3 iij of Magnesium Sulphate (Epsom salts) were used, resulting in complete recovery from an apparently hopeless con- dition. Stimulants, as ether or brandy hypodermically, should also be used freely; also hot water bottles and hot blankets if signs of collapse appear. Vegetable demulcents may be given (but no oils or glycerin), to protect the mucous surfaces. Liquor Calcis Saccharatus, or Syrupus Calcis, is also antidotal to the poison in the stomach but is much less efficient than the sulphates. Atropine, hypodermically, is a very complete physio- logical antagonist to the systemic symptoms, maintaining the heart and respiration until elimination occurs (Post). Cider Vinegar may prove antidotal, as it removes the effects of the local application of the strong acid. Soap, in strong, watery mixture (suds), is said to have acted as a perfect antidote; but its action would be confined to the poison in the stomach. Oils should not be used, as they increase the absorption of the poison. Treatment of Poisoning by Carbolic Acid. Therapeutics. Carbolic Acid owes its prominence to its having been the principal agent used in the antiseptic method of treating wounds; but its employ- ment in that connection has become much restricted, and many of the most prominent surgeons have abandoned it altogether in favor of other germicides. In the estimation of many, however, it still retains high favor as a surgical antiseptic lotion ; and it is in general use as a disin- fectant for surgical instruments, hospital apparatus, soiled linen, etc. The carbolic spray, formerly so commonly used during operations, has been entirely discarded. For disinfectant purposes about drains, privies, on floors, walls, etc., the crude acid is to be preferred, not only on account of its less cost, but also for the reason that its principal impurity, Cresol (Cresylic Acid), has very high power as a disinfectant. As a local application, Carbolic Acid has extensive and varied uses. 78 ACIDUM CARBOLICUM. Unna calls it the opium of the skin, as it relieves pruritus of almost any form, if applied in 5 per cent, aqueous solution over the itching surface; and a lotion, composed of gr. xx to §ss each of water and glycerin, makes a very efficient application for the itching of jaundice. The gly- cerite, diluted, effectively destroys the fungus of tinea tonsurans or tinea versicolor, and may be applied as a stimulant to indolent ulcers, or to the patches of aphthous stomatitis. A one per cent, solution in water and gly- cerin (npv to 3j) makes an excellent anaesthetic and cleansing gargle for the painful sore throat of diphtheria, tonsillitis, etc. Cotton soaked in the strong acid will stop the pain of a decayed tooth, but care must be taken, by covering it with dry cotton, to prevent its access to the gums, or slough- ing thereof may result. For burns, one of the best dressings is carbolized sweet oil (3j to §vj) to relieve the pain. For local anaesthesia in minor surgical operations, such as that for ingrowing toe-nail or opening a felon, the part may be soaked for ten minutes in a 30 per cent, solution, or the pure acid may be brushed over the line of incision. As a parenchymatous injection, which should be not over gss of a 2 per cent, solution, Carbolic Acid has been employed with much success in combating deep-seated inflammations. The skin being first anaesthet- ized by the local application of the acid, a hypodermic needle is intro- duced obliquely, to the centre of the inflamed tissue, and should not be connected with the syringe if any blood escapes through it, lest the in- jection be introduced into a vein. This method has been successfully used in glandular swellings, 5 to 10 minims of the solution for each gland being sufficient in phlegmons of every grade and character, erysipelas, poisoned wounds, inflamed bursae, hydrocele, acute and subacute rheu- matism, chronic synovitis, buboes, and in some severe cases of tetanus. Under the trade-name Aseptolin (see ante, page 74) Dr. Edson has re- cently put forth a solution, containing per cent, of carbolic acid and a minute quantity of a pilocarpine salt, for hypodermic use in curable cases of tuberculosis, malaria, and other diseases due to germ infection. There is nothing original in this treatment, it being a repetition of the phenic acid injection of Declat combined with the pilocarpine treatment of phthisis announced about two years ago as the “ discovery ” of Dr. Waldstein. It is now going through the usual puffing methods of trade promotion, and the few independent reports upon its use show no evi- dence of any special merit for it in these diseases. Internally, Carbolic Acid is not much employed. It has been given to relieve flatulence and dyspepsia, and is often an efficient remedy against vomiting. It has proven of considerable temporary benefit in diabetes of hepatic origin; and has been used against intermittents, typhoid fever, and various zymotic diseases ; but is probably of no efficacy in constitu- tional affections. A mixture, containing carbolic acid and spirit of chloro- ACIDUM CARBOLICUM. 79 form has been lately used as an internal remedy for typhoid fever by Dr. Quill, of the Indian army, without the loss of a, single case, and in a country where enteric fever has a very high rate of mortality. In phthisis and other chronic pulmonary diseases, it has been much employed as a spray by inhalation, and certainly does do good therein by relieving cough and irritation of the throat. In these affections, Creosote is preferred to it for both internal and local use. An acute conjunctivitis is greatly relieved by holding the open eye in the spray of a steam atom- izer, the cup of which contains a 5 per cent, solution of carbolic acid. This measure maybe also used for acute coryza with beneficial results; or a mixture of Carbolic Acid and Tincture of Iodine may be dropped on to a sponge in a wide-mouthed bottle and volatilized for inhalation by being wrapped in a cloth wrung out of hot water, or even by being held in the hand. The Sulpho-carbolates of Sodium, Potassium, etc., have been em- ployed internally with advantage in the septic diseases, as the exanthe- mata, diphtheria, puerperal fever, etc., with the object of obtaining the antiseptic action of carbolic acid without the dangers attending its use in efficient doses. They may be used locally with good results in aphthse, tonsillitis, otorrhoea, gonorrhoea, and for inflamed mucous membranes generally. Creolin was highly vaunted, by Professor von 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 de- odorant, and free from danger by absorption. The weaker solutions have given satisfac- tion as local applications in the treatment of otorrhoea, nasal ulcers, rhinitis (i to ioooj, blepharitis, keratitis, etc. ; and in female cystitis a I 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 car- bolized preparations, and with better satisfaction, Creolin being less volatile than Carbolic Acid, and of a more agreeable, though powerful, odor. Internally it has been employed in gastric fermentation, dysentery, and typhoid fever. Lysol is said to be superior to carbolic acid, creolin and the other analogous coal-tar products as a germicide, but it has no advantage over the antiseptics of established repu- tation ; and is only really efficient in solutions of such strength as to be irritating or caustic. Although not destined to play any great part in surgery, it may be useful in the prophylaxis and arrest of epidemics ; and is likely to be particularly serviceable in the disinfection of premises, privies, ships and stables, being readily soluble, reasonably active, and very cheap (Squibb). Dr. Pee, who has had very favorable results from Lysol, recommends a one per cent, solution in obstetrics and gynecology, and says that a solu- tion of one part in 200 destroys streptococci in fifteen minutes. Trikresol possesses very high germicidal power, and is said to be practically non-toxic and less irritating to wounds than either carbolic or sublimate solutions. A 1 in 1000 solution dropped into the eye produced not the slightest irritation, and the 1 to 50° solution dropped into my own eyes produced no burning sensation whatever (De ■Schweinitz). These solutions may therefore be advantageously employed as menstrua for the stock collyria, especially for those of cocaine, physostigmine and atropine, which are most liable to contamination. Trikresol is particularly fatal to pyogenic cocci, a 1 per cent, solution invariably killing them in half a minute in watery solutions, and in a minute and a half in rich albuminous fluids (Gruber). 80 ACIDUM CARBONICUM. Phenosalyl possesses an antiseptic power which is considerably superior to that of carbolic acid, a X per cent, solution immediatelykilling the staphylococcus pyogenes aureus, which is the most resistant microbe known. In order to attain the same result with car- bolic acid it is necessary to expose the staphylococcus to the action of a 2y2 per cent, solution for at least one minute. Phenosalyl does not irritate the skin, has no corrosive action on instruments, is veiy soluble in water, is non-toxic, and leaves a pleasant and non-persistent odor which does not cling about the hands or the clothes. Its solutions have no corrosive action on the skin, and the mucous surfaces treated with it remain smooth and slippery and do not become dried up, as is the case after washing with car- bolic acid or corrosive sublimate solutions (Frankel). ACIDUM CARBONICUM, Carbonic Acid, C02 (Unofficial), —is a colorless and odorless gas, of sp. gr. 1.526, slightly sharp taste, solu- ble in its own volume of pure water at the ordinary temperature and pres- sure, much more soluble under increased pressure and lowered temperature of the water, also more soluble in water containing phosphates. In water it promotes the solution of phosphates and carbonates. Its aqueous solu- tion gives an acid reaction, and is “sparkling” from rapid escape of the gas, especially when agitated. It is prepared by treating any carbonate (usually calcium carbonate in the form of marble-dust) with dilute Hy- drochloric Acid ; the resulting gas is passed into water under pressure, and the solution is thus obtained. Carbonic Acid gas occurs in the atmosphere in the proportion of 2 to 6 parts in 10,000, also in all water in varying quantity. Certain sparkling waters contain it in the propor- tion of more than one-half their volume, Johannis having more than 90 per cent. It occurs also in all the liquids of the body, especially in the blood, originating in the oxida- tion processes which are constantly taking place in the tissues, and readily passing by osmosis through animal membranes. It is continuously produced by the action of the yeast-plant, and by all other fermentation processes, and accumulates in brewer’s vats, old wells, some caves, grottoes and deep valleys, also in mines, forming the well-known “ choke-damp” of miners. It is constantly evolved during respiration and in the burning of gas, fires, etc. When the air of a room contains o. I per cent, of this gas it is unfit for continued respiration. Aqua Carbonata, Carbonated Water, Soda-water (Unofficial),—is water highly charged with carbonic acid gas, 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. Preparation. Carbonated Mineral Waters. Selters, Nassau, Germany, 30 cubic inches' Apollinaris, Nuenahr, Prussia, 47 “ Old Sweet Spring, West Virginia, II “ Sweet Chalybeate Spring, Virginia, 13 “ of C02 to the pint. There are 10 official Carbonates and 2 official Bicarbonates, which are severally de- scribed under their basylous titles. Physiological Action. Carbonic Acid gas is highly antiseptic and preservative. D’Arsonval employs it, under 30 atmospheres’ pressure, for the sterilizing of orchitic extract. Beef will remain perfectly fresh and its taste unchanged for ACIDUM CARBONICUM. 81 eight days if hung in a chamber filled with the gas. Externally, applied to the skin, mucous membranes or wounded tissues, the undiluted gas pro- duces slight hypersemia, with prickling and a sense of heat, followed by a certain degree of local anaesthesia. Internally, given by the stomach in aqueous solution, it is refreshing and quenches thirst, slightly stimulates the heart’s action, quickens respiration and causes a brief sense of exhila- ration. It increases somewhat the gastro-intestinal secretions and excites peristalsis, but diminishes the sensibility of the mucous lining of the ali- mentary canal. Inspired, the gas is highly toxic, a proportion of io per cent, thereof in the air being irrespirable and fatal. Even o. i per cent, produces unpleasant symptoms,as headache, sleeplessness and depression; 0.3 per cent, causes a throbbing headache, fulness and tightness across the temples and giddiness; and a large quantity profoundly affects the nervous system, inducing fainting, muscular weakness, somnolence or in- sensibility, and coma or convulsions. The inhalation of the undiluted gas at first excites irritation and sometimes spasmodic closure of the glottis with consequent asphyxia, but in any case it soon arrests the respiration. It hinders the exhalation of the carbonic acid normally existing in the blood, and is itself absorbed in small quantity, inducing dyspnoea, cyano- sis, slow and labored pulse, and ultimately arrest of the heart’s action. In toxic quantity it abolishes at once the functions of nerve and muscle by stopping the process of oxidation in the tissues. The symptoms of Carbonic Acid poisoning may be divided into three stages, which are the stages of Asphyxia. They are : (1) that of dyspnoea, in which the blood pressure rises from excitation of the centres in the medulla by the venous blood, the vessels of the surface become dilated, and insensibility comes on; (2) that of convulsions, in which the respira- tory movements become more violent and spread to all the muscles of the body; (3) that of paralysis, in which the convulsions cease, the blood pressure falls, the respiration gradually fails, and finally the heart stops. The autopsy shows great venous congestion everywhere, the right side of the heart distended with blood, the brain much congested, with exudation and even extravasation therein, and the blood exceedingly dark in color. The antagonists are Oxygen and stimulants of the peripheral circulation. The prime object of treatment is to get the blood oxygenated as quickly as possible. The patient should be brought at once into the open air, and if the respiratory movements have ceased, cold water should be dashed on the face and chest, in order to awaken them by reflex action. If no effect is thereby produced, recourse must be had to artificial respir- ation, which should be maintained for at least an hour. [Compare the article entitled Asphyxia and Apncea in Part III.] If the heart does not begin to beat shortly after artificial respiration has been begun, the jugular vein should be opened, with care to prevent the entrance of air, in order to relieve the distention of the right ventricle and prevent the consequent paralysis of the heart. This vein is selected because there are no valves of any importance between it and the heart. A series of sharp, quick blows upon the chest in the cardiac region will sometimes start the heart into action after it has stopped. Treatment of Carbonic Acid Poisoning. 82 ACIDUM CHROMICUM. Carbonic Acid has been locally employed as a local stimulant in ulcers and as an anaesthetic in cancers, either by directing a stream of the gas upon the part or by the application of a yeast poultice. The gas has been applied in streams to the eyes, ears, nose, vagina and rectum, in catarrhal inflammation of these parts, also to the bladder, for irritability of that viscus, and its application is beneficial when there is no acute inflam- mation present. It is injected into the vagina with good results in dysmenorrhcea and in many other painful affections of the pelvic viscera, whether neuralgic in character or arising from organic disease. Diluted with 90 to 95 per cent, of air, its inhalation is serviceable in chronic laryngitis and pharyngitis, also in asthma, chronic bronchitis and chronic cough. Carbonated water, or “soda-water” as it is popularly named, is a grateful beverage in warm weather, especially when flavored with certain syrups and fruit-juices. It is a useful drink in febrile affections, as it relieves thirst, allays nausea and gastric irritability, and is both diaphoretic and diuretic in slight degree. It is an efficient remedy for vomiting, and in the form of iced champagne is one of the numerous agents which have proven efficacious in the vomiting of pregnancy. It forms an excellent vehicle for the administration of saline cathartics, the vari- ous carbonates and piperazin. The free use of carbonated mineral waters is of service in gout, especially when they contain the salts of lithium in solution. At many European spas the course of treatment is largely based on the use of carbonic acid, administered in the forms of baths and inhalations as well as by the ingestion of the waters containing it. Bathing in the natural carbonated waters is sometimes beneficial in catarrh, gout, rheumatism, anaemic amenorrhoea and leucorrhoea, the gas acting as a gentle stimulant of the cutaneous circulation and promoting slight diaphoresis. [Compare the article entitled Aqua.] Therapeutics. ACIDUM CHROMICUM, Chromic Acid (Chromic Trioxide, Chromic Anhydride'), Cr03,—is obtained by the action of Sulphuric Acid upon Potassium Bichromate, and occurs in small, crimson, needle-shaped crystals, which are deliquescent and very soluble in water. This sub- stance is not Chromic Acid, which does not occur in the free state, and the formula of which would be H2Cr04. It should be known by one of its chemical synonyms mentioned above. It should be kept in glass- stoppered bottles, and great caution should be observed to avoid bringing it in contact with organic substances, such as cork, tannic acid, sugar, alcohol, glycerin, etc., as dangerous accidents are liable to result. It is not used internally. ACIDUM FLUORICUM. 83 Potassii Bichromas, Potassium Bichromate, K2Cr207,—large, orange-red prisms of disagreeable, metallic taste and acid reaction, soluble in 10 of water at 590 F., and in I y.£ of boiling water, insoluble in alcohol. Used locally in aqueous solution (gr. v- j to the 3), and internally in doses of gr. yj-gr. ij in trituration. 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 ; and 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, leucorrhoea, and gonorrhoea. In uterine catarrh and hemorrhages a solution of 120 grains to the § has been injected into the uterine cavity with good results. Potassium Bichromate is a good antiseptic and an escharotic of milder action than the acid. In doses of gij-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 saturated solu- tion to warts and venereal condylomata ; and in dilute solution (gr. j-x to the §) for catarrhal conditions of the nasal, buccal or vaginal mucous membrane. Internally it has been employed with benefit in locomotor 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 influ- enza, 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 mineral acids. Physiological Action and Therapeutics. 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 pre- pared by acting on fluor spar by Sulphuric Acid, the resulting gas being dissolved in water. Its dose is trpxx-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 membranous croup. 84 ACIDUM GALLICUM. ACIDUM GALLICUM, Gallic Acid, HC7H505.H,0,—is a nearly colorless solid in long needles and triclinic prisms, having a slightly acid and astringent taste, soluble in 100 of water and in 5 of alcohol at 590 F., and in 3 of boiling water. It is prepared from a paste of powdered galls (see Galla), by fermenting for six weeks, boiling and reboiling 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, C14H10O9 -j- H20 = (HC7H505)2. Dose, gr. v-xv, in solution, pill or powder. Pyrogallol, Pyrogallic Acid, Tri-hydroxy-benzene, C6H:!(OH)3,—is a triatomic phenol, obtained chiefly by the dry distillation of Gallic Acid. Light white, shining laminae, or fine needles, of bitter taste; soluble in water, alcohol and ether. Dose, gr. j-ij. 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. Hgematoxylon, Logwood. Heuchera, Alum Root. Kino, Kino. Krameria, Rhatany. Myrica, Wax Myrtle. Nymphsea, Pond. Lily. Quercus Alba, Oak Bark. Rosa Gallica, Red Rose. Rubus, Blackberry. Statice, Marsh Rosemary. Physiological Action. 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.] Pyrogallol may act as an intense poison. It has 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 anti- septic and disinfectant in i to 2y2 per cent, solutions. Mineral Acids, Alkalies, per-salts of Iron, and salts of Antimony, Lead, and Silver are chemically incompatible with preparations containing Tannic or Gallic Acid. acidum hydrochloricum. 85 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 hem- orrhages, albuminuria, diabetes insipidus, bronchorrhoea, night-sweats, chronic diarrhoea, and chronic cystitis, it is a most useful remedy. Pyrogallol has been used internally in two-grain doses for internal hemorrhages. As an ointment (3j~3j) it ranks 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 HYDROBROMICUM DILUTUM, Diluted Hydrobromic Acid, —is composed of 10 per cent, of absolute Hydrobromic 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. The action of Hydrobromic Acid on the nervous system and circulation is identical with that of the Bromides. Added to a mixture of Quinine and water (n\)j 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 substi- tute 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 1.163, pungent odor, intensely acid reac- tion 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 sub- stances forms salts, called Hydrochlorates (Muriates), of which four are official, viz.—Apomorphine, Morphine, Pilocarpine, and Quinine Hydro- chlorates, described under the titles of their respective bases. Acidum Hydrochloricum Dilutum, Diluted Hydrochloric Acid,—is a 10 per cent, solution of the absolute acid in water. Dose, rrpiij-x. Acidum Nitro-hydrochloricum, Nitro-hydrochloric Acid,—is described under Acidum Nitricum. Physiological Action of the Mineral Acids. The mineral acids (Hydrochloric, Sulphuric, Nitric, Nitro-hydro- chloric, 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- 86 ACIDUM HYDROCHLORICUM. 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 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 glands having an alkaline secretion (bile, etc.), when applied to the mouths of their ducts, 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 diges- tion, being synergistic to the action of pepsin, but if continued they im- pair digestion by lessening the production 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. Antidotes and Antagonists. Alkalies to neutralize the acid ; Oil, Albumen, or Milk, to protect the mucous mem- brane ; Stimulants, Opium, Ammonia (intravenously), to combat the resulting depression of the vital powers. 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 lithsemia, 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-poison- ing. Dilute Sulphuric Acid is used as an acid drink in fevers, and before Therapeutics of the Mineral Acids ACIDUM HYDROCYANICUM DILUTUM. 87 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 or glass tube, and the mouth should be thoroughly rinsed at once with an alkaline solution. ACIDUM HYDROCYANICUM DILUTUM, Diluted Hy- drocyanic (Prussic) Acid,—is a liquid composed of 2 per cent, of absolute Hydrocyanic Acid, HCN, and 98 per cent, of water. It is colorless, faintly acid, of peculiar odor, and is prepared by distilling solu- tions of Potassium Ferrocyanide and Sulphuric Acid together, or extem- poraneously by adding 6 grammes of Silver Cyanide to a solution of 5 Cc. of Hydrochloric Acid in 55 of distilled water, shaking together and pour- ing off the supernatant liquid, rrpxl have proved fatal. Dose, fflj-v, of a recent preparation ; as, even under the most favorable conditions, it will decompose within a year. 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. Rosacese, sub-order Amygdalese. The leaves contain a variable amount of Hydrocyanic Acid and a volatile oil. Dose, TTLv-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 Amygdalese, including the official Primus 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 on each other, forming Hydrocyanic Acid, a volatile oil, and glucose. C20H27NOn (Amygdalin) + 2H20 — C7II60 (Oil of Bitter Almond) -f- HCN (Hydrocyanic Acid) -f- 2C6H]206 (Glucose). Other Cyanogen Compounds. Potassii Cyanidum, Potassium Cyanide, KCN,—a white, opaque salt, of alkaline reaction, bitter-almond taste, and a peculiar odor when moist; soluble in 2 of water, sparingly soluble in alcohol. Dose, gr. . Locally, a solution of gr. j-v to the is as strong as should be employed. Potassii Ferrocyanidum, Potassium Ferrocyanide, K4Fe(CN)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 Iron Ferrocyanide, Diluted Hydrocyanic Acid and Potas- sium and Silver Cyanides. Rarely used medicinally. Dose, gr. v-xv. Physiological Action. Hydrocyanic Acid is one of the most powerful and rapid poisons known, half a grain having proved fatal almost immediately. 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 88 ACIDUM HYDROCYANICUM DILUTUM. but still a fatal dose, by paralysis of respiration. The symptoms are those of sudden and complete asphyxia, but 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. : (i) Dyspnoea, slow and full pulse, giddiness, loss of muscular power;—(2) Vomiting, dilated pupils, unconsciousness, 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, convulsions or rigidity, but no paralysis. Large medicinal doses may produce salivation, irritation of the throat, dizziness, buzzing in the ears, headache, 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 examination usually shows 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 paralyzant 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 medicinal dose pass off in an hour at the farthest. Locally applied to the skin, Hydrocyanic Acid penetrates the epidermis and paralyzes the end-organs of the sensory nerves in the derma. It is rapidly absorbed from mucous surfaces. Potassium Cyanide has similar action, but in addition has some few peculiar to itself. Locally used it produces dermatitis, with an eczema- tous 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 Hydrocyanic 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. Am- monia 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 poi- soning where there is time to do anything. In poisoning by Potassium Cyanide give Ferrous Sulphate, producing Ferrocyanide of Iron (Prussian Blue). Then evacuation of ACIDUM LACTICUM. 89 the stomach, artificial respiration, and Ammonia by intra-venous injection. Cobalt Nitrate is announced as an efficient antidote to Hydrocyanic Acid or Potassium Cyanide, by M. Antal, a Hungarian toxicologist and chemist. Hydrocyanic Acid is used for its anti-spasmodic and sedative effects. In vomiting, whooping-cough, and coughs of spasmodic character, in asthma and other neuroses of the respiratory organs, in affections involv- ing the pneumogastric nerve, vertigo and headache from stomachal de- rangements, 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 ad §j Aquae Rosae) to the unbroken sur- face is prompt in relieving the pruritus and other distressing sensations. Only when recently prepared is it of any service ; as, even under the most favorable conditions, it will undergo decomposition within a year. Potassium Cyanide in ointment (gr. v ad §j) is used to allay pruritus, and in solution (gr. iij-v ad §j) 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. In smaller doses (gr. Ye-yi), it is a useful ingredient of cough mixtures, where Opium or its alkaloids are not admissible. Potassium Ferrocyanide 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. Therapeutics. ACIDUM LACTICUM, Lactic Acid, —is a liquid composed of 75 per cent, of absolute Lactic Acid (HC3H-03) and 25 per cent, of water; nearly colorless, syrupy, odorless, of acid taste and reaction, freely miscible with water, alcohol and ether, but nearly insoluble in chloroform. It is produced by the lactic fermentation of sugar of milk or grape-sugar, has a sp. gr. of 1.213, and is difficult to obtain pure. It enters into Syrupus Calcii Lactophosphatis. Dose, 3ss-5 ss, well diluted. Lactic Acid is found in the stomach as a product of the food, and combines with bases in the blood, forming lactates, which, being oxidized, are converted into carbonates. It aids digestion and promotes the appetite, 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 endocarditis. Hence its supposed causation of acute rheumatism when in excess and free in the blood. It dis- solves false membranes and also calcium phosphate. Hypnotic properties have been ascribed to it. 90 ACIDUM NITRICUM. It is used with benefit in diabetes, atonic dyspepsia, oxaluria, and in the lithic and phosphatic diatheses when due to imperfect digestion and assimilation. As a solvent of false membrane in croup and diphtheria it is unquestionably of great service but painful. 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 68 per cent, of absolute Nitric Acid, HN03, and 32 per cent, of water. It is colorless, fuming, very caustic and corrosive, of sp. gr. 1.414, strongly acid in reaction, and is obtained by the action of Sulphuric Acid on Potassium Nitrate. Is only used externally as a caustic. Preparations. Acidum Nitricum Dilutum, Diluted Nitric Acid,—has of the above io parts in 58 of Distilled Water, and contains IO per cent, of absolute Nitric Acid. Dose, tiyiij-xv, well diluted. Acidum Nitrohydrochloricum, Nitrohydrochloric Acid, Nitromuriatic Acid, Aqua Regia,—a golden-yellow, fuming, corrosive liquid, composed of Nitric Acid 18 vols., Hydrochloric Acid 82 vols. Is wholly volatilized by heat, readily dissolves gold-leaf, and a drop added to test-solution of Potassium Iodide liberates Iodine in abundance. Dose, rryj-viij, well diluted. Acidum Nitrohydrochloricum Dilutum, Diluted Nitrohydrochloric Acid,—con- sists of Nitric Acid 4, Hydrochloric Acid 18, Water 78 vols. Dose, rtyv-xx, well diluted. Physiological Action and Therapeutics. The action and uses of these agents are described with those of the other mineral acids, under the title Acidum Hydrochloricum. 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 prepared, when it is of an orange-red color. This should be properly ACIDUM OLEICUM ACIDUM PHOSPHORICUM. 91 diluted when required for use, and should be constantly protected from light. ACIDUM OLEICUM, Oleic Acid, HC18H3;i02,—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 uncombined 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 a great excess of the latter. Three of these are official, viz. :— Oleatum Hydrargyri, Oleate of Mercury,—has 20 of the Yellow Oxide of Mercury, with 80 of Oleic Acid. Oleatum Veratrinae, Oleate of Veratrine,—has 2 of Veratrine in 98 of Oleic Acid. Oleatum Zinci, Oleate of Zinc,—has 5 of Zinc Oxide in 95 of Oleic Acid. Unofficial Preparations. Oleates (Oleata) of Aconitine (2 per cent.), Atropine (2 percent.), Alorphine (ioper 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 Aluminum, Bismuth, Copper, Iron, Lead, Silver, etc., are prepared by the manu- facturing 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 Pal- mitic Acids, being prepared from oils which yield the latter acid in considerable quan- tity. 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. Oleic Acid is only used in making the Oleates, which were introduced by Marshall, 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 vaseline or olive oil before being rubbed into the skin, as they may produce a cutaneous erup- tion 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 gaining favor. ACIDUM PHOSPHORICUM, Phosphoric Acid,—is a liquid composed of 85 per cent, of Orthophosphoric Acid, H3P04, and 15 per 92 ACIDUM PICRICUM ACIDUM SULPHURICUM. cent, of water, and is obtained by oxidizing Phosphorus by Nitric Acid. It is strongly acid, odorless, colorless, and of sp. gr. 1.710 at 590 F. Acidum Phosphoricum Dilutum, Diluted Phosphoric Acid,— has of Phosphoric Acid 10 parts in 75 of Distilled Water, sp. gr. 1.057, and contains 10 per cent, of Ortho- phosphoric Acid. Dose, rrpv-xxx, in sufficient water. Phosphates of Ammonium, Ferrum, and Sodium, Syrupus Ferri, Quininae et Strych- ninae Phosphatum, and Acidum Hypophosphorosum Dilutum, are described under Phos- phorus. The action and uses of Phosphoric Acid are described with those of the other Mineral Acids under Acidum Hydrochloricum. It may be given in larger doses than the other acids without deranging 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 phosphorus, it cannot be used to obtain the effects of that drug. ACIDUM PICRICUM, Picric Acid (Carbazotic Acid, Trinitrophenol), 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 thera- peutically, without any particular results. Powers as an antiperiodic and anthelmintic and against trichinae have been urged for it, but experience 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 a strong acid reaction, composed of not less than per cent, of absolute Sulphuric Acid (H2S04) and 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 1.835, and is miscible in all proportions with water and alcohol, with evolution of heat. Occasionally used as a caustic. Acidum Sulphuricum Dilutum, Diluted Sulphuric Acid,—has of the strong acid i part to 8lf of distilled water, and contains io per cent., by weight, of absolute sulphuric acid. Dose, ff\v-xv, well diluted. Acidum Sulphuricum Aromaticum, Aromatic Sulphuric Acid, Elixir of Vitriol, —is Sulphuric Acid io per cent, by volume, 20 per cent, by weight, 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, well diluted. The action and uses of Sulphuric Acid generally are described with those of the other Mineral Acids under Acidum Hydrochloricum. 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 diarrhoea and lead ACIDUM SULPHUROSUM. 93 poisoning it is generally administered in combination with Opium. The only hemorrhages in which it is efficient are those from mucous surfaces. It is excreted 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 princi- pal 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 not less than 6.4 per cent., by weight, of Sulphurous Acid Gas (S02) and 93.6 per cent, of water. It is prepared by heating Sulphuric Acid with char- coal and dissolving the gas produced in distilled water. Dose, n^v-gj, largely diluted with water. Sodii Sulphis, Sodium Sulphite, Na2SOa. 7il20,—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, Sodium Bisulphite, 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, Sodium Hyposidphite, 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. Incompatibles. All oxidizing substances change the sulphites into sulphates, and the Mineral Acids decompose them. Physiological Action and Therapeutics. 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 inflamma- tion of the respiratory passages. 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 fumi- gated, 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 applications. 94 ACIDUM TANNICUM. 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 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. The Sulphites were used in zymotic and septic fevers as internal antiseptics on theoretical grounds, but their supposed value has not been realized. ACIDLJM TANNICUM, Tannic Acid (Gallotannic Acid, Digallic Acid, Tannin), HC14H909,—is a solid body in light-yellowish scales, of strongly astringent taste and acid reaction, obtained from pow- dered galls (see Galla), by exposure for three days in a damp atmos- phere, then macerating with ether, pressing, and drying the liquid portion. It is soluble in 1 of water, in 0.6 of alcohol, at 590 F., and in about 1 of glycerin with moderate heat; very soluble in boiling water and in boiling alcohol, almost insoluble in ether, chloroform, benzol or benzin. Dose, gr. j-xx, in wafer, pill or capsule. Preparations. Unguentum Acidi Tannici, Ointment of Tannic Acid,—is a 20 per cent, ointment, made with Benzoinated Lard. Trochisci Acidi Tannici, Troches of Tannic Acid,—each troche contains nearly one grain of Tannic Acid. Glyceritum Acidi Tannici, Glycerite of Tannic Acid,—strength 1 part in 4 of Glycerin. Suppositoria Acidi Tannici, Suppositories of Tannic Acid (Unofficial),—have 1 part in 5 of Cacao Butter. Collodium Stypticum, Styptic Collodion,—has of Tannic Acid 20, Alcohol 5, Ether 25, Collodion to make 100 parts. Vegetable Astringents contain some form of tannic acid, as Quercitannic Acid from Oak-bark, Rhatania-tannic Acid in That any, etc. (P'or list, see page 84.) The offi- cial acid is Gallo-tannic Acid, being that produced from Galls. 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 and Therapeutics. Tannic Acid is a powerful astringent. It precipitates pepsin and co- agulates albumen, impairs digestion, stops peristalsis, and causes constipa- tion. A part of that taken into the stomach unites with the pepsin and albumen, while a part is converted into Gallic and Pyrogallic 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 ACIDUM TARTARICUM—ACONITUM. 95 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. 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 hemor- rhages from the lower bowel, in hematemesis, epistaxis, rectal ulcers or fissures, catarrhs and chronic affections of the mucous membranes, endo- cervicitis, conjunctivitis, dysentery 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. Tannigen, Diacetyl-tannin (Unofficial),—is an acetic acid ester of tannin, prepared by the action of glacial acetic acid on tannic acid. It occurs as an odorless and tasteless powder, insoluble in cold water and dilute acids, but soluble in cold alcohol and in dilute solutions of soda, sodium phosphate and borax. It is said to pass through the stomach unchanged and to be gradually decomposed in the intestines, thus exerting an astringent effect upon the entire intestinal canal. Its uses have been as an intestinal astringent. It appears to be absolutely innocuous. Dose, gr. iij-viij, up to g ij daily. ACIDUM TARTARICUM, Tartaric Acid, H2C4H406,—is a crystalline acid, prepared from Potassium Bitartrate (Acid Tartrate of Potassium, Cream of Tartar), by neutralizing a solution thereof with chalk and calcium chloride, then decomposing the calcium tartrate 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 0.8 of water and in 2% of alcohol at 59° F. Twenty grains exactly neutralize 27 of Potassium Bicarbonate, 22 of Sodium Bicarbonate, or of Ammonium Carbonate. Dose, gr. x-xxx. Tartaric Acid is an ingredient of the Effervescing Powders (see under Potassium). Five Tartrates and one Bitartrate (see Index) are official, and are described, with their actions and uses, under the titles of their respective bases. For Potassium Bitartrate see under Potassium. The Alkaline Cupric Tartrate Volumetric (Fehling’s) Solution is described in the Appendix. The actions and uses of Tartaric Acid are similar to those of the other Vegetable Acids, as described under Acidum Aceticum. It is chiefly employed in the preparation of effervescing refrigerant drinks and effervescing granulated salts. ACONITUM, Aconite, —is the tuber of Aconitum Napellus, a perennial plant of the nat. ord. Ranunculacese (Monkshood), found in mountainous 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, with a thick bark enclosing a seven-rayed, star-shaped pith, odorless, taste 96 ACONITUM. 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 contains gum, sugar, Aconitic Acid, and several other principles, viz.—Aconine, Napelline, Fseudaconiline, Lyctonine, etc., concerning which there is much diversity of opinion. Dose, gr. ij. Other aconite-roots are those of A. Cammarum, A. ferox, and the Chinese or Japan- ese 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 of the other two. Preparations. Extractum Aconiti, Extract of Aconite,—is at least four times as strong as the ex- tract 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 Fluidum, Fluid Extract of Aconite,—each drop represents nearly one grain of the powdered drug : an alcoholic preparation. Dose, y^-ij. Tinctura Aconiti, Tincture of Aconite,—has of Aconite 35, Alcohol and Water to 100. Is about 25 times stronger than the tincture of the leaf formerly official. Dose, hl^-iij- 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, in the French 20, the German 10, while the Linimentum Aconiti (B. P.) is really a very strong tincture, of the strength of 1 to Probably the best and safest preparation for ordi- nary use is a 10 per cent, tincture, of which the maximum single dose for an adult is stated in the P. Ger. at rtyx, and the maximum daily dose at TTLxxxv. 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. Unofficial Preparations. Aconitina, Aconitine, C33H43N012,—a white, and usually amorphous solid, of alkaline reaction, soluble in 150 of cold and 50 of hot water; much more soluble in alcohol 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 alkaloids. 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. Oleatum Aconitinae, 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. j£-§. 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 con- tains Ether, Alcohol, Turpentine, red coloring matter and water (Squibb). See Ap- pendix. 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 stimulates at first but soon relaxes the inhibitory apparatus of the heart, and paralyzes finally the vagus ends, ACONITUM. 97 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. The primary stimulation which the drug produces upon the vagus centre in the medulla slows the heart-rate at first; but its depressant action upon the motor cardiac centres and the vagus end-organs in the heart, is soon manifested ; and finally the vagus centre shares in the increasing paralysis, which affects the vaso-motor centre as well as the cardiac nervous appa- ratus. The heart-rate becomes very rapid near the end, from paralysis of the vagus ends in its structure. 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 (20 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. In two recorded cases, oedema of the entire body resulted from Aconite- poisoning by eating the leaves of the growing plant. 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. Caffeine, Atropine, Morphine, Ether, Ammonia and Amyl Nitrite antagonize its effects on the heart and respiration. Digitalis counteracts its heart action and the relaxation of cardiac inhibition. In Aconite poisoning, the stomach should be evacuated, warmth ap- plied to the extremities, stimulants administered, artificial respiration if necessary, and the recumbent posture strictly maintained. Caffeine may be administered hypodermically and per orem. Antagonists. 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 “ ther- apeutic lancet,” and is certainly responsible to a great extent for the dis- use of venesection. Its power over the circulation, respiration and trans- piration renders it of the greatest value in all affections characterized by 98 ADEPS. high, resisting pulse, dry hot skin, and elevated body-temperature. It is especially useful in acute throat affections, the early stage of acute inflam- mations of the respiratory organs, catarrhal croup, acute pleuritis and peritonitis before the stage of effusion, simple and eruptive fevers, puer- peral and surgical fevers, facial erysipelas, acute rheumatism, cardiac affec- tions with overaction or hypertrophy and without valvular lesion, diar- rhoea 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, 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 gives 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 ; com- posed 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. Fats are formed of the immediate principles, Stearin, Margarin and Olein, which are regarded as salts composed of stearic, margaric and oleic acids with a common base, glycerin ; also odorous and coloring principles. Preparations. Adeps Benzoinatus, Benzoinated Lard,—has 2 per cent, of Benzoin in powder, in- corporated by stirring. Oleum Adipis, Lard Oil,—is a fixed oil expressed from lard at a low temperature. The actions of the Oils and Fats are described under Morrhua; Oleum. Lard is only used as an ingredient of ointments and cerates. Lard Oil is used in mak- ing 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. Adeps Lanae Hydrosus, Hydrous Wool-fat (Lanolin),—is the purified fat of the wool of sheep, mixed with not more than 30 per cent, of water. A yellowish-white, ointment-like mass, having a faint, peculiar odor; insoluble in water but miscible with twice its weight thereof. Under the name Lanolin this substance was in use for several years before it became official. It is a cholesterin fat, and a very old medicament, having been mentioned by Ovid, Herodotus, Pliny and Aristophanes; yet the process for obtaining it from the suds from the washings of sheep’s wool is patented in this country by Liebrich. It differs from all other fatty substances chiefly in resisting saponification and the action of water, having no tendency to become rancid ; and readily passes through the integument, carrying with it any medicament with which it is charged. It is a perfectly neutral base, and therefore is not liable to decompose any ordinary substance. The difficulty about its use has been its very disagreeably sheepy smell, but recent samples seem in great measure to be devoid of this objectionable quality. It is particularly useful in chronic skin diseases where there is infiltration, and where a penetrative action is desired for medicaments locally AETHER. 99 applied. 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 alone desired it is inferior to Lard, Vaseline or Cold Cream. Acidum Stearicum, Stearic Acid,—is an organic acid, usually obtained from the more solid fats, chiefly tallow. In its impure, commercial form, it occurs as a hard, white, glossy solid, odorless and tasteless, permanent in the air; insoluble in water, soluble in 45 of alcohol, also in ether. It is used as a substitute for wax, and is an ingredient of the Suppositoria Glycerini. ./ETHER, Ether, Ethyl Oxide (C2H3)20,—in its absolute form is not official, the strongest preparation containing 4 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 offi- cially 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 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. (C2H60)2 — H20 — (C2H5)20. The official ethers are the two following, viz.— ./Ether, Ether,—is a volatile and inflammable liquid, composed of about 96 per cent, of absolute Ether, Ethyl Oxide, and about 4 per cent, of Alcohol containing a little water. Sp. gr. 0.725 to 0.728 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 yEther for internal administration is in syrup; hypodermically, for heart failure, It is best prescribed as Spirit of Ether, which mixes readily with water. Water dissolves a tenth of its volume of Ether, and reciprocally Ether takes up about the same proportion of water. It is colorless, of a strong and characteristic odor, hot and pungent in taste. It evaporates speedily in the open air, with the production of con- siderable cold. When good, it evaporates from the hand, without leaving a disagreeable odor. It boils at about the temperature of the body (98.6° Fah.), and its vapor is very heavy and very inflammable. It dissolves Hydrargyrum Bichloride, Hydrargyrum Iodidum Rubrum, Iodine and Bromine freely ; Sulphur and Phosphorus sparingly. It is also a solvent of the fixed and volatile oils, many resins and balsams, caoutchouc, and most of the organic vegetable alkaloids. It does not dissolve Potash or Soda, in which respect it differs from Alcohol. -/Ether Aceticus, Acetic Ether, Ethyl Acetate, C2H5C2H30,—is an inflammable liquid, transparent and colorless, of ethereal and acetous odor, soluble in alcohol, ether, chloroform, and in 8 of water. It is a constituent of Sp. Odoratus and Tr. Ferri Acetatis. Dose, tAx-3j- Hydrobromic Ether, Ethyl Bromide, C2H5Br (Unofficial),—is not inflammable. Dose, internally and hypodermically, n^x-gj. Hydriodic Ether, Ethyl Iodide, C2H5I (Unofficial),—is a colorless liquid, non-inflammable, and insoluble in water. Dose, inhaled, t^xv. 100 aether For the Chlorinated Ethers see under Chloroform. Preparations. Oleum iEthereum, Ethereal Oil,—is a volatile liquid, consisting of equal volumes of heavy Oil of Wine and Ether. Used to prepare the Spt. Altheris Comp. As it occurs in commerce is usually a worthless preparation. Spiritus ./Etheris, Spirit of Ether,—has of Ether 325 parts, Alcohol 675. Dose, Spiritus j®theris Compositus, Hoffmann's Anodyne,—contains Ether 325, Alcohol 650, Ethereal Oil 25 parts. Dose, tr^v-gj. Spiritus iBtheris Nitrosi, Spirit of Nitrous Ether, Sweet Spirit of Nitre,—is an alcoholic solution of Ethyl Nitrite, B2H5N02, 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. Glycyr- rhizse Co. (3 per cent.). Dose, Its incompatibles are Potassium Iodide, Ferric Sulphate, Tr. Guaiaci, Tannic and Gallic Acids, and Antipyrin. Anesthetic 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) approved a mixture originally introduced by Dr. Geo. Harley, and known as the “ A. C. E. Mixture.” It consists of Alcohol 1, Chloroform 2 and Ether 3 parts. 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. 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. Physiological Action of Ether. .ETHER 101 Dr. Brunton found that in a hot climate Ether will decompose within a few hours, and hence, during his investigations for the Hyderabad Chloroform Committee, he found it impossible to obtain pure ether. This may account for the preference for Chloroform as an anaesthetic which is so universal in the Southern States. 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 profound narcosis, and causes a greater degree of vomiting. It is much less dangerous than Chloroform, death from the inhalation of Ether oc- curring slowly and usually by paralysis of respiration—from Chloroform, it is almost always sudden, and is generally believed to occur by paralysis of the heart. Ether has undoubtedly been the direct cause of a number of deaths, besides several which occurred some hours after termination of its anaesthesia. (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 of the basal or medullary ganglia. If at this stage the 5th nerve be irritated, by the intimate relation of its nucleus with that of the pneumogastric reflex inhibition may be transmitted 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 dis- tribution 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 arresting 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. Modes of Dying from Anesthetics. Contraindications for Anaesthesia are—fatty degeneration or dila- tation of the heart, renal and pulmonary disease, enlarged tonsils, cere- bral 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 respiration and faradization of the respiratory muscles if breathing ceases. Strychnine, hypodermically, as a cardiac and respiratory stimulant, has many advocates, and has done good service, especially in chloroform narcosis. Amyl Nitrite by inhalation, or Ammonia, hypodermically. Heat to the body and limbs. 102 auther Comparative Safety of Anesthetics. A comparison of these agents in respect to their safety has been made by Dr. Richard- son, 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, Spirit of Turpentine. Dangerous are—Amyl Hydride, Butyl Hydride, Carbon Monoxide, Ethyl Hydride. Chloroform and Ethene Dichloride are considered useful, but requiring care. Pental, Tri-methyl-ethylene, C5H]0 (Unofficial),—is a colorless liquid, highly inflam- mable, insoluble in water, but miscible in all proportions with alcohol, ether and chloro- form. Sp. gr. 0.678. It is obtained by heating amylene hydrate in the presence of acids. Pental is an efficient anaesthetic, equal to Nitrous Oxide in its rapidity of action and safety, but superior thereto in its more prolonged action and its having no unpleasant after-effects. Under it there is seldom any stage of exhilaration, and consciousness is sufficiently retained to enable response to commands, even when insensibility to pain is reached. It does not lose its effect by repeated inhalations. Compared with Chloroform, it acts more promptly, and has no evil after-effects; with Ethyl Bromide, it is somewhat slower in action but more lasting in effect, and can be prolonged as may be necessary; with Nitrous Oxide, it can be continued for a longer time, is more safe, and free from after-effects of unpleasant character. Hydriodic Ether is an antispasmodic and a general stimulant; also an anaesthetic if inhaled for a sufficiently long time. Its use as a medici- nal 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. 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. Physiological Action of Other Ethers. 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 iETHER. 103 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 Ancestheiic 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 the article on Chloroform.] Besides its surgical uses ether-anaesthesia is employed in neuralgia, cancer, tetanus, chorea, colic, delirium, puerperal mania and convulsions, infantile convulsions, hystero-epilepsy, epileptic 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. and Atropine (gr. 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 gj to §ij, rapidly given, and being uninflammable. Its in- halation 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. The Compound Spirit of Ether (Hoffmann’s Anodyne) is an admir- able agent in gastralgia, colic, flatulence, syncope, etc., also in the vari- ious manifestations of the hysterical paroxysm. In combination with the camphorated tincture of Opium it is often remarkably efficient in check- ing 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. When its diuretic effect is desired it should be administered in iced water, and the patient should be lightly covered: but when its di- aphoretic action is required, it should be preceded by a hot drink, and the patient should be well covered. Hydriodic Ether may be obtained in glass capsules containing five 104 AGARICUS ALBUS—AGARICUS MUSCARIUS. 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 anaesthetic. AGARICUS ALBUS, White or Purging Agaric (Unofficial),—is the fungus Polyporus officinalis, which grows on the European larch. It occurs in large, white, spongy pieces ; and contains Agaricic or Laricic Acid, also from 40 to 70 per cent, of resins. The term Agaricin was formerly applied to the impure Agaricic Acid containing about 3 per cent, of Agaricol, which is physiologically inert. The taste of Purging Agaric is first sweetish, then becoming very acrid and bitter. The powder inhaled causes violent sneezing, and taken internally 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 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. Agaricic Acid has proved very valuable in checking persistent sweating from any cause, especially that occurring after influenza. The dose is gr. to : and it should not be given hypoder- mically. AGARICUS CHIRURGORUM, Surgeon’s Agaric (Unofficial),—is the interior portion of the fungus Polyporus fomentarius, which grows on the trunks of beeches, birches, and oaks in Europe. It is prepared 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 the Nitrate or Chlorate of Potassium and dried, it is very inflammable, and is called Spunk. AGARICUS MUSCARIUS, Amanita Muscaria, Fly-Agaric (Unofficial),—is a poisonous mushroom, of disagreeable odor and burn- ing, acrid taste, used in infusion with milk for poisoning flies, and by the Tartars as an intoxicant. It contains an actively toxic alkaloid, Musca- rine, 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 maybe used hypoder- mically in watery solution. Muscarinae Nitras, Nitrate of Muscarine (Unofficial),—may be used hypodermi- cally, in doses of from gr. 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 AILANTHUS. 105 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 intestinal 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. [Gelsemium does so also.] Under its action the body temperature is decidedly 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. Antagonists. 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. Digitalin is to some extent antagonistic; so also is Physostigmine. 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 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. -fa, thrice daily. AILANTHUS, Tree of Heaven (Unofficial),—is the bark of Ailanthus glandu- losa, a well-known shade tree, of the nat. ord. Simarubacese, indigenous to China, but cultivated elsewhere. It contains an oleo-resin and a volatile oil, on which its properties probably depend. Dose, gr. x-^j. Extractum Ailanthus Fluidum, Fluid Extract of Ailanthus,—Dose, bbx-jjj. Tinctura Ailanthus, Tincture of Ailanthus,—Dose, tr^x-3 ij. Ailanthus is a decided nauseant, and a drastic purgative, causing also vertigo, weak- ness, cold sweats, dull headache, pains in the back, numbness 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 tseniafuge. Ailanthus is used against tapeworm, a decoction of the fresh bark (3 j to f, 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. 106 ALCOHOL. ALCOHOL, Alcohol (Ethyl Alcohol, Ethyl Hydrate), C2H5OH. The official alcohol is Ethyl Alcohol, which is represented in the pharma- copoeia by the several preparations named Brandy, Whiskey, and Wine, as also under the following four forms, viz.— Alcohol Absolutum, Absolute Alcohol, C2H5OH,—is Ethyl Alcohol, containing not more than i per cent, by weight of Water. A transparent, inflammable, colorless, mobile and volatile liquid, very hygroscopic, of characteristic, agreeable odor, and burning taste. Sp. gr. not higher than 0.797 at 590 F. Used in the manufacture of Chloroform. Alcohol,—a liquid composed of about 91 per cent, by weight, or 94 per cent, by volume, of Ethyl Alcohol, C2H5OH, and about 9 per cent, by weight, of Water. A transparent, inflammable, colorless, mobile and volatile liquid, of agreeable odor and burning taste. Sp. gr. 0.820 at 590 F., or 0.812 at 770 F. Miscible with water in all proportions and with- out any trace of cloudiness ; also miscible with ether or chloroform. Obtained by the distillation of fermented saccharine fluids. Used in pre- paring all the tinctures and spirits, also in some of the liniments, liquors and mixtures. Alcohol Deodoratum, Deodorized Alcohol,—a liquid composed of about per cent., by weight, or 95.1 per cent, by volume, of Ethyl Alcohol, and about 7y2 per cent., by weight, of Water. Sp. gr. about 0.816 at 590 F. Alcohol Dilutum, Diluted Alcohol,—a liquid composed of about 41 per cent., by weight, or about 48.6 per cent., by volume, of absolute Ethyl Alcohol, and about 59 per cent, of Water. It is prepared by mix- ing together equal volumes of Alcohol and Distilled Water, or 410 parts by weight of the former and 500 of the latter. Sp. gr. about 0.936 at 59° F. An Alcohol is a volatile organic compound, which contains no N, has a great affinity for water, and reacts with acids, forming therewith H20 and ethers. Alcohols are there- fore analogous to the metallic hydrates, as are Ethers to salts. Methyl Alcohol is obtained by the destructive distillation of wood, Phenyl Alcohol (Phenol) by that of coal-tar, and the fermented Alcohols (Ethyl, Amyl, etc.) from any vegetable substance containing sugar (or starch and the ferment Diastase, which converts the starch into sugar), by fermentation through the agency of the yeast-plant, which splits the sugar into Alcohol and C02. The product contains much water, and is then distilled in order to separate the alcohol, which passes over first, with a certain amount of water, the greater part of the latter being left behind. In this country Alcohol is so produced from grain (chiefly barley), and is termed “ High Wine,” being disposed of by the distillers to cer- tain wholesale liquor dealers, many of whom proceed to “rectify” it by mixing and blending it with water, essential oils of corn, rye, etc., ethers, burnt sugar, and occasion- ally small quantities of genuine whiskey, brandy, etc. The product is then labeled “ Old Tom Gin,” “Old Crow Whiskey,” etc., according to the requirements of the retail dealers. True Whiskey is distilled from the mash of fermented grain (corn, wheat, and rye, or a mixture of all three), and should be not less than two years old, to be official; Brandy from the fermented juice of fresh grapes, and should be not less than four years old. Wines are the product of the fermented juice of grapes, without distillation. Alcohol may be produced synthetically by shaking Olefiant Gas (C2II4) with strong Sulphuric Acid, then diluting and distilling. Absolute Ethyl Alcohol, which is only used for chemical testing and for the manufacture of Chloroform, is obtained by shaking ALCOHOL. 107 Rectified Spirit (Alcohol) with Potassium Carbonate, decanting 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. An Aldehyde is obtained from an alcohol by removing therefrom two atoms of hydro- gen, hence its name—At (cohol) dehyd (rogenatum). Aldehydes lie in chemical con- stitution between the alcohols and the acids, and have the power of reducing silver salts in darkness, which is shared also by living protoplasm. The principal aldehydes are— Acetic Aldehyde, Aldehyde, Ethyl Aldehyde, Ethylidene Oxide, C2H40,—a colorless, mobile liquid, antiseptic, locally irritant, anaesthetic when inhaled, and a powerful de- pressant of the respiration, too dangerous for use. Formic Aldehyde, Formaldehyde, CH20,—is a gaseous body prepared by subjecting methyl alcohol to oxidation. It is readily absorbed by water, and is put on the market in the form of a 40 per cent, aqueous solution named Formalin, which is a powerful anti- septic, disinfectant and deodorant. It is described under its own title. Paraldehyde, C6H1203,—is a polymeric form of Aldehyde and a valuable hypnotic. It is described under its own title. A Ketone bears the same relation to an aldehyde that an Ether does to an alcohol, being an aldehyde in which the hydrogen has been replaced by a radical. The most im- portant Ketone is— Hypnone, Phenyl-methyl-acetone, C6H5 (CO) (CH3),—a hypnotic agent of moderate energy, described under the title Chloral. Methyl Alcohol, Methyl Hydrate, Wood-spirit, CH3OH,—also called Carbinol, Methol, Hydroxymethane. A non-fermented alcohol, obtained from the destructive distillation of wood. Ordinarily it contains many impurities, which give it a very disagreeable odor, and mixed with ethyl alcohol it renders the latter so disagreeable as to be unfit for drinking. Such a mixture is sold, under the name Methylated Spirit, for use as a solvent in the arts, as a combustible in lamps, etc. Amyl Alcohol, Amyl Hydrate, Potato-spirit, Fusel Oil, C5HuOH.— A fermented alcohol obtained from the potato, also occurring in the crude spirit produced by the fermentation of saccharine solutions with yeast, and separated by the excessive distillation thereof, passing over after the ethyl alcohol. It is oxidized into Valerianic Acid. From it is prepared Amyl Nitrite, by distilling with nitric and sulphuric acids and copper wire. It is an oily liquid, of penetrating and oppressive odor and burn- ing taste: sparingly soluble in water, but soluble in all proportions in alcohol, ether and essential oils. Principal Unofficial Alcohols. Preparations. Spiritus Frumenti, Whiskey,—obtained from the distillation of the mash of fer- mented grain; rye, wheat 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 of acetic and butyric acids on the alcohol, and traces of Amyl Alcohol (fusel-oil) even in the best. Dose, Spiritus Vini Gallici, Brandy,—obtained from the distillation of the fermented juice of grapes, and at least four years old. Sp. gr. 0.925 to o. 941. Has an alcoholic strength of 39 to 47 per cent, by weight, and CEnanthic and other Ethers developed by age. Pale Brandy is colored by the cask, the dark has caramel to color it. Is often prepared artifi- 108 ALCOHOL. cially by adding to high wines Acetic or Nitric Ether, Caramel, and Logwood or Catechu for astringency. Dose, Vinum Album, White Wine,—should contain from 10 to 14 per cent, by weight of absolute alcohol, and is made by fermenting the unmodified juice of the grape, freed from seeds, stems and skins. California Riesling, Ohio Catawba, etc. Dose, £j- Vinum Rubrum, Red Wine,—should contain from 10 to 14 per cent, by weight of absolute alcohol, and is made by fermenting the juice of colored grapes in presence of their skins. Native Claret, Burgundy, etc. Dose, Rectified Spirit, sp. gr. 0.835,—bas 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. Spiritus Odoratus, 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 Rosemary 8, Oil of Lavender Flowers 4, and Oil of Orange Flowers 4 parts. A perfume and ingredient of lotions. Vinum Aromaticum, Aromatic Wine,—consists of Stronger White Wine 94 per cent., with Lavender, Origanum, Peppermint, Rosemary, Sage and Wormwood, of each I per cent. It was official in the U. S. P. 1880. Vinum Portense, Port Wine,—is not a natural wine, spirit being added during the process 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, tannic 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. Kumyss,—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 I to 3 per cent, of alcohol, sugar, lactic acid, casein, fat, salts, carbonic acid and ethers. It is described under its own title. Unofficial Alcoholic Preparations. Physiological Action of Alcohols. The Alcohols of the series to which the above-mentioned belong are all narcotic poisons when taken in sufficiently large doses; and have the ALCOHOL. 109 general effect of paralyzing the nerve-centres in the inverse order of their development. Their symptoms may be divided into stages, viz.—(i) Stimulant, (2) Narcotic and Anodyne, (3) Anaesthetic, (4) Paralytic; therein closely following the action of the volatile anaesthetics derived from them, though wanting in the profound degree of anaesthesia which the latter produce. Ethyl Alcohol, the effects of which are detailed below, has the most typical action, and in poisoning by it all the stages follow each other in regular order. In poisoning by Methyl Alcohol the excitement is greater, the subsequent stages succeed each other more rapidly, and if the dose be insufficient to cause death, the effects pass off more quickly. They all lower the body-temperature. The post-mortem appearances, after acute poisoning by the alcohols, show changes in the blood, stomach, intestines, liver, lungs and kidneys; some of which are probably due to the asphyxiation resulting from the paralysis of respiration. The Blood is dark and clotted in the heart. The Stomach and Intestines are congested and softened, especially so if the ingested alcohol has been undiluted. The Liver is very much congested, soft and friable. The Spleen is gorged with blood and softened. The Lungs are congested and show small extravasations of blood, and in the Kidneys hemorrhages are also found. Physiological Action of Ethyl Alcohol. Externally applied, Alcohol is a powerful antiseptic and disinfectant, also refrigerant, astringent, anhidrotic, rubefacient, and slightly anaes- thetic. Applied to the exposed skin it quickly evaporates, cooling the surface, temporarily contracting the superficial vessels, and checking the secretion of the sweat-glands. If its evaporation is prevented, as by covering with a watch-glass or a piece of rubber, or if the alcohol is rubbed in, it absorbs water from the tissue and hardens it. It also coagulates the albumen of the part, but the coagulum is soon redissolved by the fluids of the tissues. It then dilates the vessels of the derma, pro- ducing a sensation of warmth and a rubefacient effect upon the skin. Upon the mucous membrane of the mouth and pharynx similar effects are produced by the same application. If the alcohol is concentrated, a burning sensation is felt immediately; also an increased flow of saliva and quickened pulse, due to reflex action. Then follows a slight local anaesthesia of the part, and if the alcohol be held there for some time, the mucous membrane becomes whitish and opaque, from coagulation of the albumen, abstraction of water from the tissue and congestion of its vessels. This soon disappears, as resolution of the albumen occurs. Internally, in moderate quantity and single dose, Alcohol acts briefly as a cerebral, cardiac and general stimulant; in large doses as an anaes- thetic, an intoxicant and deliriant, and finally as a narcotic poison and paralyzant of the nerve-centres. It is somewhat antipyretic, also diuretic and antispasmodic, and is hypnotic in many cases. A single dose of a strong alcoholic preparation, for example an ounce of neat brandy, introduced into the stomach, immediately produces ini- 110 ALCOHOL. portant and valuable reflex effects. The cardiac rate is quickened, and its force is increased ; the vessels of the entire body are dilated, especially those of the skin ; the blood-pressure is raised, and a sense of glowing heat is produced. These reflex effects are well seen in the prompt resto- ration of a fainting person by the administration of a single dram of whiskey or brandy. By the same means the nausea, paleness and other unpleasant symptoms produced by tobacco are promptly counteracted. Internally, in small quantity diluted, Alcohol dilates the gastric vessels, reddening the mucous membrane of the stomach, produces a sense of warmth and comfort, stimulates the gastric glands to increased produc- tion of gastric juice, and increases the activity of the gastric movements. Taken moderately, immediately before or during meals, it thus promotes the appetite and assists digestion ; lessens the elimination of waste-pro- ducts (urea and C02), causes a subjective sensation of heat, and slightly raises the body temperature. It briefly stimulates the heart, prolonging its systole and reducing the length of the diastole, and increases the functional activity of all the organs. The effects of large doses are very injurious; the vaso-motor nerves are partially paralyzed for a time, caus- ing dilatation of the arterioles throughout the body ; the pepsin of the gastric juice is precipitated, the gastric and hepatic vessels are congested, the walls of the stomach are inflamed, and the gastric glands and hepatic cells are over-stimulated to the production of pathological secretions. If the ingestion is continued, even in moderate quantities frequently re- peated, chronic gastritis ensues, gastric mucus is poured out in large amount, the gastric glands soon atrophy, and the permanent dyspepsia of drunkards is set up, with morning vomiting of glairy mucus. The fur- ther effects of large doses are the total arrest of digestion, the production of intoxication, perhaps hallucinations and delirium, also great incoor- dination of thought and motion, depressed sensibility, depression of the heart and respiration, lowered arterial tension and body-temperature, abolished reflexes, stupor, and, if the dose be sufficient, coma and death. Upon the Blood Alcohol acts to first increase and then diminish the amoeboid movements of the white corpuscles, and so affects the red cor- puscles as to prevent the oxyhsemoglobin from readily parting with its oxygen. It consequently diminishes the oxidation of the tissues, and may lead to imperfect combustion of fat, which then accumulates. The result is obesity in many persons who habitually consume large quantities of alcoholic beverages, especially if these contain much saccharine material. Upon the Heart and Circulation the first effects of Alcohol are those of slight and brief stimulation by reflex action. After its absorption the same effects are exhibited in a more marked degree. The pulse becomes fuller, the action of the heart is quickened and its force increased, due mainly to direct stimulation of its accelerator nerves. The vaso-motor ALCOHOL. 111 system is inhibited, causing dilatation of all the vessels of the body, espe- cially those of the periphery, and producing a sense of increased body-heat. The blood-pressure is raised, the great increase of cardiac action over- coming the results of the vascular dilatation. The mental and bodily functions are all stimulated for a time, the person feels better for the dram, his muscular power seems to be increased, more urine is passed, and per- spiration is freer. But these effects are very transitory, and after a brief period of stimulation reaction sets in, and the entire organism is depressed to a lower point than where it was before the ingestion of the alcoholic stimulant. Large doses do not stimulate the heart at all, but immediately depress it, both by reflex action and by direct paralysis after their absorp- tion. A toxic dose may paralyze the heart almost immediately by direct depressant action, but usually, after a very brief period of excitement, it produces insensibility, stertorous breathing, dilated or contracted pupils, complete muscular resolution, and death by paralysis of the heart and res- piration. The action of alcohol upon the heart clearly exemplifies two therapeutic laws : (i) That excessive stimulation is necessarily followed by depression, and (2) that drugs which in moderate doses excite a func- tion are very apt in large doses to paralyze it. The extremists, who find no good whatever in alcohol, hold that it is a fallacy to apply the term “ stimulant” thereto,—that alcohol is a paralyzant from first to last,— that its apparent cardiac stimulation is in reality the result of its narcotism of cardiac in- hibition,—and that every special sense is blunted by even small doses of this poison. They calmly ignore the fact that their premises apply to every stimulant in its special field of action as well as to alcohol in its sphere, and forget that their conclusion (that alcohol has no place in medicine except as a poison) applies by the same reasoning to every other stimulant. Hence, to be consistent, they should advocate the banishment of all stimulant drugs from the materia medica. On the Skin and Kidneys Alcohol is mildly diaphoretic and diuretic, acting partly by its vascular dilatation, partly by stimulation of glandu- lar activity. On the Intestines it has a slightly astringent effect at first, but in those who use it habitually to excess the bowels are always very loose, and the evacuations watery. Upon the Nervous System Alcohol has specific and selective*action. By a moderate dose this entire system is briefly stimulated, chiefly as a result of increased blood supply due to the vascular dilatation and cardiac ele- vation. Reaction, however, soon occurs, and if the dose be very large, the period of exaltation quickly passes into one of profound cerebral de- pression, but this is usually preceded by marked incoordination of thought and of muscular movement, shown by incoherency of language, difficult speech, and staggering gait. The reflex activity of the spinal centres is abolished next, the urine and faeces are discharged involuntarily ; the de- pression extends to the respiratory centre, breathing becomes difficult and the face cyanosed; profound coma supervenes, respiration and the heart are paralyzed, and the patient dies. 112 ALCOHOL. The reflex depression occurs early in the case, and accounts for the impunity with which a drunken man will often bear an injury which would cause death by shock to a sober one. The action of Alcohol upon the nervous system illustrates well, in the order of its events, the physiological fact that excessive stimulation is followed by depression ; as well as the law that drugs which affect the functions progressively exhibit their earliest powers upon those functions which are highest in development (being those latest acquired by the individual and last to appear in the species), and influence next the next lower, until finally the lowest, namely those of respiration and circulation. The primary stimula- tion and subsequent depression of function proceeds therefore, in a descending scale from the highest or least firmly fixed and latest acquired function, to the lowest or most firmly fixed one. Thus, by Alcohol, the intellect is affected very early and the judgment abol- ished very soon, even though the imagination, the emotions and the powers of speech remain stimulated. Soon these follow the same course, imagination is abolished, the patient loses command over his emotions, cries and laughs immoderately and without reason; next loses control over his organs of speech, talking incoherently and thickly, and then can only make a noise. At the same time other delicate and lately developed movements, as those required for writing, feeding, etc., are incoordinately performed and soon paralyzed. General muscular movements, being less highly and earlier developed, are next to become implicated, being first incoordinated, and soon abolished. The paraly- sis of reflex action follows, though lowered earlier in the case, then that of respiration and finally that of the heart. The antipyretic action of Alcohol is partly due to its power of lessening oxidation, but chiefly to the dilatation which even moderate doses pro- duce in the vessels of the surface. This dilatation subjects the warm blood from the interior of the body to the cooling influence of the atmosphere, as also to that due to evaporation from the skin ; and if kept up by repeated drams in a freezing temperature will soon so chill down the blood as to kill the subject. Under ordinary conditions the contraction of the cutaneous vessels, in a person ex- posed to cold, prevents the warm blood from approaching the surface in any great quan- tity and becoming cooled ; but this mechanism is temporarily paralyzed by every dose of alcohol, admitting the hot blood to circulate freely over the surface, and to be rapidly cooled down until the patient may be absolutely frozen to death as a result of repeatedly taking “ something to keep him warm.” This fact is well known to Arctic travelers and to the lumbermen of the northern forests, who have been taught by bitter experience to let alcohol severely alone when exposed to severe cold. Deliriiun Tremens occurs after an alcoholic debauch, usually in cases where the-stomach is so deranged as to prevent the ingestion or assimila- tion of food. So long as the toper can eat and digest his food he is practically not liable to this affection. It generally begins in from two to four days after the patient has lost his appetite and commenced to reject or vomit his food ; and is marked by great restlessness, obstinate insomnia, a peculiar tremor of the tongue and limbs; also by delusions connected with the sense of sight, the patient imagining that he sees anbnals (dogs, rats, snakes, beetles, etc.) around him. The delirium is constant and active, may become violent and pass into mania, or the patient may die suddenly while in this state, without any warning symp- toms. In several cases observed by the writer the delirium appeared four and five days after the last alcoholic dose was taken, though the patient ALCOHOL. 113 was eating, sleeping, and working during the interval, apparently conva- lescent. Under treatment, and especially if sleep is brought on, the de- lirium usually subsides gradually, and the patient recovers. Chronic Alcoholism is the result of the ingestion for a considerable length of time of an excessive quantity of alcohol, even though perhaps never sufficient to cause acute intoxication. One of the earliest symptoms usually observed is the vomiting of watery fluid or glairy mucus in the morning after rising. The bowels are generally loose, and the evacuations watery. The skin has a greasy look and a satiny feel, and the capillaries thereof on the face may become permanently dilated, giving to the cheeks a characteristic, dusky-red hue, and a flaming red color to the nose. In old drunkards, the latter organ often becomes covered on its tip with dusky-red tubercular enlargements, making it a very unsightly appendage. The stomach and liver are in a condition of chronic congestion, the food is not digested, and often to a great extent abandoned, the patient, in fact, living upon alcohol. Eructations of gas and flatulence are constant and distressing ; the body is usually puffed and bloated, the eyes bleary, red and watery. [One of the most graphic descriptions of the drunkard’s personal appearance is that by Trollope, in “ OrleyFarm,” Chapter 57.] After a time the connective tissue of the liver increases (hyperplasia), its parenchymatous structure atrophies or undergoes fatty degeneration, the organ contracts (cirrhosis), the portal circulation is impaired, the veins of the abdominal integument become prominent, and soon ascites ushers in the final stage. Cirrhosis of the kidneys may accompany that of the liver. The general impairment of function extends early to the nervous system, the mental powers are dulled, the temper becomes irrita- ble, and tremor appears in the tongue, lips and hands. As a result of the prolonged use of alcohol very serious pathological changes take place throughout the organism. It exerts its essential and most injurious influ- ence on the vital organs by its presence in the circulation, being thus brought into direct contact with the cellular tissues of the vital organs. It sets up hyperplasia of the connective tissue, resulting in sclerosis, es- pecially in the stomach, brain, liver and kidneys ; produces fatty degen- eration (steatosis) of the blood, the arterial walls and the parenchyma of the various organs, depresses the brain, the heart and the arterial tension. Chronic disease of the heart, the arteries, and the mucous lining of the stomach and intestines, gout, diabetes, Bright’s disease of the kidneys, paralysis, ataxia, peripheral neuritis, epilepsy, amaurosis, and insanity may result from the continued use and abuse of alcohol. The malt liquors (beer, ale, etc.) are less prone than the spirits to affect the brain, but are even more apt to set up fatty degeneration of the heart and liver. The heart is very liable to undergo gradual hypertrophy, partly by reason of the constant whipping up it receives from every dram of alcohol taken, 114 ALCOHOL. and partly as a result of renal cirrhosis. Several of the largest hearts ever seen by the writer at autopsies, some of which were veritable instances of cor bovinum, occurred in subjects of chronic alcoholism associated with employment involving exposure and great anxiety, as in masters of steam- ships, superintendents of mines, etc. Impurities in Alcohol increase greatly its toxic action ; so that inferior brandy from a public liquor shop has a lethal action nearly one-half greater than that of pure ethyl alcohol. (Dujardin-Beaumetz.) Alcoholic Coma may be easily confounded with that of apoplexy, opium narcosis, con- cussion of the brain, acute pneumonia, uraemia and epilepsy, the differential diagnosis being amost impossible to make with accuracy when the coma is deep. The pupils afford no trustworthy indication, as they may be either dilated or contracted in alcoholism. They are often unequally contracted in apoplexy, and in apoplexy of the pons varolii they may be equally and minutely contracted, as in opium-poisoning. The difficulty of diagnosis is increased by the common practice of giving a dram of whiskey or brandy as a reviver, so that a stranger found insensible on the street and brought to a hospital, may smell of alcohol without having been a subject of alcoholism. When no accurate history of the case can be obtained the diagnosis is so difficult as to be all but impossible in many cases. Alcohol is rapidly diffused throughout the organism, which oxidizes a portion of it, about an ounce and a half for the adult in 24 hours, the oxidation yielding force, which is utilized as nervous, muscular, and glandular power. A larger quantity is decidedly poisonous, as it sets up structural changes in the various organs, and lowers the power of resist- ance to morbific influences. It renders its victims particularly liable to phthisis, and has frequently caused directly an intractable form of that disease, pulmonary sclerosis. It makes patients bad subjects for with- standing any severe illness, especially pneumonia, or to successfully undergo severe surgical operations. The portion not oxidized is excreted unchanged by the lungs, the skin and the kidneys, but does not appear in any quantity in the urine unless very large amounts have been ingested. The very young and the very old bear more alcohol relatively than the adult. It has been proven to exist normally in the human organism, and within the limit above stated it is undoubtedly a food, as is shown by the fact of its retention and combustion in the body, supplying the place of other foods, so that the quantity of food which without it would be insufficient, with its aid be- comes sufficient to maintain the body-weight. If a very large dose has been taken recently, the stomach should be evacuated of what is unabsorbed. Then Ammonia may be given 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. Luptilin as a substitute stimulant, or Capsicum in 20 to 30 grain doses. Chloral, in 30 grain dose, repeated in two hours, to secure sleep, is very efficient, or 30 grs. each of Chloral and Potassium Bromide, for the same purpose. Chloral is said by teachers to be dangerous in old alco- holic cases, but the daily experience of physicians of inebriate asylums does not corrobo- Treat?nent of Acute Alcoholic Poisoning. ALCOHOL. 115 rate this statement. Nutritious, digestible diet in liquid form and small quantity fre- quently repeated, is an essential feature of the treatment. Ammonium Chloride, gss in y2 pint of water at one draught, and the Liquor Ammonii Acetatis, in doses of jjj, are said to have marvellous power in generally straightening up a drunken subject, restoring the faculties, and antagonizing stupor. Treatment of Delirium Tremens. Two principal objects are aimed at,—(i) to support the strength by nutritive diet, (2) to overcome the obstinate and exhausting insomnia and restlessness. For the latter pur- pose the mixture of Chloral and Potassium Brotnide above mentioned is by far the most efficient agent, and the dose (gr. xxx of each) may be repeated every two hours until sleep is secured. Digitalis has been administered in large doses to quiet the delirium, and successfully in some cases, but this is a very dangerous treatment. (Brunton.) Opium or Morphine may be used in cases which show signs of exhaustion, but should be confined to such alone. Its general employment in this affection is decidedly injurious. Bismuth, with Magnesia and Hydrocyanic Acid, for the vomiting. Nutrient Enemata may be required, if the patient is unable to retain food. Alcohol should not be given. Treatment of Chronic Alcoholism. The continued ingestion of alcohol in excessive quantities is not a disease, as sentimen- talists would have us believe, but is simply a vicious drug-habit, and may be overcome, like any other drug-habit, by the exercise of the subject’s will-power alone in abstaining therefrom. The effort to gradually reduce the amount consumed simply prolongs the agony and is much less efficient than the total and immediate withdrawal thereof en- tirely. This should be carried out in an inebriate asylum in most cases. Strychnine is a specific remedy for alcoholism, and the basis of all the so-called “ cures ” which are extensively advertised under the gold-extracting title of “ Gold Cure.” Ten to twelve minims of a solution of Strychnine Nitrate, gr.iij in g x of distilled water, should be in- jected hypodermically 3 or 4 times a day for two weeks, and less often for two weeks more, gradually reducing the dose and frequency of administration. Therapeutics of Alcohol. The external and local use of alcohol in medicine includes many appli- cations of its antiseptic, astringent, refrigerant and rubefacient qualities. Diluted, in the proportion of four parts to one of water, it makes an excellent lotion for bruises, sprains, and other slight injuries, where it is desired to cool the part and check impending inflammation. A per- fumed spirit, as Cologne Water, is commonly used as a lotion to the fore- head for the relief of headaches. Alcohol does good service as an appli- cation to prevent bedsores and cracked nipples, as it hardens the inflamed skin by abstracting water therefrom and coagulating the albumen tempo- rarily. Diluted alcohol is applied on the surface of the body in fevers, to cool the skin and check excessive sweating. Alcoholic liniments (Lin. Camphorae, etc.,) are rubbed into the cutaneous tissue for their rubefaci- ent effect, to aid the absorption of inflammatory products and to relieve pain, in chronic rheumatism, lumbago, myalgia, etc. As a gargle or spray, diluted alcohol is one of the very best local agents in tonsillitis, pharyngitis, and other inflammatory affections of the throat, especially diphtheria, in which disease it fulfils several important purposes, acting as an efficient local antiseptic, astringent and anaesthetic. Among miners, hunters, frontiermen and others, lotions of whiskey or brandy are in common use as applications to wounds and sores, and they could not find 116 ALCOHOL. a more efficient agent for the purpose, when conjoined with thorough cleanliness of the lesions. Internally, in small quantities taken just before or during a meal, alco- hol is an efficient aid to digestion, especially in the aged and feeble, or persons who are greatly exhausted by overwork. In the atonic indigestion of nervous and depressed subjects and in cholera infantum, good brandy is universally found to be beneficial. Care must be taken, however, not to exceed the amount which agrees with the case, for large quantities precipitate pepsin, paralyze the gastric secretions, and set up a subacute gastritis, which will become a chronic one if the indulgence is persisted in, with eventual atrophy of the gastric glands. In the form of a sparkling wine, as champagne, or as brandy and soda- water, alcohol may control vomiting from many causes, especially that of yellow fever and sea-sickness. A single full dose of strong whiskey or brandy is often a very efficient combatant of fainting or of collapse, by its prompt reflex stimulation of the circulation. Diarrhoea of simple form may be checked by a dram of good brandy, acting as a tonic astringent to the intestines. An attack of acute coryza, or a cold from exposure beginning with a chill, may frequently be aborted by a full dose of spirits in hot water taken just before going to bed, for the purpose of relaxing the peripheral vessels and thus promoting diaphoresis and restor- ing the disturbed balance of the circulation. In anaemia and chlorosis good red wines are almost indispensable, also in convalescence from acute diseases, sudden and profuse hemorrhages, and many other morbid conditions. In phthisis alcohol does good service if it promotes assimila- tion and assists digestion, shown by increase of the body-weight during its employment. It is invaluable in poisoning by cardiac depressants and snake-venom, and in cardiac failure from any cause. In many fevers, Alcohol is often very serviceable, but may do harm if used therein without discrimination. Its powers of lessening oxidation, of being itself oxidized in the body and acting as a food, of reducing body-temperature and promoting perspiration and sleep, are all indica- tions for its beneficial employment in most febrile conditions; while its stimulant action on the heart may be available in such diseases as typhoid fever, lobar pneumonia, etc., to tide that organ over a brief period of depression or a condition of impending collapse. Furthermore, for some unexplained reason, it often slows the pulse in fever, and when it does so' its moderate use will be of general benefit to the patient. The danger is that if continuously given in such affections it may fail to make the required impression when an emergency calling for it occurs. The best rule to observe for its administration in typhoid, diphtheria, pneumonia and other fevers is to withhold it until the first sound of the heart becomes feeble and dull, and then to use it boldly but not excessively. Many ALETRIS—ALLIUM. 117 authorities urge its continuous administration in diphtheria, probably from a belief in its antiseptic action on the poison in the blood, similar to that which it undoubtedly exercises against the venom of the rattle- snake. It is an absolute necessity in the treatment of acute lobar pneu- monia, if the patient has been accustomed to its daily use as a beverage; but in other subjects of this disease it is best given at the crisis only, to tide the patient over a brief period of extreme danger. The use of alcoholic beverages in moderate quantity by healthy per- sons is violently condemned by extreme total abstinence advocates, who make use of garbled quotations from medical authorities to support their arguments. Physicians generally agree with Mr. Lawson Tait, who has recently declared that he is “ fully persuaded after thirty years of life, as hard in work and as full of responsibility as well could be, that the mod- erate use of alcohol is a necessity in our modern life.” Dr. Robert Farquharson sums up the case for moderate drinking as follows: “All stimulant is unnecessary for the young and for people living perfectly healthy lives. But, under the stress and struggle of modern civilization, few of us beyond middle age are placed under normal physiological con- ditions, and a little alcohol helps us to round the corners, and to plane away the asperities of existence. In turns it may be a stimulant, or a sedative, or a tonic, or a digestive, or an actual food ; and unless we run on into excess, no physical damage can possibly be done to our tissues. The argument in its favor, when wisely and prudently used, seems com- plete. It does us good, and can do us no harm.” ALETRIS, Colic-root (Unofficial),—is the rhizome of Aletrisfarinosa, the Star-wort, an indigenous perennial plant of the nat. ord. Hsemodoraceae, which grows in grassy places and in sandy woods. It contains starch, and a bitter principle, but no tannin. This plant was formerly official in the secondary list of the U. S. P., and is now widely advertised by the proprietors of an Aletris Cordial, as being tonic, emetic, purgative, diuretic, carminative, sialogogue and anti-rheumatic, also “ the most powerful of uterine stimulants.” It is little more than a simple bitter in small doses, though in very large ones it may prove emeto-cathartic. It is advertised as a specific for dysmenorrhoea and a wonderful remedy for colic, dropsy and chronic rheumatism. Dose, of the powdered root, gr. x ; of the infusion (1$ j to the pint), !|ss. ALLIUM, Garlic,—is the bulb of Allium sativum, a plant of the nat. ord. Liliacese, indigenous to Asia, but cultivated in Europe and America. It is sub-globular and com- pound, consisting of eight bulblets, covered by dry, membranous scales. Its odor is pungent and disagreeable and its taste warm and acrid. It contains a Volatile Oil, which consists mainly of the Sulphide of Allyl (C3H.)2S, on which its qualities depend. Allied species are Allium Cepa, the Onion, and Allium Porrum, the Leek. Syrupus Allii, Syrup of Garlic,—contains 20 per cent, of Garlic, Sugar and Dilute Acetic Acid. Dose, 3 j—iv, according to age. 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 anthelmintic. 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 118 ALNUS ALOE. it is of real benefit in feeble digestion and flatulence, chronic catarrhal affections of children, in nervous 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. Betulaceae. 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 official in the two following named varieties, also as the Purified Aloes preparation, and the neutral principle, Aloin. Aloe Barbadensis, Barbadoes Aloes,—is the inspissated juice of the leaves of Aloe vera, a plant of the nat. ord. Liliaceae. It occurs in opaque, hard, orange-brown masses, of saffron-like odor and bitter taste. Aloe Socotrina, Socotrine Aloes,—the inspissated juice of the leaves of Aloe Perryi, a plant of the nat. ord. Liliaceae, inhabiting the island of Socotra and the eastern coast of Africa near the southern shore of the Red Sea, which has orange-colored flowers and resembles in appearance the American aloe or century-plant (Agave americana). It occurs in soft masses, hard exteriorly, of a yellowish-brown color, fragrant odor and bitter taste, soluble in alcohol and in boiling water, and containing a peculiar volatile oil, a resin and Soaloin, C15H1607, a variety of the prin- ciple Aloin, which is common to all varieties of aloes,—also Aloeiic and Chrysammic Acids. Dose, gr. j-v. Aloe Capensis, Cape or Natal Aloes, from Aloe ferox, is another variety of the same plant. Aloinum, Aloin,—a neutral principle obtained from several varieties of Aloes, chiefly the above-named, which yield respectively Barbaloin and Soaloin. These are soluble in 60 of water, 20 to 30 of alcohol, and in 380 to 470 of ether. Soaloin is soluble in 9 parts of acetic ether. Dose, gr. ss-ij. Preparatiotis. Aloe Purificata, Purified Aloes,—prepared from Socotrine Aloes by melting and mixing with £th of Alcohol, straining and evaporating. The product is in irregular, dull-brown, brittle pieces, almost entirely soluble in alcohol. From it are prepared the following preparations. Dose, gr. j-v. Extractum Aloes, Extract of Aloes,— prepared by mixing I part of Socotrine Aloes 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 xo, Glycyrrhiza 20, Diluted Alco- hol to 100 parts. Dose, 3 ss-ij. Tinctura Aloes et Myrrhae, Tincture of Aloes and Myrrh,—Aloes 10, Myrrh 10, Glycyrrhiza IO, Alcohol and Water to 100 parts. Dose, 3 ss-ij. Pilulae Aloes, Pills of Aloes,—each has of Aloes gr. ij, with the same quantity of Soap. Pilulae Aloes et Asafetidae, Pills of Aloes and Asafetida,—each pill contains gr. 1 i/j of each ingredient. ALTHAEA. 119 Pilulae 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. Pilulae Aloes et Mastiches, Pills of Aloes and Mastic, Lady Webster's Pill,—each pill has of Aloes gr. ij, Mastic gr. ss, Red Rose gr. ss. Pilulae Aloes et Myrrhae, Pills of Aloes and Myrrh,—each pill contains of Aloes gr. ij, Myrrh gr. j, Aromatic Powder gr. ss, mixed with Syrup. Pulvis Aloes et Canellae, Powder of Aloes and Canella (Unofficial),—contains the powdered bark of Canella alba. Dose, gr. v-xx. Aloes is also a constituent of Pilulae Rhei Compositae and Tinctura Benzoini Com- posita (which see, under Rheum and Benzoinum respectively). 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 hemor- rhoids, which if existing it will certainly aggravate. Given to nursing mothers it imparts a purgative quality to their milk. Aloes is chiefly used in combination with Iron, Myrrh, Nux-vomica, etc., for amenorrhoea and chronic constipation with atonic dyspepsia and hypochondriasis. It is curative in certain forms of hemorrhoids, espec- ially 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 the anaemia, amenorrhoea and constipation of girls at the period of puberty. Physiological Action and Therapeutics. ALTH/EA, Marsh-Mallow,—is the root of Althcca officinalis, a European plant of the nat. ord. Malvaceae. It contains about 35 per cent, each of vegetable mucus and starch, with 2 per cent, of Asparagiti, also pectous matter, sugar, fixed oil, but no tannin. It is a constituent of Massa Hvdrargyri and Pilulae Phosphori, and is much used as an excipient in extemporaneous pharmacy. Dose, indefinite. Syrupus Althaeae, Syrup of Althcea,—has of Althaea 5 per cent., and should be freshly made. Dose, indefinite. Althaea is one of the best mucilaginous drugs, but has no active medicinal 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 Ger. Phar. a Compound Althaea Tea is official, which under the common name, “ Ger- man Breast Tea,” is a popular demulcent drink in bronchial affections, coughs, 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 120 ALUMEN—ALUMINUM. has diuretic properties, besides being sedative to the circulation. It may be used in as- cites, especially in children, in the anasarca of Bright’s disease, and in gout. Dose, gr. ij-iij, in water. ALUMEN, Alum, Potassium Alum,—is Aluminum and Potassium Sulphate, A12K2(S04)4 + 24HsO, which, when the 24 molecules of water are driven off, becomes Alumen Exsiccatum, Dried Alum, A12K2- (S04)4. Alum occurs in large, octahedral crystals, or cubes, of sweetish astringent taste and acid reaction. It is soluble in 9 parts of water at 590 F., and in 0.3 part of boiling water, but is insoluble in alcohol. The Ammonia alum (Alumini et Ammonii Sulphas) was formerly official, and is still sold and dispensed as “Alum.” Dose, gr. x-xx,—as an emetic 3j for a child. Alumen Exsiccatum, Dried Alum,—is a white, granular powder, slowly soluble in 20 parts of water at 59° 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, 3 ]S/& of dried Alum having caused the death of an adult in 8 hours. 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, passive hemorrhages, lead colic and con- stipation. As an emetic it is employed in croup, and it is a good antidote in lead-poisoning. Alum is best administered alone, as it forms precipi- tates with a large number of drugs. ALUMINUM.—This metal is not official, though of its salts two are official be- sides Alum. They are— Alumini Hydras, Aluminum Hydrate, Hydrated Alumina, Al2(OH)6,—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. Alumini Sulphas, Aluminum Sulphate, Al2(S04tg-f- l6H20,—is a white crystalline powder, soluble in 1.2 of water at 590 F., almost insoluble in alcohol. Used locally. The Hydrate is a feebly astringent and desiccant powder, occasionally used in inflam- matoi'y 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 ad gvj) in foul discharges from mucous surfaces. A saturated solution is a mild AMMONIACUM—AMMONIUM. 121 caustic, and may be used daily as a local application to enlarged tonsils, nasal polypi, ulceration of the os uteri, and various chronic enlargements. The Benzoinated Solution of Alumina is an unofficial preparation used for the same purposes. Alumnol (Unofficial),—is an aluminum salt of naphtol-sulphonic acid, and is readily soluble in cold water. It is markedly antiseptic and astringent, and though pre- cipitating gelatin and albumen, the precipitate is soluble in an excess of either, so that when it is used on purulent discharges they do not clog up cavities, and desirable pene- tration below the surface is accomplished. It has been used both dry and in solution, as a dressing for wounds, ulcers, etc., also for acute inflammatory and parasitic affections of the skin, and in acute and chronic inflammations of mucous membranes. In 1 to 3 per cent, solution it makes a fair injection for gonorrhoea, and a 4 per cent, solution is used by ophthalmologists to check lachrymal discharge during an examination of the eye. It neither irritates nor causes pain. It is four times as expensive in this country as in Germany, where it originated. AMMONIACUM, Ammoniac,—is a gum-resin, obtained from Dorema Ammo- tiiacum, a Persian plant of the nat. ord. Umbelliferse. 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. Emulsum Ammoniaci, Emulsion of Ammoniac,—an emulsion with water of 4 per cent, strength, the resin being suspended by the contained gum. Dose, Emplastrum Ammoniaci cum Hydrargyro, Ammoniac Plaster with Mercury.— Ammoniac 72, Mercury 18, Oleate of Mercury 8 per cent., and contains also Lead- plaster, 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 mixture with Ammonium Chloride or Carbonate facilitating expectoration and lessening wheezing. It is also recommended in asthma, and in gland- ular enlargements and indolent swellings the plaster is employed as a stimulating alter- ative and resolvent. 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 organ- isms, 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. Aqua Ammoniae, Ammonia Water,—is an aqueous solution of Ammonia, contain- ing io per cent, by weight of the gas. It is a colorless liquid of pungent odor, acrid taste and strongly alkaline reaction. Sp. gr. 0.960 at 590 F. Dose, well diluted. Aqua Ammoniae Fortior, Stronger Ammonia Water,—contains 28 per cent, by weight of the gas. Sp. gr. 0.901 at 590 F. Spiritus Ammoniae, Spirit of Ammonia,—is a 10 per cent, solution of the gas in alcohol. Sp. gr. about 0.810. Dose, diluted. Spiritus Ammoniae Aromaticus, Aromatic Spirit of Ammonia,—contains Am- monium Carbonate, Aqua Ammoniae, Oils of Lemon, Lavender, and Nutmeg, Alcohol and Water. Used in the Tinct. Guaiaci Ammoniata and the Tinct. Valerianae Ammo- niata. Dose, 3 ss—ij. Linimentum Ammoniae, Ammonia Liniment,—has of Aqua Ammoniae 35 parts, Cotton-seed Oil 60, Alcohol 5 parts. 122 AMMONIUM. Ammonium Salts and their Preparations. Liquor Ammonii Acetatis, Solution of Ammonium Acetate (Spirit of Mindererus), —is prepared by neutralizing Dilute Acetic Acid with Carbonate of Ammonium, and contains about 7 per cent, of the Acetate. It should be freshly made. It is used in Liquor Ferri et Ammonii Acetatis. Dose, Ammonii Benzoas, Ammonium Benzoate, NH4C7H302,—in minute four-sided, lami- nar crystals, soluble in 5 of water and 28 of alcohol at 590 F. Dose, gr. v-xv. Ammonii Bromidum, Ammonium Bromide, NH4Br,—in prismatic crystals or as a granular salt, soluble in I of water and 30 of alcohol at 590 F. Dose, gr. ij-xx, well diluted. Children bear it well if epileptic from reflex causes. A child 1 year old will tolerate gr. v every 4 hours (Barton). Ammonii Carbonas, Ammonium Carbonate, NH4HC03.NH4NH2C02,—occurs in white masses consisting of both the bicarbonate and carbonate, which on exposure to air become a white powder (acid carbonate). Soluble in 5 parts of water. Dose, gr. iij-x. For children small doses, gr. frequently repeated. Ammonii Chloridum, Ammonium Chloride (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 Ammonium Chloride,—each contains I f grains of the Chloride. Dose, j-x troches. Ammonii Iodidum, Ammonium Iodide, NHJ,—a deliquescent, granular, white salt, soluble in 1 of water and 9 of alcohol at 5 9° F. Dose, gr. ij-x. Ammonii Nitras, Ammonium Nitrate, 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 Valerianas, Ammonium Valerianate, NH4C5H902,—in white, quadrangu- lar plates, deliquescent; very soluble in water and alcohol. Dose, gr. j-v. Raspail’s “ Eau Sedative” (Unofficial),—consists of Aqua Ammoniae 3 ij, Sodii Chloridum 3 ij, Spiritus Vini Camphorat. sj iij, Aqua 3 xxxij. For local use. Physiological Action. The gas Ammonia is intensely alkaline and irritant to mucous mem- branes; inhaled producing spasmodic cough and a sense of suffocation. Its prolonged inhalation will induce violent inflammation of the air-pas- sages and oedema of the glottis. It stimulates the nasal branch of the fifth nerve, exciting the vaso-motor centre by reflex action, and thus raising the arterial tension. Applied to the skin and allowed to evaporate, it has a slight rubefacient effect, but if evaporation be prevented it penetrates the epidermis, and has a powerfully vesicant action. The Aqua, swal- lowed 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 increases the glycogenic function of the liver, and is converted finally into urea. It is a powerful irritant to muscular tissue, causing tetanic contraction and subsequent rigor mortis when directly applied. Ammonium Salts all stimulate and finally paralyze the spinal cord, ammonium. 123 motor nerves and muscles, in animals, but the order and intensity of the action vary with the salts employed, some having a predominating influ- ence 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 (Brun- ton). 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 Sodi- um Urate in the blood, converting it into the soluble salts Ammonium Urate and Sodium Phosphate, 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 stimulates the liver, and acidifies the urine where there is phosphatic tendency thereof. 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, Bromum and Valeriana. Antidotes and Antagonists. When Ammonia is inhaled in excess give HC1 vapors by inhalation to form the chlo- ride ; if taken in solution, give Vegetable Acids, and demulcents to protect the mucous surfaces. Its physiological 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 venomous reptiles and to the stings of insects. The Carbonate is used inter- 124 AMMONIUM. nally in the eruptive fevers, delirium tremens, continued fevers, pneu- monia, etc., where much depression exists; as a stimulating expectorant 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. In doses of 5 grains, administered hypodermically in the vicinity of wounds caused by poisoned arrows, the Carbonate was repeatedly used by Dr. Parke, Stanley’s surgeon in Africa, with entire success in saving life when so employed immediately after injury. Those so wounded at too great a distance to receive this treatment invariably died within a short period of time. The Chloride has 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; ” also, in chronic congestion of the liver, jaundice from catarrh of the bile-ducts, nervous and sick headaches, myalgia, amenorrhcea, 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 bronchitis when the secretion is scanty and tough. It is remarkably efficient in straightening up a victim of acute alcoholism; administered to one on the verge of delirium tremens, in dose of drachm in half a pint of water, swallowed at one draught, it is said to restore the patient’s faculties so quickly as to astonish those who have 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 ; also, to allay itch- ing 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 vomiting; also in acute alcoholism and in erysipelas when there is feeble circulation, cyanosis 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 lithsemia, and is a very efficient cholagogue. The Benzoate is useful in cystitis with alka- line urine and phosphatic deposits, as it acidulates the urine, at the same time stimulating and disinfecting the mucous coat of the bladder. Aqua Ammonite has been administered by intra-venous injection, with efficacy and safety, in sudden or threatened thrombosis, impending car- AMYGDALA. 125 diac paralysis during Chloroform ansesthesia, and in poisoning by Hydro- cyanic Acid and other cardiac depressants. In the same manner, it has been employed, but unsuccessfully, 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, Almond.—The seeds of two varieties of Prunus Amygdalus (nat. ord. Rosacese), 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 Emul- sin in the presence of water producing Hydrocyanic Acid (see ante, page 87). 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 Prunus Amygda- lus, var. amara, a tree of the nat. ord. Rosacese, indigenous to Western Asia, but cultivated in many other parts of the world. The seed has an 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 Prunus Amygdalus, var. dulcis, a tree of the nat. ord. Rosacese. 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 presence of Amygdalin (see above). The sweet almond is largely cultivated about Malaga and in California. Preparations. Aqua Amygdalae Amarae, Bitter Almond Water,—is a weak solution of the Oil ot Bitter Almond in Distilled Water (x to 1000). Is only a flavored water. Dose in- definite. Oleum Amygdalae Amarae, Oil of Bitter Almond,—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 Emul- sin (see ante, p. 87), contains a varying quantity of Hydrocyanic Acid (3 to 14 percent.), 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 contains no Hydrocyanic Acid, but is a dangerous poison, producing toxic effects when inhaled, even in small doses. Spiritus Amygdalae Amarae, Spirit of Bitter Almond, Essence of Bitter Almond, —has of the Oil I, dissolved in Alcohol 80, and Water added to 100 volumes. Dose, to be regulated by the quantity of alcohol desired. Syrupus Amygdalae, Syrup of Almond,—has of Bitter Almond 4 per cent., of Sweet Almond 14. Dose indefinite. 126 AMYL NITRIS. Emulsum Amygdalae, Emulsion of Almond,—made of Sweet Almond 6 per cent., with Acacia, Sugar and Water. A demulcent drink, used as a vehicle for cough mix- tures. Dose, gij-^ss. Oleum Amygdalae Expressum, Expressed Oil of Almond,—is the fixed oil which is expressed from either Bitter or Sweet Almond. Used in Unguentuin Aquae Rosae, and as a bland local application in skin affections. The bitter and sweet varieties of the species Primus Amygdalus 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. 87). The Expressed Oil of Almond is demulcent, and in doses of gj-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 Emulsion 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. Physiological Action and Therapeutics. AMYL NITRIS, Amyl Nitrite, —is a liquid containing about 80 per cent, of Amyl Nitrite, C5HnN02, together with variable quantities of undetermined compounds. It occurs as a clear, yellowish 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 rrp ij—v; but larger doses are probably safe. Analogous Compounds Glonoinum, Glonoin, Nitroglycerin, Trinitrin, Glyceryl Trinitrate, C3H5(N03)3,— 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. It is a dangerous explosive, and should not be kept in stronger solution than I per cent. Dose, to Jg- or more, according to susceptibility. Official in the Spirit. Spiritus Glonoini, Spirit of Glonoin, Spirit of Nitroglycerin,—is a I per cent, solu- tion in alcohol. Dose, The strong tincture sold by the homoeopathic pharma- ceutists and official in their American Pharmacopoeia is a io per cent, solution, or ten times the strength of the above. It is an extremely dangerous preparation, both as an AMYL NITRIS. 127 explosive and as a medicine. (See American Homoeopathic Pharmacopceia, 2d ed., Boericke & Tafel, 1883, page 235.) Tabellae Nitroglycerini (B. P.), Tablets of Nitroglycerin,—are tablets of chocolate, each containing gr. of pure Nitroglycerin. Dose, j-ij. Sodii Nitris, Sodium Nitrite, NaN02, and Potassii Nitris, Potassium Nitrite (the latter unofficial),—are used as substitutes for Amyl Nitrite and Nitroglycerin. The former is a white, crystalline powder, deliquescent in the air, in which it gradually oxidizes to sodium nitrate ; has a mild, saline taste, but no odor ; very soluble in water, slightly in alcohol. Dose, gr. ss-iij, according to individual susceptibility. Ethyli Nitris, Ethyl Nitrite, C2H5N02,—constitutes about 5 per cent, of Spiritus Altheris Nitrosi. (See page 100, ante.) Physiological Action. Amyl Nitrite 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- oles,—which, is yet undecided. They cause tumultuous action of the heart by relaxing its inhibition ; lowered respiration, from paralysis of the respiratory 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 all 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 of urine voided. Mixed with blood it forms methaemoglobin, 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 inter- nal administration. Sodium Nitrite 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 contained in them. Antagonists. Ergot, Belladonna, Strychnine, Brucine, Digitalis, Picrotoxin, and all other agents which increase the functional activity of the spinal cord and sympathetic are antagon- istic, though by reason of their slower rate of diffusion the antagonism may not be always available. 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 128 AMYLUM. 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 form. It has been some- times used in threatened death from chloroform anaesthesia, and in poi- soning by strychnine. Nitroglycerin is employed with benefit in neuralgic dysmenorrhcea and sea-sickness; also 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, also migraine of spas- modic character, and has afforded immediate relief in neuralgia of the fifth and in sciatica. Its administration in angina pectoris, though not producing such prompt results as that 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 arte- rial tension is above normal; also in irritable and overacting heart, which it relieves by rapidly dilating the arterioles and thereby lowering arterial tension. Sodium Nitrite 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. Disagreeable symptoms caused by it may be prevented by prescribing it with spirit of chloroform or ammonia water and small doses of morphine. AMYLUM, Starch, C6H10O5,—is the feculaof the seed of Zea Mays, Maize or Indian Corn, a plant of the nat. ord. Graminaceae. Though corn starch is the official kind, any other might be properly used, as the starch occurring in wheat, 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 composed of starch ; wheat contains about 70 per cent., and rice 90 per cent. Starch is a carbohydrate, and occurs in distinct grains, forming irregular angular masses, white, inodorous, and tasteless, easily pulverized, of neutral reaction, and insol- uble 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 iodine, 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 dis- solves it, forming an explosive compound. Diastase, ptyalin and pan- creatin convert it into Glucose. [For Glycogen, Dextrin, Cellulose ANIMAL EXTRACTS. 129 and other allied substances see the article Saccharum in the following pages.] Glyceritum Amyli, Glycerite of Starch,—has of Starch 10 parts, Water 10, Gly- cerin 80, triturated 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. ANIMAL EXTRACTS (Unofficial).—The organs, tissues and secretions of animals were extensively employed as medicinal agents in ancient times, and many of them were official in the pharmacopoeias of the last century. At present the only ones so recognized are the diges- tive ferments, pepsin and pancreatin, ox-gall (fel bovis), and the secre- tion of the preputial follicles of the beaver (castoreum) and of the musk- ox (moschus). The first definite attempt in recent regular practice to apply animal tissues to the cure of disease was made in 1852 by Dr. Jackson of Philadelphia, who used as a tonic the blood of bullocks care- fully dried in vacuo, giving 5 to 10 grains thereof at a dose. Since then the drinking of fresh bullocks’ blood has become a common practice in certain diseases. Raw meat was administered as a remedy for diabetes at St. Bartholomew’s Hospital in London in 1874. The powdered Russian cockroach (Blatta orientalis) is still used as an efficient diuretic in drop- sies, and preparations of the bodies of various spiders and toads, also bee and serpent venoms, are recognized remedies in homoeopathic practice. The use of glandular extracts as remedies in disease is very old. It was revived in 1889 by Brown-Sequard’s advocacy of orchitic (testicular) extract for impotence and several nervous affections, and was profoundly stimulated by the results of Dr. Murray’s suggestion in 1891 of thyroid extract for the cure of myxoedema. Testicle Extract is fully noticed in the “Seplasium or the Druggist's Shop Opened,” by W. Salmon, published about 1685. In this book the author describes the testicles taken from man or beast as consisting of “a Flegm, Spirit, Sulphur and Volatile Salt joined with some Earthy Particles ; the chief used are from Bull, Horse, Goat, Ram, Boar and Buck,” which were cut out, carefully dried, and used to make a tincture, a spirit, an oil and a volatile salt. Salmon further says that “ their virtues are very great, for they refocillate the Spirits,—Natural, Vital and Animal,—comfort the Head, Brain and Nerves, and resist all Diseases afflicting them, .... they restore in Con- sumptions, .... are also good against the Collick, and particularly strengthen the Instruments of Generation and provoke Lust.” The same extract was also recom- mended by J. Fr. Leaulte, who wrote in 1717. According to Pliny the ancient Greeks and Romans ate the testicle of the ass for the purpose of curing impotence. According to the theory promulgated by Brown-Sequard, all glands, in addition to their ordinary secretions, elaborate certain materials of unknown chemical composition, which pass into the blood and perform 130 ANIMAL EXTRACTS. therein definite functions of some kind. We now know that such is the case with the thyroid gland, we suspect that it is equally true of the thymus, the spleen and the adrenals, and we have reason to believe it highly probable that the other glands of the body exert influences here- tofore unsuspected over distant parts of the organism. The effect of the entire removal of the thyroid, the pancreas or the adrenal glands is to produce the symptoms of characteristic and fatal disorders; but if a por- tion of either of these glands be left behind these toxic symptoms do not develop, and the same is true of the thyroid and pancreas if, after their entire ablation, a portion be engrafted upon the peri- toneum. It is evident therefore that the disorders so produced are of auto-toxic origin, the result of chemical poisons in the blood which were previously neutralized, destroyed or eliminated by the removed gland or some of its secretions. It has also been shown that the subcutaneous injection of an aqueous extract of the dead gland will dispel the toxic phenomena which follow the removal of that gland, proving that the active principle thereof is a chemical substance existing in the gland itself, and that the previous immunity was not due to any action of its living cells other than that required to produce the active agent. The discovery that ablation of the testicles causes retrogression of the hypertrophied prostate, and that removal of the ovaries will cure osteo-malacia, as also the long-known facts that castrated individuals usually grow very obese and develope massive skeletons, while giants are generally endowed with atrophied testicles,—clearly point to the same conclusion. The animal extracts form a group of active medicinal agents which are proving worthy of careful investigation both physiologically and clinically. The study already given to them has yielded much new knowledge, and has shown indubitably that their employment as therapeutic agents rests on a scientific basis; but most of them are as yet on trial, and the limits of their utility in medicine are by no means defined. They contain leucomaines, extractives and other chemical substances, all of which possess physiological powers, many proving distinctly poisonous when their excretion is prevented. Excepting thyroid extract and perhaps some others, the animal extracts are only active medicinally when injected subcutaneously or by the rectum, as most of them when given by the mouth are destroyed or altered in the stomach, or prevented by the liver from entering the general circulation. Physiological chemists are en- deavoring to separate their active principles, a line of research which promises more accurate and positive results. It is already demonstrated that some of their principles are the most powerful of all alteratives, and that others possess the most energetic action upon the muscular fibres in the walls of the arterioles. The initial doses of many animal extracts should be very small, in ANIMAL EXTRACTS. 131 order to avoid the possible systemic disturbance which has been frequently noticed by clinical observers as following on their administration. Sodium Phosphate in solution, administered hypodermically, is considered by Luton and Crocq, of Rheims, to be equally effective in reconstructive power with the animal extracts. (See under the title Phosphorus.) Thyroid Extract is the most efficient member of the group of ani- mal extracts. Its administration has been eminently successful in the treatment of myxoedema, which five years ago was classed among the in- curable diseases, but is now considered curable by thyroid feeding, or by the use of an extract of the thyroid gland of the sheep. Myxoedema is a symptom or combination of symptoms of thyroid absence or inadequacy, and occurs as a result of the removal of the gland or of disease impairing its functional activity. It is characterized by imperfect oxygenation of the blood, lowered body temperature, impairment of intellect, memory and speech, also increase of the fibrous tissue and subsequent mucoid de- generation thereof, with thickening of the skin, drying of the surface and shedding of the epithelial structures. When caused by ablation of the thyroid the disease is fatal to cats and dogs in a very few days, but their life has been saved by engrafting a portion of the removed gland in other situations, and also by intravenous injections of thyroid extract. This treatment of the idiopathic form of myxoedema was suggested and commenced by Professor Geo. R. Murray, of the University of Durham, in 1891, and has since proved remarkably successful. At first the remedy was administered hypodermically, but it was soon found that the raw gland fed to the patient was equally efficient, or that a dry extract may be used. The latter represents the entire thyroid, divested only of its water, is easily administered and proves very efficient, improvement being usually noticed within a very few days, and going on steadily to apparent perfect recovery if the remedy is continued. The thickening of the skin disappears, the normal body heat returns, and speech, memory and intel- ligence are restored. In mild cases recovery is effected in a few weeks, but in severe ones several months of treatment are necessary ; and in most cases the symptoms of the disease return when the thyroid treatment is stopped, but disappear again when it is resumed. It is probable that the subjects of this disease will require to take a certain quantity of the remedy regularly and continuously for many years, perhaps for life. Dr. Murray has recently published the after history of the first case of myxcedema treated with thyroid extract. The patient, a woman, was 46 years of age in 1891, and had suffered from the disease for four or five years previously. Under the thyroid treat- ment, which was administered hypodermically, “ she gradually lost all the symptoms of myxoedema, which however partly returned on two occasions when the use of the remedy was discontinued for a time. She has for long been free from myxcedema and is so now. The swelling has gone, and the skin is soft and moist; the hair has grown again, the temperature is normal, and she leads an active life as the wife of a working man. She continues to take one drachm of thyroid extract during each week. As this case remains well at the end of more than four years it is evident that as long as she 132 ANIMAL EXTRACTS. continues to take the extract she will not have myxoedema, even if she lives for another twenty years.” (British Medical Journal, Feb. 8th, 1896.) Thyroid extract has produced great amelioration in cretinism (con- genital myxcedema) which is a thyroid disease, and the improvement has been steady and progressive in many cases while the remedy was used, but ceased as soon as it was discontinued. In psoriasis, eczema, ichthy- osis, pityriasis rubra, lupus, universal alopecia and some other skin affec- tions, it has been employed as a stimulant of the cutaneous functional activity with most satisfactory results ; several cases of psoriasis treated with this remedy alone recovered completely in the course of a few weeks (Bramwell). In exophthalmic goitre thyroid extract has been beneficial, and though some observers report ill effects from its use in this disease, others show that they were due to a primary aggravation of symptoms which subsides when the dose is largely reduced, and is then followed by distinct improvement under the administration of a very small quantity of the remedy (Bruns, etc.) In the insanity of the adolescent, climacteric and puerperal periods, the thyroid treatment has seemed to be especially beneficial (Bruce) ; but in several cases of insanity where there was paren- chymatous (not cystic) enlargement of the thyroid, the extract was used without result upon the mental affection though it diminished the size of the goitre and caused a marked loss of weight (Reinhold). In many cases its continued administration has produced emaciation, which fact suggested its employment for the reduction of obesity, and it has been successfully used for this purpose in many cases (Guttmann). It has given satisfaction in various other affections, including tetanus, ozaena, uterine fibroma and some forms of syphilis. A large dose of thyroid extract gives rise to marked constitutional symptoms, and several cases are recorded in which it has caused death. Nausea, vomiting, neuralgic pains in the back and limbs, and marked cardiac irritability and weakness even to syncope, are the principal symp- toms observed during its excessive use. It produces a distinct fall of the blood-pressure, even though the cardiac rate and force may remain un- affected, this effect being evidently due to its increasing the calibre of the vessels (Schafer and Oliver). In one case all the symptoms of diabetes developed under its continuous administration for psoriasis (James). In an- other instance a typical attack of gout came on, but subsided when the ex- tract was stopped, and reappeared when it was again administered (Harris). The chemical constituents of thyroid extract have not been definitely ascertained. According to Dr. Gourlay it contains a nucleo-albumin, a very small amount of proteid and possibly a ferment; but neither mucin, peptone nor proteose. Liquid Thyroid Extract is prepared from the fresh thyroids of the sheep, by macerat- ing them in equal parts of glycerin and water for 24 hours, and then squeezing through ANIMAL EXTRACTS. 133 fine calico. For hypodermic use the water employed in the menstruum should contain 0.5 per cent, of carbolic acid. A dry extract, three times stronger than the licjuid one, is made by expressing the juice from the glands, mixing it with sugar of milk, and dry- ing it on glass plates at a temperature of 90° F. The dose of this product is from 2]/z to 5 grains at first, thrice daily by mouth ; which dose may be gradually increased as long as it causes no systemic disturbance. The Thyreoidin prepared by Parke, Davis & Co. of Detroit, is a dry powder, each grain of which represents IO grains of the fresh gland or 1.6 grain of desiccated thyroid. The dose of this preparation is grain two or three times a day, to be increased at the discretion of the physician. Thyreo-Antitoxin is a substance recently obtained by Dr. Frankel from the thyroid gland, to which he has given the above name and assigned the formula CBHUN3()5. It is inodorous and tasteless, and produces rapid emaciation. It is improperly named an antitoxin. Thymus Extract. The thymus gland is active only during the developmental period of life, and becomes atrophied about the age of two years. The suggestion has been made that an extract thereof may prove useful in diseases characterized by defective de- velopment, as rachitis and pseudo-hypertrophic paralysis. It has been used with reported benefit in exophthalmos with ansemia and debility, also in leucocythsemia, chlorosis, idio- pathic and pernicious ansemia, and in Paltauf’s so-called “ status thymicus. ” The mode of preparation and dose are similar to those of thyroid extract. Bone Marrow Extract.—Red bone marrow has been long known as one of the sources of the red blood corpuscles, and it is thought prob- able that it contains chemical ingredients which may stimulate the pro- duction of blood cells by other blood-forming organs in which such natural stimulus may be lacking. In pernicious anaemia the marrow of the long bones shows characteristic changes, which fact suggested the administration of red bone marrow as a remedy for that disease. This treatment has proved remarkably successful even in cases which were apparently hopeless. One of the most striking cases so treated is that of the gardener patient of Professor Fraser of Edinburgh. Under the use of raw bone marrow by the stomach his blood corpuscles increased in number from less than 900,000 to over 4 millions per cmm., the propor- tion of haemoglobin rose from 18 to 35 per cent., and the man became well enough to resume his occupation. This use of bone marrow was first suggested by Dr. Dixon Mann, who administered a glycerin extract thereof in cases of haemophilia, chlorosis, profuse haematemesis and other anaemic affections, with good results. Its employment is indicated in disorders characterized by hyperfluidity of the blood, from whatever cause; and it may render good service in any debilitating or blood-im- poverishing affection, and in convalescence after severe osteitis. The raw marrow, freed from spicules of bone, may be administered to the amount of about 3 ounces daily in divided doses ; or it may be given as a paste made with wine, glycerin and gelatin. Tablets, containing from xy2 to 5 grains each of the dried marrow, are on the market and may be used if preferred. Nuclein is a proteid substance, possessing a large proportion of Phos- phorus in the form of Nucleinic Acid, which is combined with a highly com- plex base, the latter being different in the different tissues. Nucleins are the 134 ANIMAL EXTRACTS. chief chemical constituent of cell nuclei, and their number is limited only by the varieties of the cells. They are found in both animal and vege- table tissues ; wherever there is a nucleus we find a nuclein. They are generally insoluble in dilute acids, but are soluble in dilute alkalies, and resist peptic digestion. Their functions in the organism are supposed to be (i) that of a natural antiseptic, to destroy toxic products which may accumulate through faulty elimination, and (2) that of a natural bacteri- cide, to resist microbic invasion. Two nucleins only have been clini- cally studied in this country, that obtained from yeast-cells and that from the thyroid and thymus glands. Nuclein is harmless, causing no functional derangement when admin- istered by the stomach or subcutaneously, even in very large doses. When injected hypodermically its principal effect is to produce a very marked increase of leucocytic activity (an artificial leucocytosis), both in healthy and in tuberculous subjects. The increase is observed to be chiefly of the polynuclear leucocytes; it varies in degree with the individual, appears within three hours after administration of the nuclein, and disappears after forty-eight hours or thereabouts (Huber). The effect is to energize any existing inflammation, or to awaken such when comparatively quies- cent, as in latent tuberculosis (See). Nuclein was introduced into medicine by Professor Vaughn of the Uni- versity of Michigan. Its employment as a therapeutic agent is based on the assumption that for immunity against and the cure of bacillary dis- eases we should look to non-toxic germicides of cellular origin, and to substances which stimulate the activity of those organs whose function it is to protect the body against such invasion. As the nucleins apparently fulfil these requirements they have lately excited considerable attention among the advocates of animal extracts. Nuclein has been successfully used in diphtheria, suppurative tonsillitis and other suppurative disorders, also in chronic rheumatism and malaria, chronic bronchial catarrh and neurasthenia, and has been employed in tuberculosis with encouraging results (Vaughn). In one case an ulcer of twenty years’ standing was cured in four months by the local application of nuclein. A physician reports his own case, one of genito-urinary tuberculosis, as apparently cured by nuclein injections. In simple anaemia, chlorosis, typhoid fever, debility from any cause, and convalescence from acute diseases, such as pneumonia and influenza, the beneficial results of nuclein medication are prompt and permanent (Aulde). As bactericides the nucleins may prove therapeutically useful, by reason of their harmlessness to the human subject. Nucleins are prepared from separate animal tissues and glands, as the thyroid, thymus, liver, spleen, etc. (animal nucleins) ; also from all the tissues and glands combined (protonuclein), and from yeast-cells ('vegeta- ANIMAL EXTRACTS. 135 ble nuclein). Vaughn uses a solution of yeast nuclein, containing 1 per cent, of nucleinic acid, prepared by Parke, Davis & Co. The dose of this solution is 30 minims, administered hypodermically, and increased daily as long as no unfavorable symptoms appear. Tablets of nuclein are on the market, for administration by the mouth, the dose being 1 grain or more, as may be deemed advisable. Protonuclein is the trade-name of an extensively advertised product, which is said to be a combination of nucleins obtained from all the available lymphoid structures of bullocks and pigs, including the entire brain, the pancreas, liver, spleen, salivary glands, thyroid, thymus, gastric and intestinal glands, etc. The manufacturer claims that it is “the true tissue-builder of the organism” and its “natural antitoxic agent,” and pub- lishes the usual florid literature, which includes clinical reports of the therapeutic efficacy of protonuclein in some forty-five different affections. It is sold in tablets and powder; also in a special powder containing no milk-sugar, and intended for inhalations and injections. The dose is 3 grains every 3 or 4 hours. Orchitic Extract (Didymin, Testicular Juice'),—was the subject of a communication to the Societe de Biologie at Paris, in 1889, from Pro- fessor Brown-Sequard, in which the aged and distinguished writer declared that he himself had experienced a wonderful degree of rejuvenescence after its use, and recommended it as a general tonic for the aged and for subjects of impotence or a debilitated nervous system. In subsequent communications made to the Academie des Sciences by Dr. Brown- Sequard and his assistant Dr. D’Arsonval, it was claimed that general paralysis, locomotor ataxia, contractures, and certain forms of insanity, affections due to organic lesions of the nervous system or impairment of its functions, are cured or ameliorated by injections of testicular juice; also that organic or constitutional diseases due to defective nutrition of the organs, as anaemia, glycosuria and tuberculosis, may be arrested by this procedure. Its remedial effects they held to be due to the action of a ferment or diastase contained in the fluid, which replaces the natural ferments produced by normal testes and other glandular organs of the body. Although Brown-Sequard’s claims for this agent were undoubt- edly extravagant, and his assertions as to the results obtained therefrom were exaggerated, subsequent experience has confirmed his general state- ment of its effects, and the restorative power of testicular juice when in- jected subcutaneously is now admitted. Testicular extract injected into the human subject produces a steady in- crease of oxyhsemoglobin in the blood, the cardiac force is strengthened, the vascular tone is exalted, and the oxygenation of waste products is promoted as shown by the increased excretion of urea and the lessened amount of phosphoric acid in the urine. Intestinal peristalsis is slightly stimulated, the mind becomes clearer and more active, and the body temperature is usually raised but may remain unaffected. The crude ex- tract is said to be mildly bactericidal. These effects closely coincide with those produced by Spermine (see below), and this substance is believed by 136 ANIMAL EXTRACTS. Poehl to be the active principle of the juice, but it does not possess the powerful reconstructive properties of the latter, and cannot be efficiently substituted therefor. This extract has been employed by many competent physicians in several diseases, often with most beneficial results. It is a powerful tonic, especially in the decrepit subject of old age or exhaustion from wasting disease, as it stimulates the tissues and organs to renewed activity and endows the body with greater strength and with a feeling of increased well-being. It has been used in general adynamia, anaemia, atonic gastro- intestinal affections, scurvy, malaria, epilepsy, cancer, nymphomania, perverted sexual habits, impotence, neurasthenia, hysteria, melancholia, diabetes, tuberculosis, hemiplegia, paralysis agitans and locomotor ataxia. In the last-named disease this remedy has shown the best results ob- tained therewith; and under its administration the characteristic pains have ceased, steadiness and accuracy of motion have increased, and in some cases the ataxia has wholly disappeared. In diabetes it has been more satisfactory than pancreatic or any other organic extract. Under its administration in anaemia one physician observed the haemoglobin to increase from 3 to 14 per cent, every three weeks; and in tuberculosis it has caused the temperature to recede to normal, the cough to lessen, the appetite and weight to increase, and the general condition to improve in every way. In sexual neurasthenia it has frequently proved to be of great benefit. No specific action is claimed for it in any of these affections, but all observers agree that it acts by stimulating functional activity. Many of the results observed have been ascribed to mental suggestion, but after the application of check experiments in similar cases the weight of evidence was found to be in favor of the remedy. D’Arsonval prepares this extract or emulsion in the following manner. The testicles of bulls, enveloped in their membranes, are washed in a io per cent, solution of subli- mate, and again with sterilized water, are each divided into five or six parts, placed in aseptic glycerin (a pint to the pound of testicle) and allowed to macerate therein for 24 hours. An equal quantity of a 5 per cent, solution of common salt in boiled water is then added, the mixture is filtered and sterilized by being subjected to a pressure of 30 atmospheres of carbonic acid gas. The dose is 10 to 20 minims, hypodermically once daily or every other day, with strict aseptic precautions as to the syringe used and the site of injection; the latter should be washed with a 1 to 1000 sublimate solution or a 2 per cent, solution of carbolic acid. The extract seems to have little or no effect when given by the mouth, but is efficient when used by the rectum. Some observers believe that it is dangerous by hypodermic administration, on account of its proneness to decomposition when prepared by the above method ; and one experimenter has made an extract from the crude juice for administration by the mouth, which he claims to have used in a thousand cases. The composition of the emulsion prepared by the above process is very complex, but it is supposed to include at least four active principles, viz. : —(i) Phosphorized Albumins, in large quantity, (2) Lecithin, known as phosphorized fat, (3) Spermine, and (4) Nuclein. The first two have undoubted value as nerve foods, the third is believed to increase the ANIMAL EXTRACTS. 137 oxygen-carrying power of the blood corpuscles, and the last possesses bactericidal properties. The combination should prove of value as a remedy in many morbid conditions. Phospho-Albumen. Under this trade-name and the sub-title Syrup of Di-Oleyl- Lecithin, an animal extract is prepared in Chicago, which is said to be derived solely from the testes, spinal cords and brains of bulls. The juice is sterilized by D’Arsonval’s carbonic acid process, and is mixed with simple syrup as a preservative menstruum and some flavoring material. It is supposed to contain lecithins, spermine, nuclein and phos- phorized albumins, is put up in 12-oz. bottles, and is apparently a favorite tonic with many prominent physicians of Chicago. It is not patented, copyrighted or advertised, is sold only on physicians’ prescriptions, and its manufacturers assure the profession that so far as their methods of promotion are concerned it will remain practically inaccessible to the laity. Spermine has been found in the form of a phosphate in the thyroid and thymus glands, the spleen, the ovaries and the blood, as well as in the testes. Dr. Poehl be- lieves it to be an alkaloidal product of the retrogressive metamorphosis of albumins (a leucomaine) ; and a most powerful intraorganic restorative of the oxidizing properties of the blood. He states that it should not be as a specific for any particular malady, but should be used as a means of promoting oxidation in the body. It has been employed with decided benefit in ataxy and delirious epilepsy (Poehl), as a tonic in tuberculosis (Upenski), also in senile marasmus and the nervous affections of the aged (Victoroff). The Hydrochlorate is used hypodermically, in doses of grain twice daily, in the morning and at noon, avoiding evening administration as it may cause in- somnia. No reaction follows its injection. Brain Extract (Cerebriniri) is obtained from the gray matter of the sheep’s brain by digestion in 5 times its weight of pure glycerin and then adding an equal quantity of a 12 per cent, solution of common salt. Its effects are almost identical with those of orchitic extract, the most notice- able being increased strength and a feeling of well-being, regulation of the organic functions and increase of the cardiac force. It has been em- ployed with benefit in locomotor ataxia, neurasthenia and allied affections, nymphomania, perverted sexual habits of cerebral origin, hysteria, melan- cholia, insomnia, the general debility of malaria, chlorosis and even more profound anaemias (C. Paul); also in cases of defective development of the spinal apparatus, as Freidrich’s ataxia. Mental derangement is not helped by it, or at most but temporarily. The dose is 16 minims (1 cc.) once daily or every other day, administered subcutaneously. Cerebrine is an extract of the entire brain of the ox, prepared by Dr. Hammond of Washington, by digestion for six months in a mixture of glycerin, alcohol, and a satur- ated solution of boric acid, and fdtration through porous stone. The dose is 5 mimiins diluted with an equal quantity of distilled water at the time of administration by hypo- dermic injection. Dr. Hammond prepares similar extracts of the spinal cord (meditlline), the heart (cardine), the pancreas (pancreatine), etc., and advocates their use medicinally on the organopathic theory that they are curative of depressed conditions of the corresponding human organs. Pineal Extract. The pineal gland is present during the entire life of the individual, and its removal has been followed in animals by structural changes in the central nervous system. It is thought that the substance of this gland may act remedially in organic and functional affections of the brain attended with failure of cerebral nutrition, as chronic softening, chronic mania and dementia. Pituitary Extract. The complete removal of the pituitary body (or gland) gives rise to symptoms which occur in a definite order, beginning with lowered temperature and 138 ANIMAL EXTRACTS. loss of appetite, then twitchings, tremors and nervous phenomena, and finally dyspnoea and death. Many of these symptoms have abated considerably after the administration of pituitary gland substance or an extract thereof. This organ has been found enlarged in cases of myxoedema in which the thyroid was functionally absent, and other observa- tions point to some connection between it and the disease known as acromegaly. Inter- nally administered it causes increase of the cardiac force and rate, and a rapid rise of the blood-pressure due to direct contraction of the vessels. It is administered with the view of reestablishing perverted brain nutrition and function, and also with the object of supplying tone and structural growth to the entire nervous and muscular systems, on which its secretion seems to act as an alterative. Adrenal Extract. The ablation of the supra-renal glands in guinea- pigs and frogs is followed by serious nervous disturbances, shown by lower- ing of the body temperature and progressive paralysis, and culminating in convulsions and death. Brown-Sequard made these observations in 1856, and later showed that the subcutaneous injection of extracts of the healthy glands in such cases restored the animals to almost a normal state for a time. As Neurin has been found in the blood of animals suffering from Addison’s disease, it has been suggested that it is the toxic substance which is neutralized by these organs in health ; but the recent researches of Schafer and Oliver have demonstrated that the function of these glands is not a defensive one, but that their secretions possess most positive and remarkable physiological properties, strongly contracting the muscular system in general, but especially the skeletal, the vaso-motor and the cardiac muscle. No other drug produces so great a rise of the blood- pressure as adrenal extract causes; this effect being due to its extraordi- nary contractile power over the muscular fibres in the walls of the arterioles. In this respect its action is directly opposed to that of thyroid extract. Another remarkable property of this extract is the smallness of its active dose, the of a grain of the dried gland producing a maximal effect upon the heart and arteries in a twenty-pound dog. From this the con- clusion is formed that its active principle is capable of producing a well- marked physiological effect in the dose of of a grain for an adult man. This is probably the smallest active dose on record for any article in the materia medica. The medulla of the suprarenal gland contains a dialyzable organic principle which is soluble in water. It is not eliminated by the gland itself or by the kidneys ; and is not oxidized or destroyed by the blood, inasmuch as it retains its full power after having been in contact with blood for 24 hours. It is probably stored in the organism and rendered harmless by some of the other glandular organs after it has performed its proper function. Though produced in very small quantity it doubtless preserves the normal action of mus- cular tissue, especially of that in the blood-vessels, and its absence gives rise to a series of symptoms which terminate in prostration, inanition and death. Adrenal Extract has been employed in a few cases of Addison’s disease, anaemia and diabetes, with some benefit, but the improvement ceased with the discontinuance of the remedy. It may be tried in muscular dis- orders, especially those which involve loss of tone or changes of degenera- tive type. The dose of the dry extract, as put up in tablets, is from 5 to 30 grains. ANISUM. 139 Renal Extract.—An extract of the kidney substance is suggested as being possibly beneficial in affections arising from impairment or failure of nitrogenous metabolism, the promotion of which is one of the functions of that organ, according to the new physi- ology. There are no reliable data on which to base any opinion as to the merits of this agent as a remedy. Lymphatic Extract.—An extract prepared from the lymphatic glands of animals has been employed in exophthalmic goitre, lymphadenoma, and other glandular swell- ings, but there are no trustworthy reports as to the results. Pancreatic Extract.—In many cases of diabetes decided structural changes have been observed in the pancreas after death, and the ablation of this gland in animals is followed by emaciation and glycosuria; but these symptoms will not occur if a portion of the pancreas is left, or if a part of it be engrafted on the peritoneum after its removal from its proper location. These facts have suggested the probability of the possession by the pancreas of power over carbohydrate metamorphosis, through the action of some substance elaborated by the peculiar, vascular epitheloid tissue which occurs in isolated patches throughout its substance, and which is not found in any other duct-bearing gland in the body. Upon this theory the pancreas, both in substance and extract, has been administered as a remedy for diabetes, but the results have been negative in nearly all the cases. A few instances are recorded in which its use was followed by some temporary amelioration of the symptoms of the disease. Splenic Extract.—Excision of the spleen, or the serious impairment of its functions by disease, is usually followed by marked tissue changes and great susceptibility to altera- tions of temperature, especially in malarial subjects. The substance of this organ has been used medicinally in various disorders of the blood, with the idea of supplying to that tissue some material which may be necessary to its health. The possession of bactericidal power by some secretion of the spleen is strongly indicated by certain facts, among which are the evident incompatibility of tuberculosis and malaria and the enlargement of the spleen in acute infectious diseases, as though purposely battling against the germs there- of. It has therefore been suggested that the splenic substance of animals naturally im- mune against certain of these diseases be employed as a remedy therein,—for example, in tuberculosis, malaria, and typhoid fever. By this method of treatment it is hoped that some light may be thrown on the functions of this organ, as has so recently been done in the case of the thyroid gland. Ovarian Extract.—The substance of the ovaries has been administered with some benefit in the nervous manifestations and pathological conditions which occur when the ovarian functions are partially or wholly arrested, as in cirrhosis or malignant disease thereof, or after the operation of ovariotomy. It is said to be a serviceable remedy in cases of depression or other mental disturbance coincident with the climacteric. Uterine Extract.—The substance of the uterus has been employed as a remedy in those disorders and cachexise which seem to be consequent on the removal of this organ and its appendages. The available data are not, however, sufficient to enable any con- clusion to be formed as to its efficacy. ANISUM, Anise,—is the fruit of Pimpinella Anisum, a European plant of the nat. ord. Umbelliferge. It occurs in ovate bodies, of grayish color, aromatic odor, and sweet, spicy taste, resembling conium fruit in appearance. Dose, gr. x-xx. Oleum Anisi, Oil of Anise,—is a volatile oil distilled from Anise, and represents the medicinal qualities of the plant. It congeals at 50° to 590 F., is soluble in an equal part of alcohol, and is an ingredient of Tinctura Opii Camphorata, Troschisci Glycyrrhizse et Opii, and of the two following preparations. Dose, rr\J-v. Aqua Anisi, Anise IVater,—has in 500 parts I of Oil of Anise triturated with Calcium Phosphate, and mixed with distilled water. Dose, indefinite. Spiritus Anisi, Spirit of Anise,—is a 10 per cent, solution of the oil in alcohol. Dose, 3 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-mixtures, and relieves slight intestinal colic and flatulence in children. In full doses it has weak narcotic power. 140 ANTHEMIS ANTIMONIUM. ANTHEMIS, Chamomile—the flower heads of Anthemis nobilis, a European per- ennial of the nat. ord. Composite, collected from cultivated plants. They contain a volatile oil, a camphor and a bitter principle, but no alkaloid. There are no official preparations. An infusion ( 3 iv to Oj) may be given in doses of § j-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, nyj-x, on sugar. Chamomile is a stomachic tonic. It improves the appetite and aids digestion by increas- ing 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 remarkably efficient in reducing reflex excitability in frogs, even after its excita- tion 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 chil- dren, spasmodic asthma, whooping-cough, colic, and the spasmodic and pseudo-neuralgic affections of hysterical women. It should prove extremely useful in poisoning by Strych- nine, from its power over reflex excitability. The Chamomilla of the homoeopaths is the Matricaria Chamomilla, or German Cham- omile, official in the U. S. Pharmacopoeia as “ Matricaria,” which see. 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. : Antimonii et Potassii Tartras, Antimony and Potassium Tartrate, 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 65, Alcohol 150, White Wine to 1000. Contains about 2 grains of Tartar Emetic to the f,, and is an ingredient of Mistura Glycyrrhizae Composita. Dose, rt\v-xv, as a febrifuge and expectorant. Syrupus Scillae Compositus, Compound Syrup of Squill, Cox's Hive Mixture, Hive Syrup (See under SciLLA),—contains about 1 grain of Tartar Emetic to the with Squill, Senega, etc. Dose, rqj-gj, cautiously in children. Antimonii Oxidum, Antimony Oxide, Sb203,—-a heavy, gray powder, insoluble in water or alcohol, but readily and wholly soluble in Hydrochloric or Tartaric Acid solu- tions. Dose, gr. j-iij. It constitutes of— Pulvis Antimonialis, Antimonial (or James’) Powder,—consists of the Oxide of Antimony 33 parts, with 67 of Calcium Phosphate. Dose, gr. iij-viij, every 3 hours as a diaphoretic, larger doses for emetic and cathartic effects. Antimonii Sulphidum, Antimony Sulphide, 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. Antimonii Sulphidum Purificatum, Sb2S3,—is purified by maceration in Aq. Am- monise, washing and drying. Dose, gr.^-j. Antimonium Sulphuratum, Sulphurated Antimony, Kermes Mineral,—is chiefly Sb2S3, with a very small amount of Sb203. A reddish-brown, odorless and tasteless pow- der, insoluble in water or alcohol. Is a constituent of Pil. Antimonii Composite. Dose, gr- j-v. Pilulae Antimonii Compositae, Plummer's Pills,—each pill containing about gr. ]/z each of Calomel and Sulphurated Antimony, with Guaiac and Castor Oil. Compounds of Antimony and their Preparations. antimonium. 141 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 ulcera- tions, extending from the mouth to the stomach, with salivation and pain- ful 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,—the same phenomena as 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. Physiological Action. Antidotes, Antagonists and Incompatibles. 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 142 ANTIPYRINUM. 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. -gVtV)* being highly efficacious in acute inflammatory affections of the respiratory tract, especially pneumonia, broncho-pneumonia, acute oedema of the lungs, feverish and catarrhal colds, bronchitis, laryngitis and tonsillitis. 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 often simulate asthma, the attacks being marked by cough, wheezing, and difficult respiration, with 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. j to the 3) should be remembered in administering it to children. (See under 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. ANTIPYRINUM, Antipyrin, Phenyl-dimethyl-pyrazolon, C20H18- N402,—unofficial in the United States, but official in the Br. Ph. under the name Phenazonum, Phenazone,—is a crystalline substance obtainable from phenyl-hydrazine, and prepared by a patented and complicated pro- cess. It is a synthetical base, forming salts which are analogous to those of Ammonium; and occurs as colorless and inodorous scaly crystals, with a bitter taste, freely soluble in water, alcohol and chloroform, less soluble in ether. It gives a deep red color with ferric chloride, a deep green with nitrous acid, and with nitric acid a yellow color which deepens to crimson on warming. It is not irritant to the stomach or the tissues and may be administered hypodermically. ANTIPYRINUM. 143 Dose and Administration. The Br. Ph. states the dose at from gr. iij to gr. xx. An average adult dose may be placed at gr. x. For children the dose is gr. y per year of age between 2 and 5 years, gr. y2 per year from 5 to 10, not exceeding gr. v at a dose for any child under 15 years of age. Antipyrin 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 X to 5 grains;—or in Aromatic Elixir,—say gr. lxxx in * iv, of which solution each 5J contains gr. ijss. If vomiting result, the same dose may be dissolved in half its weight of hot water, and injected hypodermically while warm. Incompatibles. Antipyrin 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. It is more or less decomposed or thrown out of solution by a large number of chemical compounds and other preparations, of which the following are the most important, viz. : — Acid, Hydrocyanic, Dilute. Acid, Tannic. Butyl-chloral Hydrate. Chloral Hydrate. Cinchona, Decoction. Cinchona, Fluid Extract. Catechu, Infusion (cone.). Ferrum, Sulphate. Ferric Salts in Solution. Ilamamelis, Tincture. Iodine, Tincture. Arsenic and Mercury, Solution of the Iodides of. Mercuric Chloride. Naphtol (3 (solid). Nitrites in solution (acid). Sodium Bicarbonate. Sodium Salicylate (solid). Tinctures containing Tannin, Iron, or Quinine. Rose, Infusion. Uva Ursi, Infusion. Antipyrin and Phenyl-urethan liquefy when rubbed together. Unofficial Preparations. Salipyrin, Antipyrin Salicylate,—is formed by combining Salicylic Acid 57.7, and Antipyrin 42.3 parts ; and is the only salt of the base which has any therapeutic import- ance. Described under Salix. Hypnal.—is a combination of Antipyrin and Chloral, heated together, which is credited with hypnotic and analgesic power. It is described under Chloral. Migranin,—is a double Citrate of Antipyrin and Caffein, lately brought forward in Germany as a specific for sick headache and neuralgia. A report is published that the police authorities of Hamburg have issued a notice forbidding its free sale in the local pharmacies, and warning the public against using it except under a physician’s direction (Squibb). The dose is placed at about gr. xv. Phenopyrin,—is prepared from equal parts of crystalline Phenol and Antipyrin. It is an oily liquid, colorless and odorless, insoluble in cold and sparingly soluble in hot water. It has as yet no medicinal importance. Physiological Action. Antipyrin is a powerful antipyretic, a local anaesthetic, and a general analgesic,—and also possesses diaphoretic, mydriatic, antiseptic, disinfec- tant, hemostatic and slight hypnotic powers. After the ingestion of a full medicinal dose (gr. xx-xxx), there is a stimulant stage of short dura- tion, 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 de- 144 ANTIPYRINUM. pression, and if fever be present by lowered temperature ; the latter com- ing 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 x to 10 hours, a fair average being about 2 hours. In one case a fall of 120 F. was observed. When given with Kairin, the mixture of the two drugs has been found to produce a much greater fall of temperature, with longer continuance down, than that produced by an equal quantity of either drug given alone. After the antipyretic effect of the dose 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 Kairin, Chinolin, and other members of the group. In health the administration of a full dose 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 an urticarial eruption on the skin ;—and may cause such a degree of depression as to amount to collapse. It has little or no effect upon the respiration, but acts as a sedative upon the cerebrum, leaving behind a somewhat depres- sant influence on the brain. It dilates the pupils and is rapidly eliminated by the kidneys, appearing in the urine within half an hour after its inges- tion. The profuse sweating which it causes may be prevented by giving in advance a small dose of Atropine or Agaricine. In toxic dose Antipyrin probably acts as a primary stimulant and a sec- ondary depressant of the spinal cord, paralyzes both the motor and sen- sory nerve trunks, decreases the arterial pressure, and exerts a poisonous influence on the blood, altering the shape of the red corpuscles, separating the hsematin, and causing decomposition of that fluid tissue. A peculiar livid discoloration of the surface is one of the most characteristic symp- toms of antipyrin poisoning, and is probably due to the formation in the blood of methsemoglobin or some similar compound. As an Antipyretic, Antipyrin, 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 due to evap- oration of the sweat. As an Analgesic, Antipyrin has a very considerable degree of power, in common with all the Chinolin derivatives ; but its property in this re- spect 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 Ergotin. ANTIPYRINUM. 145 One of the most popular of the modern antipyretics, Antipyrin deserves high rank in professional esteem, being an excellent analgesic and one of the most certain and most powerful depressants of temperature, though somewhat dangerous, and devoid of any other influence upon the course of any febrile disorder. Its principal applications are as follows : (i) As an antipyretic, it has been employed in all diseases with high temperature, and it may be used in asthenic fevers, as it has little effect upon the circu- lation. It has held a high place for several years in the treatment of acute rheumatism, and affords valuable aid in the pyrexia of intermittent fever, a stage in which the slow action of quinine prevents that drug being avail- able for immediate relief. (2) As an analgesic, it is highly efficient ex- cept when the pain is dependent upon a local inflammation, in which case it is of no value for this purpose. It is often remarkably efficient in migraine and other headaches, in the fulgurant pains or the pain-crises of locomotor ataxia, and in other paroxysms of suffering dependent on dis- ease of the nerve centres, or having the character of nerve storms. It is very serviceable in neuralgia, neuritis and other painful affections, espec- ially when of rheumatic origin, as lumbago, sciatica, hemicrania, supra- orbital neuralgia, etc., in which ten-grain doses are generally sufficient and may be given hypodermically. It often relieves dysmenorrhcea, also the painful affections of hysteria, pain from cerebral tumors, and that due to cardiac disease. In acute gout, a preliminary dose of 25 grains, fol- lowed by 10 grain doses every two hours, promptly relieved the pain and shortened the duration of the paroxysms in one very carefully observed and thoroughly reported case. In chronic gout, very remarkable results are reported as due to Antipyrin, indicating a specific and curative influ- ence on that disease. For the relief of pain, the conjoint administration of Antipyrin and Morphine is said to be much more efficient than the use of either agent alone. (3) To allay nervous irritation; thus it has been used with extraordinary success in nervous urticaria, and is often em- ployed with benefit in the restlessness of hysterical subjects. In the urti- caria-like eruptions of children its action has been so promptly efficient as to indicate for it a direct influence upon the vascular nerves ; and as a symptomatic remedy against itching it is equally efficient in nervous pru- ritus, true prurigo, urticaria, erythema, pemphigus vulgaris and lichen ruber. (4) To antagonize excitability of the motor nerve centres, as in laryngismus stridulus, whooping-cough, tetanus, epilepsy and chorea. In the latter disease Antipyrin is held in high esteem as a curative remedy, and although it often fails entirely in epilepsy, it sometimes acts therein with extraordinary power, especially when given in combination with ammonium bromide. (5) To affect secretion, as in infantile diarrhoea, in which it has rendered signal service, administered in doses of to 1^ Therapeutics. 146 ANTITOXINS. grain ; and as an antigalactagogue, when it is desired to arrest the secre- tion of milk, doses of gr. iv every two hours will prove efficient. It has also been employed with benefit in diabetes, both true and insipid, and has been found to be remarkably effective in promoting the absorption of pleuritic effusions. (6) As a local ancesthetic it is equal if not superior to cocaine, if applied to the mucous membranes in a 30 to 50 per cent, so- lution (St. Hilaire). (7) As a local hcemostatic, it is highly efficient in 15 per cent, solution as a spray for epistaxis, and hemorrhages of almost any kind are checked by the application of stronger solutions. It has the advantage of constricting the small vessels without causing any external clot which may break down. (8) As an atitiseptic it possesses properties which compare favorably with most of the anilin and coal tar derivatives. Antipyrin has rendered good service in bronchial asthma, in sea-sick- ness, in cerebro-spinal meningitis, and in croupous pneumonia. In the latter affection it has been employed in combination with camphor and small doses of morphine with excellent results. ANTITOXINS (Unofficial). The remarkable reports which have been published during the last two years upon the antitoxin treatment of diphtheria and tetanus have excited fresh interest in bacterio-therapy, and seem likely to dispel the cloud which has rested thereon ever since the failure of Koch’s tuberculin. After the discovery of the bacillus tuberculosis in 1882 several other micro-organisms were found to be con- stantly associated with certain acute infectious diseases, notably tetanus, diphtheria, cholera, pneumonia, erysipelas and typhoid fever. The specific microbes of these affections were at first believed to be the imme- diate cause of their respective disorders, but later researches have shown that such diseases are due to the action of chemical poisons (toxins and toxalbumins) produced by their specific bacteria growing on suitable soils either within the animal organism or outside it. (Compare the article entitled Toxins.) It was shown by Von Fodor in 1887 and subsequently by Nuttall that the blood serum of healthy animals is naturally bactericidal, that it possesses this quality in varying degrees of efficiency, and that it may be sufficiently powerful in this respect to prevent certain pathogenic bacteria from gaining lodgment on the organism, thereby conferring natural immunity against a particular disease upon the individual so protected, and in some cases even upon the species. Further study and experiment established the fact that temporary artificial immunity against certain dis- eases may be imparted to an individual animal naturally susceptible by repeated inoculations of the specific bacteria or their toxic products in gradually increasing degrees of virulence (Behring, Kitasato, Roux). The crowning discovery that the blood serum of such an immunized ANTITOXINS. 147 animal maybe successfully employed for curative as well as prophylactic purposes against its particular disease upon other animals of the same or different species, was made by Professor Emil Behring of Berlin, in 1891. This was no chance discovery, but was the legitimate result of logical reasoning and hard work, and is formulated under the title Behring's Law, as follows : That the blood serum of an animal which has been arti- ficially rendered immune against a certain infectious disease, when injected into the body of another animal, has power to protect the latter individual against the same disease and to cure the disease after infection has occurred. An Antitoxic Serum or Antitoxin is a blood serum possessed of these immunizing and curative properties. The term Antitoxin is also applied, and more correctly, to the suppositious defensive proteids, which are chemical substances assumed to be contained in the antitoxic serum, and believed to be produced by the blood or tissue cells for the defence of the organism against the foreign bacterial toxins. Alexins are similar substances, natural antitoxins, which are supposed to exist in the blood of naturally immune animals. Ehrlich has shown that Behring’s law is valid also for the chemical poisons, Ricin and Abrin, the respective toxalbumins of the ricinuspalm and the jequirity bean. The blood of animals slowly immunized by increasing doses of these toxins contains antitoxic sub- stances named Antiricin and Antiabrin, which, if added to their respective poisons, will attenuate and even neutralize the latter. These facts are advanced as proof that the slowly increasing artificial immunity is not a simple tolerance acquired by the organism, as Sternberg taught, but is due to the production of new antagonistic and defensive sub- stances by the living cells of the organism. Theories deduced from the observed facts are as follows : (1) That, as the various pathogenic bacteria produce the causative toxins of their re- spective diseases, so the organic cells of the body, reacting under the stimulus of the poisons thus introduced, immediately proceed to elaborate defensive antitoxins, which if produced in sufficient quantity will neu- tralize the effects of the toxins. (2) That residual antitoxins remaining in the blood after recovery render the animal immune for a time against the disease. (3) That the immunizing and curative effects obtained by the injection of the blood serum of an immunized animal into the circu- lation of another animal are due—either to direct chemical neutralization of the toxins themselves by the antitoxins so introduced (Behring, Kita- sato), or to a particular influence exerted by the antitoxins upon the living cells of the organism, which, being affected in two opposite direc- tions, remain neutral to the disease (Buchner). Specific action is a characteristic of the antitoxins with perhaps a few exceptions; which means that the serum from an animal inoculated with the toxin of the diphtheria bacillus is effective only against diphtheria, and the tetanus antitoxin only against tetanus. A dose of an antitoxin followed by a dose of the corresponding toxin produces no effect from either, the action of the one being rendered ineffective by the other. 148 ANTITOXINS. The corresponding toxin and antitoxin may be mixed together outside the body and then injected with like result, though of course there must be a certain amount of antitoxin present to counteract a given dose of toxin. The immunizing or vaccine property of the antitoxins, though transient, are probably destined to be of considerable importance. In- stances are already recorded in which epidemics of diphtheria in schools were apparently stopped by vaccinating all the children therein with diphtheria antitoxin. An Antitoxic Serum is prepared as follows. Either a highly virulent culture of the specific micro-organisms of the particular disease, or still better, a strong toxin of tested strength prepared therefrom, is injected into the cellular tissue of a suitable animal, generally a horse, at first in very small quantity. The effect is soon shown by the onset of fever and other symptoms of acute disease, which are known as the “reaction.” After an interval of time sufficient for recovery from these symptoms, the injection is repeated with a stronger toxin or with a culture of greater virulence, or with a larger quantity of the original toxin. With proper care the amount injected may be gradually increased, until ultimately a dose many hundred times greater than one which would have been fatal at first can be given with impunity. This process is continued for several months, or until the animal no longer “ reacts ” to the poison, and then sufficient antitoxin is presumed to exist in its blood to render it immune to the toxin and to the disease. After each inoculation the animal’s blood serum is tested as to its value by experiment on guinea-pigs of defi- nite weights. When the desired degree of immunity is reached the ani- mal is bled from the jugular vein under strict aseptic conditions, from 6 to 12 pints being taken from a horse, according to his size and general condition. The blood is received in sterilized flasks, which are carefully stoppered and stored on ice until the clot has separated from the serum. The latter is tested to determine its value in antitoxin, has carbolic acid added to it in the proportion of 0.5 per cent., and is bottled in vials which contain in each the dose for one patient. The vials are labeled with a statement of the number of normal antitoxin units per ccm. of the contents, expressed in multiples of a standard normal serum. The effec- tive antitoxin value of a serum intended for protective purposes is much less than that of one intended for curative action, and the earlier in the course of the disease that the latter serum is employed the smaller will be the quantity capable of producing a certain remedial effect. Serum-therapy properly means the prophylactic and curative treatment of certain acute infectious diseases by the subcutaneous injection of a blood serum containing an antitoxin specific to the particular disease. As generally used, however, this term includes the treatment of the same disorders by the toxins produced by attenuated cultures of their respective ANTITOXINS. 149 microbes; but these toxins, though sometimes grown on blood serum, may be cultivated on other media, and are never administered in a serum as the antitoxins invariably are. The antitoxins at present employed in serum-therapy are those of diphtheria, tetanus, tuberculosis, erysipelas, pneumonia, cholera, syphilis, and typhoid fever, but only the first three have come into anything like general use. The toxin treatment is described under the title Toxins. Diphtheria Antitoxin, though not the first antitoxin discovered is by far the first in practical importance. The bacillus of diphtheria was discovered by Lceffler and Klebs in 1884, its toxic products were isolated by Roux, and the antidote to them was found by Behring, who estab- lished the preventive and curative properties of this antitoxin. In the meantime Sidney Martin had proved the chemical identity of the labora- tory toxins discovered by Roux with those produced in the body by the bacillus. The clinical results obtained in Paris by the use of Behring’s diphtheria antitoxic serum were announced by Roux at the Buda-Pesth Congress of Hygiene in 1894, and attracted universal attention. Since then the statistics of diphtheria serum-therapy have grown voluminous, have included a large number of reports from official and private sources of the highest professional authority, and the weight of evidence has steadily grown more and more favorable to this treatment. The statistics first presented by Roux covered 300 cases of true diphtheria, treated at the Hopital des Enfants Malades in Paris, with a mortality under the serum treatment of 26 per cent., against a mortality of 51-7 per cent, in the same hospital during the pre- vious four years in 3971 cases, and a mortality of 60 per cent, in 520 cases during the six months immediately preceding. Professor VlRCHOW stated, at the last Christmas ftteoi the Empress Frederick Hospital in Berlin, that from April to November, 1895, out of 335 diphtheria cases treated therein with the serum 305 were cured ; and that the diphtheria mortality in that hospital, formerly 43 per cent., had declined to 9 per cent, under the antitoxin treatment. Professor Welch of Baltimore has collected and an- alyzed the statistics available in July, 1895, covering 7,166 cases from 80 different sources, and showing a general mortality under the antitoxin treatment of 17.3 per cent., against a previous general mortality of 42 per cent. Tabulating the results according to the time at which the treatment was commenced, he shows for 814 cases treated on the first and second days of the disease a mortality of 5 per cent.;—for 531 cases treated on the third and fourth days 15.2 per cent.,—and for 286 cases treated after the fourth day 31.8 per cent. (Bulletin of the Johns Hopkins Hospital, 1895, No. vi.). Similar evidence is presented in nearly every report published, and in estimating its weight it should be remembered that these reports -are not made by unknown men, but emanate from trained clinicians and recognized professional authorities in the most populous centres of the civilized world. The clinical history of the disease under the serum treatment, as re- corded by its observers, is equally favorable, and shows an extraordinary decrease in the severity of the symptoms. The membrane loosens and clears off rapidly, the temperature if high is lowered, and the pulse slows and gains in force (Washbourn). Evident signs of distress vanished within 24 hours, and apparent strength and good-humor took the place of a previously low condition both mental and physical (Kossel). In no case did the larynx become involved after the use of the serum if not so 150 ANTITOXINS. previously, and many cases showing laryngeal symptoms recovered with- out tracheotomy (Kossel). Even in the fatal cases life was prolonged (Caiger). While diphtheria antitoxin properly prepared and used under aseptic precautions is generally conceded to be harmless, some ill effects are re- corded as caused by it. An urticarial eruption on the skin, also pains in and swellings about the joints occur in about 5 per cent, of the cases, but these symptoms are usually transient and without serious consequences. Abscess at the site of the injection has occurred, but rarely forms if proper aseptic measures are used. Welch states that over 100,000 injections have been given, and that the serious mishaps directly attributable to the serum can be counted on the fingers. Two deaths are recently reported, one in Berlin and one in Oregon, as having occurred within a few minutes after the injection of the antitoxin in healthy children. The following seem to be established facts as to the use of antitoxin in diphtheria. That the immunized serum is far more efficient as a curative agent than any remedy heretofore employed, the general mortality of the disease having been reduced by its use to about 17 per cent, from a pre- vious rate of about 42 per cent. That a marked improvement in both the local and general symptoms is usually noticed within 24 to 48 hours after the injection of the serum. That the remedy has decided power to prevent the spreading of the false membrane into the larynx and trachea. That it is powerless to repair damage already done to the tissues by the diphtheria toxins, hence the earlier that the serum is administered the better are its results. That it is decidedly more efficient in the fibrinous form of the disease than in the septic form, and in cases of simple infec- tion than in those of double or mixed infection. That the (liability to paralysis and albuminuria is not lessened but is perhaps somewhat in- creased by this treatment, though genuine nephritis is less frequently seen under its use than in cases treated by other methods. That the serum may cause certain untoward symptoms, as cutaneous eruptions, swellings, etc., but that these are not serious and are not attended with danger to life. That its injection is very rarely followed by serious local disturb- ances, as abscess, and probably would never be complicated thereby if the serum were always pure and used with strict aseptic precautions. That recent improvements in the methods of preparation and more definite knowledge as to the dose and manner of employment have made the later reports even more favorable than the earlier ones. At the 1895 meeting of the British Medical Association, Professor Klein made the statement that “ the scientific basis for the application of antitoxic serum is as firmly founded and as thoroughly established as the use and application of any known drug.” Local antiseptic treatment of the throat is still insisted on in connec- 4 ANTITOXINS. 151 tion with the serum injection in every case of the disease. If thoroughly carried out in the incipiency it may destroy the dangerous streptococci and other microbes, thereby preventing the mixed infection which proves so virulent; if continued throughout the case and during convalescence it will minimize the danger of infecting other persons. In some in- stances bacilli were found as long as two months after recovery. Diphtheria Antitoxin is now prepared in all European countries and in the laboratories of several boards of health, manufacturing druggists and others in this country. The serum on the English market differs somewhat in strength, Aronson’s being a highly concentrated form obtained by precipitating the greater part of the inert constituents, while Klein’s is prepared by injecting both the toxins and the bacilli into the animal to be immunized. The serum furnished by the British Institute of Preventive Medicine contains 1,500 normal units in each 10 ccm. In Germany the preparation of the serum is conducted by a private firm under the supervision of Professors Behring and Ehrlich, and is tested by official experts' before its distribution is permitted by the government authorities entrusted with the control of its manufacture. Behring's Diphtheria Antitoxin is standardized in comparison with a “ normal therapeutic serum ” of which one-tenth of a gramme will neu- tralize one gramme of diphtheria toxin, and 1 ccm. of which is termed equivalent to one “ normal” or “ immunizing unit.” As distributed the serum contains at least 100 such normal units in each ccm., the label on every vial showing the potential strength of its contents, thus: “This phial contains 6 ccm. of 100 times normal strength = 600 normal units.” Four different potentials are furnished,—one with a yellow label, possess- ing 200 units, and intended only for prophylaxis, and three for therapeu- tic employment, viz: (1) that with a green label, containing 600 units, for use only in fresh cases on the first or second day; (2) that with a white label, possessing 1,000 units, to be used in more serious cases on the first or second day, or in less serious cases of longer standing ; (3) that with a red label, possessing 1,500 units, and meant for adults or for very severe cases in children. The dose for prophylaxis is 200 units, to be repeated after two or three weeks if the case is still exposed to infection ; but this amount is too small if the patient is in the incubation period of the disease. The im- munity is only temporary, its duration depends on the quantity of anti- toxin injected, and it gradually decreases as the latter is eliminated, but it can be maintained for a long time by the repeated use of smaller doses at short intervals. The dose for curative purposes should be rather large than small, in order to guard against a virulent infection, 200 to 300 units for a light case, 500 to 800 for a severe or advanced one; to be repeated on the next or even on the same day if the case seems grave, until 800 to 1,000 or even 1,500 units have been given. The maximum quantity decided on may be administered in one dose, and as a rule will not require to be repeated. The necessary amount for any case can only be determined by comparative estimation of the quantity of toxin present as indicated 152 ANTITOXINS. by the symptoms; remembering that this quantity increases rapidly with every day after infection. The prognosis is unfavorable if the case is so far advanced before treatment that the toxin has had time to accumulate and to exert its paralyzing influence on the nervous apparatus of the heart. Gibier’s Diphtheria Antitoxin is prepared at the biological laboratory of the New York Pasteur Institute from the blood of horses made immune by injection for over a year with diphtheria toxin. Two forms are supplied, a liquid and a dry one. The liquid product is supplied in bottles containing 5, 10 and 25 ccm. each, representing re- spectively 500, 1,000 and 2,500 units. The smallest size is intended for immunizing purposes, the medium one is a single curative dose for incipient cases, and the largest for repeated injection and extended treatment in fully developed or grave cases. In the latter the dose should be 25 ccm. at first, 25 ccm. more within 24 hours, and even 100 ccm. may be injected within a few days, the serum being entirely innocuous. The dry form is a powder, one gramme of which is to be dissolved in 15 to 25 ccm. of sterilized water in a sterilized vial, furnishing the equivalent of over 1,500 units. This amount will suffice for an incipient case, for a severe one two or even three times the quantity may be used on the first day of treatment. The injections are given by means of a sterilized hypodermic syringe, preferably in the lateral part of the abdomen, after the site of injection has been carefully washed with a 4 per cent, solution of carbolic acid or a I per cent, solution of lysol. They are almost painless, and subsequent massage is unnecessary as the swelling caused by the fluid disap- pears quickly. Gibier’s Double Antitoxin is a serum obtained from a horse which has been im- munized against streptococcus virus after having been previously rendered immune against the diphtheria bacillus. It is supposed to contain both the diphtheria and streptococcus antitoxins, and is intended for the virulent cases due to a mixed infection with these two poisons, but it may be used in any case of diphtheria. It is supplied in vials containing 25 ccm. each, which quantity should be injected in two doses 12 hours apart in an ordinary case; but for severe cases the amount used should be 25 ccm. at first and 25 ccm. more within 24 hours, to be repeated daily until 100 ccm. have been administered. Concentrated Diphtheria Antitoxins, containing 200, 300 and 400 antitoxic units to the ccm., have been produced at the laboratory of the New York Board of Health. Tetanus Antitoxin. Tetanus was one of the first diseases to be studied successfully by the bacteriologists, and its antitoxin was the first one prepared. Breiger (1880) showed that a crystalline substance of high toxicity could be obtained from tetanic fluids, and that it would repro- duce the symptoms of tetanus when injected into healthy animals. Rosen- bach found the tetanus bacillus in human cases of the disease, and Nico- laier demonstrated its existence in soils. Kitasato soon afterward obtained pure cultures of the bacillus, and demonstrated the immunizing power of the serum of animals inoculated with its toxin. As human tetanus is a comparatively infrequent disease there are but few available statistics of its treatment with antitoxic serum, all the reported cases numbering less than a hundred; but its previous mortality, as shown by the two largest sets of statistics, covering 2,789 cases, was 88 per cent., which has been reduced to 20 per cent, under the serum treatment (Kreiger). Dr. Marson has reported a series of 38 cases so treated by various physicians, with 25 recoveries, a mortality of 34.2 per cent. In spite of its failure in many instances, the antitoxic serum is unquestionably the most efficient remedy known for this disease. As tetanus is only recognizable by symptoms due ANTITOXINS. 153 to nerve lesions, which symptoms are not manifested until the nervous system has been damaged by the toxin, an early diagnosis is impossible; and when first seen by the physician the disease has usually advanced too far for the curative action of the remedy to be available. For this reason, and as the immunizing properties of this antitoxin are very potent, it is advised that a preventive inoculation thereof should be given in all cases where infection is possible, such as lacerated wounds soiled with earth or rust, especially when occurring in those tropical countries where the disease is most common. For this purpose a dose of 10 ccm. would suffice, if repeated at intervals of two or three weeks. For curative purposes the serum should be injected as soon as possible, the quantity being deter- mined according to its stated strength, the gravity of the symptoms, the patient’s age and the time since infection. The shorter the time of in- cubation or the more serious the symptoms, the larger should be the initial dose. As a rule one injection should be given every other day, using a smaller quantity at each repetition, so as to maintain sufficient immunity and prevent relapse. Along with the serum treatment the usual remedial measures should be employed, namely: excision of the part or the actual cautery if the wound is recent, chloroform anaesthesia, chloral, etc. The actual cautery, or the application of a strong solution of corrosive sub- limate with tartaric acid, are the most efficacious means of neutralizing the tetanus germs in the wound. The tetanus antitoxin prepared by Dr. Gibier of the New York Pasteur Institute is dispensed in dry form only, may be transported any distance without injury by heat or frost, and is said to preserve its qualities for an indefinite time if kept in a dark and dry place. It represents as many antitoxic units as are contained in about 12 times its weight of liquid serum. The powder is put up in 25 ccm. bottles, each containing 3 grammes, to be filled with sterilized water when required for use, and shaken thoroughly until the powder is dissolved. Each bottle then contains two doses of antitoxic solution, and this amount is to be administered daily for four or five days, beginning on the very first appear- ance of symptoms of the disease. For prophylactic use 1 or 2 ccm. of the solution should be injected immediately after the infliction of a suspicious wound. Tuberculosis Antitoxin has superseded Koch’s tuberculin, which was a toxin treatment, in the serum-therapy of tuberculous disease. Boinet immunizes goats with injections of tuberculin, and claims to have used the resulting serum in eight cases of tuberculosis with marked bene- fit. Professor Maragliano, of Genoa, has treated 82 cases with a serum similarly prepared. He reports that the cases of unmixed infection, with circumscribed foci of disease, slight surrounding consolidation, and but little fever, are distinctly benefited by the treatment and even some are cured thereby ; but that those with much broncho-pneumonic consolida- tion or with cavities do not show any great improvement. Dr. Maragliano administers in apyretic cases or those with slight fever I ccm. of the serum every second day for the first ten days, then a similar dose every day for another ten days, then two similar injections daily for the next ten days. If there is high fever io ccm. should be given at once, and after three days a daily injection of I to 2 ccm. if 154 ANTITOXINS. the fever does not rise again, but if it persists a second dose of 10 ccm. is given eight days after the first one. Improvement is noticeable often within two weeks but sometimes not until after two months have elapsed. Even when a cure seems complete the injec- tions should be continued for at least a month and even for a year. General hygienic measures must not be neglected, and the efficiency of the digestion must be especially attended to. Dr. Paul Paquin of St. Louis has reported upon 22 serious cases of this disease, treated by him in the city hospital with a serum obtained from horses immunized by injection of the toxins of the bacillus tuberculosis. He states that a large percentage of these cases increased in weight from 5 to 16 pounds each during 6 to 8 weeks, and at the same time showed other evidences of general improvement, without the use of tonics or any special diet, only the regular fare of the city hospital or poor-house being available for them. After the lapse of six months the entire 22 were alive, all having improved and more than one-half the number having been dis- charged from the hospital as well enough to work. Numerous reports from other observers testify to good results obtained with Paquin’s serum in the worst cases, e.g., knee-joint tuberculosis (Cale), laryngeal tuberculosis (Loeb), and acute pulmonary tuberculosis (Lemen). The effects observed after injecting Paquin’s serum include erythema, urticaria, local swellings, pain, swelling and stiffness of joints, numbness, pain in the spine, in the back of the head and in the stomach. The most serious complication is a sudden disturbance of the circulation, caused by the injection entering a vein or the muscular tissues, which requires the prompt administration of cardiac stimulants, as alcohol, nitroglycerin, etc. Over 3,000 injections were made in human subjects without one serious accident. Dr. Paquin administers a beginning dose of io minims, with strict aseptic precautions, hypodermatically into the subcutaneous tissue of the back, avoiding vessels and muscular tissue. He repeats the injection once daily, increasing the daily dose by 5 minims so long as it does not raise the temperature above 1° F. A dose of 25 minims is usually sufficient as a maximum. He advocates the use at the same time of a continuous acting vaporizer containing creosote and other antiseptics ; also the inhalation of the vapor of the essential oils of peppermint, eucalyptus and cinnamon from a“ lip-trough inhaler” worn under the nose, and repeated disinfection of the mouth and throat by an antiseptic gargle. He states that a fever rising above loi° F. usually indicates a mixed infection, in which the serum treatment is not indicated; the cases amenable to it being the incipient ones and those in the first and second stages of the disease. Antiphthisin, the remedy prepared by Dr. Ivlebs, may be mentioned in this connec- tion, though it is not an antitoxin, but a derivative of Koch’s tuberculin, the germicidal constituents of which it is supposed to possess, separated from the toxic ones. It is more fully described under the title Toxins. Streptococcus Antitoxin has been employed successfully in erysip- elas, puerperal fever, and several forms of septicaemia and pyaemia due to streptococcus infection. The credit for the suggestion and preparation of this antitoxin is due to Dr. Marmorek, of the Pasteur Institute, Paris, who has treated therewith 411 cases of erysipelas with a mortality of 3.4 per cent. He also treated 16 cases of puerperal fever with this serum; antitoxins. 155 seven of which, due to streptococcus infection, recovered; one, due to bacterium coli, died ; and among eight of mixed infection with strepto- coccus, bacterium coli, and staphylococcus, five died. Several cases of puerperal fever, erysipelas, and other forms of streptococcus infection, are reported by Pozzi, Charrin, Roger and others, as having been treated successfully with this antitoxin. Many of the most virulent cases of diph- theria are due to a double infection with the diphtheria bacillus and the streptococcus, and for the treatment of such cases a combination antitoxin has been prepared by Marmorek and also by Gibier of New York. (See under Diphtheria Antitoxin, ante). The treatment of sarcoma and carcinoma by injections of streptococcus antitoxin is noticed under the title Toxins, and the sub-title Erysipelas and Prodigiosus Toxins. Streptococcus Antitoxin is obtained from the horse immunized against streptococcus erysipelatis by inoculations with the toxins of cultures which have been rendered exceed- ingly virulent by passage through a certain series of animals. The serum possesses great activity, and is dispensed in vials containing a quantity sufficient for four injections of 6 ccm. each, two of which may be given immediately and the remaining two on the follow- ing day. Syphilis Antitoxin.—A serum obtained, from the blood of lambsand dogs has been used by Tommasoli and other Italian experimenters in the secondary and tertiary manifestations of syphilis, with encouraging results. It has been recently suggested that the natural insusceptibility of certain animals to this disease may be increased by injecting into them the blood serum from human subjects in the primary or active secondary stages of syphilis. This has been carried out by Triboulet and others, without pre- judicial effect on the animals injected, and their serum was used in the treatment of extensive tertiary ulcerations, with the result that these lesions almost completely disappeared, although they had resisted a six months’ course of the ordinary treatment. Hericourt records a striking improve- ment in a case of syphilitic tabes under the same method, and other simi- lar observations have been reported with equally favorable results. The doses employed were 2 ccm. of the serum on successive or alternate days. The only complications observed were a transitory roseolar eruption, slight albuminuria, and a brief elevation of temperature. Antivenene is the name given to an antitoxin prepared by Fraser in consequence of Calmette’s observation that the serum of an animal immunized by the injection of increasing doses of serpent venom pos- sesses antidotal and immunizing properties against the effects of the bites of poisonous snakes. The active principle of serpent venom is of albu- minous nature and is analogous to the so-called toxalbumins, active ingre- dients of the bacterial toxins. Antivenene does not seem to be specific, as the antitoxins in general are, for Fraser finds that when obtained by the inoculation of cobra-poison it is equally effective against the venom of several serpent species, including the cobra, the rattlesnake, etc. 156 APIOLUM APOCYNUM. Calmette states that tetanus antitoxin antagonizes the effects of cobra venom to a certain extent, also that intra-venous injections of calcium hypochlorite produce a blood serum which possesses antitoxic properties against the effects of the cobra poison. Other Antitoxins have been prepared by inoculating the cultures or the .toxins of Frankel’s pneumococcus, the typhoid bacillus, and the bacteria of cholera, erysipelas, anthrax, vaccinia and the plague. Even rabies has its so-called antitoxin, though its bacterial origin has never been demonstrated. The results reported therefrom have so far been few and unimportant. Typhoid Antitoxin is obtained by injecting sheep for three months with broth cultures of the typhoid bacillus. The resulting serum is found to be efficient in neutralizing the effects of the typhoid toxins in guinea-pigs, and a few cases of human typhoid have been treated with it, apparently with good results. Vac- cinia Antitoxin is supposed to exist in the serum of vaccinated heifers, and M. BecUre has treated a few cases of variola with such a serum, in one case using 1,560 ccm., with the result that the patient recovered rapidly without suffering any inconvenience. In another case an infant 21 days old received injections of the serum to the amount of of its weight, and was cured of a serious form of small-pox. APIOLUM, Apiol (Unofficial),—is a non-volatile, oily liquid, of green color, acid reaction and pungent taste, soluble in alcohol, ether, chloroform, and in glacial acetic acid. It is extracted from the fruit of Petroselinum sativum (Parsley), a biennial plant of the nat. ord. Umbelliferse, 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, ttphj-x in capsule two or three times a day ; as an emmenagogue, trpxv in one daily dose. A camphor, also named Apiol, C12Hu04, is obtained from the same source, and occurs in white needles, of a feeble parsley odor, insoluble in water, but freely soluble in alcohol or ether. Dose, gr. xv as an antiperiodic, gr. v-x against dysmenorrhoea. In small doses (tTLiij—v) Apiol is carminative, diuretic, diaphoretic, expectorant and stimulant to the circulation. In full doses (rqxv') it is decidedly emmenagogue and feebly antiperiodic, producing headache, tinnitus aurium, intoxication, giddiness, etc., its action generally resembling that of Quinine. Large doses are decidedly narcotic. It has had some reputation in intermittents and in malarial neuralgise, but is most fre- quently employed in amenorrhoea and dysmenorrhoea, 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 generally 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 Apocynum cannabinum, an in- digenous perennial plant of the nat. ord. Apocynacese, and is inodorous, but of bitter, dis- agreeable taste. It contains a peculiar active principle, Apocynin, also tannic and gallic acids, resin, wax, caoutchouc, etc. Dose of the powdered root, gr. v-xxx. A decoction ( % ss to the pint) may be given in doses of j-ij thrice daily. Extractum Apocyni Fluidum, Fluid Extract of Apocynum,—Dose, np v-xxx. Apocynum is powerfully emetic and cathartic in full doses, also diaphoretic, expecto- rant and sometimes actively diuretic. It lowers the pulse-rate, produces much nausea, and induces drowsiness. It should not be confounded with the Indian or American Hemps (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. to gr. y2. AQUA 157 AQUA, Water, H20,—is natural water, in its purest attainable state; a colorless limpid liquid, devoid of odor or taste, and of neutral reaction. Besides entering into the composition of most of the official extracts, fluid extracts, and many other pharmaceutical preparations, from it are prepared the 17 official Waters (Aquae), and also the following : — Aqua Destillata, Distilled Water, H20,—1000 parts of water are distilled, the first 100 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 described under Acidum Carbonicum, ante, page 80. Nomenclature of Water. Aqua Fluvialis, River-water. Aqua Pluvialis, Rain-water. Aqua Fontana, Spring or Well-water. Aqua Marina, Sea-water. Aqua Carbonata, Carbonated Water, Soda Water. Aqua Destillata, 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 constituents in varying proportions,—from common water (Aq. Com- munis), 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, Alka- line, Saline, Sulphuretted, Silicious, etc. Full analyses of all the princi- pal mineral waters of Europe and America are given in the 15th edition of the United States Dispensatory, but a few of the most prominent will be mentioned here. Alkaline Alineral 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. Salute Mineral Waters. Friedrichshall, Germany. Hunyadi Janos, Hungary. Baden-Baden, Germany. Cheltenham, England. Kissengen, Bavaria. Reichenhall, Bavaria. 158 AQUA. Saline Mineral Waters. Wiesbaden, Germany Carlsbad, Bohemia. Pullna, Bohemia. Seidlitz, Bohemia. Marienbad, Bohemia. 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 Carbonates 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°—160°). 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. Friedriehshall 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, IX of Sodium Chloride, and a small quantity of Ferrous Carbonate to the pint; in transpor- tation, 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, Sodium Bicarb. 80, Sodium Chlo- ride 40 ; a dessertspoonful in water as a mild saline purgative. These waters are imported into, and made in the United States in large quantities, and may be ordered through any druggist. Aix-la-Chapelle, Prussia. Bareges, S. France. Eux-Bonnes, S. France. Llandrindod, Wales. Harrowgate, England. Sulphurous Mineral Waters. Blue Lick Spring, Ivy. 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. 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. They are described under Acidum Carbonicum, ante, page 80. Carbonated Mineral Waters. Silicious Mineral Waters. The constituents of these waters are chief!}' alkaline Silicates. Hot Springs, Iceland. Geysers of Yellowstone Park. 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 of the urine, and 99 of the tears. Physiological Action of Water. AQUA 159 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 elimi- nation 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 quickened 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°-xoo° 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°-ii2° 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- 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 produces 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. Pathogenic Microbes of several diseases, notably those of cholera and typhoid fever, are conveyed to the human system in drinking water contaminated therewith. But these organisms are destroyed by a temperature of 1440 F. in the absence of their spores, while a temperature of 212° F., that of boiling water, maintained for five minutes, destroys the spores of all pathogenetic organisms which have been tested (Sternberg). This fact is of the highest practical importance, as it shows that no germs of disease need ever gain en- trance to our bodies through our drinking water, if we will only boil it. Many years ago an English physician’s report was quoted in Braithwaite’s Retrospect, in reference to the immunity of the Chinese from typhoid fever, though, he said that in Pekin there was no system of sewerage, but that all excreta were thrown on the ground to find their way into the watercourses by which the city was supplied, to soak into wells, etc. Yet, the author said, that contrary to all experience elsewhere, typhoid fever was unknown in Pekin. The reason is to be found in the fact that the Chinese boil all the water they drink. Those who know them best say that they never drink cold water, but always tea, i. e., boiled water. There must be something to account for their remarkable health under otherwise adverse hygienic surroundings. 160 aqua 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 tempera- ture 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 ten- dency 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 inflammation of the chest organs, and hot injections for chronic inflammation of the uterus. Hot water dressings for wounds are strongly favored by many high surgical authori- ties. Vapor and Turkish baths are used as diaphoretics in advanced kid- ney disease, in acute and chronic rheumatism, mineral poisoning, and syphilis. Warm baths, with cold applications to the head, are esteemed 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. Therapeutics of Water. 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 under treatment at home. The same may be said of the treatment at the so-called “hydropathic” or “water-cure” establish- ments. As a rule, those springs will prove of most value which are Therapeutics of the Mineral Waters. ARGENTUM. 161 furthest removed from the patient’s residence, for “ distance lends en- chantment ” 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 dis- orders, obesity, plethora of the pelvic organs, hypochondriasis, skin dis- eases, especially those dependent on gastric derangement, phthisis, con- stitutional syphilis, metallic poisoning, etc., in all of which the influences 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, Friedrichshall, 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 Acidum Carbonicum, Sodium Chloride, Sodium Sulphate, Magnesium Sulphate, etc., also in the therapeutical part of the book. ARGENTUM, Silver, Ag,—is represented by the following four official salts, viz.: — Argenti Nitras, Silver Nitrate, AgN03,—occurs in colorless rhombic crystals, of bitter caustic taste and neutral reaction, soluble in 0.6 of water and 26 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 Fusus, Moulded Silver Nitrate, Lunar Caustic,—for local use as a mild caustic and astringent. Argenti Nitras Dilutus, Diluted Silver Nitrate, Mitigated Caustic,—is the same salt melted with twice its weight of Potassium Nitrate. Is used locally by ophthalmologists. Argenti Cyanidum, Silver Cyanide, AgCN,—has no medicinal use except for the extemporaneous preparation of Hydrocyanic Acid. (See ante, page 87.) Argenti Iodidum, Silver Iodide, 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, Silver Oxide, Ag20,—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. /4~ij in pill. Is not dangerous. All the silver salts should be protected from light in dark amber-colored vials. Silver Compounds and their Preparations. Silver Nitrate is a powerful astringent and a limited escharotic. Ap- plied to the skin or mucous membrane it combines with the albumen of Physiological Action. 162 ARGENTUM. the tissue, excites superficial inflammation, which is soon followed by an altered condition of the part, and stains the same black under the influ- ence of light. The stains may be removed by washing with a strong so- lution 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 collectively 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 mem- branes, with centric impairment of the nervous system producing paralysis on a large scale, loss of coordination power, convulsions, 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 consti- tutional 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. Common Salt freely used is the antidote, precipitating the silver as the insoluble chlo- ride and acting as an emetic. The Nitrate is exceeding 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 astringent 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. Antagonists and Incompatibles. Therapeutics. 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 strengths, from gr. j to gr. xl to the §, are much better. The mildest so- lutions are employed in conjunctivitis (never over the cornea), the stronger in throat and mouth affections, and the strongest in lupus, erysipelas and other skin diseases. A solution in Nitrous Ether (gr. xl to the §) is said to abort superficial inflammations if applied early to the neighboring in- tegument, and in erysipelas a solution of gr. xx to the § 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 membrane of the conjunctiva, fauces, larynx, urethra, bladder, uterus, vagina and rectum, have all been subjected to the local action of this salt. Internally the silver salts are used in dyspepsia with vomiting of yeasty ARNICA. 163 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 inflam- mations 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 employed 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 roots 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. Arnicae Flores, Arnica Flowers,—the flower-heads of Arnica mon- tana, large and yellow, of feebly aromatic odor and bitter, acrid taste. Used in Tincture and Infusion. Arnicae Radix, Arnica Root,—the rhizome and rootlets of Arnica montana, is externally brown and rough from leaf-scars, internally whitish, with a thick bark containing a circle of resin-cells and a large, spongy pith. Odor somewhat aromatic, taste pungent, aromatic and bitter. Resembles Valerian, which is distinguished by its smell; Serpentaria, which has many contorted rootlets; and Veratrum Viride, which has thicker rootlets. Dose, gr. v-xx. Preparations of the Flowers. Tinctura Arnicae Florum, Tincture of Arnica Flowers,—strength 20 per cent. Dose, t^v-xxx. Infusum Arnicae, Infusion of Arnica (Unofficial),—Arnica flowers 20, to 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, nor the insoluble principle Arnicin. Extractum Arnicae Radicis, Extract of Arnica Root,—Dose, gr. j-iij. Extractum Arnicae Radicis Fluidum, Fluid Extract of Arnica Root,—Dose, 1T\v-xx. Tinctura Arnicae Radicis, Tincture of Arnica Root,—io per cent. Dose, rr^v-xxx. Emplastrum Arnicae, Arnica Plaster,—contains Extract of Arnica Root 33 parts to 67 of Lead Plaster. Preparations of the Root. 164 ARNICA. 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. Derivative. 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. 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. Ex- ternally, the tincture in water has a popular reputation in sprains, bruises, etc., though an infusion is better for local use. Ecchymoses are 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 employed effectively 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, it has rendered good service. 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. Physiological Action and Therapeutics. ARSENUM. 165 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. It 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 liniment (1 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 movements when not suspending them entirely. ARSENUM, 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.:— Acidum Arsenosum, Arsenous Acid (Arsenic Trioxide, 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 carbonates, hydrochloric acid and in glycerin. It is volatilized at 424.40 F., with- out melting, and when thrown on ignited charcoal it emits an alliaceous odor. Arsenous Acid is obtained by roasting native arsenides, and condensing the fumes in a long hori- zontal chimney. Dose, gr. to . Liquor Acidi Arsenosi, Solution of Arsenous Acid,—is a 1 per cent, solution in HC1 and Distilled Water. Dose, nyj-viij, thrice daily in water after meals. Liquor Potassii Arsenitis, Solution of Potassium Arsenite (Fowler's Solution),—is a 1 per cent, solution, prepared by boiling together Arsenous Acid 1, Potassium Bicar- bonate 2, Comp. Tincture of Lavender 3, and Distilled Water to 100. Dose, tryj-viij, in water thrice daily after meals. Sodii Arsenas, Sodium Arsenate, Na2HAs04 7H20,—is a salt of the second oxide, Arsenic Acid, As205. Occurs 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. 53~xV Liquor Sodii Arsenatis, Solution of Sodium Arsenate (Pearson's Solution),—is a 1 per cent, solution of the dried Arsenate in Distilled Water. Dose, rr\jj-xv, in water after meals. Arseni Iodidum, Arsenic Iodide, Asl3,—occurs in glossy, orange-red crystalline masses or scales, gradually losing iodine by exposure to the air, soluble in 7 of water and in 30 of alcohol at 590 F.; is gradually decomposed by boiling water and by boiling alco- hol, and is completely volatilized by heat. Dose, gr. Liquor Arseni et Hydrargyri Iodidi, Solution of Arsenic and Mercuric Iodide [Donovan's Solution),—has Arsenic Iodide and Mercuric Iodide, of each 1 part in 100 of Distilled Water. Dose, rr\^ij—viij, in water after meals. Arsenic Compounds and their Preparations. Unofficial Arsenic Compounds. Cupri Arsenis, Cupric Arsenite,—occurs in the various cupro-arsenical pigments used for wall-paper coloring and as insect-poison, viz.—Scheele’s green, Mineral green, Paris green, etc. Is highly poisonous. Dose, gr. daily, in divided doses. Liquor Arseni Bromidi, Solution of Arsenic Bromide, Clemens' Solution,—so named by Dr. Clemens, who described it as a chemical union of Arsenic and Bromine, but the action of Bromine on Arsenous Acid results in the formation of Arsenic Acid and Hydro- bromic Acid, and the preparation is rather a Liquor Potassii Arsenatis et Bromidi. It contains Arsenic equal to I per cent, of Arsenous Acid ; and is prepared by boiling to- gether Potassium Carbonate and Arsenous Acid, 3 j of each in % x of distilled water, until a clear solution is formed ; when cold 2| ij of Bromine and xij of water are added, and the mixture is allowed to stand until all color disappears, when it is ready for use. Dose, "li-v, thrice daily in water after meals. 166 ARSENUM. Solutions of the Bromides of Arsenic and Gold (Arsenauro), of Arsenic, Gold and Mercury (Mercauro), of Arsenic, Gold and Calcium (Calcauro), and of Arsenic, Gold and Manganese (Mercauro), are described under the title Aurum. Physiological Action. Arsenous 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 appe- tite 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 mountains without diffi- culty 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 membrane, congestion of the lungs and bronchi, and fatty degeneration of the liver, kidneys and cardiac muscle. The poison is found in the urine, saliva, tears, sweat, etc., and may be detected even in the paren- chymatous tissues. In the nervous form of poisoning by Arsenic, pro- found coma and insensibility come on suddenly without any gastro-intes- tinal symptoms. Arsenical preparations are generally classed as alteratives, but they are ARSENUM. 167 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. The long-continued use of arsenic may induce peripheral neuritis, the chief symptoms of which when so caused are—severe darting pains in the limbs, paralysis of the muscles of the extremities, especially the extensors of the hands and feet, ataxic gait, herpes zoster, and rapid muscular atrophy. In several cases it has caused general brown pigmentation of the skin, and may give rise to brown pigmentation of psoriasis patches. After death from chronic poisoning, in addition to the gastro-intestinal and nervous lesions, there is found wide-spread fatty degeneration, affect- ing most of the organs, but particularly the liver, kidneys, stomach and muscles, including the heart. To avoid arsenical poisoning during a course of the drug, full doses 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 dilu- ents, 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, Magnesium and Calcium, also 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 arsenous 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 168 ASAFCETIDA. 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 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. Anaemia and chlorosis are remarkably benefited by it, and in rheumatic arthritis and chronic rheumatism 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 amen- able to Arsenic. Epithelioma may be retarded by small doses long con- tinued, 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 so-called Bromide of Arsenic, in the form of Clemens’ Solution, has rendered good service as a remedy for diabetes mellitus of hepatic origin. Cupric Arsenite is being highly recommended in typhoid fever. ASAFGETIDA, Asafetida,—a gum-resin obtained by incision from the living root of Ferula foetida, a perennial herb of the nat. ord. Um- bellifene, native 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 when triturated with water it yields a milk-white emulsion. Its principal constituent is a Sulphuretted Volatile Oil, consisting chiefly of Allyl Sulphide, C6H10S; it also contains a gum and a resin, with ferulaic, malic, acetic, formic and valerianic acids. Dose, gr. v-xx. Preparations. Tinctura Asafcetidae, Tincture of Asafetida,—strength 20 per cent. Dose, 3 ss-ij. Emulsum Asafcetidae, Emulsion of Asafetida, Milk of Asafetida,—strength 4 per cent, in water. Dose, % ss-ij. Pilulse Asafcetidae, Tills of Asafetida,—each pill has gr. iij with gr. j of Soap. Dose, j-iv pills. Pilulae Aloes et Asafcetidae, Pills of Aloes and Asafetida,—each pill has gr. of each ingredient with the same of Soap. Dose, j-iv pills. Mistura Magnesiae et Asafcetidae, Mixture of Magnesia and Asafetida, Dezvees' Carminative (Unofficial), has of Magnesium Carbonate 5, Tinct. Asaf. 7, Tinct. Opii 1, Sugar 10, Aqua Dest. q. s. ad 100 parts. Dose, ASCLEPI AS ASPI Dl UM. 169 Spiritus Amraoniae Fcetidus (Unofficial),—Asafetida iy£, Liquor Ammoniae Fortior 2, Spirit 20 parts. Dose, 3 ss-j. Physiological Action and Therapeutics. 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. In small doses con- tinued it is said to cause impaired digestion, alliaceous eructations, acrid sensation in the fauces, gastralgia, flatulent distention, 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 in- creased and the inhibition relaxed. Asafetida also stimulates the brain even to 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 ac- quired. The disgust which is generally felt for this remedy makes its use very restricted, though a valuable medicine. The Emulsion is extremely ser- viceable in the flatulent colic of infants, and as an enema in infantile convulsions. There is no better remedy in hysteria and hypochondriasis with indigestion and flatulence,—in constipation with amenorrhoea of anaemic subjects, due to ovarian and intestinal torpor,—in bronchial affections, cough of habit, chronic catarrhs, and flatulent indigestion. It has recently been highly praised in the treatment of habitual abortion. ASCLEPI AS, Pleurisy Root,—is the root of Asclepias tuberosa, a plant of the nat. ord. Asclepiadacese and a native of the Eastern and Southern States. Two other species of Asclepias are used in medicine and were formerly official. Extractum Asclepiadis Fluidum, Fluid Extract of Asclepias,—Dose, 3 ss-j. 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 every 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 probably 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, rheumatism, gastralgia, and to promote the eruption in exanthematous fevers. It is undoubtedly a powerful diaphoretic. ASPIDIUM, —is the rhizome of Dryopteris Filix-mns (Male Fern) and of Dryopteris marginalis (Marginal Shield Fern), plants of the nat. 170 aspidosperma. ord. Filices, the former found in most parts of the world, the latter indi- genous to N. America. The active principle is Filicic Acid, CuH,805, which is extracted in the oleoresin. It also contains a green, fatty oil, a volatile oil, resin, tannin, etc. Dose, 3ss~3jss in a single dose fasting, or in divided doses at short intervals, followed by a purgative. Oleoresina Aspidii, Oleoresin of Aspidium,—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. Aspidium is an efficient vermicide against tapeworm, 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. Cusso may be combined with it advantageously. A formula for a mixed treatment by Aspidium, Pomegranate and Pumpkin-seed is given under the title Granatum. ASPIDOSPERMA, Aspidosperma, Quebracho,—is the bark of Aspidosperma Quebracho-bianco, 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 particular tree above named is known as Quebracho- bianco, from the white color of its wood. It contains several alkaloids, no one of which represents the action of the bark itself; the most important being Aspidospermine, C22H30N2O2, and Quebrachine, C21H26- N203. Several false Quebrachos are found on the market, that most frequently seen being the bark of Loxopterygium Lorentzii, or Quebracho Colorado, an Argentine tree of the order Terebinthacese. Extractum Aspidospermatis Fluidum, Fluid Extract of Aspidosperma,—is the only official preparation. Dose, Tinctura Quebracho, Tincture of Quebracho (Unofficial),—strength 20 per cent. Dose, gj-iv. Vinum Quebracho, Wine of Quebracho (Unofficial). Dose, Extractum Quebracho, Extract of Quebracho (Unofficial). Dose, gr. ij to x. Preparations. Aspidosperma 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. V v Physiological Action and Therapeutics. AURANTIUM. 171 This drug 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 diseases of the heart, nor in that of aged subjects of atheroma. 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. It has been used as an antipyretic, also in cardiac neuroses 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 100 of cod-liver oil by the aid of heat. The average dose is about gr. j-ij. 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. Aurantiacese, 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, Ci0H16, and a bitter, crystalline princi- ple, Hesperidin or Aurantiin. Aurantii Dulcis Cortex, Sweet Orange Peel,—is the rind of the fresh fruit of Citrus Aurantium. It contains a Volatile Oil differing from that of the bitter orange, and less of the bitter principle. Extractum Aurantii Amari Fluidum, Fluid Extract of Bitter Orange Peel.—■ Used as flavoring. Dose, gss-j. Tinctura Aurantii Amari, Tincture of Bitter Orange Peel,—strength 20 per cent. Dose, A flavoring preparation. Tinctura Aurantii Dulcis, Tincture of Sweet Orange Peel,—strength 20 per cent. Dose, j-ij. A flavoring preparation. Syrupus Aurantii, Syrup of Orange,—Sweet Orange Peel 5, Calcium Phosphate Precip. 5, Sugar 70, Alcohol and Water to 100. Dose, Used for flavoring. Syrupus Aurantii Florum, Syrup of Orange Flowers,—Sugar 85, Orange-flower Water to X00. Dose, A delicate flavoring agent, but having to some persons an extremely sickish taste. Spiritus Aurantii, Spirit of Orange,—Oil of Orange Peel 5> Deodorized Alcohol 95. Dose, to be regulated by the quantity of alcohol desired. « Spiritus Aurantii Compositus, Compound Spirit of Orange,—Oil of Orange Peel 20, Oil of Lemon 5, Oil of Coriander 2, Oil of Anise yz, Deodorized Alcohol to 100. Dose, as for alcohol. Preparations. 172 AURUM. Aqua Aurantii Florum Fortior, Stronger Orange-flower Water,—is water saturated with the volatile oil of fresh orange flowers. Dose, indefinite, for flavoring. Used to prepare— Aqua Aurantii Florum, Orange-flower Water,—consists of equal volumes of the preceding and Distilled Water, mixed immediately before use. Dose, indefinite. Oleum Aurantii Corticis, Oil of Orange Peel,—a volatile oil, obtained by expres- sion from the fresh peel of either orange. Is soluble in about 4 times its volume of alcohol, and is an ingredient of the two official Spirits of Orange and also of Spiritus Myrcise (Bay Rum). Dose, gtt. j-v. Oleum Aurantii Florum, Oil of Orange-Flowers (Oil of Neroli),—a volatile oil, distilled from the fresh flowers of the bitter orange. Is the most important constituent of Cologne Water (Spiritus Odoratus), and is soluble in an equal volume of Alcohol. Dose, gtt. j-v. Elixir Aromaticum, Aromatic Elixir (Simple Elixir),—has of the Comp. Spt. of Orange 1.2, Precipitated Calcium Phosphate 1)4, Syrup Deodorized Alcohol and Distilled Water to 100. A flavoring vehicle. Dose, fij— J-j, or more. Physiological Action and Therapeutics. Orange is aromatic and tonic, also more or less bitter, but has little action except a mild stimulant influence on the nervous system due to its volatile oil. Persons much exposed to its fumes are 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 flavor- ing purposes, though the preparations of the Bitter Orange may be used as gentle tonics and stimulants to the digestion, but they are usually com- bined with agents more energetic for these purposes. AURUM, Gold, Au.,—is represented by only one official salt, the Gold and Sodium Chloride, but triturations of the metal itself may be pre- pared, according to the general pharmacopoeial formula for such prepara- tions. The unofficial solution of Gold and Arsenic Bromide (see below) is a very efficient preparation. Fine gold and a solution of the perchlo- ride are in the Br. Ph., and powdered gold, also the oxide, chloride, sodio-chloride, iodide, and cyanide, are official in the French Codex. Auri et Sodii Chloridum, Gold and Sodium Chloride,—is a mixture composed of equal parts of dry Gold Chloride, AuC13, and Sodium Chloride, NaCl; and occurs as an orange-yellow odorless powder, of saline and metallic taste, slightly deliquescent in damp air, very soluble in water, partly soluble in alcohol, and contains about 32 per cent, of pure gold. Its solutions are decomposed by organic substances, by light, and by almost all salts. Dose, gr. 35—5, once or twice a day. The Ph. Ger. gives the maximum single dose as gr. and the maximum daily dose as gr. iij, but these doses are entirely too high. Preparation. Auri Pulvis, Powdered Gold,—maybe obtained by triturating gold leaf with ten times its weight of sugar of milk or potassium sulphate until brilliant particles are no longer visible in it, and then washing the diluent away with boiling water. A Trituration of Gold may be prepared in the same manner, retaining the sugar of milk, as directed by the pharmacopoeia under the title Triturationes. Dose of powdered gold is gr. j, or a little of it may be applied by friction to the sides of the tongue. Unofficial Preparations. AURUM 173 Auri Chloridum, Gold Chloride— also called the perchloride or terchloride of gold (AuCl3), the “potable gold” of the alchemists,—occurs in needle-shaped prisms of a deep orange color, very deliquescent and freely soluble in water, in alcohol and in ether. Dose, gr. in pill or solution, preferably the latter. The commercial salt so named, and much used by photographers, is not the pure chloride but a crystallized double salt of gold and sodium, containing 50 per cent, of metallic gold. Auri Bromidum, Gold Bromide, AuBr3,—occurs as a yellowish-gray, friable mass, which is insoluble in water but soluble in ether, and contains 55 per cent, of Bromine. Dose, gr. 6~l, but against migraine the minimum quantity should be used twice daily an hour before meals. Auri et Sodii Bromidum, Gold and Sodium Bromide, AuBr;lNaBr.2IIO,—may be used hypodermically in solution, 2 parts to 100 of distilled water, the dose of which is rrviij increased to respectively representing to | of a grain. Liquor Auri et Arseni Bromidi, Solution of Gold and Arsenic Bromide (Barclay),— is marketed under the trade-name “ Arsenauroand contains gr. of each salt in tl\x. Dose, in water, thrice daily after meals, or hypodermically. This solution may be prepared as follows : (1) Take of Nitric Acid gj and of Hydro- chloric Acid giij, mix them and dissolve in the mixture 21 grains of pure Gold, then evaporate to dryness in a water-bath. Dissolve the resulting Chloride of Gold in distilled water §j, and add slowly a solution of 35 grains of Ammonium Bromide in water. Shake with Squibb’s ether until all the gold is taken out, separate in a separating funnel, and treat the ether solution with fused calcium chloride to remove all water. Distil off the ether, and dissolve the remaining Gold Bromide in % iv of water, to make Solutioti No. 1. (2) Dissolve grains of Arsenous Acid in % iv of distilled water by the aid of heat, and when cold add 3 j of Bromine and let the mixture stand for 24 hours. Then drive off the excess of bromine by boiling in a sand-bath until the solution is colorless, which gives Solution No. 2. (3) Mix the two solutions and add sufficient water to make 1 quart. Liquor Auri, Arseni et Hydrargyri Bromidi, Solution of Gold, Arsenic and Mer- cury Bromide (Barclay),—is marketed under the trade-name “ Mercaurof and contains gr. of each bromide in n\x. Dose, in water, thrice daily after meals, or hypo- dermically. Similar solutions, of the bromides of gold, arsenic and calcium (“ Calcauro ”) and of the bromides of gold, arsenic and manganese (“ Manganauro ”), are on the market, and may be used in like doses. The action of the salts of gold upon the human organism is analogous in many respects to that of mercury, causing local irritation and escharo- tic effects when applied in substance or in strong solution. In continued medicinal doses given internally they produce a condition of general erethism which strongly resembles the mercurial fever, and is accompanied by salivation but without tenderness or ulceration of the gums. The Chloride is one of the most active salts, being, according to Chrestien, even more toxic than corrosive sublimate. Locally, it produces irritant and caustic effects, and imparts a yellow stain to the skin, which later on turns violet and even black, from reduction of the metal therein. In overdoses it causes gastric pain and inflammation, also ulceration of the gastro-intestinal mucous membrane, and otherwise acts as a corrosive poison ; toxic doses produce a violent gastro-enteritis with such nervous phenomena as convulsive tremor, cramps, priapism, insomnia and insen- sibility (Magendie). The salts of gold, administered in small medicinal doses, increase the appetite and the digestive power and stimulate the functional activity of Physiological Action. 174 AURUM. the secreting organs, especially the skin and the kidneys. They also stimulate the generative apparatus, causing diaphoresis and diuresis, and exciting the menstrual flow in women and the sexual appetite in men. The observations of several competent physicians have established the power of these salts to excite the vascular and muscular systems and to produce fever, to increase the urine and the sweat, to cause salivation without stomatitis, a sense of heat in the stomach, headache and diarrhoea, to promote menstruation, excite the genitalia, and profoundly affect the nervous system. In large or continued doses they cause dryness of the tongue, redness of the pharynx, gastric and intestinal colic, nausea and vomiting, and even erosion of the gastric mucous membrane. The Bromide, though containing only 55 per cent, of bromine, is found to be many times more active, weight for weight, than the ordinary bromides. Administered in doses of from grain to 3 grains per kilogramme of body weight, it depressed the cortical motor centres to such a degree that the strongest electrical stimulation thereof failed to produce an epileptic seizure (Shtcherbak). Antidotes and Antagonists. Poisoning by gold salts is treated like that by corrosive sublimate. The Antidote is Albumen in some form, followed by evacuation of the stomach, as the albuminate is not wholly inactive. The Antagonists are Bismuth, Tannin, Sodium Sulphite, and diluted Nitric Acid, in water, as gargles and mouth-washes for the salivation; Belladonna to lessen the salivary secretion, Hyoscyamine for the tremor, and Morphine for shock. Therapeutics. The literature of gold shows that it is one of the most ancient medicines. Pliny, in the first century, recorded its use as a recognized remedy for several conditions in which it is still employed, including lichenoid eruptions, fistula, hemorrhoids, warts, putrid ulcers, and sores emitting an offensive smell. In the finely divided metallic state it was employed as a panacea by the Arabian physicians and by the alchemists. During the 17th and 18th centuries it was highly esteemed as an anti- syphilitic, also for leprosy, dropsies, epilepsy, the pest, fevers, amenorrhoea, sterility and uterine diseases. During the first quarter of the present cen- tury it was in high repute among the Continental physicians as a remedy for syphilis and for scrofula. Mitchill (1818) administered gold salts for syphilis in the New York Hospital, with excellent results. In his opinion “ the muriate of gold will effect all that is achieved by the muriate of quicksilver, with incomparably less inconvenience to the patient, who gets well under the former without the hazard of a sore mouth or a salivation, and with very little wear and tear of constitution.” Trousseau (1851) says that the happy results of gold in the treatment of venereal diseases are incontestable; and von Schroff of Vienna (1868) gave it great praise for the restoration of a case of syphilis in which the strongest mercurials had failed to avert destruction of the nasal bones or the deep, spreading ulcers of the skin. Phillips (1894) says that its efficacy is best seen in the later developments of syphilis, such as ulceration of the nose and larynx, cutaneous syphilides, hard nodes, etc., also that it may especially be employed in long-standing cases with chronic peri- ostitis and when mercury has already been given to saturation. Still it has never obtained AURUM 175 general professional favor in the United States or in England, until recently. Professor Barton, of Jefferson Medical College, Philadelphia (1827), pronounced the following judgment upon it in his lectures on materia medica. “ On the whole view of what has been said in favor of gold, I am not inclined to attach great importance to it as a remedy. It is well enough in its proper place and for its proper purposes, for which it is more use- ful than as a medicine. Plenty of it would doubtless cure many diseases of mind and body.” Such has been the general opinion since the above words were printed, but of late years a number of compounds of gold with other elements (chlorine, bromine, iodine, arsenic and mercury) have been employed as medicines with considerable satisfaction. Dr. Piffard of New York finds that Gold is unquestionably useful in the later stages of syphilis, and says that its best effects are obtained with very small doses, gr. fa or less, which he rarely continues for more than one or two weeks at a time. Several other observers have given it great praise as a remedy in constitutions which are broken down by the com- bined influence of syphilis and mercury, for syphilis in strumous subjects, and for the various manifestations of scrofula. Under its use the auric fever may develop, and the local affections for which it is administered may assume an aggravated intensity, and even new ones appear; but these phenomena do not call for the suspension of the remedy, for the dis- ease retrogrades rapidly in a few days after they appear (Trousseau) ; and on lessening the dose pyrexia subsides and good effects are more con- spicuous (Phillips). Strumous affections have been recently reported as cured by the internal and local use of auric preparations, including scrofulous ulcers, lupus, ozsena, enlarged and indurated cervical glands, and hypertrophy of the tongue with induration thereof. Gold has been credited with many cures of cancer of the uterus, mammse and tongue, but it is probable that such have really been cases of scrofulous ulceration. Squamous skin diseases, the “dartres” of the older writers, are, next to syphilis, the most suc- cessful field for the action of gold. In cutaneous diseases it is used locally as well as internally. Dropsy is one of the affections in which it was anciently recommended, and in which modern therapeutists have found it efficient, especially in ascites due to chronic hepatic disease or induration of the abdominal organs, also in post-scarlatinal dropsy and ovarian dropsy. Many disorders of the female generative organs have proved amenable to gold when persistently employed. Amenorrhoea due to ovarian torpor and chronic metritis with scanty menstruation are often benefited there- by, while sterility dependent on these states or due to coldness, is more certainly cured by the auric preparations than by any other merely medicinal means. The tendency to habitual abortion may be averted by the use of the Chloride, which is also beneficial for mental symptoms of hysterical character, especially when connected with uterine disease. Many competent clinicians have highly commended gold in suicidal melancholia, hypochondriasis accompanying hepatic or testicular disease, 176 AURUM. in decline of the sexual power in men, and as a tonic for low-spirited, pining boys with undeveloped testes. Sclerosis of the internal organs, especially the liver and kidneys, may be retarded by the persistent use of the Gold and Sodium Chloride, in doses of gr. thrice daily. Nervous dyspepsia, characterized by a red and glazed tongue, epigastric pain increased by food, and relaxation of the bowels after eating, is greatly benefited by the same salt in equally small doses. Catarrh of the duodenum and bile-ducts, and jaundice therefrom, also vertigo and vertiginous sensations connected with gastric disorders or due to cerebral anaemia, are often removed by a course of treatment with the salts of gold. The Bromide has been employed in doses of from gr. y to gr. y2 with decided benefit in obstinate cases of hysteria and epilepsy. Goubert used it successfully for migraine, epilepsy, chorea and exophthalmic goitre, in daily doses of gr. y£ to y, continued until its characteristic headache was produced. He claims for it greater efficacy in epilepsy than is possessed by the other bromides, and says that, as compared with them, it is better tolerated and does not induce depression and emaciation or the other pronounced symptoms of brom- ism. A combination of Gold and Arsenic (Auri Arsenas) was introduced by Chrestien and extensively employed by Massart in cancer and phthisis, with sufficient success to merit the approval of the medical societies of Lyons and Toulouse. It is said to be particularly serviceable in scrofu- lous affections, especially lupus, and to exercise a highly beneficial influ- ence on anaemia and chlorosis. A solution of the Bromides of Gold and Arsenic has been successfully employed for several years by Dr. Barclay and others in the various diseases of which sclerosis is the chief factor, such as cirrhosis of the liver and lungs, interstitial nephritis, atheroma and calcareous degeneration of the arteries, senile degenerative changes and neurotic disease, fibroid phthisis, locomotor ataxia, etc ; also in cervical adenitis, arthritis deformans, syphilitic neuralgia and iritis, miliary tuber- culosis, epilepsy, chronic neuritis, sciatica, chronic muscular rheumatism and neurasthenia. Arsenauro is the trade-name of this solution, which has lately been the subject of extended reports from competent observers, many of whom claim to have obtained from the use of this combination results which neither of its constituents are capable of when administered alone. It is held to have marked alterative power upon the glandular system and upon all non-malignant scleroses ; to be not only a blood- maker but a blood-builder, increasing the number of the corpuscles and improving their quality, and also increasing the amount of haemoglobin therein. It is eliminated by the kidneys and produces no irritation when administered either by the mouth or hypodermically. A similar solution of the Bromides of Gold, Arsenic, and Mercury, named Mercauro, is on AVENA SATIVA—BALSAMUM PERUVIANUM. 177 the market, and is highly praised in the treatment of the late manifestations of syphilis, particularly those affecting the nervous system. A so-called “ Bichloride-of-Gold Cure ” for inebriety has lately become notorious through extensive advertising and other commercial methods, but from the most reliable information obtainable it is reasonably certain that the only preparation of gold which plays a prominent part therein is the gold coin which passes from the patient’s pocket to that of the manager of the “institute.” The physiological symptoms produced by the remedy employed are those of strychnine and atropine, the adminis- tration of which hypodermically several times daily for three or more weeks is decidedly dangerous. In many cases cardiac failure has occurred soon after the completion of the treatment, and in a large number of instances insanity or other serious psychoses have developed immediately after the subjects had been through one of these so-called “cures.” A VENA SATIVA,—the common Oat, a plant of the nat. ord. Graminacese,—was official in the U. S. P. 1870, as Avena Farina, or Oat-meal. A concentrated tincture or fluid extract has 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 doubtless some stimulant and narcotic power; but the claims ad- vanced for it, as a specific remedy for the cure of the opium-habit, have been strenuously denied by many competent observers. Dose of the concentrated tincture or fluid ex- tract may be stated at ij. AZEDARACH (Unofficial),—is the bark of the root of Melia Azedarach, or Pride of China, a handsome tree of the nat. ord. Meliacese, indigenous to China and India, but naturalized in the Gulf States. A decoction of the fresh bark (3 ij to Oj boiled to 0}£) may be used in tablespoonful doses. 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 also an anthel- mintic against the round-worm. Its active principle has not been isolated. It is only employed as an anthelmintic 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 Toluifera Pereirce, a Central American tree, of the nat. ord. Leguminosge. Occurs as a thick, brown-black liquid, its odor reminding of benzoin and vanilla, soluble in 5 of alcohol, almost insolu- ble in water, which only extracts from it some Cinnamic Acid and Cin- namein. It is not a true balsam, as it contains no volatile oil. Composi- tion is,— Cinnamein (Benzyl Cinnamate, C16Hu02) 60 per cent., Cinna- mic Acid 6 per cent., Resins 30 per cent.; also Benzoic Acid and other bodies. Dose in emulsion. There are no official preparations. 178 BALSAMUM TOLUTANUM—BAPTISIA. The action of Balsam of Peru is that 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 gastralgia, nausea and vomiting, colic and diarrhoea. It closely resembles in physio- logical 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 ulcers, and to kill the acarus scabiei, being con- sidered by some authorities the best of all applications in itch. Inter- nally, it is used as a stimulant and disinfectant expectorant in chronic bronchitis, asthma, etc., as well as in gonorrhoea, gleet, leucorrhoea, and other discharges from mucous membranes. Incorporated with Iodoform it partially covers the odor of that drug. BALSAMUM TOLUTANUM, Balsam of Tolu,—is a balsam obtained from Toluifera Balsamum, 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 color, more agreeable odor, and contains a volatile oil, Tolene, in the proportion of about i per cent. Tinctura Tolutana, Tincture of Tolu,—contains xo per cent, of the Balsam dis- solved in alcohol. Dose, tip x-xxx. Syrupus Tolutanus, Syrup of Tolu,—has of the Balsam I per cent., with Sugar 85, in Alcohol 5, and Water to 100. Is much used in cough mixtures, and covers the taste of Chloral Hydrate well. Dose, gj-ij. Balsam of Tolu has similar action to that 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 Bap- tisia 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, ob- tained by precipitation from the alcoholic extract with water. Unofficial Preparations. Extractum Baptisiae, Extract of Baptisia.—Dose, gr. j-x. Extractum Baptisiae Fluidum, Fluid Extract of Baptisia,—Dose, rrpij-xx. Tinctura Baptisiae, Tincture of Baptisia,—Dose, Ttpv-xxx. Baptisin,—the resinoid. Dose, gr. j-v. Baptisia has a bitter and acrid taste ; in small doses it is laxative, in large ones violently emeto-cathartic, and may excite severe gastrointesti- nal inflammation. It is a decided stimulant of the liver, and increases the secretions of 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 BARII DIOXIDUM—BELLADONNA. 179 and painful ulcers, in threatened or existing 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. BARII DIOXIDUM, Barium Dioxide, Barium Peroxide, Ba02—is the commer- cial anhydrous Barium Dioxide, a heavy, grayish-white, amorphous powder, odorless and tasteless: gradually decomposed by exposure to the air, from which it slowly attracts moisture and carbon dioxide. Used to prepare the Aqua Hydrogenii Dioxidi. Though almost insoluble in cold water, Barium Dioxide forms therewith a definite hydrate, and imparts thereto an alkaline reaction. It is decomposed by most of the min- eral acids, producing the corresponding barium salts, and liberating Hydrogen Dioxide, H202, which remains in the solution lor a considerable length of time, if the reaction has taken place in the cold, and if an excess of the acid is present. In this way is prepared the official Aqua Hydrogenii Dioxidi (Solution of Hydrogen Peroxide), for which seethe title Oxygenium. BELLADONNA, Deadly Nightshade.—T he Atropa Belladonna is an herbaceous, perennial 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 Cen- tral and Southern Europe and Asia, and is cultivated in Europe and in the United States. It contains two alkaloids,—the official Atropine (see below), and Belladonnine, the latter being considered by many authori- ties as identical with Hyoscyamine, Daturine, and Duboisine. These exist in the plant in combination with Malic Acid. The plant also con- tains the usual vegetable constituents, as albumen, gums, etc., and a col- oring principle named Airosin. The official titles are as follows :— Belladonnae Folia, Belladonna Leaves,—ovate and tapering, brown- ish-green above, grayish-green below, of slight odor and bitter, disagree- able taste. Stramonium leaves are more wrinkled, Hyoscyamus leaves are more hairy. Dose, gr. j, gradually increased. Belladonnae Radix, Belladonna Root, — cylindrical, tapering, wrinkled pieces, y2 to 1 inch thick, nearly odorless, taste bitter and acrid. Dose, gr. j, cautiously increased. Preparations of the Leaves. Extractum Belladonnae Foliorum Alcoholicum, Alcoholic Extract of Belladonna Leaves.—Dose, gr. to Tinctura Belladonnae Foliorum, Tincture of Belladonna Leaves,—15 per cent. Dose, trpj-xxx. Emplastrum Belladonnae, Belladonna Plaster,—has of the above extract 20 per cent., mixed with Resin and Soap Plasters, of each 40 per cent. May produce the physiological action of the drug. Unguentum Belladonnae, Belladonna Ointment,—has of the above extract 10, Diluted Alcohol 5, Benzoinated Lard 85. 180 BELLADONNA. Preparations of the Root. Extractum Belladonnae Radicis Fluidum, Fluid Extract of Belladonna Root.— Dose, try—v. Linimentum Belladonnas, Belladonna Liniment,—has of Camphor 5, dissolved in Fluid Extract of Belladonna Root to 100. 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 130 of water at 590 F. Is decomposed by prolonged contact with caustic alkalies and is resolvable into Tropin and Tropic Acid. Atropinae Sulphas, Atropine Sulphate, (C17H23N03)2H2S04,—a white powder of bitter taste and neutral reaction, soluble in 0.4 of water and in 6.2 of alcohol at 590 F. Dose, gr. y^p-yV Homatropina, Homatropine, C16H21N03 (Unofficial),—is a derivative alkaloid, ob- taineby the action of dilute HC1 on Amygdalate of Tropin. The Hydrobromate 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 pneumogastric, thus stimulating the accelerator apparatus while lessening the inhibitory. [Digitalis in- creases both.] The vasomotor ganglia are stimulated all over the body, 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 either the local or systemic use of the drug, it stimulating 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 quan- tity of Atropine which will affect the pupil is stated at gr. xmnnr (Wood), Sr• 20000 (Roosa), gr-xtro"0"tr (Ely), gr. TZTBinr (trousseau), gr. xWtnnr (Loring), gr. (Bonders). The brain is congested by Belladonna, headache, vertigo, busy delirium, hallucinations, etc., being produced, the latter from a selective action on BELLADONNA. 181 the cells of the gray matter. The spinal cord is stimulated from the 3d cervical vertebra to the 10th dorsal, resulting in complete motor paraly- sis, 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 scar- let fever, is often produced on the skin and fauces by Belladonna, with dysphagia and sore throat, and is sometimes followed by desquamation 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 those 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, Antidotes, 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, Phy- sostigmine or Pilocarpine for the nervous disturbance. Caustic alkalies decompose Atro- pine 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 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 admin- istered. Inflammations of the lungs, iris, bladder, kidneys and breasts are all amenable to it. In constipation from atony of the bowels it is re- markably efficient, and in the enuresis of children it is equally so if used freely, io 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, inflamed and swollen tonsils, in many skin diseases, in asthma and whooping-cough, epileptic and puerperal convulsions, spermatorrhoea and seminal losses, 182 BENZINUM—BENZOLUM. 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 Hydro- cyanic Acid; in ptyalism from mercury, pregnancy, etc.; in the sweats of phthisis, in 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 antag- onist, superinducing belladonna-narcosis upon the opium-narcosis. In cases of heart-failure from Chloroform or Ether inhalation, the hypoder- mic injection of Atropine has, in the writer’s hands, saved several lives when all other methods of resuscitation had failed. It is highly efficient in lead poisoning, if used in combination with Potassium Iodide; and has given the most satisfactory results as a hemostatic in profuse metror- rhagia after abortion, in metrorrhagia of obscure origin, and in phthisical hemoptysis. BENZINUM, Benzin (Petroleum Ether),—is a purified distillate from American petroleum, and consists of a mixture of hydrocarbons, chiefly of the mash-gas series (C5H12,C6Hu, and homologous compounds). It is a transparent, colorless liquid, very diffusive, highly inflammable, insoluble in water, soluble in alcohol, ether, chloroform, benzol and fixed and volatile oils. Its sp. gr. is 0.670 to 0.675, and its boiling point 122° to 140° F. It should be carefully kept in well-stoppered bottles or tin cans, in a cool place, remote from lights or fire. Dose, gtt. v-x, on sugar or in mucilage. Benzin taken internally in overdose is known to produce gastro-enteritis, and such a case is reported which terminated fatally. In the ordinary medicinal doses it does not produce either vomiting or diarrhoea. Benzin poisoning may be produced by its inhala- tion, which is becoming quite a practice among glove-cleaners, and alcoholics have been known to take to inhaling benzin in place of drinking spirits. It has been used with some success externally as a remedy for rheumatic pain, neuralgia, itch and prurigo; and inter- nally as a vermicide against tapeworm. In pharmacy it has many uses on account of its power as a solvent for oils, fats, resins, caoutchouc and some alkaloids. In the household it is used as a solvent application for removing grease from clothing. BENZOLUM, Benzol {Benzene, Phenyl Hydride), C6H6 (Unofficial),—is a con- stituent of coal-gas tar, obtained by distilling coal naphtha. It is a thin, colorless, oleagi- nous liquid, very inflammable, of agreeable odor, and sp. gr. 0.850. It is very diffusible, and the vapor, when inhaled, acts as an anaesthetic. Dose, gtt. v-x, on sugar, in emul- sion or capsules, up to gjss daily. Benzol is a reliable pulmonary antiseptic, and has been used successfully in the treat- ment of whooping-cough, the vapor being diffused throughout the room, and proximity to a light or fire being carefully avoided. It has made quite a reputation in the treatment of influenza, and has been found effectual in destroying both head and body lice, for which purpose a single application is usually sufficient. It has also been given internally BENZOINUM. 183 for the destruction of trichinae, followed by a brisk laxative; and, mixed with lard, is used externally in parasitic skin diseases, especially scabies; also in rheumatism and neuralgia. 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 com- posed of Resins 80 per cent., Benzoic Acid 10 to 20 per cent., and a trace of Volatile Oil. Some varieties of benzoin yield also Cinnamic Acid. Adeps Benzoinatus, Benzoinated Lard,—is prepared by suspending the powdered Benzoin, tied up in coarse muslin, in melted Lard, in the proportion of 2 parts to 100, for 2 hours, then removing the residual benzoin, and occasionally stirring the lard as it cools. When intended for use in warm weather 5 per cent, or more of the lard should be re- placed by White Wax. Tinctura Benzoini, Tincture of Benzoin,—has of Benzoin 20 parts, Alcohol 100. Dose, 3 ss-j. Tinctura Benzoini Composita, Compound Tincture of Benzoin, Friar's Balsam,— has of Benzoin 12, Aloes 2, Styrax 8, Balsam of Tolu 4, Alcohol to 100. Dose, gss-ij. Preparations of Benzoin. Preparations of Benzoic Acid. Acidum Benzoicum, Benzoic Acid, HC7H502,—occurs in light, feathery plates and needles, and is obtained from Benzoin by sublimation, or prepared artificially, chiefly from Toluol. It is soluble in 500 of water, and in 2 of alcohol at 590 F., but its solu- bility 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, Ammonium Benzoate,—is soluble in 5 parts of water and in 28 of alcohol. Dose, gr. v-xxx. Lithii Benzoas, Lithium Benzoate,—soluble in 4 parts of water and in 12 of alcohol. Dose, gr. v-xxx. Sodii Benzoas, Sodium Benzoate,—is efflorescent on exposure to air, soluble in about 2 parts of water and in 45 of alcohol. Dose, gr. v-^j. Physiological Action. Benzoin is decidedly antiseptic and disinfectant, and when used exter- ternally is somewhat stimulant to the vessels. Its action is due to its Ben- zoic Acid, which taken internally produces slight epigastric heat, increases the pulse-rate, and stimulates the action of the skin, the salivary glands, and the bronchial mucous membrane. It is principally 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 quantity. 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 affec- tions. The compound tincture, gj to §j in a pint of boiling water, is a 184 BERBERIS. useful sedative inhalation for the irritation and cough of subacute laryn- gitis and tracheitis. It has also been used beneficially in chlorosis and some uterine disorders. The compound tincture is a good local applica- tion (i part 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 surfaces involved. Phosphatic calculi are said to be dissolved by the long con- tinued use of Ammonium Benzoate. Sodium Benzoate has been largely used as a substitute for the salicy- lates 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 (gij-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 x-gVif °f body-weight daily has seemed to be of value. It has also proved very efficient in whooping-cough. Lithium Benzoate is intended for use in gout and the uric acid diathesis, 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 other- wise become uric acid, the latter product will be lessened. BERBERIS, Barberry (Unofficial), is the root ot 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, C20H]7NO4, a yellow, crystalline body, soluble in hot water and alcohol, but not in ether, which is found also in several other plants, as Hydrastis, Coptis, Podophyllum, Menispermum, Calumba, Xanthoxylum, etc. Extractum Berberidis Fluidum, Fluid Extract of Berberis (Unofficial),—Dose, TtUv-xxx. Tinctura Berberidis, Tincture of Berberis (Unofficial),—I to 5- Dose, x-gj. Berberina, Berberine (Unofficial),—Dose, gr. j-x. Usually occurs in commerce as “ Hydrastin,” which is a Berberine Hydrochlorate prepared from Hydrastis. Berberis is an astringent bitter, a tonic and stomachic in small doses, but in large doses it is cathartic, producing watery diarrhoea with abdominal pain. It is also believed to possess considerable alterative powers. It has been successfully used as a local appli- cation in conjunctivitis, and internally as a remedy for intermittent, remittent and typhoid fevers, diarrhoea and dyspepsia. As an alterative and tonic it is 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. Berberine has some antiseptic and antiperiodic value, but in large doses is a gastro- BERGAMOTTiE OLEUM—BISMUTHUM. 185 intestinal irritant. The Hydrochlorate is a useful injection in gonorrhoea, in which it acts by virtue of its antiseptic and astringent powers. BERGAMOTTAE 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. Aurantia- ceae, native in Southern Europe. It is of greenish color, faintly acid, and is soluble in alcohol, glacial acetic acid and liquor potassae. It contains several hydro-carbons of the formula C10Hlg, 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.—This metal is represented in med- icine by four official salts, and several unofficial ones;—the most import- ant of which are the following: — Official Salts of Bismuth. Bismuthi Citras, Bismtith Citrate, BiC6H507,—a white, amorphous powder, odor- less and tasteless, insoluble in water or alcohol, soluble in Water of Ammonia. Used only for pharmaceutical purposes. Bismuthi et Ammonii Citras, Bismuth and Ammonium Citrate,—is a combination of the citrate with aqua ammoniae, and has no definite chemical composition. Small, pearly scales, very soluble in water, sparingly in alcohol. Dose, gr. j-v. Bismuthi Subcarbonas, Bismuth Sttb carbonate,—a white or yellowish-white pow- der, of somewhat varying chemical composition, tasteless and odorless, insoluble in water or alcohol. Dose, gr. v-xxx, in powder or emulsion. Bismuthi Subnitras, Bismuth Subnitrate,—a heavy, white powder, of somewhat varying chemical composition, odorless and almost tasteless, of slightly acid reaction ; insoluble in alcohol, almost insoluble in water. Dose, gr. v-xxx, several times a day, in powder, pill, or milk; often combined with opium, morphine or belladonna. Unofficial Salts of Bismuth. Bismuthi Salicylas, Bismuth Salicylate,—exists in two forms, the acid salt and the basic salt, the latter being the one used therapeutically. It contains 76 per cent, of the oxide of bismuth, and 23 per cent, of salicylic acid; and occurs as a white, crystalline salt, almost entirely insoluble in water, alcohol or glycerin. It should give no reaction with perchloride of iron. Dose, gr. v-xx. Bismuthi Subiodidum (Oxyiodidum), Bismuth Subiodide,—a brick-red, heavy, amorphous powder, insoluble in water, insoluble in any reagent without decomposition. Used locally as an antiseptic dusting powder, and internally in doses of gr. jss—iij. Bismuthi Subgallas, Bismuth Subgallate (“ Dermatol”),—a fine, odorless, saffron- yellow powder, insoluble in all ordinary solvents. Dose, gr. v-x, in tablets. Bismuthi Oleas, Bismuth Oleate,—a pearly-gray, soft, bland substance. [See under Acidum Oleicum, ante, p. 91.] Physiological Action. The action of the insoluble Bismuth salts is chiefly a local one, they being sedative to the end-organs of the nerves, though a minute quantity passes into the blood and acts as a tonic, promoting constructive meta- morphosis 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 effects when occurring are ascribed to Arsenic, with which the 186 BISMUTHUM. commercial preparations were formerly contaminated. Lately, however, it has been shown that Bismuth salts possess toxic powers of their own, and that the symptoms of bismuth poisoning may develop when these prepara- tions are applied as a dressing to a large, denuded surface, or taken inter- nally in large doses for a long period of time. A black line along the margins of the gums, headache, nausea, vomiting, pale face, elevated temperature, rapid pulse, oedema of the lower extremities, diarrhoea, and an odor of urine on the breath are some of the symptoms observed in such cases. Black and gangrenous sloughs may occur in the intestines, and the urine may contain albumen. 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 Subnitrate is regarded by many practitioners as almost a specific in cholera infantum, given in hourly doses of 3 to 6 grains: also in the diarrhoea of phthisis, in dysentery and intestinal ulceration, it is highly efficient, in doses of 15 grains every hour or two. Externally, it is em- ployed as a dusting powder, either pure or mixed with starch (1 to 5); as a drying application for the nasal, pharyngeal and laryngeal mucous membranes; in suspension as an injection in gonorrhoea (4 to 10 per cent.) ; and with vaseline (10 to 15 per cent.) as an ointment in eczema, burns and wounds. The Bismuth and Ammonium Citrate being soluble, is more rapid in action, but also more astringent and irritant than the other salts, though it is probably precipitated in the stomach by the hydrochloric acid of the gastric juice. It is serviceable in diarrhoea without irritation of the intes- tinal mucous membrane, but rather with relaxation thereof. The Salicylate (basic salt) when pure, is well borne by the stomach, and can be used for longer periods than the subnitrate. It has been es- pecially serviceable in the diarrhoea of phthisis, in that of typhoid fever, and in chronic gastric and intestinal disorders. It is highly praised as an internal antiseptic in dilatation of the stomach, and to prevent fermen- tation in the intestinal canal after operations. The Oleate is credited with mildly astringent and emollient properties, having been used with benefit in pustular affections of the skin and in acne. The Subiodide is an exceedingly valuable agent in the treatment of burns, wounds, ulcers, and similar affections, as a substitute for Iodo- form. (See under Iodum.) Therapeutics. BOLDUS BROMUM. 187 Dermatol, Bismuth Subgallate (Unofficial),—is one of the many proprietary substitutes for Iodoform, and has been patented in this country. It has great stability, as well as valuable drying and bactericidal qualities, and is an excellent vulnerary for wounds and burns. It has proven useful in the treatment of moist eczema, ulcers, and other affections of the eye, diseases of the middle ear and dental caries. It occasionally produces der- matitis, and Dr. Cantrell holds that it is decidedly irritating, is a stimulant rather than an astringent, does not check but rather increases discharge, and does not fulfil the claims made for it. Efforts are now being made to show value for it as an internal remedy in fermentative dyspepsia and gastric catarrh. Dose, gr. v-x, in tablets. BOLDUS, Boldo (Unofficial),—the leaves and stems of Peumus Boldus, an ever- green shrub of the nat. ord. Monimiacese, found in Chili. It contains a volatile oil and a bitter alkaloid, Boldine. A tincture is made (1 to 5), of which the dose is ftp v-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 Quinine. 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. BROMUM, Bromine, Br,—is a dark, brownish-red, volatile liquid, evolving an irritant vapor of peculiar and suffocating odor. It is soluble in 30 of water at 590 F., very soluble in alcohol, ether, chloroform and carbon disulphide; is a non-metallic element found in sea-water, and in the mother-liquor of certain salt-works, usually in combination. On exposure to air or heat it is completely volatilized. It destroys the color of solutions of litmus and indigo, and imparts a yellow color to solution of starch. It is only used by inhalation and locally as an escharotic. Bromides and their Preparations. Potassii Bromidum, Potassium Bromide, K Br,—colorless, cubical crystals, soluble in 1.6 of water, and 200 of alcohol. Dose, gr. ij-3 j, well diluted. Sodii Bromidum, Sodium Bromide, NaBr,—colorless, monoclinic crystals, soluble in 1.2 of water, and 13 of alcohol. Dose, gr. well diluted. Lithii Bromidum, Lithium Bromide, LiBr,—a white, granular, deliquescent salt, very soluble in water and alcohol. Dose, gr. ij-xx, well diluted. Ammonii Bromidum, Ammonium Bromide, NH+Br,—colorless, prismatic crystals, soluble in 1.5 of water, and 30 of alcohol. Dose, gr. ij-xx, well diluted. This Bromide is well borne by children in comparatively large doses if epileptic from reflex causes. A child one year old can tolerate gr. v every 4 hours (Barton). Calcii Bromidum, Calcium Bromide, CaBr2,—a white, granular, deliquescent salt, very soluble in water and alcohol. Dose, gr. ij—3 j, well diluted. Strontii Bromidum, Strontium Bromide, SrBr2(H20)fi,—colorless, hexagonal crys- tals, very deliquescent, very soluble in water and in alcohol; insoluble in ether. Dose, gr. ij-xxx, well diluted. Zinci Bromidum, Zinc Bromide, ZnBr2,—a white, granular, deliquescent powder, very soluble in water and alcohol. Dose, gr. well diluted. Syrupus Ferri Bromidi, Syrup of Iron Bromide (Unofficial),—is a syrupy liquid containing 10 per cent, of Ferrous Bromine, FeBr2, prepared by acting on Iron Wire 35 parts with Bromine 75, adding Sugar 600 and Water up to 1000 parts. A translucent, pale-green, odorless liquid of sweet, ferruginous taste and neutral reaction. Dose, 3 ss-j. Bromoformum, Bromoform, Tri-bromo-methane, CHBr3, (Unofficial),—is prepared by the action of sodium hypobromite on acetone, or by the action of bromine upon a solution of equal parts of caustic potash and methyl alcohol. A clear and colorless 188 BROMUM. liquid, of pleasant odor and sweet, agreeable taste ; slightly soluble in water, readily soluble in alcohol, and in glycerin. Dose, If it has color it should be rejected as unsafe by reason of decomposition. Arsenic Bromide is described on page 165, Aurum Bromide on page 173, Ethyl Bromide on pages 99 and 102, Hydrobromic Acid on page 85, and Camphora Monobromata under Camphora. Physiological Action. Bromine is an active and very painful escharotic, a deodorant and an antiseptic, setting free ozone. Its vapor is highly irritant to the respira- tory raucous 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 powerful depressants of the cerebral and spinal func- tions, 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 re-formed at the points of elimi- nation (fauces, bronchi, intestines, skin and kidneys), where they irritate the mucous membranes. Continued for some time, they produce severe gastric catarrh. They reduce the number of the respirations, and the heart’s action and force; and though diminishing the calibre of the arte- rioles, they lower arterial tension. They lessen the activity of the brain cells, producing somnolence ; and diminish the sensibility of the periph- eral 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 hallucinations in some cases, in others melancholia with suicidal tendency ; also incompetence of the sphincters and paralysis, beginning at the periphery 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 Brotnism, and is heralded 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. It is believed that a previous prolonged use of opium or morphine renders the organism extremely susceptible to the action of the bromides. Dr. Hammond mentions several cases of fatal bromide poisoning in one of the last chapters of his treatise on Nervous Diseases, and several cases of poisoning by Potassium Bromide have been recently published by Dr. Greenless. The first was that of an epi- leptic who took 75 grains a day for three weeks, when stupor, coma, and extreme pros- tration and death followed. The post mortem showed intense congestion of the meninges. In another case, an epileptic, the same amount of potassium bromide, 75 grains a day, BROMUM. 189 was given, and in ten days coma and death followed. Both the brain and meninges were congested and the kidneys were in the advanced stage of cirrhosis. The other cases were less prominent and clearly from bromidism which was the result of long use of the drug. In some cases of inebriety larger doses of bromides produce stupor and prostration, from which recovery is slow, and is followed by continued prostration. Differences in Action between the ordinary 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 resembles 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 bromides. Strontium Bromide is said to be less apt than the other bromides to produce the bromic acne and the other results of bromism. 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 not official. 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. 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 in epilepsy is that of a specific, but therein they are terribly abused, by patients, nurses, and even by physicians. They should not be used in anaemic conditions, and never for any length of time without the daily supervision of a physician. If Opium be administered in ascending doses for four to six weeks before commencing a course of treatment by bromides, the latter will be much more effective in smaller doses than otherwise. The mixture of Potassium Bromide and Chloral is very unsafe in cases where fatty or weak heart exists, both drugs being active cardiac depressants. In convulsive and spasmodic affections, the bromides are very efficient, 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 myal- gia, also in the uric acid diathesis, and various affections due to unde- Therapeutics. 190 BRYONIA. veloped gout, the lithium salt gives good results. In tetanus and strych- nine-poisoning the potassium salt, in large doses, is antagonistic. These agents are generally efficient in nervous erethism, insomnia with conges- tion, infantile colic, cholera infantum, vomiting of cerebral origin, car- diac irritability when not due to anaemia, delirium tremens, melancholia, whooping-cough and other reflex coughs, seminal losses when plethora exists, and nymphomania. The potassium salt is, by some writers, con- sidered almost specific in subinvolution of the womb, and in uterine hemorrhage not due to a mechanical cause. Strontium Bromide has been favorably known for some time for its beneficial action in gastric affections, particularly in dyspepsia, acetic and lactic fermentation, flatulence from decomposition and vomiting of various origin, including the vomiting of pregnancy. In severe cases of the latter affection it proved entirely successful, administered in doses of gr. xv with meals, twice daily for a month. In epilepsy it has been em- ployed with advantage, in doses of gr. xx thrice daily, gradually increased : and has been used in the treatment of nervous and sick headaches, sea- sickness, insomnia, and other conditions for which the bromides are con- sidered suitable. It is said to be less productive of the bromic acne than are the other bromides in general use. The Syrup of Iron Bromide has been reported by some observers as very efficient in chorea, and its usefulness therein is as strenuously denied by others. 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 npviij to the 5, used internally, and inhalation of the vapor, have been used successfully in the most severe cases. Bromoform is an analogue of Chloroform, and was discovered in 1832 by Lowig. Inhaled, it produces anaesthesia on animals, but of shorter duration than that of ether or chloroform. Deep narcosis has been produced in children by overdoses, taken internally; the little patients having been tempted, by the pleasant taste of the medicine, to the sur- reptitious ingestion of more than was prescribed. It has proven of special efficacy in whooping-cough, administered in daily doses of 5 to 20 minims, administered in glycerin and alcoholic solution. It aborts the paroxysms and reduces their number somewhat, but has little influence otherwise on the regular course of the affection. Increasing doses must not be pushed very far, for fear of toxic symptoms, and the drug must be absolutely colorless if pure. Inhalations of Bromoform have been used with some success in the treatment of diph- theria; and it has been employed locally with benefit, as a deodorizer, disinfectant and analgesic, in ozaena and in tuberculous and other ulcers of the larynx. BRYONIA, Bryonia, Bryony,—is the root of Bryonia alba and of Bryonia dioica, European perennial plants of the nat. ord. Cucurbitacese. Its taste is acrid and bitter, but it is inodorous. The active principle is the glucoside Bryonin, C48H80O19, which is intensely bitter, and soluble in BUCHU, 191 water and in alcohol, but insoluble in ether. Dose, of powdered root, gr. x-xxx. Preparations. Tinctura Bryonise, Tincture of Bryonia,—a io per cent, solution of the root in alcohol. Dose, npv-J ss. Bryonin (Unofficial),—is a violent poison in doses of from 3 to 4 grains. Dose, as a drastic purgative, gr. Bryonia is a pure irritant, setting up local inflammation wherever ap- plied, with febrile phenomena. It has a vesicant action on the skin, and is violently irritant to the serous and mucous membranes. Taken inter- nally, 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 pleura, and is also irritant to muscular fibre, and to the bronchial mucous membrane, caus- ing 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. 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 fre- quently repeated are required. Also, in rheumatic fever, after the swell- ing 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 “gas- tric” fever, relapsing fever, congestive headaches increased by stooping, bilious headache with vomiting, 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 shoot- ing 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. Physiological Action and Therapeutics BUCHU, Buchu, —is the leaves of Barosma betulina, B. crenulata, and B. serratifolia, S. African shrubs, of the nat. ord. Rutacese. They contain a Volatile Oil, which is probably the active principle, and gives 192 CACTUS GRANDIFLORA CADMIUM. them a peculiar and penetrating odor; resembling that of peppermint; also, Barosmin, a bitter extractive, and resin, gum, lignin, etc. Dose, of the leaves, gr. xv—xxx. Preparations. Extractum Buchu Fluidum, Fluid Extract of Buchu.—Dose, Tt^x-gj. Infusum Buchu, Infusion of Buchu (Unofficial),— 3 j to the pint. Dose, 3 ss-ij. Physiological Action and Therapeutics. 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. 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. CACTUS GRANDIFLORA, or Night-blooming Cereus (Unofficial),—is a native of tropical America, which has long had a local reputation as a remedy for dropsy, but was first brought into notice as a cardiac remedy by Dr. Rubini. Its active principle, Cactine, a supposed alkaloid, has been physiologically studied by Dr. Myers, who finds it possessed of very decided stimulant action upon the heart, the arterial tension and the spinal motor centres. Therapeutically, this drug has been employed as a cardiac stimu- lant in the functional disorders of the heart connected with anaemia, neurasthenia, dyspepsia, tobacco poisoning, exophthalmos, sexual exhaustion and low fevers, also in pseudo angina pectoris. It does not prolong the diastole, as Digitalis does, and on this account it has been especially recommended in complicated aortic regurgitation. A tincture is prepared of tbe strength of 3 iv of the fresh stems to a pint of strong alcohol, the dose of which is tr^xx—xxx every 4 hours. CADMIUM, Cd (Unofficial).—This metal was official in the Pharmacopoeia 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, Cadmium Sulphate (Unofficial),—transparent oblique prisms, efflor- escent, 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). Cadmii Iodidum, Cadmium Iodide (Unofficial),—large, white, pearly crystals, soluble in water and alcohol. Used as an ointment, I to 8 of lard. The Sulphate has been used almost exclusively as a stimulating astringent in gonor- rhoea and diseases of the eye. Corneal opacities are absorbed under the use of a solu- tion of gr. ij to the , and in gonorrhoea a mild injection (gr. lf ad § j) 's ver7 benefi- cial. An ointment of the Iodide has been usefully employed for enlarged glands, chronic joint affections, cutaneous diseases, nodes and chilblains. CAFFEA. 193 CAFFE A, 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. Rubiacese, 15 to 30 feet high, native of South Arabia and Abyssinia, but cultivated in various parts of the world. Its seeds contain the alkaloid Caffeine (partly free, partly as a tannate), also tannic and caffeic acids, sugar, legumin, etc. By roasting them, part of the caffeic acid is converted into methylamin, the sugar is changed into cara- mel, 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 (Tri-methyl-xanthin), C8H10N4O2-j-H2O. The U. S. Pharmacopoeia of 1890 defines Caffeine (Theine) as “ a feebly basic, proximate principle, obtained from the dry leaves of Thea Sinensis, . . . or from the dried seeds of Coffea Arabica, . . . and found also in other plants.” In the edition of 1880, Guarana was included by name among its sources. Therefore, the principles named Caffeine and Theine are now officially declared to be identical, and their identity with Guara- nine is left unsettled. That all three are identical was the general opinion until recently, their composition being expressed by the formula C8H10Nr 02, and the physiological action of one being accepted for the others. Some investigators, however, doubt the identity of the first two, and some observers maintain that Guaranine also is a separate body, distinct from either of the others. The Caffeine of commerce is usually obtained from old tea leaves, and is in reality Theine. It contains more nitrogen than almost any other proximate vegetable principle. It occurs in colorless, flexible, silky crystals, which are soluble in 80 of water and 33 of alcohol at 590 F. Dose, gr. j-v. Theine is contained in the leaves of Thea Sinensis, the tea-plant, a native of China and Japan, and a member of the nat. ord. Temstromiaceae. The tea-plant also contains much Tannic Acid, and a volatile oil, the latter being most abundant in green teas. Theine is found on the market, Merck’s being considered to be the most reliable. Its solubility in water is much increased by adding an equal part of Sodium Benzoate, say gj of each to the fluid , with gr. x of Sodium Chloride. Of this, Ttpvj equals gr. of Theine. Dose, gr. ]/(,-), hypodermically, several times a day, for relief of pain. Preparations. Caffeina Citrata, Citrated Caffeine,—is a very uncertain mixture, and is not considered to be a definite compound. It is prepared by dissolving equal weights of Caffeine and Citric Acid in double the quantity of hot distilled water, evaporating the solution to dry- ness, and powdering the product, which is white, odorless, of acid taste and acid reaction, soluble in about 3 parts of water, precipitated as Caffeine on further dilution with water, and redissolved with about 25 parts of water. Dose, gr. ij-x. Caffeina Citrata Effervescens, Effervescent Citrated Caffeine,—composed of Caf- feine 1, Citric Acid 1, Sodium Bicarbonate 33, Tartaric Acid 30, Sugar 35, triturated, mixed with Alcohol to a paste, dried, and powdered. Dose, 5jj-ij,in a glassful of water, as an effervescing drink. Extractum Caffeae Viridis Fluidum (Squibb), Fluid Extractof Green Coffee (Un- official),—is intended as a substitute for the fluid Extract of Guarana. Dose, [Compare the title Guarana.] 194 CAFFEA. 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. As a beverage, if used with moderation Coffee assists digestion, pro- motes 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 disturbances of the nervous system, shown by headache, vertigo, mental confusion, and palpitation of the heart. It increases secretion, blunts sensation, exalts reflex excitability, increases 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 wake- fulness 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 stimulating 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. CAFFEA. 195 Coffee ( Coffea Arabica, nat. ord. Rubiacese), is more stimulating than Coca and less sustaining. It is apt to cause severe palpitation of the heart in some persons, and may disorder the digestion if long infused be- fore ingestion. The coffee-bean contains only from 0.2 to 0.8 per cent, of caffeine. Tea (Thea sinensis, nat. ord. Ternstromiacese), is one of the most refreshing and stimulating members 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, pallor of the surface, irregular cardiac action, and feeble impulse, hallucinations, night-mare, anorexia, headache, nausea and vomiting, obstinate neuralgiae, especially of the supra-orbital and occipital nerves; also constipation, and a pain in the left side are not infrequent. The condition of chronic tea-poisoning is termed Theism, and is very often seen among women of the lower class in cities, who do not indulge in alcoholic beverages, but freely accept the dominion of the “ cup that cheers ” and worse than inebriates. Tea con- tains much more Tannin than coffee, and that used as a beverage by the poorer classes is little more than a decoction of tannin, and a fruitful source of dyspepsia and other forms of gastric disorder. Mate {I/ex Paraguayensis, nat. ord. Aquifoliaceae), is supposed to be intermediate in its effects between tea and coffee. It contains Theo- bromine as well as Caffeine, the latter in the proportion of 1.2 per cent., also a little tannin. Guarana (Paullinia Cupana of Brazil, nat. ord. Sapindaceae), con- tains an alkaloid—Guaranine, in the proportion of 5 percent., which is probably identical with Caffeine, though some think it more analogous to Theine. It is especially noted for relieving a nervous headache, for which purpose the official fluid extract may be used in doses of three or four times daily, when the basis of that preparation happens to be of good quality. [Compare the article on Guarana.] Coca, or Cuca (.Erythroxylon Coca, nat. ord. Lineae), is probably more sustaining than either tea or coffee and less of a direct stimulant, at least as used by the Peruvian natives. Its habitual and excessive use produces a very serious train of nervous symptoms. [Compare the article entitled Coca.] Its alkaloid, Cocaine, is allied in action to Caffeine, but is more powerful, and its proportion in the leaves of the plant varies greatly in the different samples which occur in commerce. Cocoa ( Theobroma Cacao, the Chocolate-tree, nat. order Sterculiacege), pronounced Kah-kow,—is more directly nutritious than any of the group, containing a large quantity of fat, Olemn Theobromatis (cacao-butter), which makes it difficult of digestion to many persons. Its alkaloid, Theobromine, is chemically a Dimethylxanthin, and is closely allied to Caf- 196 caffea. feine, 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. [Compare the article entitled Theobromatis Oleum.] Kola (Cola acuminata, nat. ord. Sterculiacese), is the nut or seed of the Kola plant, which is a handsome tree growing 30 to 60 feet high in the tropical forests of Africa and in the West Indies. It contains both Caffeine and Theobromine, the former in larger proportion than any mem- ber of the group except Guarana ; also Tannic Acid and a glucoside sub- stance named Kolanine, which, in the presence of a ferment, splits up into free caffeine and glucose, the yield of caffeine therefrom being 3 per cent. The Kola nut is highly valued by the negroes as a stimulant bev- erage and food and as an aphrodisiac, the latter quality being ascribed to the essential oil, which is not present in the dried nuts. It improves the appetite and the digestion, promotes cheerfulness of the spirits and inclination to exertion. It is becoming a fashionable stimulant under the commercial methods which are employed in pushing the sale of the various preparations on the market. Physiological Action of Caffeine. Caffeine is in general terms 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 thereby great heaviness of the head, flashes of light before the eyes, tinnitus aurium, insomnia, restlessness, and even delirium, the pulse be- coming 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 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 CAFFEA. 197 hydragogue diuretic; acting by stimulation of the secreting apparatus in the kidney, as well as by generally raising the arterial tension (Brunton). The action of caffeine on the kidneys is two-fold ; during the first stage it causes a fall of general blood-pressure and constriction of the renal vessels; during the second stage, which persists much longer than the first, the blood pressure returns to its normal height, and the kidney undergoes great expansion (Murrell). Theine, according to Dr. Mays, agrees in most respects with Caffeine in its action upon the smaller animals, 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 convulsions, 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 rhyth- mical 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 anaesthesia 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 to be identical with Caffeine, though some few ob- servers 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 hypersesthesia, and subsequently con- vulsions 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 Caffeine, both phy- siologically and chemically. In fact, Caffeine may be considered a Methyl-theobromine, C7H9(CII3)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 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 cervico- brachial neuralgia, Caffeine may be used hypodermically in doses of gr. j, increased to gr.v. In lithsemia and gout, a tincture of the green bean has marked diuretic and antispasmodic powers, and is very useful in these conditions. In the insomnia of chronic alcoholism, gr. y?, of Caffeine hypodermically, is often efficient. For adynamic fevers, it may well be used in place of alcoholic stimulants. In intermittents, Coffee has a cur- ative reputation among the inhabitants of the Philippines, which is corrob- orated by the Dutch physicians. In asthma, Coffee is valuable for the paroxysm if not used habitually. In opium narcosis, Caffeine hypoder- 198 CAFFEA. mically, or better still, strong black coffee by the mouth, will antagonize the increasing torpor of the nervous centres. Although Caffeine is an efficient diuretic in cardiac and renal dropsies, there are many objections to its use for this purpose. It sometimes acts as a purgative as well as a diuretic, and although at first it produces copious diuresis, tolerance is soon established and it loses its diuretic power. Moreover, it is a powerful cardiac stimulant, and in many persons it exerts a very marked excitant action upon the central nervous system. Lastly, and as a minor disqualification, it sometimes sets up considerable smart- ing in the penis and produces a mild form of urethritis (Murrell). Caffeine is an ingredient of the many proprietary preparations of which the active ingredient is Acetanilid (see ante, page 67). Its office therein is that of a corrigent, antagonizing the depressant action of Acetanilid on the heart. A double Citrate of Caffeine and Antipyrin named Migranin is described on page 143. Theine, according to Dr. Mays, is a valuable analgesic, especially so by reason of its prolonged influence over sensation. Its great field of em- ployment is in neuralgia of any kind, cervico-brachial, sciatic, etc., in which doses of gr. yfc to gr. 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, quickly relieving pain, without producing any narcotic effect. Kola is a useful agent in gastric catarrh and in the dyspepsia of alco- holic subjects, as an adjunct to other treatment. After an alcoholic debauch it will do much in restoring the nervous system to its normal condition. It will counteract the depressing effects of tobacco, and has been employed with benefit in asthma, of both the nervous and cardiac forms. As it contains a good deal of Tannin, it is especially efficient in atonic diarrhoea, and in gastro-intestinal irritation with looseness of the bowels, a restricted diet and Kola-wine are frequently all that is needed. As an aphrodisiac, it deserves high rank, though it acts in this respect not so much by stimulating the sexual appetite as by enabling the organism to escape the sense of exhaustion and extreme debility which neurotic patients are so apt to complain of (Woodbury). Sodio-Theobromine Salicylate, Diuretin (Unofficial),—was introduced under the latter title as a proprietary preparation. It occurs as a colorless powder, of sweetish, saline and alkaline taste, soluble in x/2 its weight of water, and should contain per cent, of Theobromine. Being a very unstable compound, it should not be prescribed in combination with other drugs, and when dispensed it should be well sealed from contact with the air, from which it rapidly absorbs carbonic acid, thereby undergoing decomposi- tion. If ordered under its chemical name, and insisted on, the cost should be less than that of the same article under its proprietary title (Squibb). Dose, gr. x-xv, in powder or aqueous solution, several times a day, as a diuretic. Diuretin was introduced as a soluble preparation of Theobromine, of value for its prompt diuretic action, influencing the kidneys without causing serious or dangerous CAJUPUTI OLEUM CALAMUS CALCIUM. 199 results upon the heart, the action of which, however, it strengthens and regulates. Given to healthy persons it does not increase the quantity of the urine, but during its adminis- tration in morbid conditions of the renal or cardiac apparatus the volume of urine in- creases three- and four-fold, and exudations of non-inflammatory character are rapidly absorbed. It may give rise to slight diarrhoea, and the author has found the body-tem- perature uniformly subnormal in non-febrile patients while under its influence. Diuretin has been employed with marked benefit in both cardiac and renal dropsy, in hepatic cirrhosis, and in various diseases of the heart and kidneys accompanied by oedema. The author has seen a large pleuritic effusion disappear rapidly under its use, the fluid having re-accumulated after having been once removed by tapping the pleural cavity. It should be administered in aqueous solution, avoiding acids or acid vegetable juices, which are chemically incompatible, as they precipitate the alkaloid in the form of a thick white sediment. CAJUPUTI OLEUM, Oil of Cajuput,—is a volatile oil distilled from the leaves of Melaleuca Leucadendron, a tree of the nat. ord. Myrtacese, native of the Molucca Islands. It is a bluish-green or colorless liquid, of camphoraceous odor, and neutral re- action, freely soluble in alcohol. It contains Cajuputol or Bihydrate of Cajuputene, which forms % of it, the other y( being another oil. Dose, tty j-v. Cajuput Oil resembles Oil of Turpentine, and has similar action to that of the other volatile oils, being a stimulant carminative, somewhat diuretic and diaphoretic, antiseptic, parasiticide and anthelmintic. Externally 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, and syphilis, also in elephantiasis and other cutaneous disorders. Externally, as a strong, 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. Araceae, 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. Extractum Calami Fluidum, Fluid Extract of Calamus,—is made with Alcohol as a menstruum. Dose, try xv-^j. Calamus is an aromatic bitter, and stomachic tonic, increasing the appetite and stimu- lating 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 although itself unofficial it is represented by several official salts and preparations. Lime (Calx) and Chalk (Creta) are respectively the Oxide, CaO, and the Carbonate, CaC03, of Calcium, the latter occurring in the native forms called chalk, marble, limestone, oystershells, etc., which are converted into Lime by heating to full red- ness (calcination), thereby driving off carbonic acid and leaving the oxide behind. The latter, in this form, is known as “ burnt lime ” or “ quick- lime; ” and, by the addition of to its weight of water, combines with one molecule of H20 to form Calcium Hydrate, Ca(HO)2, or “slaked lime,” the process being termed “slaking” and being accom- panied by the evolving of a high degree of heat. Lime is one of the four alkaline earths, the other three being Baryta, Magnesia, and Strontia. As such, however, it never occurs naturally, though in combination with 200 CALCIUM. various acids it is found in all the three kingdoms of nature ; its base, the metal Calcium, being a widely distributed element, forming the basis of all calcareous and cretaceous substances. Besides the forms mentioned above, Calcium occurs as a sulphate (gypsum), also as a phosphate in bones, shells and various organic tissues, and as a silicate and a fluoride in certain minerals and vegetables. Calx, Lime (Calcium Oxide), CaO,—is Lime prepared by burning white marble, oyster-shells, or the purest varieties of native Calcium Carbonate. Occurs in 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 Hydras, Calcium Hydrate (Slaked Lime), Ca(HO)2,—official in the Br. Phar., is prepared by pouring I pint of water over 2 pounds of Lime in a metal pot. It should be recently prepared and kept excluded from the air. It is sparingly soluble in water (gr. xj in Oj) and less soluble in hot water, but its solubility is greatly increased by the addition of sugar. Calcii Carbonas Prsecipitatus, Precipitated Calchim Carbonate, CaCOs,—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 native Calcium Car- bonate. (See below.) Dose, gr. v-^j. Calcii Chloridum, Calcium Chloride, CaCl2,—hard, colorless masses, deliquescent, of sharp, saline taste, soluble in 1)4 of water and in 8 of alcohol. Dose, gr. iij-x in solution. This salt should not be confounded with Chlorinated Lime. Calcii Sulphas Exsiccatus, Dried Calcium Sulphate (Dried Gypsum),—contains about 5 per cent, of water. A fine, white powder, without odor or taste, insoluble in alcohol, soluble in 410 of water at 590 F., in 388 of water at loo° F., and in 476 of water at 2120 F. Used in the preparation of Calx Sulphurata. Calcii Sulphidum, Calcium Sulphide, is described under Sulphur ; Calcii Bro- midum, Calcium Bromide, under Bromum ; Calcii Hypophosphis, Calcium Hypo- phosphite, and Calcii Phosphas Praecipitatus, Precipitated Calcium Phosphate, under Phosphorus. Official Salts of Calcium Liquor Calcis, Solution of Lime (Lime-water),—contains about 0.17 per cent, of Calcium Hydrate, Ca(HO)2. A clear, colorless liquid, of saline taste and alkaline re- action. Dose, 5ss-iv. Syrupus Calcis, Syrup of Li?ne (Saccharated Solution of Lime),—contains 6)4 per cent, of Lime, and 40 of Sugar, the latter aiding the solvent power. Dose, j. Is an antidote to poisoning by Carbolic or Oxalic Acid. Linimentum Calcis, Lime Liniment (Carron Oil),—contains equal volumes of Lime-water and Linseed Oil, mixed by agitation. For local use. Calx Chlorata, Chlorinated Lime, is described under Chlorum ; Potassa cum Calce, Potassa with Lime, under Potassium, and Calx Sulphurata, Sidphurated Lime, under Sulphur. Preparations of the Oxide. (Lime.) Preparations of the Carbonate. (Chalk.) Creta Praeparata, Prepared Chalk, CaC03,—is native Calcium Carbonate, freed from most of its impurities by elutriation ; a tvhite, amorphous powder, odorless and tasteless, insoluble in water or alcohol. Dose, gr. x-3 j. Is a constituent of Hydrargyrum cum Creta, and also of the following : Pulvis Cretae Compositus, Compound Chalk Powder,—has of Prepared Chalk 30, Acacia 20, Sugar 50 parts. Dose, gr. v-gj. Mistura Cretae, Chalk Mixture,—has of the preceding 20 parts, Cinnamon Water 40, Water to 100, rubbed together and made fresh as required. Dose, 3 ss-ij. Trochisci Cretae, Troches of Chalk,—each contains of Prepared Chalk 4 grains, Acacia 1, Sugar 6, with a little Nutmeg. Dose, indefinite. Testa Praeparata, Prepared Oyster-shell (Unofficial),—contains animal matter inti- mately mixed with the Carbonate of Calcium. Dose, gr. x-xx or more. CALCIUM. 201 Allied Substances. Substances allied to Chalk, and derived from the animal kingdom, are—Crabs'- eyes, which are concretions obtained from the stomach of the craw-fish, Coral, Cuttle-fish Bone, Egg-shells and Oyster-shells (Testa, see above) ; all of which are mainly composed of Calcium Carbonate, but also contain the phosphate and sulphate of calcium and other metallic salts in small quantity, as well as organic material. In the past special virtues have been ascribed to these substances, and even now some authorities maintain that the animal carbonates derange the stomach less than the mineral ones, and are to be pre- ferred for infants and delicate persons. Physiological Action. Lime, in its unslaked form (quick-lime), has a great affinity for water and readily combines with sulphur, thereby decomposing and destroying organic matter. Upon the skin its action is irritant and superficially caustic, but more severe on the mucous membranes, and if inhaled or swallowed it may produce dangerous local inflammation, followed by ulceration. In weak solution it has an astringent and sedative effect both locally and internally, and acts as an absorbent and an antacid. Chalk possesses the astringent and antacid qualities of lime without its irritant property. Calcium Chloride is a very diffusible salt, and in small doses has re- markably alterative action, being apparently a powerful antagonist to the condition known as the strumous diathesis. Full doses produce symptoms of muscular poisoning similar to those caused by potassium salts, with lowered temperature, slowed pulse, and a tendency to cardiac paralysis. In large doses it is an irritant poison. It increases the amount of the urine and probably promotes the excretion of urea. It has a great affinity for water, and is used in pharmacy to abstract water from other substances, as in the preparation of absolute alcohol and ether. In solution it is used as a test for tartrates, citrates and oxalates. Calcium Salts play an important part in the circulation and in most of the other functions of the body. The heart or any other muscle, de- prived of calcium, will no longer contract. These salts have a remark- able influence on the nutrition of plants and animals, the Phosphate be- ing as essential to the nourishment of the organs of locomotion (cartilage, bone, tendon and muscle) as Iron is to the blood or Phosphorus to the nerve tissue. They possess high coagulating power on the blood, their deficiency gives rise to lymphatic and osseous disease, and their absence results in emaciation and finally death. They are excreted almost entirely by the intestines, a very small portion being absorbed and but little of that passes out by the kidneys. Their absence from water renders the latter flat and insipid to the taste, but if present in excess (above 20 grains of the carbonate to the gallon) the water containing them is be- lieved to be one of the factors of goitre. The Sulphate, in even so small a proportion as 6 grains to the gallon, is unwholesome, as it is liable 202 calcium. to irritate the bowels and produce constipation and diarrhoea alternately, according as its astringent or irritant effects predominate. Antidotes, Antagonists and Incompatibles. In poisoning by Caustic Lime the antidotes are a dilute Vegetable Acid or Lemon- juice or Carbonated Water freely, followed by demulcents or fixed oils to protect the mu- cous membranes. Opium or Alcohol as antagonists against the vital depression. Potas- sium salts and Calcium salts are mutually antagonistic. Poisoning by Calcium Chlor- ide is treated by Albumen, mucilaginous drinks, oils, milk, flour and water, but no acids. Incompatible with preparations of Lime and Chalk are all the Acids and metallic salts, especially the Sulphates and Tartar Emetic ; and borates, alkaline carbonates and astring- ent vegetable infusions are also incompatible with the preparations of Lime. 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. The Chlorinated Lime is an excellent antiseptic and disinfectant, but as it owes its energy entirely to its power of evolving Chlorine it will be described under the title Chlorum. Lime-water is a favorite remedy for vomiting, especially in children, and is added to milk to increase its digestibility. A mixture of milk and lime-water will be retained by the stomach when no other food can be borne. Lime-water is an efficient agent in acid dyspepsia, mucous enteritis and typhoid fever, as an astringent and antacid. Locally, it is well employed as an enema against thread-worms, as a mouth-wash for aphthae, and as a lotion for cracked nipples, eczematous eruptions, and many mucous and purulent discharges. For such purposes it may be mixed with oil or glycerin, and if a few drops of carbolic acid be added the efficacy of the mixture is much in- creased. The Liniment is best known by the name Carron Oil, from the foundries at Carron, where it is extensively used. It is one of the best applications for burns and scalds, and makes a good dressing for the face in small-pox, and for cases of eczema affecting a large area of the skin. The vapor of slaking lime, or lime-water in the form of spray, have been usefully employed as inhalations in diphtheria. Lime-water is a good injection into the bladder in vesical calculus, in which its benefit is prob- ably due to its astringent and soothing effects on the inflamed vesical mucous membrane, blunting itts sensibility, and preventing the further growth of the stone by neutralizing the free acid of the urine. One of the curiosities of medical history is the fact that in 1739 the British Parliament gave the sum of to Mrs. Johanna Stephens for divulging the nature of a certain lithontriptic remedy. This, she stated, consisted of calcined egg-shells and soap, with various aromatic bitters, a combination which had previously been recommended by Barbette for the same purpose. The nauseousness of this compound suggested to Whytt the use of lime-water as a substitute, and the latter was found to be efficacious in many instances. The Syrup contains more lime in solution than lime-water does, and CALENDULA CALUMBA. 203 may be used instead of the latter when a strong preparation is indicated. It is one of the antidotes in poisoning by carbolic and oxalic acids, while lime in any form (wall-plaster, whiting, etc.) is the antidote for any min- eral acid. Chalk is the basis of all dentifrices, and may be used as a dusting- powder on ulcers, burns and excoriations of the skin. Chalk-mixture is a common remedy for diarrhoea, and is usually employed in combination with other astringents, also with opium and aromatics. It is particularly serviceable for the diarrhoeas of children with sour-smelling stools and other symptoms of gastro-intestinal acidity. Calcium Chloride is used with benefit as an internal remedy in the various manifestations of the strumous diathesis. It often causes the resolution of glandular enlargements, and the calcification of tubercular deposits, aids the cicatrization of ulcerating cavities, and has proved curative in eczema and lupus. It is highly praised in phthisis, also in chorea, and for the colliquative diarrhoea of strumous children. In solu- tion used externally as a fomentation it is said to hasten the maturation of boils. The therapeutics of the other salts and combinations of calcium are described under the titles of their more active ingredients, Bromum, Chlorum, Phosphorus and Sulphur. CALENDULA, Marigold,—is the florets of Calendtila 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 promote the healing process in wounds, ulcers, burns and other breaches of tissue. Ex- travagant views of its powers as a vulnerary are promulgated by the so-called “ homoeo- pathic surgeons,” and serve as one of their excuses for professing an exclusive position in the art of surgery. CALUMBA, Columbo ,—is the root of Jateorhizapalmata, a plant of the nat. ord. Menispermacese, native in southeastern Africa, but culti- vated in the East Indian Islands. It contains the alkaloid Berberinef^see under Berberis, ante, page 184), a bitter principle named Calumbin, also Calumbic Acid and Starch, but no Tannin. Dose, gr. v-xxx. Preparations* Extractum Calumbae Fluidum, Fluid Extract of Calumba.—Dose, rtpv-xxx. Tinctura Calumbae, Tincture of Calumba,— I in io. 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 to other members of that class (Quassia, Gentian, Cornus). It stimulates 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. 204 CAMBOGIA CAMPHORA. 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. 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, vomit- ing, sea-sickness, cholera morbus and cholera infantum. An Infusion 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 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 Gamboge. Its dose, as a cathartic, is gr. ij-v,—as a diuretic, gr. j at short intervals. 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 frequently caused death. On the other hand, large doses have been given continu- ously 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, digi- talis, etc.). However, for dysentery, especially when in young subjects, very small doses (gr. j at short intervals, up to gr. in 24 hours, have proven to be remarkably effi- cacious. CAMPHORA, Camphor, C10H16O,—is a stearopten (solid volatile oil), derived from Cinnamomum Camphora, a tree of the nat. ord. Lauri- nese, and purified by sublimation. It occurs in white, translucent, waxy masses, of penetrating odor and pungent taste, lighter than water, in which it is sparingly soluble (1 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, and Safrol, also contained in Sassafras oil, but obtained in much larger quantities from Camphor oil, a waste by-product in the production of crude camphor. Official Preparations. Aqua Camphorse, Camphor-water,—Camphor 8, Alcohol 5, Distilled Water to 1000. Used externally or as a vehicle. Dose, 3 j—iv. CAMPHORA. 205 Spiritus Camphorae, Spirit of Camphor,—10 per cent, in Alcohol. Dose, rrpv-xx. Linimentum Camphorae, Camphor Liniment,—Camphor 20, Cotton-seed Oil 80. Ceratum Camphorae, Camphor Cerate,—has of the Liniment 10, White Wax 30, Lard 60. Used for itching skin-affections. Camphora Monobromata, Motiobromated Camphor, C10H15BrO,—colorless, pris- matic 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. Camphor is also an ingredient of Linimentum Saponis, Linimentum Sinapis Com- positum, and Tinctura Opii Camphorata. Acidum Camphoricum, Camphoric Acid, C8Hu(COOH)2,—is a dibasic acid, ob- tained by the action of nitric acid on camphor. Occurs in white, acicular, odorless crystals, of feebly acid taste; insoluble, or nearly so, in cold water, readily soluble in hot water, alcohol, ether and fatty oils. Dose, gr. x-xxx, dry on the tongue. Rubini’s Tincture of Camphor,—is a saturated solution in alcohol, 3j in oiX> of which the dose is from 4 to 10 drops, rt\_vij have caused toxic symptoms in an adult. Raspail’s “ Eau Sedative,”—contains Aq. Ammonise Sodii Chloridum ij, Camphorated Spirits of Wine 3 iij, Water Oij. Used externally. 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 3 ij), and many other salts of alkaloids. It is often a serviceable ap- plication 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 substance has been used with very satisfactory results in the treatment of phagedena, spreading syphilitic sores, epithelioma, lupus, etc. Oleum Camphorata, Camphorated Oil,—strength 10 per cent., is used for hypoder- mic injection, in doses of rr^xv-gj. Unofficial Preparations. 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 per- haps death. As many as 200 grains have been taken without fatal result, yet 6 or 7 grains have produced extreme drowsiness and weakness of the 206 CAMPHORA. 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, Antidotes 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, vomiting, gastralgia, cardiac depression, nervousness and nervous headache, nym- phomania, capillary bronchitis, typhoid and eruptive fevers, dysmenor- rhoea, 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. Subcutaneous injections of camphor dissolved in oil have been employed with excellent results in the collapse of pneumonia and in other conditions where collapse is imminent. In fibrinous pneumonia these injections produce a depression of about one degree in the temperature, and greatly ameliorate the general condition. They are also employed with benefit in the treatment of phthisis during the period of softening, rendering the patient more comfortable and prolonging life. Camphor administered in this manner is not well borne by young children, even in minimum doses. Monobromated Camphor is used as a nerve sedative and hypnotic, but is not particularly efficient. It has been employed with advantage in whooping-cough, neuralgia, chorea, hysteria, delirium tremens and epi- lepsy, but it is taken with difficulty and is very liable to irritate the stomach. Camphoric Acid in solutions of y2 to 6 per cent, strength, has been used with benefit as a topical agent in cystitis, and in coryza, acute bronchitis, and other affections of the respiratory tract. Internally administered it gives good results as an intestinal disinfectant, and has lately come into prominence as one of the most efficient agents against sweating from various causes, especially the profuse night-sweats of pulmonary tuberculosis. For this purpose it is best administered dry on the tongue, in dose of io to 30 grains, not more than two hours before the time for the expected sweating to occur,—as it is quickly and abundantly eliminated by the urine. CANNABIS INDICA. 207 CANNABIS INDICA, Indian Cannabis, Indian Hemp,—is the flowering tops of the female plant of Cannabis sativa, grown in the East Indies; a coarse, pubescent, somewhat viscid annual of thenat. ord. Urti- cacese. Its odor is peculiar and narcotic, taste slightly acrid. Cannabis Americana, American Cannabis (Unofficial),—is the same plant, Cannabis sativa, grown in the Southern States. The two 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 Volatile Oil, from the latter of which are obtained Cannabene, a light hydrocarbon, and Cannabene Hydride, a crystalline body. Cannabis should not be con- founded with the so-called “ Indian or Canadian Hemp,” Apocynum cannabinum (see ante, page 156). Preparations. Extractum Cannabis Indicae, Extract of Indian Cannabis.—Dose, if active. Hering’s English Extract is one of the best. Extractum Cannabis Indicae Fluidum, Eluid Extract of Indian Cannabis,—is an alcoholic preparation which in mixtures must be thoroughly emulsified with Acacia, otherwise the resinous drug will separate and float to the top or adhere to the sides of the bottle. The Dose is put at h\j~v or x> but the author has frequently administered gj of a good fluid extract without untoward results. 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 preparation 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. Tincture Cannabis Indicae, Tincture of Indian Cannabis,—strength 15 per cent. Dose, The above remark on mixtures containing the fluid extract applies also to the tincture of this drug. 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 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 Indica is antispasmodic, analgesic, anaesthetic and narcotic, a cerebro-spinal stimulant and a powerful aphrodisiac. Its increases intel- 208 CANNABIS INDICA. 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 peculiar but generally pleasant form of intoxication, dur- ing which the particular 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 seeming as if hours or even days. With this occurs increased sexual desire, great uterine activity, and sensations of double consciousness and enormous 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 ravenous appetite is usually one of its effects. 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. Antagonists and Incompatibles. Therapeutics. Cannabis Indica was formerly much employed as an anodyne and hyp- notic, also as an anaesthetic during surgical operations. It is now some- what 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, dysmenorrhcea, etc., are greatly benefited by its anodyne quality and its power over the uterine muscular fibre. It is one of the best hypnotics in delirium tremens, and in traumatic tetanus and paralysis agitans large doses of this drug 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 combined with Ergot and Nux-vomica. In gonor- rhoea it lessens the discharge, relieves the inflammation, burning pain and restlessness, and allays chordee. The tincture of Cannabis 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 drop 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 CANTHARIS. 209 menopause, but should be used cautiously until the activity of the sample and the susceptibility of the patient are tested. Dr. Lees has recently called attention to the fact that aqueous prepara- tions of this drug, which contain but little of the resin, are much used by the natives of India for intoxicating and stimulating purposes, which in- dicates that the volatile oil and not the resin is the active principle. He uses a strong aqueous extract, prepared without heat, which gives all the beneficial effects of the alcoholic preparations without the extreme ex- hilaration bordering on intoxication so often produced by even medium doses of the latter. He finds that, in pulmonary affections generally, this Liquor Cannabis Indices acts most favorably as an anodyne and hyp- notic, while in phthisis pulmonalis it relieves the cough and aids the patient by its stimulant and exhilarating qualities to a degree which no other drug can accomplish. Dr. Lees has also used it in indigestion with constipation, and in many affections of children in which nervous symp- toms are prominent it has done good service. The adult dose is gss-j. Cannabin Tannate is considered by Fronmiiller to be a very useful hypnotic, not in any degree dangerous and neither disturbing the secre- tions 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, Tincture of Cantharides,—5 per cent. Dose, TT\J-xx. Ceratum Cantharidis, Cantharides Cerate, Blistering Cerate,—Cantharides 32, Yel- low Wax, Resin, Lard, of each 18, Oil of Turpentine 15. Collodium Cantharidatum, Cantharidal Collodion, Blistering Collodion,—Canthar- ides 60, Flexible Collodion 85, Chloroform to 100. Emplastrum Picis Cantharidatum, Cantharidal Pitch Plaster, Warming Plaster, has of Cerate of Cantharides 8 parts, Burgundy Pitch to 100. 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 irri- tating, 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- 210 CANTHARIS. 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 produce dangerous symptoms. It is abortive only in toxic doses. 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, neigh- boring parts are affected by direct extension of the inflammation pro- duced, and distant parts are also affected by absorption through the ves- icated 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 vincinity, but if permitted to remain long enough to pro- duce large blebs, the result is depression proportionate to the amount of serum abstracted, the serum containing nearly as much albumen as the blood itself. Antagonists and Antidotes. There is no chemical antidote nor physiological antagonist to Cantharis. Evacuation of the stomach, mucilaginous drinks freely, Opium for the gastro-enteritis, are the best measures 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 treat- ment. It is invaluable in subacute joint affections. As an internal remedy Cantharis must be employed in very small doses (rtp j-iij of the tincture) in order to be efficient. When so used it is an admirable agent in acute desquamative nephritis after the active inflam- mation and fever have subsided to reduce the albumen and blood in the capsicum. 211 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, prostatorrhcea, scanty menstruation and menorrhagia in subjects of lax fibre and general want of tone it is often very serviceable. Cutaneous squamae and vesiculse are greatly improved by small doses frequently ad- ministered and gradually increased, and it is one of the best remedies for 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 1 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, African Pepper,—is the fruit of Capsicum fastigiatum, a plant of the nat. ord. Solanacese, native in tropi- cal Africa and America. It contains Capsicin, which is a thick, red liquid, and is the active principle,—also a volatile alkaloid having the odor of Coniine. Dose of the powdered drug, gr.v-x. Preparations. Extractum Capsici Fluidum, Fluid Extract of Capsicum, alcoholic. Dose, Tip j-x. Tinctura Capsici, Tincture of Capsicum,—5 per cent, strength. Dose, Oleoresina Capsici, Oleoresin of Capsicum,—prepared by ether. Dose, Emplastrum Capsici, Capsicum Plaster,—prepared from the Oleoresin of Capsicum and Resin Plaster. An excellent warming 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 di- gestion, and produces more easy and copious alvine evacuations. It stimulates the action of the heart, is diaphoretic and diuretic, also decid- edly 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. 212 CARBO. Therapeutics. Capsicum is an excellent stomachic tonic in atonic dyspepsia and in that of chronic alcoholism with tremor and insomnia. In acute dipsomania 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 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 (gj to gviij) or the powder with honey, form excellent gargles for relaxed throat and its accompanying cough, relaxed uvula, inflammatory sore throat, and thecynanche 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, C.—This element is widely distributed through- out all the kingdoms of nature. United with oxygen in the form of Carbonic Acid gas, C02, it occurs in the air and in many mineral waters, while as carbonates, such as limestone, etc., it constitutes a large portion of the surface of the earth. [Compare the article entitled Acidum Car- bonicum, ante, page 80.] Another compound with oxygen, Carbonic Oxide or Carbon Monoxide, CO, is a highly poisonous gas, which is formed to a certain extent during the combustion of charcoal, but does not form salts. Two forms of Carbon are official, viz.:— 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, and very finely powdered ; is black, shining, brittle, inodorous, tasteless and insoluble. Preparations. Carbo Animalis Purificatus, Purified Ani?nal Charcoal,—the bone-phosphate and calcium carbonate being removed by digesting with Hydrochloric Acid and washing. Dose, gr. xx-^j. Carbonei Disulphidum, Carbon Disulphide, CS2,—is a clear, colorless, diffusive liquid, of strong, offensive odor, aromatic taste and neutral reaction ; soluble in alcohol, CARDAMOMUM. 213 ether, chloroform and oils, and in 535 of water ; vaporizes at ordinary temperatures, and is highly inflammable. Dose, H\ss-j. Physiological Action. Charcoal is an efficient deodorant and disinfectant, at 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 Disulphide 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. Charcoal is used in pharmacy for decolorizing vegetable principles, 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 constipa- tion, 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 poisons on theoretical grounds, but its efficacy in this respect is doubtful. Carbon Disulphide 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. Therapeutics. CARDAMOMUM, Cardamon,—is the fruit of Elettaria repens, a plant of the nat. ord. Scitaminese, cultivated in Malabar. It contains about Per cent, of a Vola- tile Oil, C10H16, isomeric with Oil of Turpentine, which oil is the active principle, also a 214 CARDUUS CARUM—CARYOPHYLLUS. fixed oil, coloring matter, etc. It is an ingredient of Pulvis Aromaticus and of Ex- tractum Aromaticum Fluidum (See under Cinnamomum), as well as of several com- pound preparations. Tinctura Cardamomi, Tincture of Cardamon,—10 per cent. Dose, 3 j-ij. Tinctura Cardamomi Composita, Compound Tincture of Cardamon,—has of Car- damon 20, Cinnamon 20, Caraway 10, Cochineal 5, Glycerin 50, Diluted Alcohol to 1000 parts. Dose, 3 j—ij • Infusum Cardamomi, Infusion of Cardamon (Unofficial),—maybe made in the strength of gj to 0)4, and used in wineglassful doses. 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 seedsof Carduus marianus, or St. Mary's thistle, an annual European plant of the nat. ord. Composite. A decoction (% ij ad Oj) is the pre- paration usually employed. It is an old 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, g j- ss, of a tincture, trpx-xx. Carduus Benedictus, the “blessed thistle,” also called Cnicus benedictus and Cen- taurea 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 pharyngeal constriction, with nausea, vomiting, colic, and diarrhoea. It acts chiefly as a bitter tonic, resembling Calumba and Taraxacum most closely. CARUM, Caraway,—is the fruit of Carurn Carvi,a. European plant of the nat. ord. Umbelliferse. Its odor and taste are aromatic and agreeable. The active principle is the Volatile Oil, which is also official. Caraway is an ingredient of Tinctura Carda- momi Composita. Oleum Cari, Oil of Caraway,—is the volatile oil distilled from Caraway, and is resolvable into Caruen, C10H16, isomeric with Turpentine, and Caruol, C10HuO, iso- meric with Thymol. It is an ingredient of Spiritus Juniperi Compositus. Dose, try—v. Infusum Cari, Infusion of Caraway (Unofficial),— ad Oss. Dose, The Oil of Caraway is fatal to small animals, and in one case gj produced 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 of Eugenia aromatic a, a handsome evergreen tree of the nat. ord. Myr- tacese, cultivated in the East and West Indian Islands. They emit oil when scratched, have an aromatic odor, and a pungent, spicy taste, and are contained in Tinctura Lavandulae Composita, Tinctura Rhei Aromat- ica 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. Oleum Caryophylli, Oil of Cloves,—a volatile oil distilled from Cloves, soluble in alcohol, and of sp. gr. 1.060. It consistsof a light and a heavy oil, the latter containing Preparations. CASCA BARK CASCARA AMARGA CASCARILLA. 215 Eugenol, C10H12O, a phenol-like compound, and Caryophyllin, ClnII160, which yields as a product of its oxidation, Caryophyllinic Acid, C.20H32O6. Dose of the oil, rrpj-iv. Infusum Caryophylli, Infusion of Cloves (Unofficial), may be made of strength I to 40, and used in doses of one to two fluid ounces. 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 and gum-resins. Such are Orange, Lemon, Allspice, Cajuput, Caraway, Peppermint, etc. Their oils are antiseptic, locally anaesthetic, stimulant and irritant, antispasmodic, stomachic and carminative. Internally they increase circulation and temperature, promote digestion and nutrition (in quantity may cause inflammation), relieve pain and spasm, and are excre- ted by the kidneys, skin, liver and the bronchial mucous membrane, stimulating and disinfecting their routes throughout 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. Physiological Action and Therapeutics CASCA BARK, Sassy Bark, Ordeal Bark (Unofficial),—is the bark of Erythro- phlceum 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 ( ad Oj) of which the dose is n\x; 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 3 ss-j thrice daily. CASCARILLA,—is the .bark of Croton Eluteria, a shrub or small tree of the nat. ord. Euphorbiacese, growing in the Bahamas. It contains Cascarillin, a crystalline prin- 216 CASSIA FISTULA—CAULOPHYLLUM. ciple, two resinoid extracts, aromatic volatile oils, with tannic acid, etc. There are no official preparations, but an Infusion (1 to 10) or a Tincture (1 to 10) may be prepared and given in doses of j- Cascarilla is an aromatic bitter. It increases appetite and digestion, the mucous secre- tion, 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 continued it will set up gastric catarrh and conse- quently indigestion. It has slight antiperiodic power. 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 precipitate 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. 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 Sennae. Cassia-pulp is laxative in doses of gj-ij, and purgative in large quantities, 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 dentata, a stately tree of the nat. ord. Cupuliferse, which should be collected while green. They contain tannic and gallic acids, salts, gum, etc. Extractum Castanea Fluidum, Fluid Extract of Castanea.—Dose, gss-^ij. This drug has not been studied as to its physiological action, if it has any. It is classed among the vegetable astringents by reason of its containing tannin. Its only reputation therapeutically is as a remedy for whooping-cough, in which it is said to be very effica- cious. 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. It 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-^ss. Preparations. Tinctura Catechu Composita, Compound Tincture of Catechu,—contains Catechu io, Cinnamon 5, Diluted Alcohol q. s. ad 100 parts. Dose, ttpx-sjj. Trochisci Catechu, Troches of Catechu,—each troche contains of Catechu nearly 1 grain, mixed with Sugar, Tragacanth and Orange-flower Water. Catechu is a powerful astringent, acting by virtue of its tannic acid, (See ante, page 94, for action 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. C AULOPHYLLUM, Blue Cohosh,—is the rhizome and rootlets of Caulophyllum thalictroides, a plant of the nat. ord. Berberidacese growing in Canada and the northern CERA—CERII OXALAS—CETACEUM. 217 United States, and 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. 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 con- tractions 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 dysmenorrhcea, and pains in other organs seemingly in sympathy with uterine affections. It has somewhat of a reputation in acute rheuma- tism of the hands and fingers, and as a preparative medicine for labor. CERA, Wax,—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 tnellifica, the honey-bee. It is a yellowish solid, of agreeable odor and faint, balsamic taste, insoluble in water and also so in cold alcohol, but soluble in 35 of ether, 11 of chloroform, boiling alcohol, fixed and volatile oils. 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 5 compound Cerates, 2 of the 22 compound Ointments, and 2 of the 13 Plasters. 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 applications. They form the bases of the most of the compound preparations so named. CERII OXALAS, Cerium Oxalate, Ce2(C204)3 -(- 9H20,—is a white, slightly granular powder, odorless and tasteless, insoluble in water or alcohol, but soluble in diluted sulphuric or hydrochloric acid. Dose, gr. j-x, in pill or powder. Cerium Oxalate is a gastric sedative, and is thought to possess selective action as such on the motor distribution of the pneumogastric nerve. It is considered to be particularly useful in vomiting 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 recommended 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 macrocephalus, the sperm whale. It occurs in white, pearly masses, odorless, of bland taste, and neutral reaction, 218 CETRARIA—CHAULMOOGRA OIL—CHELIDONIUM. becoming rancid in the air, soluble in ether, chloroform, carbon disul- phide and boiling alcohol. Is a constituent of— Ceratum Cetacei, Spermaceti Cerate,—has of Spermaceti 10, White Wax 35, Olive Oil 55- Unguentum Aquae Rosae, Ointment of Rose Water, Cold Cream,—has of Sperma- ceti White Wax 12, Expressed Oil of Almond 60, Stronger Rose Water 19, Sodium Borate y£. Unguentum Cetacei, Spermaceti Ointment (Unofficial),—has of Spermaceti 5, White Wax 2, Almond Oil 18. The ointment of the B. P. has Benzoin y2 in addition, rendering an emollient preparation irritant, and therefore unsuitable for eye-ointment, for piles, etc. Spermaceti consists of Cetin (Cetyl Palmitate) with several other fats in small quantities. Its action is solely that of an emollient, and it is rarely used internally, though an alcoholic preparation was once a regular prescription for coughs, bronchial irritation, and for a recently delivered woman. The Cerate is employed as a bland ointment for blisters, abra- sions and ulcers, but is too stiff for easy application, and the unofficial Ointment is preferred in practice. The latter on lint to broken blisters from walking affords great relief, and is employed to prevent injury to the feet by smearing on them before starting for a rough tramp over broken ground. The Ointment of Rose Water, popularly known as “cold cream,” is one of the most agreeable emollient and protective applica- tions for chapped hands, chilblains and other slight affections of the skin. CETRARIA, Iceland Moss,—is the lichen Cetraria islandica, found in northern latitudes. Contains Lichenin or lichen starch, which forms as a jelly when the plant is boiled in water; also Cctraric Acid. Decoctum Cetrariae, Decoction of Cetraria,—5 per cent, strength. Dose, 3 ij-iv. Cetraria is nutrient, demulcent and feebly tonic. It has a popular reputation in pulmo- nary 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. Bixaceae. It is nauseous and bulky, and soluble in alcohol, ether, chloroform, 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. xxad j 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 recommended as an external application in scaly eczema, psoriasis, syphilitic skin-diseases, chronic rheumatism, rheumatic arthritis and tabes mesenterica. CHELIDONIUM, Celandine,—is the plant Chelidonium majus, nat. ord. Papa- veraceae, which grows in Europe and N. America, about rocky places. It contains 2 alkaloids, Ckelidonine, C19H17Ns08, 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 rrpv-xx. There are no official preparations. Chelidonium used externally is irritant, internally it is a drastic purgative but an unre- liable 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 CHENOPODIUM CHIMAPHILA—CHINOLINUM. 219 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 ambro- sioides, var. anthelminticum, a plant of the nat. ord. Chenopodiacese, indigenous in the United States. Its active principle is a Volatile Oil which is official. Oleum Chenopodii, Oil of Chenopodium,—a thin, colorless or yellowish liquid, of aromatic odor and pungent, bitter taste. Dose, rr^v-xv. The Oil is tfyfe only preparation used and that rarely, its odor and taste being very dis- agreeable. It increases the cardiac rate, and promotes the secretions of the skin, bronchi and kidneys. It is an efficient anthelmintic against the round worm in doses of gtt. x three times a day for two days, 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. CH IMA PH I LA, Pipsissewa,—the leaves of Chirnaphila umbellata, or Prince’s Pine, an evergreen plant of the nat. ord. Ericaceae, indigenous in all parts of the United States. It contains Chimaphilin, a yellowish crystalline principle, Arbutin, also crystal- line but colorless, with tannic acid, etc. Extractum Chimaphilae Fluidum, Fluid Extract of Chimaphila,—Dose, Decoctum Chimaphilae, Decoction of Chimaphila (Unofficial),—I to 17. Dose, SHy- 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, stimu- lating 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 principle. 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 pas- sages, as hematuria, ischuria, dysuria and gonorrhoea. It is believed to check the secre- tion of uric acid, and should prove useful in gout and rheumatism. Externally, it has been applied to ulcers and tumors with benefit. CHINOLINUM, Chinolin (Leucolin, Quinoline), C9H7N (Unof- ficial),—is a constituent of coal-tar oil, but may be obtained from Qui- nine or Cinchonine by their destructive distillation with potassium hy- drate, and is artificially prepared by heating Anilin or Nitro-benzol with glycerin in the presence of a dehydrating agent. Chemically, it is con- sidered to be formed by a union of Benzene and Pyridine atoms. (Com- pare the article Cinchona.) It is a colorless, oily liquid, strongly re- fractive, turning 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. Chinolini Tartras, Chinolin Tartrate (Unofficial),—a white, micaceous, crystalline powder, of pungent odor and sharp taste, stable in the air and soluble in water. Dose, gr. v-xx. Chinolin is a valuable antiseptic, and antipyretic, being nearly as effective in this respect as Quinine, which it closely resembles in chemical 220 CHIRATA—CHLORAL. character and physiological action. It is one of the most powerful anti- pyretics of the substances which have been discovered in the search for an artificial quinine (Hydroquinone, Antipyrin, Pyrocatechin, Resorcin, Thallin, Kairin, etc.). Chinolin has a very disagreeable taste and smell, and is irritant in action, hence the tartrate is preferred for medicinal 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 beneficially in neuralgia and whooping-cough, and as an antiperiodic in intermittents. Quinalgen, Ortho-athoxy-ana-mono-benzoyl-amido-quinoline, NIICOC6H5H (Un- official),—is a derivative of quinoline (chinolin), and is a reformed and renamed An- ALGEN (see a7ite, page 67), differing therefrom by having the benzoyl instead of the acetyl radicle. Its action is similar to that of Antipyrin, except that it is claimed for this substance that no unpleasant effect or after-effects are noticed after taking it. It has been used in gout, influenza, migraine, sciatica, neuralgia, hay fever and rheumatic pains, with asserted benefit. Dose, gr. viij—xv, not to exceed gr. xlv daily. CHIRATA, Chirata, (Chiretta),—is the Indian plant Swertia Chirata, nat. order 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 Chiratse Fluidum, Fluid Extract of Chirata,—made with glycerin and diluted alcohol. Dose, ttpxv-xxx. Tinctura Chiratae, Tincture of Chirata,—10 per cent. Dose, gss-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 particu- larly serviceable in the dyspepsia of gouty subjects. As it contains no tannin, it may be administered with preparations of Iron. •CHLORAL, Chloral, (Chloral Hydrate), C2HCI30 -f- H20,—is a crystalline solid, composed of Trichloraldehyde (Chloral) with one mole- cule of water. It occurs in colorless, transparent, rhomboidal crystals, slowly volatilizing when exposed to the air; of aromatic, penetrating and slightly acrid odor, bitterish, caustic taste, and neutral reaction. It is freely soluble in water, alcohol, ether, chloroform, oils, etc.; liquefies when triturated with about an equal quantity of camphor, menthol, thymol or carbolic acid; melts at 136° F. and is decomposed by alkalies into Chloroform and a formiate of the alkaline base. Its aqueous solution becomes acid, but the alcoholic solution remains neutral. Chloral itself, (Trichloraldehyde, C2HC130), is an unstable, oily, color- less fluid, formed by the action of chlorine upon alcohol, whence its name, Chlor-al. The Hydrate is the only official preparation. The 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, recovery has occurred after the ingestion of an ounce, sev- CHLORAL. 221 eral hundred grains have been taken at a time in more than one instance without fatal results, and where tolerance has been established by habitual 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 of Tolu, or in Peppermint water. Caution is necessary when prescribing this drug in combination with alcoholic prepara- tions, as the Chloral is then very apt to separate as an alcoholate, especially if the Bro- mides 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. Chloralamid,—is described under its own title. Somnal,—is the suggestive name given to a liquid preparation formed by the union of Chloral, Alcohol and Urethan, described as Ethylirtes Chloral-urethan, represented by the formula C7H12C1303N, and claimed to be a complex body, not a simple mixture of its constituents. It occurs as a colorless liquid, resembling chloroform in its behavior with cold water, with which it forms globules and refuses to mix or dissolve. It is solu- ble in hot water, in alcoholic solutions, and in alcohol, 3 parts in 1. The advantage 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 respiration. In doses of 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 deleteri- ous effect. The effects are much more striking and certain than those of Urethan, and far less depressing than those of Chloral; and there is no vertigo or depression, as may follow the use of Sulphonal. In drachm-doses, this drug is not powerful enough to de- cidedly control delirium tremens, maniacal delirium or severe pain. (Dr. Gilman Thomp- son.) Hypnal is a combination of Chloral and Antipyrin, occurring as tasteless and odor- less rhombic crystals, soluble in 6 of water, and credited with simultaneous action as a hypnotic and analgesic. Dose, gr. xv-xxx in aqueous mixture with some alcohol, flavored with syrup of orange. It is said to cause no gastric disturbance. Although Chloral and Antipyrin are incompatible with each other, they form, when heated together, the above described compound, which resembles both and yet differs from each. Its chemi- cal appellation is Tri-chloraldehyd-phenyl-dimethyl-pyrazolon. Unofficial Preparations. Paraldehydum, Paraldehyde,—is described under its own title. Official Analogue of Chloral. Unofficial Analogues of Chloral. Amylene Hydrate, C5Hi20, Di-methyl-ethyl-carbinol,—is a tertiary alcohol, occur- ring as a clear, colorless fluid, of peculiar odor, soluble in 8 of water and readily misci- ble 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 pro- duce 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, 3j-3jss. Chloral Butylicum, Croton-Chloral,—is described under its own title. Hypnone, C6Iis(CO)(CH3), Phenyl-methyl-acetone,—is a member of the Ketones, occurring above 70° F. as a colorless, mobile liquid, having a strong almond and orange odor. It is insoluble in water or glycerin, and is best given in capsules. It is a hypnotic, of only moderate intensity, but said to be especially useful in the insomnia of alcoholism. Its use is devoid of danger, and leaves behind no unpleasant effects, except a disagreeable odor of the breath, the drug being eliminated by the lungs as well as by the kidneys. In very large doses it has induced coma, followed by paralysis of the heart and respira- tion. Dose, trpv-x, in capsule, to being usually required. 222 CHLORAL. Methylal, CH2(OCH3)2, Methylene-di-methyl Ether,—is one of the products of the oxidation of Methylic Alcohol, occurring as a volatile, mobile liquid of pleasant, aromatic odor and taste, readily soluble in water, alcohol, etc. It is a local anaesthetic, and an efficient hypnotic, producing a deep sleep of short duration, with more or less general anaesthesia and lowered reflex excitability. It is depressant to the heart, respiration and body temperature, but in medicinal doses does not leave any bad after-effects. Dose, per orem ny v-v, repeated thrice at short intervals. Urethan, Ethyl Carbamate, NH2C02C2H5,—occurs in crystals which are readily soluble in water, with scarcely any taste or odor, devoid of irritant action, and hence may be administered hypodermically. It is a pure hypnotic, but a mild one at best, and not so reliable as Paraldehyde or Chloral. It does not affect the circulation, nor does it de- press (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 Strych- nine. Dose, gr. xv- an average hypnotic dose being gr. xxx ; but it is best given in 5-grain doses repeated frequently, as a large dose may cause vomiting. It is a safe and efficient hypnotic for children. (Squibb.) Physiological Action. Chloral is a powerful hypnotic, also an antispasmodic, an antiseptic, a preventive of the coagulation of fibrin, indirectly an anaesthetic, and es- pecially 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 percent, solu- tion (gr. v ad §) 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, dilates the peripheral vessels and lowers arterial tension, diminishes oxida- tion 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 awakened, but immediately falls asleep again, and which is not followed by headache or depression. This effect is con- sidered by some authorities to be the result of cerebral anaemia produced by the drug. In some persons, instead of sleep it causes headache, in- somnia and delirious excitement. It is not an anodyne, as it does not affect the conductivity of the sensory nerves, and does not interrupt the transmission of pain ; but by overwhelming the centres it drowns the consciousness of pain, and is therefore indirectly anaesthetic. A toxic dose produces profound narcotism, abolishment of reflexes and sensibil- ity, 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. On the blood its action is to increase the fluidity, crenate the red cor- puscles, 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, CHLORAL. 223 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. The Chloral-habit produces a state of marked anaemia and muscular weakness, especially of the legs ; 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, uncontrollable in speech and action, talking in a silly manner and very volubly, and show- ing 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. 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. Atropine antagonizes its cardiac, respiratory and spinal depression, and should be in- jected in small doses frequently repeated, until its effects are apparent. Morphine ad- ministered 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; yet in a case described by Dr. Colenso in the British Aledical Journal, Nov. 3, 1894, in which recovery occurred after the ingestion of an ounce of Chloral, nine-tenths of a grain of Strychnine was em- ployed by hypodermic injection in broken doses. Heat is a necessary application, to maintain the body temperature. Artificial Respiration should be employed if required. All Alkalies are incompatible with preparations containing Chloral. Antagonists and Incotnpatibles. Therapeutics. Chloral Hydrate is of great value as a hypnotic and antispasmodic, but must be cautiously used if at all in persons with weak or fatty hearts, atheromatous vessels or advanced pulmonary disease. In combination with Potassium Bromide it is much used in asylum and general practice, and equally abused, both drugs being active cardiac poisons. It is by far the best hypnotic in acute mania and in delirium tremens, but has been too incautiously employed therein. The condition of alcoholic intoxication seems, however, to antagonize its depressant action on the heart to a great extent, even in old topers, for 30-grain doses, repeated twice within 7 or 8 hours, are commonly used in inebriate asylums and by police surgeons, for the purpose of straightening up a case of acute alcoholism,with no fatal effects resulting from its direct action. Chloral possesses marked power to relax spasmodically contracted unstriated muscle and to dilate the peri- pheral vessels, properties which govern its employment in many morbid conditions. Associated with Potassium Iodide it is of service in bronchial asthma, and has been used in the form of an enema for checking hemop- tysis by the revulsion which it produces in dilating the cutaneous vessels. Chloral is exceedingly efficient as a gastric antiseptic and sedative in the so-called nervous dyspepsia of neurotic persons, characterized by severe 224 CHLORAL. pain in the cardiac region of the stomach. It is very serviceable in fevers, when high temperature exists with excitement, restlessness and a sthenic condition, as it lowers temperature and prevents the coagulation of fibrin. In the algid stage of cholera and in violent cases of cholera morbus it has been 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 relieve after-pains. For nocturnal epilepsy a full dose at bedtime is a useful palliative. In neuralgia it may be tri- turated with Camphor and applied over the course of the affected nerve, and the same preparation is efficiently employed as a local application for toothache and earache. Chloral is well borne by children, and is an excellent remedy for in- fantile convulsions and colic, chorea, whooping-cough, laryngismus stri- dulus and the first stage of diphtheria, but it should not be used when the first sound of the heart becomes dull and weak. It is highly efficient for the purpose of calming children in scarlet fever. In these affections it may be given with Paregoric, as its combination with Opium enhances its value and guards the patient against its dangers. Its hypnotic power in adults is much increased by the conjoint administration of Laudanum or Morphine, and this combination is an excellent remedy in colic, cholera and cholera morbus. Tetanus is well treated by Chloral and Potassium Bromide given together in full doses. In Strychnine poison- ing Chloral is the antagonist. It is generally given by the mouth in very dilute solution with some simple elixir, syrup of tolu, 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. Chloral may be applied to the skin as an antipruritic in the eruptive diseases, for which purpose it is well combined with Carbolic Acid, ten grains of each to an ounce or two of water or oil. It is said to be the best of all local applications for boils, 3jss in §iv each of glycerin and water constantly applied to the boil by a tampon of cotton. For ulcers and cancers a 25 per cent, solution is a good antiseptic and anodyne application. The chief contra-indication to the use of Chloral is the presence of a cardiac affection, although it may be prescribed with much benefit in neurotic palpitation of the heart and in pseudo angina pectoris. Other contra-indications are rosacea, or a tendency to it, and hysteria of grave character. Chloral easily produces congestion of the face, and in hys- terical subjects it may excite paroxysms of delirium and hallucinations. Somnal (see ante, page 221),—manifests its hypnotic and sedative action to best ad- vantage in the insomnia of convalescence from acute disease, but where an adynamic condition exists it must be used with caution. In whooping-cough, spasmodic laryngitis, asthma, the so-called “ nervous cough ” and in chorea, it shows decided sedative proper- CHLORAL BUTYLICUM CHLORALAMIDUM. 225 ties. A great element of safety in its use is that its action is never out of proportion to the quantity ingested, nor does it act in a cumulative or other unexpected manner. It seems to have little or no influence over insomnia due to acute inflammation. (Myers.) It is injurious in acute mania and general paralysis, but is of great value in cases of melan- cholia, in which it promotes sleep and produces a soothing effect on the mental condition by removing depression and gloomy forebodings. It is contra-indicated when the diges- tion is out of order. (De Montyel.) CHLORAL BUTYLICUM, Butyl-chloral Hydrate, Croton-chloral, C4H5CI3- 0,H20 (Unofficial),—is formed by the action of Chlorine upon Aldehyde, then adding to the Butyl-Chloral thus produced the necessary water. It occurs in crystalline scales, insolu- ble in chloroform, sparingly soluble in water, (1 in loo), but freely soluble in alcohol, hot water and glycerin, (1 in 4). 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. The action of Croton-chloral closely resembles that of chloral, but it is feebler as a hyp- notic, less depressant to the heart, and generally less poisonous, but more disagreeable to the taste. It has a specific paralyzant power over the fifth nerve, and over its distribu- tion causes an anaesthetic condition long before it produces general anaesthesia (Liebreich). It has been used with benefit in various neuralgiae, especially tic-douloureux, also in sci- atica and dysmenorrhoea. All statements concerning the action and therapeutics of this drug are to be received with hesitation, as wide differences therein are reported by the best authorities. CHLORALAMIDUM, Chloralamid, Chloral Formidate, (Unof- ficial),—is chemically a union of Chloral anhydride (C2HC130) with Formamide (CHO.NH2). It is a proprietary drug, having been both patented and trade-marked, wherever possible, by its proprietor and ex- clusive manufacturer, Schering, of Berlin. It occurs as colorless, faintly bitter, odorless crystals, which are decomposed in hot water or warm solutions, and are soluble in 20 parts of cold water, or in 1 y2 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 is 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, at 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, and in one case 140 grains were taken at one dose, without producing 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 membrane should be known. Physiological Action and Therapeutics. The action of Chloralamid is essentially a hypnotic one; it is exten- sively advertised as the least depressant and most efficient sleep-producer at our command,—without unpleasant after-effects from ordinary doses, except in 2 per cent, of the cases in which used, 1 per cent, having gastric and the other 1 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 226 CHLOROFORMUM. any cumulative action, nor any tendency 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-dyspnoeic and anti-hydrotic action. The main field for the use of Chloralamid is found 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 alcohol- ism, and similar states; also in that accompanying typhoid fever, asthma (both cardiac and bronchial), organic heart disease, the opium habit, and diabetes mellitus (Steele). It is less effective in organic nervous affections 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 dysmenorrhoea it 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 15 grains thrice daily for five days, in a boy of eleven years; and in a girl who had resisted all other treatment 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 its best hypnotic results, the drug should be given about an hour and a half before sleeping-time, in a dilute alcoholic menstruum, and on a stomach con- taining little or no watery fluids to interfere with its solution and absorption. CHLOROFORMUM, Chloroform, CHC13 (or CHC12C1), Ab- solute Chloroform, the Terchloride of Methyl, or the Chloride of Bichlor- inatedMethyl (Di-chlor-methyl Chloride),—is formed by the substitution of 3 atoms of Chlorine 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 pyrogenous 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. The official form is— Chloroformum, Chloroform, CHC13,—a liquid consisting of 99 to 99.4 per cent, by weight, of absolute Chloroform, and 1 to 0.6 per cent, of Alcohol. A heavy, clear, colorless, mobile and diffusible liquid, of characteristic, ethereal odor, a burning, sweet taste, neutral reaction ; volatile, not inflammable ; soluble in 200 of water, freely so in alcohol or CHLOROFORMUM. 227 ether, also in oils, benzol or benzin. Sp. gr. not below 1.490 at 590 F., or 1.473 at 77° F. Dose, internally, npj-xx, for inhalation 3], repeated until the desired effect is produced. Chloroformum Venale, Co7nmercial Chloroform, (Unofficial),—is a liquid containing at least 98 per cent, of Chloroform, and having a sp. gr. not lower than 1.470. It con- tains sundry Hydrocarbons, free Chlorine, Aldehyde and Hydrochloric Acid, and is used only for external applications, or to make the purified article. Preparations. Aqua Chloroformi, Chloroform Water,—a saturated solution, prepared by agitating an excess of chloroform in distilled water and pouring off the needed quantity of the solution. Dose, 3 ss— 3 ij. Emulsum Chloroformi, Emulsion of Chloroform,—has of Chloroform 4, Expressed Oil of Almond 6, Tragacanth 1)4, Water to 100. Dose, 3 j— j. Spiritus Chloroformi, Spirit of Chloroform,—has of Chloroform 6, Alcohol 94. Dose, ITLx-gj, well diluted. Linimentum Chloroformi, Chloroform Liniment,—has of Chloroform 30, Soap Liniment 70. Linimentum Chloroformi Compositum, Compound Chloroform Liniment, (Un- official),—has of Chloroform j, Oil of Turpentine §j, Tincture of Opium g ss, Tincture of Aconite 3 ij. Chlorodyne, (Unofficial),—is a celebrated secret mixture, put forth by Dr. J. Collis Browne, of London, and since imitated by many others. It contains Morphine, Chloro- form, Ether, Cannabis Indica, Hydrocyanic Acid, Capsicum, etc., and is powerfully ano- dyne, antispasmodic and narcotic, and therefore highly dangerous in non-professional hands. Dose, irpx-xxx, according to the quantities of Morphine and Chloroform present, these being the active agents in the preparation. A tabular comparison of the principle formulae which are used in imitation of B rozone's Chlorodyne, with the formula of the latter preparation itself, is given in the Appendix to this book, and will show the wide differences between them in Morphine strength. A list of 25 formulae for Chlorodyne was published in the Therapeutic Gazette for October, 1883. Tinctura Chloroformi et Morphinae (B. P.),—has been recently made official as a substitute for Chlorodyne. Each dose of 10 minims contains of Chloroform trpi )£, Ether Alcohol n\)4, Morphine Hydrochlorate Dilute Hydrocyanic Acid Oil of Peppermint Fluid Extract of Liquorice rtpilf, Treacle and Syrup q. s. Tinctura Chloroformi Composita (B. P.),—has of Chloroform 2, Alcohol 8, and Compound Tincture of Cardamom 10. Dose, trpxx-^j. Anaesthetic Mixtures containing Chloroform,—see under HLtiier, ante, page 100. Some Unofficial Chlorinated Ancesthetic Compounds. Ethylene Bichloride, Dutch Liquid, Chloric Ether, C2H4C12,—is a rapid andpower- ful 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 discov- ered Chloroform. 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,—alcolorless 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 neuralgiae to produce intense cold, and with re- markable success. Methylene Bichloride, Dichloro-methane, CII2C12,—is an effective anaesthetic which it was supposed would displace Chloroform as being much safer. Dr. Richardson intro- duced it and Sir Spencer Wells advocates its use, but though little used as compared with 228 CHLOROFORMUM. other anaesthetics several deaths have occurred from its employment. It kills by paralyz- ing the heart. Carbon Tetrachloride, CC14,—is less irritant than Chloroform, but far more danger- ous to the heart. The action of Chloroform is similar to that of Ether (see ante, page ioo) with several important differences. It is more irritant to the mucous membranes, and if swallowed undiluted it produces violent gastroenteri- tis, which becomes apparent after the subsidence of the profound narcot- ism which at first follows its ingestion in quantity. A dose of inter- nally may cause death, though recovery has taken place after the ingestion of one, two and even three ounces (H. C. Wood). It clots the blood outside the body, converting it into a mass resembling sealing-wax. The inhalation of Chloroform produces on the whole sensations which are rather agreeable than otherwise, and many persons acquire a liking for it. After a few whiffs the patient experiences noises in the ears and light before the eyes, also a feeling of weight upon the chest; the heart is felt to be beating wildly and a throbbing sensation is felt in the carotid arteries. In this first stage hysterical symptoms may become manifest, the patient laughing, crying, screaming or swearing. The pulse is at first quite rapid from nervousness, but soon falls in frequency and gains in force. In a short time all sensation of discomfort passes away, the patient becomes quiet, breathes easily, and is evidently comfortable. The consciousness becomes affected, questions being heard but not understood, and are answered hesitatingly and slowly and in an irrelevant manner. After a brief period of repose there may be another spell of excitement, during which the patient may struggle and endeavor to get up; but this soon passes away, and the muscles, which were contracted become flaccid, and the patient gradually assumes a condition of complete insensibility. In this state all reflex action is abolished and pain is not experienced ; the pupils are contracted, and the limbs, when raised and let go, fall heavily. Dangerous symptoms are—(i) respiration becoming stertorous or shallow, (2) sudden dilatation of the pupils, (3) signs of cardiac failure. As compared with Ether the inhalation of Chloroform is less stimu- lating, much more depressant to the vital functions, and much more dangerous on account of its direct paralyzant action on the heart. Its vapor is less irritant to the air-passages, uninflammable, more agreeable, more prompt in action, produces much less subsequent vomiting, a shorter stage of excitement and a more profound degree of narcosis; and should be diluted with per cent, of air to produce anaesthesia with safety, according to the general teaching on this subject. Its mortality is much greater, being about 1 in 3,000, against 1 in 16,000 for Ether; and fatal cases continue to be reported, though none of these have occurred in ob- stetrical practice. Physiological Action. CHLOROFORMUM. 229 The Hyderabad Chloroform Commission’s investigations, conducted under the direc- tion of Dr. T. Lauder Brunton, led to the conclusion that Chloroform and Ether act in the same manner upon the heart and respiration, both paralyzing the respiratory centre before the heart, and Chloroform acting more quickly and powerfully than Ether in both directions. Prior to this investigation it was taught that death from Chloroform is almost always sudden and occurs by cardiac paralysis, while from Ether it is slow and usually by paralysis of respiration. The subsequent researches of Gaskell, McWilliam and others tend to sustain the latter view, and show that the verdict of the commission cannot be accepted as conclusive. There is very little doubt but that Chloroform may paralyze the heart without first affecting the respiration; and it is probable that the paralysis of the vaso-motor centre, and the consequent withdrawal of blood from the heart and brain to the dilated splanchnic area, may be an important factor of a fatal result. Chloroform un- doubtedly exerts a powerful depressant action on the heart. Injected into the jugular vein it instantly arrests the cardiac action and destroys its muscular irritability. Its vapor, applied to the exposed heart, paralyzes it, and even when artificial respiration is main- tained the effect is very apparent. There can be no doubt but that Chloroform destroys the contractile power of the heart muscle (Murrell). At a certain stage of chloroform anaesthesia women often exhibit marked signs of sexual excitement, and on recovery it is not uncommon for them to bring charges of improper conduct against some one present, with no false intention but in the belief that impropriety actually occurred. It is never safe to administer an anaesthetic to a woman without the pres- ence of a third party (Murrell). For the modes of dying from anaesthetics, see under the title ante, page ioi. Treatment of Chloroform Poisoning. There is no chemical antidote, and if the drug has been swallowed the stomach should be evacuated, and the case treated as one of irritant poisoning. Oxygen or Amyl Nitrite may then be given by inhalation, and Strychnine or Atropine hypodermically to sustain the heart. Artificial respiration should be used as soon as possible. In cases of danger from Chloroform inhalation prompt measures must be taken. The tongue should be pulled out with forceps and kept out. The doors and windows should be thrown open so as to produce a current of fresh air, but care must be taken that the body is not cooled thereby. The face and chest should be slapped with a wet towel, and Artificial Respiration should be commenced at once and kept up for some time, not faster than 20 to the minute. A succession of quick, sharp blows on the chest, over the cardiac region, will sometimes provoke the heart to renewed action after it has apparently failed. Venesection is wrongly neglected in such cases; it would relieve the right cardiac engorgement, which is so constantly found at the autopsy. Galvanism may stimulate the heart into action. Atropine hypodermically has rendered excellent service in several cases in the author’s experience. Strychnine is considered antagonistic by many authori- ties, and has been used with good results. Oxygen is the best antagonist of all (Sayre). Chloroform has a large field of therapeutic action besides its use as an anaesthetic. It is frequently employed in liniments as a rubefacient and anodyne application, also to promote the passage of other agents through the epidermis, and to relieve itching. The vapor may be directed onto the raw surface of an ulcer or a superficial burn in order to relieve pain ; and that arising from a few drops placed in the hand and held close to the eye will relieve photophobia. Internally it is administered with great Therapeutics. 230 CHLOROFORMUM. benefit in vomiting, colic, dysmenorrhoea and cholera morbus; also in true cholera, in which it has probably been more efficient than any other single remedy, and in gastric ulcer, gastralgia and other painful affections of spasmodic character. In three to ten drop doses well diluted it markedly improves all the functions of the stomach, and is a valuable remedy for many gastric disturbances, especially acute dyspepsia. In sciatica, tic-douloureux and other neuralgise 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. In several cases of severe supra-orbital neuralgia, the writer has injected two or three minims of Chloroform into the vicinity of the supra-orbital nerve just above its foramen of exit, with the most gratifying permanent results, though severe local pain and considerable swelling were experi- enced for several days. The vapor of Chloroform inhaled in small quantities from warm water or from a handkerchief is a very useful remedy in many neuroses, as hay- fever, spasmodic asthma and reflex cough. It is one of the best palliatives in the cough of phthisis, as was long ago pointed out by the then Mr. (now Sir) Spencer Wells. It may be used with much benefit as a pul- monary antiseptic in many affections of the air-passages, as acute nasal catarrh, influenza and bronchitis; and has promptly checked a severe case of catarrh extending into the antrum and causing great pain. Car- ried to the production of muscular relaxation it is often used as an aid to diagnosis, especially in cases of malingering, in suspected disease of the abdominal viscera, and to aid in reducing dislocations and hernise. It is used with great benefit in parturition, decreasing the sensibilty to pain, relaxing the passages, and easing the labor, while it does not inter- fere with the uterine contractions, nor predispose to inflammation, hemor- rhage or convulsions. In such cases the quantity needed is very small, a few whiffs from time to time being quite sufficient. In some cases, as in acute mania, a patient may require to be kept under the influence of chloroform for a long time,—for hours, days or even weeks, and this has been done in the digital treatment of subclavian and other aneurisms. The writer, on one occasion, kept an insane woman continuously under its influence for a period of three weeks, except during the time necessary for taking food. For the production of complete anaesthesia the use of Chloroform is steadily decreasing 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 g6}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, CHLORUM. 231 gr. with Atropine, gr. given 20 minutes before commencing the inhalation, are means of great utility in sustaining the heart and respira- tion, as well as in rendering the ansesthesia more profound. No opera- tion, especially on parts supplied by the fifth nerve, should be undertaken during partial chloroform anaesthesia, for the reasons given on page 101. Syme administered Chloroform in five thousand cases without a single death therefrom. He ascribed this excellent record to his adherence to the following rule : “ Never mind the pulse, never mind the heart, leave the pupil to itself, but keep your eyes on the breathing, and if it becomes embarrassed to a grave extent, pull the tongue well out with an artery for- ceps.” The Edinburgh rule is practically this : “Watch the respiration, the heart will take care of itself;” but Professor Stewart suggests that a second one should be inculcated, namely—“Watch both the breathing and the pulse ; and if the heart threatens to fail for want of blood, fill it by raising the legs and compressing the abdomen.” The elder Sayre administers Chloroform in a manner which is apt to startle an unin- itiated observer who is impressed by the orthodox rule of per cent, of air with per cent, of the anaesthetic as the only safe proportion. Having been made familiar with the practice of Dr. Sayre through observance of his method as employed by some of his pupils, the writer sought for more direct instructions from that distinguished 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 therefore speak with confidence as to its safety. “ My plan is simply to anaesthetize 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 ancestheiic. “ 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- 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.” CHLORUM, Chlorine, Cl,—is a greenish-yellow gas having a suf- focating odor, belonging to the Halogen group of elements; and though not official itself, it is represented in medicine by several of its compounds, as well as by several preparations which furnish it. The so-called Halogen Elements derive their title from a/.f, the sea,—because the most important members of the group are obtained, directly or indirectly, from the ocean, viz. : Chlorine, from sea-salt; Brotnine, from sea-water ; and Iodine, from sea-weed. They are all noted for their affinity for hydrogen, and consequent power as decomposers of organic matter. 232 CHLORUM. Chlorine Compounds, described under the titles of their respective metallic bases, are—the Chlorates of Potassium and Sodium ; the Chlorides of Ammonium, Calcium, Potassium, Sodium, Mercury, Gold, Iron and Zinc, etc.;—also Hydrochloric Acid, classed with the mineral acids (see page 85), and Chloral, Croton-chloral, and Chloroform. 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 Manganese Dioxide 10 parts and Hydrochloric Acid 35 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, gj-ljss, well diluted, as a lotion or spray; internally, rrpx-xx, in water. Chlorine Water may be extemporaneously prepared by mixing in a mortar Chlorate of Potassium 40 grains and Hydrochloric 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 35 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 Calcium Chloride (see ante, page 200). It occurs as a whitish, dry powder or friable lumps, gradually de- composing in the air, of saline, disagreeable taste and a feeble Chlorine odor, partially soluble in water and in alcohol, and when dissolved in dilute Plydrochloric acid gives off Chlorine gas. Dose, gr. iij —vj in water; for external use a 1 to 3 per cent, solution. Liquor Calcis Chlorates, B. P., is a solution of I pound in I gallon of water. Liquor Sodae Chloratae, Solution of Chlorinated Soda (Labarraque's Solution),—a pale-greenish liquid, of faint Chlorine odor, and alkaline taste and reaction ; prepared by adding together watery solutions of Sodium Carbonate 150, and Calx Chlorata, 75, each in water, then adding Water up to 1000. Is an aqueous solution of several chlorine- compounds of sodium, containing at least 2.6 per cent., by weight, of available chlorine. Dose, 'n 20 Parts of water. In the presence of moisture Chlorine is one of the most powerful of disinfectants and deodorants, and an antiseptic and antifermentive agent of the highest activity ; its power in these respects being due to its affinity for hydrogen, decomposing all bodies which contain hydrogen as a mole- cular constituent, forming hydrochloric acid and setting oxygen free in its nascent form (ozone). Administered internally, it is converted, on reaching the stomach, into hydrochloric acid and chlorides, losing all ac- tion on the organism in its own character. Locally applied, it is irritant to the skin and mucous membranes, producing a sense of heat, with burn- ing sensations and even vesication. Inhaled in any quantity, it causes cough, sneezing, and spasm of the glottis, also inflammation of the mucous lining of the air-passages and of the lungs. Physiological Action. Ammoniacal Vapors inhaled after Chlorine to form 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 Ammonite, sufficiently diluted, may also be administered with advantage. Antidotes. CHLORUM. 233 Therapeutics. 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 slough- ing 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 wash the hands after con- tact with infectious material, and to prevent infection by the syphilitic poison. A combination of Potassium Chlorate and Tinctura Ferri Chloridi, makes a solution of Chlorine, Euchlorine, Potassium 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 beneficial results, except in diphtheria, for which disease the internal administration of Chlorine Water diluted has many .advocates among practicing physicians. Chlorine gas is a powerful local stimulant, and has been used with great benefit to promote healing in old ulcers. Absorbent cotton may be ex- posed to the gas extemporaneously prepared as directed above, and ban- daged on the surface of the ulcer. Chlorine inhalations were used forty years ago, by Sir James Simpson and others, in phthisis, with apparent benefit. Chlorinated Lime, freshly prepared, in solutions of various strength, from i in 12 to i in 60, are used by hypodermic injection in Australia as an antidote to serpent venom. The solution is injected into several points above the wound, 20 to 100 minims being inserted at each place. In some cases this procedure causes great pain, but it does not seem to in- duce any local inflammation, and it is highly efficient for the purpose for which it is used. A common method of disinfecting a sick-room is to place a pound of Chlorinated Lime into a canvas bag and immerse it in a mixture of com- mon Muriatic Acid, pint, and Water 4pints, allowing it to remain for 24 hours. A still better method is to mix common salt, Manganese Dioxide and Sulphuric Acid in a saucer. The Chlorine generated is heavier than atmospheric air, so that the vessel should be placed on a high shelf and not on the floor, in order that it may be diffused throughout the room. 234 CHONDRUS CHRYSAROBINUM CIMICIFUGA. CHONDRUS, Irish Moss, Carragheen,—consists of two sea-algae, Chondrus cris- pus and Gigartina mammilosa, dried and bleached. Is horny, translucent, pale yellow- ish-white, swelling in water, of sea-weed odor and mucilaginous, saline taste. On boil- ing 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 pre- pared by boiling ij in xxxiv of water for an hour, straining and adding iij of sugar while hot. Dose, indefinite. Irish Moss is a demulcent and nutrient substance of some slight value in bronchial and catarrhal affections. Having no starch in its composition 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 ex- tracted from Goa-powder, a substance found in cavities formed by decay in the wood of the trunk of Andira Araroba, a Brazilian tree of the nat. ord. Leguminosae. It is com- monly misnamed “ Chrysophanic Acid” (which is one of the constituents of Rheum)— though easily converted into that substance. Occurs as an orange-yellow powder, odor- less and tasteless, nearly insoluble in water and alcohol, but readily soluble in ether, solu- tions of alkalies and sulphuric acid. Dose, gr. xx. Unguentum Chrysarobini, Chrysarobin Ointment,—Chrysarobin 5> Benzoinated Lard 95 parts. Should be diluted for average use from 1 to 3 times. 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 furuncular 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 vegetable origin, and for psoriasis, in the latter affection being the best remedy known. It may be used in weak ointment locally, and internally in doses. CIMICIFUGA, Black Snake-root, Black Cohosh,—is the rhizome and roots of Cimicifuga racetnosa, a plant of the nat. ord. Ranunculacete, native in the United States. It contains a Volatile Oil when fresh, resin, tannic and gallic acids, also an acrid, crystallizable, neutral principle. Cimicifugin 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. Extractum Cimicifugae, Extract of Cimicifuga.—Dose, gr. j-v. Extraction Cimicifugae Fluidum, Fluid Extract of Cimicifuga.—Dose, rtpv-xx. Tinctura Cimicifugae, Tincture of Cimicifuga,—20 per cent.—Dose, Macrotinum, Macrotin, (Unofficial).—Dose,gr. ss-ij. Preparations. 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 CINCHONA. 235 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. Therapeutics. 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- toid arthritis and rheumatism of the localized muscular variety, as lum- bago, torticollis, pleurodynia, 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 neu- ralgia. Chorea about the age of puberty is one of the affections in which it is most efficient, and the same maybe said of the hysterical form of this disease. Many uterine disorders are remarkably benefited by Cimicifuga, such as amenorrhoea, neuralgic and congestive dysmenorrhoea, subinvolution, spinal irritation due to some obscure sympathetic or neuralgic affection of the womb, sympathetic pains and neuralgiae arising from the so-called irritable womb, passive menorrhagia, etc. In obstetrics it gives excel- lent results when used to initiate uterine contractions, to check hemor- rhage, and to allay afterpains and nervousness after delivery. In puer- peral 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 culti- vation. 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 5 per cent, of total alkaloids of which at least 2*4 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. 236 CINCHONA. The principal varieties of the sub-order Cinchonese, the barks of which are found in commerce and used by manufacturers of the alkaloids, are— Cinchona Calisaya, Cinchona Flava, Yellow Bark,—from Peru, Bolivia and India. Cinchona Succirubra, 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. The official species are two, viz.: — Cinchona, Cinchona,—the bark of Cinchona Calisaya, Cinchona officinalis, and of hybrids of these and of other species of Cinchona, yielding, when assayed by a prescribed process, not less than 5 per cent, of.total alkaloids, and at least 2*4 per cent, of Quinine. Cinchona Rubra, Red Cinchona,—is the bark of Cinchona Succi- rubra, containing not less than 5 per cent, of its peculiar alkaloids. From it is prepared the Compound Tincture of Cinchona. Bark may be administered in doses of gr. but it is never used now in substance, being too bulky and disagreeable. Cinchona bark contains 21 natural alkaloids (of which 4 are official), 8 artificial alkaloids, 2 simple acids, 2 tannic acids, a resinoid and color- ing matter, as follows :— Quinine, C20H2tN2O2,—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 power- ful 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 for- mer 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 astringent 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. Extractum Cinchonae, Extract of Cinchona.—Dose, gr. j-v. Extractum Cinchonae Fluidum, Fluid Extract of Cinchona.—Dose, rrpx-^j. CINCHONA. 237 Tinctura Cinchonae, Tincture of Cinchona,—20 percent. Dose, gss-ij. Tinctura Cinchonae Composita, Compound Tincture of Cinchona,—made from Red Cinchona—strength 10 per cent. Contains Bitter Orange-peel 8, and Serpentaria 2 per cent. Dose, 3 j-iv. Infusum Cinchonae, Infusion of Cinchona,—has of Cinchona 6, Aromatic Sulphuric Acid 1, Water to 100. Is the only official infusion containing this acid. Dose, 3|j-2j. Huxham’s Tincture of Bark, 1788 (Unofficial), is still used. Red Cinchona 3 iv, Orange peel 75 iij, Serpentaria gr. lxxx, Spanish Saffron gr. clx, Cochineal gr. lxxx, Brandy 3 xl, digested for 4 days, expressed and filtered. Dose, 3 ss-ij. Quinine and its Salts. Quinina, Quinine, C20H24N2O2 -f- 3H20,—a white, amorphous or minutely crystalline powder, of alkaline reaction and very bitter taste, soluble in 1670 of water and 6 of alco- hol at 590 F., in 23 of ether, 5 of chloroform, and readily in dilute acids. Dose, gr.j-xx, or xl in special cases. Is insoluble in saliva. Quininae Sulphas, Quinine Sulphate, (C20H24N2O2)2.H2SO4 -f- 7H20,—very light, snow white, fragile crystals, of very bitter, persistent taste, soluble in 740 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. Quininae Bisulphas, Quinine Bisulphate, C20H24N2O2.H2SO4 -f 7H20,—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. Quininae Hydrobromas, Quinine Hydrobromate, C20H24N2O2IIBr -f- H20,—color- less needles, of very bitter taste, soluble in 54 of water and in 0.6 of alcohol at 590 F., very soluble in boiling water and in boiling alcohol. Dose, gr. j-xx. Quininae Hydrochloras, Quinine Hydrochlorate, C20H24N2O2HCl 2H20,—white needles in tufts, of very bitter taste, soluble in 34 of water and 3 of alcohol at 590 F., in I of boiling 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. Quininae Valerianas, Quinine Valerianate, C20H24N2O2C5H10O2 -f- H20,—white pearly crystals, of valerianic odor and bitter taste, soluble in loo of water and in 5 of alcohol at 59° F. Dose, gr. j-iij. It is the only salt of Quinine supposed to be affected by the constituent acid. Quininae Hydrochloras Carbamidata, Quinine Carbamide Hydrochlorate (Unoffi- cial),—is a new compound salt of Quinine and Urea, soluble in equal parts of water and therefore 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 Quinine Borate (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 membranatym- 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:— R. Aloes soc. lb j ; Rad. rhei (chinens), Sein. angelicse, Confec. Damocratis,* aa j|iv; Rad. helenii (s. enulse), Crocisativi, Sem. fceniculi, Cretse prep., aa^ij; Rad. gentianae, Rad. zedoariae, Pip. cubebse, Myrrhse elect., Camphorae, Bolet. laricis, aa % j. Digest the whole with 500 oz. of proof spirit in a water-bath for 12 hours, express, add Bi- sulphate of Quinine, dissolve by aid of a water-bath, cool, and filter. Dose, :$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 etmyrrhae) 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. * For the formula for this ingredient see the article on Confections in the section on Extemporaneous Pharmacy, Part II. 238 CINCHONA. Other Official Alkaloids and their Preparations. Cinchonina, Cinchonine, C19H22N20,—white, lustrous prisms or needles, of bitter after-taste, almost insoluble in water, readily so in dilute acids and 116 of alcohol at 590 F. Dose, gr. j-xxx or more. Cinchoninae Sulphas, Cinchonine Sulphate (C19H22N20)2H2S04 -f- 2H20,—white, shining prisms, of very bitter taste, soluble in 66 of water and in 10 of alcohol at 59° F., and readily soluble in dilute acids. Dose, gr. v-xxx or more. Cinchonidinae Sulphas, Cinchonidine Sulphate (C19H22N20)2H2S04 -}- 3H20,— white, silky crystals, of bitter taste, soluble in 70 of water and in 66 of alcohol at 59° F., freely soluble in acidulated water. Dose, gr. j-xx or more. Quinidinae Sulphas, Quinidine Sulphate (C20H24N2O2)2H2SO4 -f- 2H20,—white, silky needles, of bitter taste, soluble in 100 of water and in 8 of alcohol, readily in acidu- lated water, at 590 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 the therapeutic power of Quinine. Dose, gr. v-xxx or more. Quinquinina, Quinetum,—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.” Cinchonidinse Salicylas, Cinchonidine Salicylate,—has anti-malarial power only inferior to that of the salts of Quinine. Unofficial Preparations. 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 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, C6H5. The distinctive action of the lower members of this series is their atitiseptic 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- Resorcin, or Meta- Hydroquinone, or Para- C6H4(OH)2. dioxybenzol,—by replacing 2H by 2OH. CA(OH)., Pyrogallol, Pyrogallic Acid, Tri-hydroxybenzene, 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 NOa (nitroxyl). CINCHONA. 239 Benzoic Acid, C6H5CO.OH—by replacing H by CO.OH (carboxyl). Salicylic Acid, HC7H5Os—by replacing 2H by OH and CO.OH. Naphtalin, C10H8—by uniting two Benzenes in an over-lapping ring. Pyridin, CSH-N—by replacing tetrad C by triad N. Chinolin, C9H7N—by uniting Benzene (CgH6) and Pyridin (C5H.N). Derived front Chinolin is the hypothetical base— Chinicin, or Qninicin, C9H9N2,—represented in Antipyrin. Also Kairin, Thallin, and other compounds. The most important of these are Antipyrin, Acetanilid, Resorcin, Chinolin and Naphtalin, which are respectively described in separate articles. Others of the same class are the following, viz. : — Kairinum, Kairin (Hydrochlorate of Oxy-ethyl-chinolin-hydride), C10H]3NO.HC1. H20,—is an artificial alkaloid prepared from Chinolin, 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 otf 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 Antipyrin. It occurs in white crystals, which are freely soluble in water, but is best given in wafer paper, or capsules. Dose, gr. iij-xxx. Kairolinum, Kairolin [Sulphate of Tetra-hydromethyl-chinolin),—is antipyretic, but much less efficient than Kairin. Thallin, Parachinanisols,—is a synthetically prepared substance, having the chemical name Tetra-hydro-paramethyl-oxy-chinolin. It occurs as a colorless powder which is soluble in water, and enters into combination with acids, forming salts, of which the tar- trate and sulphate are the most eligible, especially the latter. The dose of Thallin 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. Thallin 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, 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, CgH4(OH)2,—is isomeric with Resorcin (see ante, page 238). It crystallizes in rhombic, colorless prisms which are slightly sol- uble in water, readily so in alcohol and in ether, and is obtained from Arbutin, a glucoside constituent of Uva Ursi and other Ericaceae. It is an efficient antipyretic, without in- jurious effects so far as observed, but its influence is only temporary. The action of this drug on animals is summarized in the N. Y. Medical 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. Gr. 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 Resorcin. Some Unofficial Antipyretics. 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 (gij) the powdered bark has produced flatu- lence and eructation, and in many well-authenticated instances has appa- rently produced a well-marked febrile paroxysm, beginning with chill, then Physiological Action. 240 cinchona. fever and headache, which gradually subsided in slight perspiration. So also, Quinine, while incapable of producing intermittent fever in a healthy person, may, 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 caus- ing 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-corpuscles 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 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. Quinine reduces the size of the spleen when enlarged, and lowers the temperature of py- rexia by lessening oxidation, though it does not depress the body tem- perature in health. Large doses lower the reflex function of the spinal cord. In some subjects it produces sexual excitement, in others cutane- ous eruptions sometimes followed by desquamation. It lessens the excre- tion of uric acid, but not that of urea, and is a uterine stimulant in labor, but its power to initiate uterine contractions is a much debated question. A remarkable case of poisoning by six drachms of Quinine Sulphate is reported by Surgeon-Captain A. E. Roberts, M. B., of Aligahr, India, in The Lancet of March 9, 1895. The patient, an Eurasian woman, aged 35,married,no children, in comfortable cir- cumstances, had always enjoyed good general health, but had been troubled for nearly two years with menorrhagia associated with slight uterine retroflexion. About an hour after swallowing the large dose mentioned above, Captain Roberts first saw her. In his own language “she was lying upon her bed totally unconscious—an inert, paralyzed mass. The whole surface of her body was deadly cold and blanched, or, rather, livid; her temperature (axilla) was 950 F., breathing almost imperceptible, shallow, and slow, and the pulse was 45, thin and small. Her eyes were closed, and the pupils were consider- ably dilated, there being no response to light; no tendon reflex was obtained and there CINCHONA. 241 was no response to external stimuli, and save that she at long intervals uttered a low groan she appeared to her friends to be dead. . . . There was little, if *iny, change in her condition for several hours, during which she vomited ‘ coffee-ground substance ’ several times. Indeed, definite and obvious signs of rallying were deferred until the early hours of the next day, and it was then ascertained that, in addition to slight deaf- ness, she was * stone blind,’ even to total non-appreciation of strong sunlight. The deaf- ness gave no trouble ; perfect hearing was restored within a week, with the gradual re- turn of general functional activity, but it was long ere all traces of the tremendous shock to the general system had disappeared. . . . The blindness was the dense, uncom- promising darkness of atrophy, . . . and . . . lasted, I believe, for fully two weeks ; the first perception after that was the flash of light from the ophthalmoscopic mirror, but there was no perception of external objects until the third or fourth week, when certain things—a small bright metal time-piece, the looming figure of an individual—were seen at a distance of four to eight yards. This distant vision was a marked feature of the case for two or three months, and though it gradually gained in distinctness of outline, the detail was a blurred impression on a dim and hazy background. ... I have re- cently heard from my patient that, although much better in most respects, there is much left to be desired in her visual powers ; she gets about, reads and writes, and uses her mirror satisfactorily for toilet purposes, but her color vision is defective, red and yellow being still most easily distinguished, and these at a distance, nearness of approach caus- ing objects to appear black, the general hazy blur of the background of the visual field being also a trouble to her.” 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 precordial 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 Tan?iic 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 therewith and 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 influence is specific, by reason of its power to prevent the development of the plasmodium to which malaria is due. In intermit- tents, 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 may cause a daily exacerbation of temperature if long continued. In remittents 20- to 30- grain doses should be administered once or twice a day until the tempera- ture 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. 242 CINNAMOMUM. more effective. Small doses of Quinine (gr. ij-iij per diem) are efficient as a prophylactic against malaria. As an antipyretic Quinine is used with the best results, especially in septic fevers, typhus, typhoid, variola, pneumonia and acute rheumatism. Inflammations may, at their inception, be aborted by 15-or 20-grain doses, combined 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, pyaemia 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 fever, 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 3 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 Phenacetin. 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 neuralgige, acute nervous exhaustion and sudden collapse without organic disease. The most pro- nounced testimony to its value is that of Dr. Maclean (Med. Times a?id 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 Quinine alone. The remedy has become much less of a favorite since its origina- tor was induced to make public the secret of its composition. 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, Eriodyc- tion or Chocolate to cover the taste if given in solution or powder. The taste is ex- tremely well covered by using as a vehicle a combination of Glycyrihizin and Fluid Ex- tract of Eriodyction, named “ Vela tine, ’ ’ but the Quinine must be suspended therein by the aid of mucilage, for when an acid is used to dissolve it the bitter taste cannot be dis- guised. For hypodermic use the best salt is the Carbamide Hydrochlorate, by reason of its ready solubility and freedom from irritant quality. A dm in istra tion. CINNAMOMUM, Cinnamon, —is official under the three following titles, viz. Cinnamomum Cassia, Cassia Cinnamon,—is the bark of the shoots of one or more undetermined species of Cinnamomum (nat. ord. Laurinese), grown in China. Is a constituent of the compound tinctures of Cardamon, Catechu and Lavender. COCA 243 Cinnamomum Saigonicum, Saigon Cinnamon,—the bark of an undetermined species of Cinnamomum. , Cinnamomum Zeylanicum, Ceylon Cinnamon,—the inner bark of the shoots of Cin n a m o m u m Zeyla n icu m. The latter occurs in light, yellowish-brown quills, consisting 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 principle is a Volatile Oil, and they also contain a resin, and tannic and cin- namic acids. Dose, gr. x-xx. Oleum Cinnamomi, Oil of Cinnamon, Oil of Cassia,—a volatile oil distilled from Cassia Cinnamon. A yellowish-colored liquid, of sp. gr. 1.055 to 1.065 > soluble in an equal part of alcohol or of glacial acetic acid. Becomes darker and thicker by age and exposure to air. Dose, gtt. j-v. Aqua Cinnamomi, Cinnamon Water,—has of the Oil 2, triturated with Precipitated Calcium Phosphate 4, and Distilled Water to 1000. Dose, indefinite. Spiritus Cinnamomi, Spirit of Cinnamon,—has 10 per cent, of the oil in Alcohol to 100. Dose, H\v-xxx. Tinctura Cinnamomi, Tincture of Cinnamon,—has of Ceylon Cinnamon 10, Gly- cerin 5, Alcohol and Water to 100. Dose, Pulvis Aromaticus, Aromatic Powder,—has of Ceylon Cinnamon 35, Ginger 35, Cardamom 15, Nutmeg 15, triturated together to a fine powder. Dose, gr. x-xxx. Extractum Aromaticum Fluidum, Aromatic Fluid Extract,—has of Aromatic Powder 100 per cent, in Alcohol. Dose, n^x-xxx. Cinnamon is an agreeable carminative, somewhat astringent and stimulant, 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. In overdoses it acts as an irritant and narcotic poison. The various preparations are in general use as flavoring excipients, and the Aqua is a pleasant vehicle for extemporaneous mixtures. Th£ Bark and its preparations are used to check diarrhoea in combination with opium, chalk, or some vegetable infusion. Cinnamon was formerly used with success in uterine hemorrhage, generally in com- bination with sulphuric acid, which is itself an efficient uterine hemostatic. The Oil is a good remedy for flatulence, paralysis of the tongue, cramp of the stomach, enteralgia and similar complaints, and is sometimes used to check nausea and vomiting. It has an an- cient reputation for healing properties, and its antiseptic powers have long been known, especially on the mucous membranes, being utilized as an injection for gonorrhoea. 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 bacillus of which disease it is believed, by its advocates, to have specific and destructive powers. Preparations. COCA, Coca, Cuca,—the leaves of Erythroxylon Coca, a small shrub of the nat. ord. Lineae, indigenous to the mountains of Peru and Bolivia, and extensively cultivated in those and other S. American states. Its odor is tea-like, its taste slightly bitter and aromatic. It contains a crys- talline 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. 244 COCA Extractum Cocse Fluidum, Fluid Extract of Coca,— Dose, Leaves of good quality are often so difficult to be obtained that Dr. Squibb, the well-known pharmaceu- tist, has more than once 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, C17H2]N04 (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. ]/%-]. Cocainae Hydrochloras, Cocaine Hydrocklorate, C17H21N04HC1,—also called Co- caine Muriate, but is more properly Cocaine Chloride,—occurs in colorless crystals, odor- less, of saline, slightly bitter taste, producing on the tongue a tingling sensation followed by numbness. Soluble in 0.48 of water, and in of alcohol. Is used in aqueous solu- tions of 2 to 10 or more per cent, hypodermically or locally to mucous surfaces as a local anaesthetic. Dose, internally, gr. '/%-); by hypodermic injection, gr. Cocainae Oleas, 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. Celerina, (Unofficial),—is a proprietary preparation which is said to contain in each fluid-drachm gr. v each of Coca, Celery, Kola and Viburnum, with aromatics. Dose, Preparations. 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, raises 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 elim- inated by checking the processes of waste. Large doses produce im- paired 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 columns of the spinal cord. It kills rabbits and dogs by paralysis of the respiratory centre. In proper doses it raises arterial tension by stimulat- ing 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 prompt diuretic. It improves digestion, stimu- lates respiration, increases the heart’s action, raises the arterial tension, and exalts the irritability of the sensory nerves. It stimulates the brain by increasing its blood-supply, producing wakefulness and marked dim- inution 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 COCA. 245 energy on a lessened supply of food. It first decreases and then 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 often very marked;—the skia grows cold and clammy, and the subject is seized with a sense of impend- ing dissolution. Death occurs in animals by paralysis of the respiration, but in man a tetanoid spasm of the cardiac muscle seems to occur, which is equally dangerous to life. Maurel has shown that, as the capillaries contract powerfully under the influence of cocaine, thromboses and embolisms, particularly pulmonary embolisms, capable of causing fatal accidents, may be produced thereby. It profoundly affects the leucocytes, which become spherical and rigid, increase in size, and no longer adhere to the walls of the vessels. Other symptoms are impairment of coordi- nation, hallucinations and delirium. Lethal doses paralyze the intra- cardiac motor ganglia, the posterior columns of the cord, the sensory nerves, and the respiratory centre. Nearly five years ago, Satterwliite, as a result of the study of one hundred cases of poisoning by this alkaloid, called attention to the dangers attending the use of even very small doses, and at about the same time another author, after summarizing the records of fifty cases, made a similar announcement. A case is reported by Broughton in which unconsciousness, an irregular, slow respiration, and a slow pulse, followed the application of three minims of a twenty per cent, solution within the cavity of a tooth. Whistler, after the application of a four per cent, solution to the nasal cavity, noted vertigo and threatening syncope. In a case of glossitis, Ricket states that the patient became mori- bund after the use of a similar solution. Myrtyle dropped three minims of a three per cent, solution in each eye, which immediately caused a sense of numbness in the back of the tongue and throat, palpitation, threatened syncope and nausea. Bettleheim records that in one case the hypodermatic injection of one-sixth of a grain induced alarming symptoms ; and in another, one-eighth of a grain similarly injected caused unconscious- ness, congestion of the face, irregular breathing and trismus. Baker mentions a case in which one grain injected into the gums by a dentist produced death in a few minutes, and Hsenel records the case of a man in whom the injection of grain was followed by a fatal result. As a Local Ancesthetic the power of Cocaine is very great over a limited area. Applied to such structures as the Schneiderian membrane, and the 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 tempor- arily destroys both taste and tactile sensibility ;—to the ocular conjunctiva, it produces profound anaesthesia of that membrane, together with dilata- tion of the pupil, partial paralysis of accommodation, enlargement of the 246 COCA. palpebral fissure, slight lachrymation, and sometimes temporary ptosis. This profound degree of anaesthesia is thought by some to be caused by its paralyzing the terminal twigs of the sensory nerves,—by others to be due to vaso-motor stimulation rendering the nerves bloodless and there- fore unable to transmit sensory impressions. It produces mydriasis by stimulation of the ends of the sympathetic in the iris, and does not affect the third nerve or the sympathetic centre. In general action, Cocaine resembles Atropine very closely, especially in its influence upon the pulse and blood-pressure, the respiration, pupils, salivary- and sweat-glands and intestinal peristalsis. In its symptoms, both from large and small doses, it exactly parallels Sparteine, another cardio-inhibitory depressant. Antagonists. Ammonia and Amyl Nitrite combat the earliest symptoms of cardiac depression,—then Alcohol and Opium as stimulants to the heart, also Artificial Respiration. The most di- rect antagonist is Chloral, so also are Chloroform and Ether. Morphine is also directly antagonistic at almost all points. The Cocaine-Habit. Cocainism, the Cocaine-habit, is now presenting itself to observation, numerous in- stances 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. A peculiar set of hallucinations is characteristic of the action of Cocaine. One patient was always scraping his tongue to extract from it little black worms ; another made his skin raw in the endeavor to draw out cholera microbes ; a third was constantly looking for cocaine crystals in his skin. Two of these subjects suffered from epileptic attacks and the third from cramps. (Magnan and Saury.) Some observers report the most extraordinary mental changes resulting 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 charged to this drug. The author’s experience of a large number of such cases convinces him that a cocaine habitue who has used the drug daily for a month is practically an insane individual while under the influence of the drug; but that the mind soon resumes its normal condition after withdrawal thereof, which can be done, in nearly all cases, at once, without involving any serious suffering. Many of the proprietary catarrh-snuffs contain cocaine, and their use may cause the cocaine-habit, which, however, is in most cases acquired by morphine habitues who go to cocaine in the expectation of finding help in their struggle against the tyranny of the for- mer drug. In this hope, however, they are always disappointed 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 symptoms due to 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.’ ’ As the stimulant effect of a single hypodermic injection passes off very quickly, within about 15 or 20 minutes, the cocaine habitu6 is under the necessity of constantly injecting the drug, so that, as one such expressed it, “ I had no time to go home,—no time to do anything except to prepare and take one ‘ shot ’ after another.” The effect of such re- peated puncturing of the skin is very disastrous to that tissue, causing great induration and numerous sloughing sores. COCA. 247 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. Co- caine is a useful stimulant to the brain and the nervous system in many morbid conditions, particularly cerebral and spinal anaemia, neurasthenia, melancholia, hysterical and hypochondriacal insanity, and in protracted mental depression with suicidal tendency. It may be 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- 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 irri- table 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. Cocaine Hydrochlorate has achieved notoriety as a local anaesthetic, 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, solution is brushed lightly over the mucous surface or injected into the urethral 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 anaes- thetic action is so entirely local and generally free from unpleasant 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 prepuce to pre- vent 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 248 COCCUS. or to relieve chordee, and it is an excellent application to the gums of teething infants. To be efficient it must reach the terminal filaments 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 or oleate, freely over the affected surface. It gives instant relief from the burning and itching, and speedily reduces the dermatitis. The rapid accumulation of cases in which alarming symptoms followed the local appli- cation of small quantities of cocaine, together with the fact that these untoward effects are due to individual idiosyncrasy and do not invariably occur immediately, is a positive warning to the profession that this powerful substance should not be used in any case for the first time without proper antidotes directly at hand and the patient being kept under surveillance for at least a half hour. There seems to be no doubt that cocaine is absorbed with extraordinary rapidity and that the stronger the solution which is locally applied, the greater the danger of toxic symptoms, but whether the latter are to be attributed merely to the larger dose or to some obscure action, is not apparent. Falk has found that the rapidity of absorption varies in the different tissues—absorption taking place most rapidly through the conjunctiva, then in the following order; nose, larynx, mouth, and ear. It is generally conceded that a 5 per cent, solution is sufficiently strong for most purposes, besides being free from many of the dangers attending the use of stronger ones. Dr. F. de Havilland Hall employs a solution containing 10 per cent, of Resorcin and 20 per cent, of Cocaine Hydrochlorate, for the production of local anaesthesia, apply- ing it by means of cotton on a suitable holder, and not by the spray. He claims that the Resorcin diminishes the toxic effect of Cocaine, increases its anaesthetic effect, prevents it crystallizing out and acts as an antiseptic in the solution; and says that with this double solution even the slight toxic symptoms have been of rare occurrence. 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 Bromides, and in spinal paralyses. In these cases it has all the advan- tages 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; but never as a regular remedy, at regular intervals of time, even by him. COCCUS, Cochineal,—is the dried female of Coccus cadi, an insect of the order Hemiptera, which feeds on the cactus plants of Mexico and Central America. It is of ovate, plano-convex form, of a purple-gray or purple-black color, yielding when crashed a dark-red powder, which contains Carniinic 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. COLCHICUM. 249 The only therapeutic use of Cochineal is in whooping-cough and neuralgia, in which affections it is supposed to have considerable influence, especially in the former. Its dose to an infant is about gr. thrice daily. COLCHICUM, Meadow Saffron,—is the conn and seed of the Colchicum autumnale, a European plant of the nat. ord. Liliacese. It contains an intensely bitter, poisonous alkaloid, Colchicine, C17H19N05, which by the action of acetic and mineral acids is converted into Col- chiceine 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 an inch long, white internally, grooved on one side, inodorous, taste sweetish, bitter and acrid. Is less active than the seed. Dose, gr. ij-viij. It 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. It contains of Colchicine, 3.35 per 1000. Extractum Colchici Radicis, Extract of Colchicum Root,—made with Acetic Acid 35 parts to ioo of the root, and sufficient water. Dose, gr. j/f-ij. Extractum Colchici Radicis Fluidum, FI. Extract of C. Root. Dose, up ij-x. Extractum Colchici Seminis Fluidum, EL Extract of C. Seed. Dose, hfi j-v. Vinum Colchici Radicis, Wine of Colchicum Root, 40 per cent. Dose, v-xv. Vinum Colchici Seminis, Wine of Colchicum Seed, 15 per cent. Dose, np x-xxx. Tinctura Colchici Seminis, Tincture of C. Seed, 15 per cent. Dose, Tip x-xxx. Colchicina, Colchicine, C17H19N05 (Unofficial),—a white or yellowish, amorphous powder, of saffron-like odor and bitter taste, soluble in water and in alcohol. Dose, gr. 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 3 j to ]/2 pint of highest proof alcohol, standing for 2 weeks. Of this g v to water cj. s. ad Oj4> of which the dose is ss every 4 hours night and day, avoiding acids, until nausea, vomiting and purging set in. Colchicine Salicylate (Unofficial),—is marketed in capsules, each capsule containing Colchicine, gr. and natural Methyl Salicylate (Oil of Wintergreen), gr. iij. Dose, I capsule every 2 hours, up to IO or 15 daily. Preparations. Physiological Action. Colchicum is emetic, diuretic and diaphoretic, a drastic purgative, a gastro-intestinal irritant and a cardiac depressant. In small doses it increases 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 discharges, lowered arterial tension and depression of the heart by reflex action over the distribution of the pneumogastric,—then great prostration, 250 COLOCYNTHIS. 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. Antagonistics and Incompatibles. Tannic Acid to retard absorption. Emetics and cathartics, also warm demulcent drinks freely. Morphine hypodermically to antagonize the cardiac depression, also Alcohol. 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 repetition. 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 continued 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 preparations in acute gout. The preparation known as Colchicine Salicylate is a solution of colchicine in oil of wintergreen. It should prove to be a reliable remedy for gout and rheumatism, and also for many disorders in which the rheumatic diathesis is a factor. 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. Cucurbitacese, 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, Cr)6H84023, an amorphous but crystallizable bitter glucoside, readily soluble in water. It also contains Colocynthein, a resin, and Colocymthitin, which is a tasteless, crystalline powder, soluble in ether but not in water, and devoid of purgative action. Extractum Colocynthidis, Extract of Colocynth.—Dose, gr. Extractum Colocynthidis Compositum, Compound Extract of Colocynth,—con- tains of the preceding 16 parts, Aloes 50, Cardamom 6, Resin of Scammony 14, Soap 14, Alcohol 10. Dose, gr.v-xx. Pilulae Catharticae Compositae, Compound Cathartic Pills,—have of the preceding 8, Calomel 6, Extract of Jalap 3, Gamboge I Water to make 100 pills. Dose, j-iij. Pilulae Catharticae Vegetabiles, Vegetable Cathartic Pills,—have of Compound Extract of Colocynth 6, Extract of Hyoscyamus 3, Extract of Jalap 3, Extract of Lep- tandra 1 Resin of Podophyllum I ]/z, Oil of Peppermint 0.8, Water to make 100 pills. Dose, j-iij pills. Preparations. CONIUM. 251 Laville’s Anti-Gout Remedy,—is a proprietary medicine prepared in France and purporting to be “ a mixture of prepared Kino-colocynthine.” The published formula is as follows: Active principle of Colocynth 2]/2, 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 and Therapeutics Colocynth is classed among the tonic-astringent and resin-bearing pur- gatives. 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 produced fatal gastro-enteritis. It is popularly supposed to be abortifa- cient, but this is only true of quantities sufficient to endanger life. It is an indirect diuretic. Colocynth is too severe an agent to be administered alone for consti- pation, but it makes a useful factor in compound purgatives, as the com- pound cathartic pills. 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 (iTtWf °f a tincture) Colo- cynth is an efficient remedy in colic, sciatica, ovarian and other neural- gise, 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 heretofore suspected, an example of which is seen in the recently-discov- ered cardiac influence of Convallaria, a drug until lately known only as a purgative and a diuretic. CONIUM, Hemlock, —is the full-grown fruit, gathered while green, of Conium maculatum, the spotted hemlock (nat. ord. Umbelliferae). It contains 3 alkaloids, namely,— Coniine, C8H15N, liquid and volatile, Methyl-coniine, C8HUNCH3, and Conhydrine, C8H17NO, solid and vola- tilizable ;—also Coniic Acid and a volatile oil. Paraconiine is an artifi- cial substance produced by the reaction between Butyric Aldehyde and an alcoholic solution of Ammonia, and is isomeric with Coniine but not identical with it. The leaves of Conium are no longer official. Preparations. Extractum Conii, Extract of Conium,—each grain represents a grain of the crude drug. Dose, gr. ij-v-xl. Extractum Conii Fluidum, Fluid Extract of Conium,—has the same strength as the extract. Dose, tryij-v-xl. Comma, 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 de- 252 CONIUM. composed by heat, and if exposed to the air soon becomes inert. Dose, gr. or in minim-doses, ULrV-b• Is t°d irritant for hypodermic use, unless carefully neutralized by acetic acid. The Hydrobromate in watery solution of gr. viij to the g , of this tT\_x = gr. y,5, is a good form for subcutaneous or stomachal administration, and may be given in doses of gr. y to gr. j, as it is not actively toxic. All the preparations of Conium are uncertain in action, particularly the extract, 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 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, on the contrary, stimulates the spinal cord, and produces the convulsions often seen in Conium poisoning. The sensory nerves are not affected, but the general sensibility is, a feeling of numbness being experienced in the ex- tremities. 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 counter- acts 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. It is closely allied in its physiological action to Curare. Nux Vomica and its alkaloids, Picrotoxin and other tetanizers are antagonistic. Tannic acid and caustic alkalies are chemically incompatible. Antagonists and Incompatibles. 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 and paralysis agitans it palliates, by depressing the motor nervous system. 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 Therapeutics. CONVALLARIA. 253 used with very great benefit. The pain of cancer seems to be especially amenable to its influence when locally applied, and Coniine-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 respiratory muscles has been followed by a marked decrease in the temperature and pulse-rate. CONVALLARIA, —is the rhizome and roots of Convallaria majalis, Lily of the Valley, a stemless perennial of the nat. ord. Liliacese, indig- enous to Europe, Northern Asia and the Southeastern portion of the United States. The preparations in the market vary in action, according to the quantity of the Resin present, it being emeto-cathartic. Conval- laria contains two glucosides, namely, Convallamarin, on which the car- diac action depends, and Convallarin, a crystalline, purgative principle, insoluble in water ;—also an acrid Resin which probably contains the latter glucoside. Preparations. Extractum Convallariae Fluidum, Fluid Extract of Convallaria,—is the only offi- cial preparation, and probably contains Convallarin, which is not present in aqueous preparations, being insoluble in water. Dose, trpij-x. Extractum Convallariae (Unofficial),—from the flowers and stalks with of the leaves and root ; is freely soluble in water and in alcohol. Dose, gr. ij-x. Infusum Convallariae (Unofficial),—prepared from the flowers, leaves and stems 25 parts, in water 75. Dose, 3 ss—ij. Convallamarinum, Convallamarin, C23Hu012 (Unofficial),—an amorphous, white, bitter powder, freely soluble in water and in alcohol. Dose, gr. X-b- 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, probably due to a preponderance of the resin. Those freed from this ingredient correspond in action with Convallamarin, stimulate the appetite, without impairing digestion, increase peristalsis without producing catharsis, slow the heart and raise the arterial also slowing and deepening 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 pneumogas- tric, the motor and sensory nerves retain their irritability, the muscles preserve their contractility, and the cerebral functions and the pupil are unaffected. Physiological Action. 254 COPAIBA. Convallarin is a drastic purgative in 3-grain doses. Convallamarin 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 in- creases the force of its contractions, raises arterial tension, augments the force and volume of the respiration, and produces prompt diuresis with- out altering the composition of the urine. It is often a 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 bv 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, 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. It is not a balsam as it contains no cinnamic acid. Its constituents are a Volatile Oil and a Resin in about equal proportions, the latter contain- ing nearly 99 per cent, of Copaibic Acid. Dose, hLx~3j. Preparations. Oleum Copaibse, Oil of Copaiba, C10H16,—the volatile oil, a pale yellow liquid, of sp. gr. 0.890, of bitter taste and neutral reaction, soluble in 10 volumes of alcohol. Dose, n\x-xv. Resina Copaibae, Resin of Copaiba,—is the residue left after distilling off the vola- tile 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 \]/2 per cent, of a viscid resin. Dose, gr. j-v. Massa Copaibse, Mass of Copaiba, Solidified Copaiba,—consists of Copaiba 94, fresh Magnesia 6, triturated with water and set aside to concrete into a pilular mass. Dose, Mistura Copaibae Composita, Compound Mixture of Copaiba, Lafayette's Mixture (Unofficial),—. Copaibae 3 vij> 01. Cubebae 3 j, Glyceriti Vitelli 3 vij. Triturate and add gradually while triturating Syrupi Aq. Menth. Piperitae Jjijss. Then add with con- stant stirring Liq. Potassae Tr. Cardamomi Co. 3 ij, Spt. Etheris Nitrosi 3SS, Aq. Menthae Pip. q. s. ad 3 viij. Dose, 34-5ss. Physiological Action and Therapeutics. Copaiba is a stimulant diuretic, diaphoretic, expectorant, and a gastro- intestinal irritant. Its taste is bitter and nauseous. In the stomach it CORJANDRUM—CORNUS COTO. 255 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 elimi- nation. The various secretions have the odor of the drug, especially the urine. In medium doses it increases the quantity of urine and its solid constituents, but large doses will cause scanty urine, containing albumen, casts and blood, with pain in the loins and other signs of renal conges- tion. On the skin it often produces itching and several forms of erup- tion. 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 it is a useful remedy, but its nauseous taste and irritant effects on the stomach are driving it out of fashion, especially in private practice. One eminent surgeon declares 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 character- ized by torpid peripheral circulation, this drug has been administered in- ternally 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. Umbelliferre. It contains a volatile and a fixed oil. Dose, gr. x-xx. Oleum Coriandri, Oil of Coriander,—a volatile oil distilled from Coriander. A colorless liquid, of aromatic, bitter and pungent taste; soluble in io volumes of alcohol, forming a slightly turbid liquid, neutral to litmus paper. Dose, trpij-v. 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 purga- tives. Its flavor covers the taste of Senna and Rhubarb, and it is an ingredient of the official Confectio Sennse. CORNUS, Dog-wood (Unofficial),—is the bark of the root of Cornus florida, a small tree of the nat. ord. Cornaceee, indigenous in the U. S. It contains a bitter prin- ciple named Cornin, which is crystallizable and soluble in water and in alcohol; also a resin and tannic acid. Cornus is a simple bitter, having stomachic and other qualities similar to those of Calumba (which see). In addition it is possessed of considerable antiperiodic power, and has a good deal of reputation in the Southern States as a remedy in malarial fever, the physicians of that section considering it as next to quinine in efficiency. Heat de- stroys its active principle, consequently a decoction is a useless preparation. A fluid extract is on the market, the dose of which is TT^x-^j. COTO, Coto Bark (Unofficial),—is the bark of some unknown tree growing in Bolivia. It contains an acrid, bitter principle, of yellow color, crystalline and soluble in 256 CREOSOTUM. hot water and alcohol, named Cotoin, C22H1806 ; also Piperonylic Acid, C8H604, and a volatile oil, resin, etc., but no tannin. Dose, gr. j-xv. Paracoto Bark, or False Coto.—Its principle, Paracotoin, C19H1206, has a strong similarity to Cotoin therapeutically, but is less active. A fluid extract of the official strength is prepared, also a tincture (10 per cent.), which may be administered in doses of from rry-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 membranes. After its internal admin- istration 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 ten- dency to acute inflammation of the gastro-intestinal tract this agent must be used with caution. Small doses of the tincture (ffij-v) are said to be very effective in the diarrhoea of children. CREOSOTUM, Creosote,—is a mixture of phenols, chiefly Guaia- col and Creosol (also Methylcreosol and Phlorol), obtained during the distillation of wood-tar, preferably of that derived from the Beech. It occurs as an almost colorless, or pinkish, inflammable, oily liquid, of smoky odor, caustic taste, and neutral reaction; soluble in about 150 of water, and in all proportions in absolute alcohol, ether, chloroform, ben- zin, carbon disulphide, acetic acid, and fixed and volatile oils. It does not coagulate albumen (?) or collodion while Carbolic Acid does. It was named from its remarkably preservative power over meat {ereas, flesh, sohzoh, preserve). Much of the commercial Creosote is an impure Car- bolic Acid, or a heavy oil distilled from coal-tar and containing Carbolic and Cresylic Acids. Dose, ny-iij, well diluted, in wine or whiskey. Morson’s beechwood creosote is the best for internal use. There is only one official preparation, viz. :— Aqua Creosoti, Creosote Water,—is a I per cent, solution, containing nearly 5 minims of Creosote in each fluid-ounce. Dose, Guaiacolum, Guaiacol (Methyl Pyrocatechin), C6H4OHOCHg (Unofficial),—is the most active ingredient of Creosote, of which it constitutes from 60 to 90 per cent. It occurs as a colorless liquid, highly inflammable, of a powerfully aromatic odor, very slightly soluble in water, readily soluble in alcohol. Dose, n\J-xv, in capsules, pills, or alcoholic solution. Guaiacoli Carbonas, Guaiacol Carbonate (Unofficial),—is a tasteless and odorless, crystalline powder, insoluble in water. Dose, gr. gradually increased to a maxi- mum of 90 grains. Benzosolum, Benzosol, Benzoyl Guaiacol (Unofficial),—is prepared by heating Guaia- col with Benzoic acid, and occurs in small, colorless, odorless, and almost tasteless crys- tals, practically insoluble in water. Contains 54 per cent, of Guaiacol. Dose, gr. v-xv. Unofficial Derivatives. Physiological Action. Creosote is expectorant, astringent, antiseptic, styptic, escharotic, an- aesthetic and narcotic. Its action is practically the same as that of Car- CREOSOTUM. 257 bolic Acid (see ante, page 75), 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 the 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. Guaiacol, locally applied, is rapidly absorbed by the skin, and appears in the urine fifteen minutes after its application. Applied by painting it over the skin of the thigh, abdomen or chest, in quantity of 20 to 50 minimi, it causes a rapid reduction of body temperature, and thereby the temperature in malarial fever, typhoid fever and pneumonia falls as much as 70 in the course of an hour or two, but soon rises again (Da Costa). This rapid antipyretic action is not accompanied by any marked disturb- ance of the nervous system or any signs of collapse, not even by a very profuse sweat, neither does there occur any active chill, though slight chilliness is sometimes experienced. Internally administered, the action of Guaiacol is similar to that of Carbolic Acid, and overdoses may prove equally fatal. Professor O. Wyss, of Zurich, reports the case of a girl nine years of age who had been acci- dentally given 75 drops of guaiacol. In a short time she became uncon- scious, the conjunctivae became injected, the corneal reflexes diminished, and the pupils no longer reacted to light; there, were frequent attempts at vomiting, and the saliva flowed from the mouth in large quantities. The pulse became rapid and the sensibility of the skin much diminished. Finally, the patient began to vomit,—the physician detecting the odor of guaiacol the stomach was washed out, but she did not rally. The cyanosis gradually diminished, and instead of it a deadly pallor was observed and the respiration became frequent. Three and a half hours after the guaiacol had been swallowed the patient passed one hundred cubic centimetres of brownish-red urine. The spleen and liver soon enlarged, the temperature fell to 96° F., and small hemorrhages were observed upon the skin of the arms and legs. The urine contained albu- min, blood, and casts, and Ehrlich’s carbolic-acid test was positive. Jaundice soon appeared, the stupor increased, and the patient died on the third day. The autopsy revealed an acute gastritis and enteritis, parenchymatous degeneration of the liver, acute hemorrhagic nephritis, parenchymatous degeneration of the heart-muscle, and ecchymoses in the pleurae, peritoneum, endocardium, and pericardium ; the spleen was much enlarged. 258 CREOSOTUM Guaiacol is said to be a powerful local anaesthetic, equal in this respect to cocaine and much safer, as it can be injected in ten times larger doses without producing ill effects. For this purpose it is used in sterilized olive oil (1 in 10 or 20) hypodermically, and it is claimed that thereby perfect local anaesthesia is obtained for the extraction of teeth, the removal of small tumors, and similar operations. Creosote, being a very complex substance of varying composition, has been almost entirely supplanted in therapeutics by Carbolic Acid for external use, and by Guaiacol for internal administration. As an astrin- gent 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 been administered internally with decided benefit in abnormal fermentative processes in the stomach and intestines, in reflex nausea and vomiting, (as from sea-sickness, pregnancy, etc.) ; also as an aseptic expectorant in chronic basilar cavity, in which it seems to have greater efficacy than any other remedy; and in bronchitis, pulmonary gangrene, carcinoma of the stomach and diabetes. In pulmonary tuberculosis, when well borne by the stomach, and con- tinued over a long period of time, it has probably proved more efficient than any other remedy. Its employment in this disease is based on the statement of Guttmann, that tubercle bacilli are destroyed by blood which contains per 1000 of Creosote, while even one-half that propor- tion arrests their growth. The commencing daily dose, of Creosote (or Guaiacol), is 2 or 3 minims, largely diluted to prevent irritation, taken after meals, and increased by the addition of one minim daily until a maximum daily dosage of 15 to 18 minims is reached, at whicli rate it should be continued for several months. Under this treatment cough is relieved, expectoration diminished, night-sweats are stopped, the fever lowered, while body-weight and appetite are increased in most cases; and in many even the local conditions are decidedly improved, as evinced by the physical signs. Recent researches indicate that the good effects of this treatment are due to the formation of soluble compounds between the remedy and the toxic albuminous by-products of the tubercle bacillus, which products are then eliminated from the blood. Therapeutics. Creosote was advocated for phthisis by Reichenbach in 1833, and revived by Bouchard and Gimbert in 1877, since which time it has been tried in this disease and approved by a long list of authorities, including Jaccoud, Dujardin-Beaumetz, Dieulafoy, Germain See, Sommerbrodt, Von Brun, Guttmann, Douglas Powell, Burney Yeo, J. Solis-Cohen, and many others, who all agree as to its utility, though differing as to its mode of action, CREOSOTUM. 259 dosage, and the methods of administration. The number of cases dealt with by some of these observers is so considerable that there is at least strong pruna facie evidence in favor of this drug and its derivatives. Bouchard reported on 93 cases at first, and on more subsequently ; Sommerbrodt’s report included over 5,000 cases, treated during more than nine years; and Von Brun dealt with 1,700 cases. Professor Sommerbrodt con- tends that it is possible to administer the quantity necessary to inhibit the growth of the bacilli, and believes that he did so in many cases. He had the most gratifying success with this medication, and states that the more creosote the patient could bear the better was the result. Of late years the tendency has been to administer Creosote (or Guaiacol) by hypodermic injection. Lepine uses creosote dissolved in oil, and finds that a much larger quantity can be used hypodermically than the stomach will tolerate. Picot injects a mixture of sterilized olive oil containing 1 per cent, of Iodoform and 5 per cent, of Guaiacol, beginning with 1 ccm. of the mixture and increasing the dose to 3 ccm. He states that no swelling or other local reaction follows this injection. Burney Yeo has used the same method with a more concentrated formula for the injection. Guaiacol is preferred by many, for internal administration, instead of Creosote, being the principal ingredient of the latter, and of more definite chemical composition, though nearly or quite as irritant to the stomach. It may be given in mixture with wine or brandy, in capsules, or hypoder- mically in combination with cod-liver oil. When neither of these agents agree with the patient, a useful and efficient substitute therefor is Guaia- col Carbonate, in doses of 6 to 8 grains, gradually increased to gjss daily. This preparation is well borne, as it does not irritate the gastric mucous membrane or disturb the digestion. The antipyretic power of Guaiacol, when painted on the surface of the body, has recently been utilized in the treatment of several diseases ac- companied by hyperpyrexia. In typhoid fever Dr. Montagnon applied xo or 15 drops with a brush whenever the temperature exceeded 102°, and the application was followed by a profuse perspiration, the tempera- ture fell, and in a few hours a large quantity of urine was passed. The action lasted about two hours, and the treatment was renewed about every three or four hours with excellent results, none of the patients suffering a relapse. Similar results have been obtained in the pyrexia of malarial fever and pneumonia, and this employment of the drug is claimed to pro- mote the absorption of pleuritic effusions in a remarkable manner. Only pure guaiacol should be used, as an inferior quality produces a very grave cutaneous irritation. By other clinicians it is mixed with glycerin before application, in the proportion of 1 part to 8 of the latter, or even in equal quantity, and it is claimed that thereby no inconvenience is expe- rienced. This application of Guaiacol is also decidedly ansesthetic in effect, and has been utilized in orchitis, in the chest-pains of tuberculous subjects and in other painful affections, especially sciatica and rheuma- tism. Benzosol contains Guaiacol in the proportion of 54 per cent. In the intestinal canal the latter is probably set free by the action of the alkaline secretions, as Benzosol is excreted by the urine in the form of guaiacol and benzoic acid combinations. Compared with guaiacol, this agent has 260 CROCUS—CUBEBA. the advantage of being almost tasteless; hence it can be given in large doses without the digestive disturbance and disagreeable eructations pro- duced by the parent substance when administered in liquids, and without the local irritant effect caused by the latter in capsules. In doses of 4 grains, gradually increased to 12 grains thrice daily, results are claimed to have been obtained from this agent, in the treatment of phthisis, equal if not superior to those produced by Creosote. CROCUS, Saffron,—the stigmas of Crocus sativus, a plant of the nat. ord. Irideas, cultivated in Europe, containing a volatile oil and coloring matter. So-called American Saffron is not Crocus but the flowers of Carthamus tinctorius. True Saffron is expen- sive, as it requires about 60,000 flowers to furnish one pound of the stigmas. Dose, gr. v—xx, in infusion. Tinctura Croci, Tincture of Saffron,—10 per cent. Dose, ,^j-ij. Saffron Tea, so much used in domestic practice, is an infusion of Carthamus tinc- torius, the 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 symptoms. On the continent of Europe it is employed as a stimulant and emmenagogue, but in this country its only use is as a color- ing agent. The miscalled Saffron Tea noted above is used in domestic practice for measles and other exanthemata. CUBEBA, Cubeb ,—is the unripe fruit of Piper Cubeba, a plant of the nat. ord. Piperacese, cultivated in Java. It contains a Volatile Oil, which is official, an acrid resin composed in part of Cubebie 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 vola- tile 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-gij. Extractum Cubebse Fluidum, Fluid Extract of Cubeb. Dose, n\v-xxx. Tinctura Cubebse, Tincture of Cubeb,—20 per cent. Dose, tr^x-^nj. Oleoresina Cubebae, Oleoresin of Cubeb,—extracted by ether. Dose, TT^v-xxx. Trochisci Cubebae, Troches of Cubeb,—each contains of the Oleoresin 4, Oil of Sas- safras I, Extract of Glycyrrhiza 25, Acacia 12, and Syrup of Tolu q. s. to form 100 troches. Dose, j-iij. Oleum Cubebae, Oil of Ctibeb, C15H24,—is the volatile oil, a colorless or pale green- ish-yellow liquid, of sp. gr. 0.920. warm, aromatic taste, odor of cubeb and neutral re- action. Is soluble in an equal volume of alcohol. Dose, n^v-xx. Preparations. Cubeb belongs to the pepper family, and like black pepper is an aroma- tic stomachic and a stimulant diuretic in small or medium doses, but large doses derange digestion and may act as a gastro-intestinal irritant. Its constituents are eliminated by the bronchial mucous membrane, the skin and the kidneys, stimulating and disinfecting the genito-urinary CUPRUM. 261 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. It is used in the acute stage of gonorrhoea, in 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 one of its salts is, namely 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. Cupri Sulphas, Copper Sulphate, CuS04 -f- 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 io or 15 minutes,—as a tonic, gr. Ye-yi- Alkaline Cupric Tartrate Volumetric Solution, Fehling's Solution,—the official reagent for glucose, is prepared as follows. (1) Dissolve 34.64 grammes of pure Cupric Sulphate in water, to measure exactly 500 cubic centimeters. (2) Dissolve 173 grammes of Potassium and Sodium Tartrate and 125 grammes of Potassium Hydrate in water to measure exactly 500 cubic centimeters. Keep the two solutions in small, rubber-stop- pered bottles, separate; and for use, mix exactly equal volumes of the two at the time required. One cubic centimeter of the mixed solution is the equivalent of— Cupric Sulphate, crystallized, CuS04-f Gramme, 0.03464 Cupric Tartrate, CuC4H406 + 3H20, “ 0.03685 Glucose, anhydrous, C6H1206, “ 0.00500 Cuprum Ammoniatum, 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. l/e~)- Cupri Arsenis, Copper Arsenite,—is described under Arsenum, ante, page 165. Salts and Preparations of Copper. 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 262 CUPRUM. 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 line (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, the metal seeming to have 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. Brass-founding is known to cause various forms of disease, as gout, chronic nephritis, progressive paresis of the legs, tremor, muscular wasting, and locomotor ataxia. A group of symptoms spoken of as “brass founders’ ague” has also been noticed. The fit of ague is ushered in by languor and depression,then follow prostration with pallor, cold sweats, and chills, that even may amount to rigors, with chattering of the teeth, precordial anxiety, headache, nausea and muscular pains. The onset of vomiting arrests the symptoms and usually is followed by sleep, from which the patient arouses almost well. It is not clear whether these symptoms are due to copper or to zinc, both of which enter into the composition of brass. Copper Sulphate 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 is astringent to the gastro-intestinal tract. Ex- ternally applied in solution it is a useful stimulant and astringent to dis- eased 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 violently irritant poison. Ammoniated Copper has no special action other than above noted. Antidotes, Antagonists and Incompatibles. Potassium Ferrocyanide is the antidote in poisoning by the Copper salts, but Albumen or Magnesia may be used. Any chemical antidote should be followed by prompt evacua- tion 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, and 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 compara- tively 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- 263 CURARE. duced. In acute diarrhoea and chronic dysentery it is the best metallic astringent in doses of gr. to 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 granu- lations and chronic inflammations of mucous membranes. In most of these affections weak solutions (gr. to to the §) 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 bejng con- sidered the most efficient preparation in these cases. In Germany a tincture 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 Copper Sulphate, Zinc Sulphate, of each 15 parts, Liquor Plumbi Subacetatis 30, Vinegar 200. The solu- tion is thoroughly injected into the sinuses leading to the carious bone. CURARE, Woorara (Unofficial),—is a vegetable extract obtained from various members of the Strychnos family, also 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. ¥V“i hypodermically,—of Curarine, gr. hypoder- mically, or gr. by tbe 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 para- lyzed first, death occurring by paralysis of respiration. The absorption of the drug by the stomach is very slow, as its active principle passes with difficulty through animal membranes, and its elimination, which takes 264 CUSSO CYDONIUM. place by the kidneys, being more rapid and complete than that of any other agent, no marked effect may be produced when it is administered in- ternally. When hypodermically injected its action is very prompt. The urine of a curarized animal will poison another, and that of the second animal will paralyze a third. » As compared with other motor depressants Curarine and Coniine paralyze the end-organs of the motor nerves, and Gelsemine paralyzes the motor centres. 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. Antagonists and Incompatibles. Therapeutics. Curare is chiefly used for experimental purposes on the lower animals. It has an historical interest from its having been the means by which Bernard demonstrated the existence of muscular contractility as an essen- tial endowment of that tissue. It has been used with some success in spasmodic nervous affections, particularly in tetanus, both idiopathic and traumatic, in hydrophobia, chorea and epilepsy. It does not promise well as a therapeutic agent, but undoubted cases of hydrophobia are reported by high authority as cured by this drug. CUSSO, Kousso, Brayera,—is the female inflorescence of Hagenia abyssinica, an Abyssinian tree of the nat. ord. Rosacese. It contains tannic acid, a volatile oil, and a crystalline principle named Koussin, which by itself is apparently inert. Dose, of Cusso, ofl-Sj- Extractum Cusso Fluidum, Fluid Extract of Kousso.—Dose, gij-jf j. Cusso has little or no effect except the nausea, vomiting, colic and slight diarrhoea pro- duced by large doses. Its chief action is anthelmintic 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. 3 ij to § j of the flowers infused in iv 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 a 6 per cent, 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. CYDONIUM, Quince Seed (Unofficial),—is the seed of Cydonia vulgaris, a tree of the nat. ord. Rosacese, native in Crete and Austria, and cultivated elsewhere. The seeds placed in water 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. Mucilago Cydonii, Mucilage of Cydonium (Unofficial),—is prepared by macerating 2 parts of Cydonium in loo of Distilled Water. Dose, indefinite. Cydonium is of value for its mucilage, which is used as a bland, demulcent application in conjunctivitis, abrasions of the skin, and fissures of the mucous membranes, and as a vehicle for injections in gonorrhoea. Internally 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 mucilage of Cydonium. CYPRIPEDIUM DIGITALIS. 265 CYPRIPEDIUM, Ladies’ Slipper, —is the rhizome and roots of Cypripedium pubescens, and of C. parviflorum, the Moccasin-plant, or American Valerian (nat. ord. Orchidese). It contains a volatile oil, a volatile acid, resins, and tannin. Extractum Cypripedii Fluidum, Fluid Extract of Cypripedium.—Dose, n^x-xxx. Cypripedin (Unofficial),.—is an impure alcoholic extract. Dose, gr.ss-iij. Cypripedium is antispasmodic, tonic, stimulant and diaphoretic, possessing the same general properties as Valerian, whence one of its common names, American Valerian. It is a popular remedy in some parts of the U. S. for nervous hypersesthesia unaccompa- nied 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. DAMIANA (Unofficial),—the leaves of Turnera aphrodisiaca, a plant of the nat. ord. Turneracese, growing in Mexico and Lower California. 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, daily. Extractum Damianae, Extract of Damiana (Unofficial).—Dose, gr.ij-x. Extractum Damianae Fluidum, Fhiid Extract of Damiana (Unofficial).—Dose, nlx-3J • Damiana is said to be a powerful aphrodisiac in cases of sexual atony, but the pub- lished 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 head- aches 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. Solana- ceae, resembling Stramonium very closely, with which it generally agrees in its physio- logical action and therapeutics. It is distinguished 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, Foxglove,—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. Scrophularinese, 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 to the physiological activity of any particular sample or preparation. The seeds are known to contain the active principles in much greater proportion than the leaves, but they are never used. 266 DIGITALIS. Constiluents. The active principle of Digitalis was first designated by the term Digi- talinum (Digitalin), under which name a substance was official in the U. S. Phar. and a process was given therein for its extraction, until the revision of 1880, when it was omitted. It was an amorphous product, of complex composition, and did not represent Digitalis. In 1871 Nativelle received theOrfila 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 Sapottin, forming a solution which froths easily and antagonizes the other three ;—(5) Digitin, which seems to be entirely inert. The first three are active cardiac stimulants and highly poisonous. The fourth is a direct depressant of the heart, antagonizing the stimulant action of the others. All five are non-nitrogenous, and, except Digitin, are glucosides. Digitalis contains no alkaloid. Digitalis, Digitalis,—the powdered leaves. Dose, gr.ss-iij. Extractum Digitalis, Extract of Digitalis,—By maceration and percolation in Alco- hol 2, Water I, distilling off the alcohol, and evaporating the residue. Dose, gr. Extractum Digitalis Fluidum, Fluid Extract of Digitalis,—By maceration and percolation in Alcohol 2, Water I, and evaporation. Dose, tr^ss-dj. Tinctura Digitalis, Tincture of Digitalis,—Digitalis 15, Diluted Alcohol to 100. By maceration and percolation. Dose, rrpv-xxx. Infusum Digitalis, Infusion of Digitalis,—Digitalis i]4, Alcohol 10, Cinnamon Water 15, Boiling Water 50, Water to 100. By maceration in boiling water. Dose, 3 j-iv. Notice that the dose is in drachms, not in ounces. Digitalinum, Digitalin,—is the complex product of the process formerly official in the U. S. and Br. Phar. Dose, gr. Homolle’s (or Quevenne’s) Digitalin (Unofficial),—is touch used in France in form of granules. Consists chiefly of Digitalin with a little Digitoxin, and possesses the action of the leaves. An amorphous, yellowish-white powder or small scales, intensely bitter, inodorous, but irritant to the nostrils. Dose, gr. equal to about gr. jss of the powdered leaves. Nativelle’s Digitalin,—consists largely of Digitoxin, and is cumulative in action. Light, white, crystalline tufts of needles, of very bitter taste ; soluble in alcohol, insoluble in water. Dose, gr. in pill. The Tincture and Fluid Extract, being alcoholic preparations, contain a large pro- portion of Digitalin and Digitale'in, with a small proportion of Digitoxin and Digitonin. On the addition of water thereto, the Digitoxin is precipitated to the bottom. The Infusion contains a large proportion of Digitonin, some Digitalein, and little or no Digitalin or Digitoxin. The Infusion is the best preparation for diuretic purposes, the Tincture for cardiac action ; but to obtain the action of the plant itself the powdered leaves must be used in pill or capsule. To obtain the best action of the Tincture on the heart, it should be administered without admixture, or at least, with water alone, the latter being added immediately before ingestion and any precipitate being also swal- lowed. Preparations. 267 DIGITALIS. Physiological Action. Digitalis is a cardiac tonic, a vascular stimulant, and an excito-motor, also emetic, diuretic, hemostatic, anaphrodisiac, and paralyzant. In over-doses it irritates the mucous membranes, causing sneezing, severe gastric disturbance, nausea, vomiting, colic and purging, the discharges being of a grass-green color. It lowers temperature, probably by lessen- ing 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 muscle and its inhibitory apparatus; also 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 final effect on striped muscular tissue is to lessen the contractile power, causing great weakness and languor. Under it, the excretion of urea is at first increased, but soon decidedly diminished. It lessens the sexual appetite and impairs the venereal function. It has been conclusively shown that in many cases of pneumonia Digitalis failed to influence the pulse, the result probably of the partial paralyzant influence of high body temperature upon the vagus centre and endings in the heart, thus weakening the inhibitory apparatus to such a degree that the drug awakens no responsive increase of inhibition. In cases with but moderately high pyrexia the characteristic action of the drug is not interfered with. 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, Digiialin, 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 ;—whde 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 268 DIGITALIS. and convulsions follow, also death by sudden paralysis of the heart, which is arrested in systole. Compared with Aconite, both it and Digitalis slow the heart, but otherwise their actions are antagonistic. Aconite at first stimulates and soon relaxes inhibition and depresses the cardiac motor ganglia,—Digi- talis increases inhibition and stimulates the cardiac muscle. Both drugs finally paralyze the heart, Aconite by direct depression of its motor ganglia, Digitalis by over-stimulation of 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 muscle of the heart is so nearly paralyzed by over-stimulation that on suddenly assum- ing the erect position the cardiac energy may fail, more especially if the doses are administered too closely together to admit of the elimination of one before the ingestion of the next. This is the explanation of the so-called cumulative action of Digitalis, which is not now generally recognized in the sense in which the term was formerly applied. Another explanation is that it may stop its own excretion, by arresting the renal circulation and the secretion of urine through extreme contraction of the renal vessels, and thus may really accumulate in the blood. 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, Iron Sulphate, Tinc- ture of Ferric Chloride, and Lead Acetate, also syrupy and watery solutions, which may decompose the active principles of the plant. Therapeutics The employment of Digitalis in disease is chiefly based on its action as a cardiac tonic and a diuretic. The forms of heart disease in which it is indicated are the affections of the auriculo-ventricular orifices, namely, mitral and tricuspid disease, whether regurgitant or obstructive in char- acter. It is contra-indicated in aortic disease, except for special symp- toms, and in fatty degeneration of the cardiac muscle. Its sphere of usefulness is Mitral Regurgitation, especially when accompanied by venous engorgement and oedema of the lungs, the right heart, the liver, kidneys and subcutaneous tissues. In such cases its action is shown to striking advantage, ameliorating all the symptoms by assisting the flow of blood in the veins. By prolonging the diastole, it gives time for the dilated auricle to empty itself through the incompetent orifice ; and by strength- 269 DIGITALIS. ening the contraction of the left ventricle, it causes the better approxi- mation of the mitral flaps, consequently less regurgitation, less venous engorgement, and the propulsion of more blood into the arterial system. If it also acts as a diuretic, as it usually does in these cases, the diuresis will tend to remove the oedema; and the general improvement in the circulation produced by it will relieve the cardiac pain and distress, the dyspnoea and cyanosis. The less a case of mitral regurgitation approaches the oedematous type, the less good will Digitalis do, as a rule. In Mitral Constriction, Digitalis is usually of great assistance, the lengthened diastole giving more time for the blood to pass through the narrowed orifice, and the increased force of the auricular contraction helping in the same direction. In Tricuspid Regurgitation or Constriction, Digitalis is beneficial in the same manner as in disease of the mitral valve. 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 Aortic Regurgitation, Digitalis is generally injurious; the prolonged diastole caused by it giving more time for the blood to regurgitate through the imperfectly closed orifice, and thus increasing the danger of fatal syncope. It may do good if compensatory hypertrophy has not set in, if the heart is feeble and its action rapid, or when there is but little blood regurgitating, or when there are reasons, such as the coincident presence of aortic obstruction, for wishing to strengthen and regulate the contraction. In any case, the dose administered should be a small one, and its effects should be carefully watched. In Aortic Constriction, Digitalis is generally contra-indicated, especially when, as is usually the case, this lesion is accompanied by aortic regurgi- tation. It may be of service, however, when the force of the heart-beat requires strengthening; or when, as a result of the obstruction, mitral dilatation has set in, with much regurgitation, and the consequent venous and pulmonary engorgement. It should not be used in aortic stenosis with compensatory hypertrophy, in simple hypertrophy when compen- sated, in pericarditis or in fatty degeneration of the heart, except tem- porarily for some special indication. In the irritable heart of soldiers Digitalis is often curative, and palpita- tion, cardiac failure and venous engorgement are well treated by it. In exophthalmic goitre it has apparently benefited some cases, when used over a long course of treatment; but, as a rule, this affection is not amenable to its influence. When the cardiac action of Digitalis is desired, the tincture should be employed, given on sugar or bread, prohibiting the ingestion of any 270 DIGITALIS. aqueous fluid within 20 minutes either before or after swallowing it. If the diuretic action is required, the proper preparation is the infusion, which contains a much larger proportion of Digitonin than of the other principles. This agent, acting upon the renal apparatus and antagoniz- ing the action of the other three, is freely soluble in water, but sparingly so in alcohol. On the other hand, Digitalin, to which the cardiac action of the drug is chiefly due, is almost insoluble in water, but readily soluble in alcohol; and Digitoxin, the most active constituent, is insoluble in water, though somewhat soluble in alcohol. In Bright’s disease Digitalis is not a suitable diuretic. It has been used in the early stage of the acute form, but it is very questionable prac- tice to dilate the vessels of any acutely inflamed organ. Moreover, in such cases the arterial tension is always somewhat raised, and this drug only aggravates that condition. In chronic Bright’s disease it is still more injurious, for the same reason, the arterial tension being very high therein. It may be of service, however, in cases of renal cirrhosis, when the car- diac hypertrophy has failed to overcome the peripheral resistance, and consequently there is dilatation of the left ventricle and the left auriculo- ventricular orifice, with the resulting mitral regurgitafion. In such cases, a diuretic pill is frequently of service, consisting of Digitalis leaves in powder, Calomel and Squill, a grain of each, made into pill with extract of Hyoscyamus. Digitalis is always an uncertain diuretic unless the heart is diseased ; yet it has rendered good service in renal dropsy as well as in the cardiac form. Its contractile power over the arteries may so predominate as to arrest the renal circulation completely, and stop the secretion of urine (Brunton). On this account it is well to administer at the same time an agent which causes dilatation of the renal vessels, as Sodium Nitrite. It has been employed with benefit in the early stage of scarlet fever, and when the kidneys strike work in that disease. As a hemostatic it may be used in hemorrhage from a large surface, in the hemorrhagic diathesis, hemop- tysis, and menorrhagia. As an antipyretic it has been much used in fevers, in the first stage of pneumonia, and in other inflammations, 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 particularly indicated for any cardiac complications. It was formerly much used in delirium tremens, in con- gestive headaches, acute mania and other congestive conditions of the brain, but generally without much benefit. 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 particu- DIOSCOREA DITA BARK DROSERA DUBOISIA. 271 larly adapted to blondes and persons of sanguine and indolent tempera- ment. Sometimes the vomiting caused by it is so severe as to prevent its use. DIOSCOREA, Wild Yam, Colic-root (Unofficial),—is the rhizome of Dioscorea villosa, a creeping plant of the nat. ord. Dioscoraceae, indigenous to the eastern U. S. It contains an acrid resin, and is reported 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, dysmenorrhcea 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 pharma- copoeia! rule may be administered in doses of TT^xv-xxx. DITA BARK (Unofficial),—is the bark of Alstonia scholaris, a tree of the nat. ord. Apocynacese, growing in the Philippine Islands. It contains 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 3 j—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 whooping-cough and other spasmodic coughs ; especially when marked by violent paroxysms, the cough being loud and harsh, and followed by bleeding 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, rrpv-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. Extractum Duboisiae, Extract of Duboisia,—Dose, gr. ]/(,-/(■ Tinctura Duboisiae, Tinctrtre of Duboisia,—Dose, n\,v-xx. Duboisinae Sulphas, Duboisine Sulphate (I.angenberg’s),—Dose, gr.TJ7-jff. Unofficial Preparations, Physiological Action and Therapeutics. 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. If administered in the intervals between meals it disorders the ensuing digestion, but does not so act if given while digestion is in progress. Duboisine is highly praised for its sedative action in the mental exci- 272 dulcamara. tability of the insane, in the treatment of the morphine habit and in paralysis agitans. In doses of gr. to of the sulphate, admin- istered hypodermically twice daily, it induces quiet and refreshing sleep and is not dangerous. When given in larger doses it may produce vertigo, nausea or even syncope, but no fatal cases from its moderate use have been reported (Massant). Its sedative effect is at the same time the most persistent and also that of which the patient first acquires a toler- ance. Of 22 cases in which the calmative effect was at first decided, a tolerance was acquired in eight. In such cases the sedative action of the drug may be restored by ceasing its continuous administration and length- ening the interval between the doses (De Montyel). It has been well employed in puerperal mania, and may be used instead of Atropine in many conditions, especially in the night-sweats of phthisis, respiratory neuroses and cardiac failure. It is employed as a mild mydriatic by eye surgeons, its advantages for them over Atropine being its more rapid action in paralyzing accommodation and effecting mydriasis, the shorter duration of its effects and the slight degree of conjunctival irritation produced by it. Duboisine is an efficient antagonist to Morphine. Its own antagonists and incompatibles are the same as for Atropine, and are stated under Belladonna, ante, page 181. DULCAMARA, Bittersweet,—the young branches of Solarium Dulcamara, or Woody Night-shade, a shrub of the nat. ord. Solanacese, growing in Europe and N. America. It contains the glucoside Dul- camarin, a peculiar principle named Picroglycion, and the alkaloid Solanine, which exists in the stems of other species of Solanum, namely, S. tuberosum (potato), S. 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. Extractum Dulcamarae Fluidum, Fluid Extract of Dulcamara,—Dose, Decoctum Dulcamarae, Decoction of Dulcai?iara (Unofficial),—may be made of io per cent, strength and given in doses of j-ij. Preparations. Dulcamara is but imperfectly understood. In overdoses it has pro- duced nausea and vomiting, vertigo, convulsive muscular movements, pruritus, erythematous eruptions on the skin, and 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, Physiological Action and Therapeutics. ELASTICA. 273 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. 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, in chronic bronchitis and in whoop- ing-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. ELASTICA, India-rubber (Caoutchouc),—is the prepared milk- juice of various species of Hevea (nat. ord. Euphorbiacege), growing in S. America, and being known in commerce as Para Rubber. It is very elastic, insoluble in water, diluted acids, or diluted solutions of alkalies, soluble in chloroform, carbon disulphide, oil of turpentine, benzin and benzol. When pure, or nearly pure, it floats on water. India-rubber is a hydrocarbon, and may be combined with sulphur by the aid of heat (vulcanized), which process, long continued, converts it into hard rubber. It is used in the fabrication of catheters, bougies, pessaries, court plaster, bandages, elastic stockings, tubing, etc. An analogous substance is Gutta-percha, which was official in the U. S. Phar., 1880. Gutta-percha (Unofficial),—is the concrete exudation of Isonandra gutta, a large tree of the nat. ord. Sapotacese, 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., insoluble in water or alcohol, soluble in chloroform, oil of turpentine, carbon disulphide, benzin and benzol. It contains a hydrocarbon, Gutta, C10H16 (80 per cent.), two Resins named Fluavil and Albau, also a volatile oil, salts, fat and coloring matter. Preparations of Gutta-percha. Liquor Gutta-perchae, Solution of Gutta-percha (Unofficial),—Gutta-percha 9, Car- bonate of Lead 10, in Chloroform 91. Used as a protective application to eruptions and slight wounds, the evaporation of the menstruum leaving behind a thin adhesive and non- irritating pellicle. Traumaticin (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. 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 manufactured pessaries, specula, stethoscopes and other instruments. 274 ELATERINUM—ERGOTA. 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. ELATERINUM, Elaterin, C20H28O5,—is a neutral principle ex- tracted from Elateriwn, a substance deposited by the juice of the fruit of Ecballium Elateriutn, or Squirting Cucumber, a cultivated European 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 337 of alcohol and in solutions of the alkalies. Dose, gr. Trituratio Elaterini, Trituration of Elaterin,—Elaterin 10, Sugar of Milk 90, thoroughly mixed by trituration. Dose, gr. ss-j. Preparation. 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 (class Fungi), growing within the flower and replacing the grain of Rye, Secale cereale, (nat. ord. Graminese). It occurs in fusiform, curved, grain-like bodies, of purplish-black color, peculiar and heavy odor, and oily, disagreeable taste. It should be only moderately dried, and should be preserved in a close vessel, and have a few drops of chloroform dropped upon it fron\ time to time, to prevent the development of insects. When more than one year old it is unfit for use. 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 Ergotinine, C35H40- N4Q6 (dose, gr. also a volatile camphoraceous substance. ERGOTA. 275 Dragendorf and his pupils (1875-1879) stated the active principles to be two in number, Sclerotic or Sclerotinic Acid, a very powerful body, yellow-brown, amorphous, tasteless and well adapted for hypodermic use in doses of gr. Scleromucin, a colloid substance, 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 which are inert. Kobekt (1885) announces that Ergot contains three active principles, viz., (1) Ergo- tinic Acid, a glucoside, and the chief constituent of Sclerotinic Acid ; having no ecbolic action, but affecting the nervous system, the heart and the respiration ;—(2) Sphacelinic Acid, non-nitrogenous, unstable, soluble in alcohol, insoluble in water, stimulates the vaso-motor centre, and is believed to be the active agent in contracting the blood-vessels, and producing gangrenous ergotism ;—(3) Cornutine, an alkaloid, believed to be the agent which contracts the uterus. It produces convulsions and peristaltic contractions of the uterus, and is the active agent in convulsive ergotism. Tanret’s Ergotinine has been proved to have no action on the uterus. The Ergotin of Bonjean, 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, and is said to be really a mixture of Sphacelinic acid and Cornutine. For the Ergotin of commerce see below. Ergot also contains Trimethylamine, to which its odor is due, a fixed oil, (30 per cent.) and tannin. Extractum Ergotae Fluidum, Fluid Extract of Ergot,—prepared with Acetic Acid and Diluted Alcohol. Dose, 3 ss—ij. Extractum Ergotae, Extract of Ergot, commonly called Ergotin,—is prepared by evaporating the fluid extract at a temperature not above 1220 F., until reduced to a pilu- lar consistence. Dose, gr. ij-xx. Vinum Ergotae, Wine of Ergot,—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 has about the same strength as the official extract, and represents the general powers of Ergot. It may be used hypodermically in doses of gr. 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. Preparations. Ergot is an excito-motor and a hemostatic, chiefly affecting the spinal cord, circulation, respiration, intestinal and uterine muscular fibres. Its principal action is the production of an artificial ansemia, 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 irri- tant, causing nausea and vomiting, gastralgia, colic, thirst, difficult mic- turition and purging. It slows the heart, raises the arterial tension greatly, Physiological Action. 276 ERGOTA. dilates the pupils and produces pallor, vertigo and frontal headache. 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 arterial sys- tem, is a much disputed question. It certainly stimulates the contraction of unstriped muscular fibre, especially affecting the sphincters and the uterus, causing continuous labor pains and tonic contraction of the sphinc- ter vesicse, making micturition difficult if not impossible. It also pro- duces cerebral and spinal anaemia, coldness of the surface, tetanic spasms and violent convulsions, but very large doses (several ounces) are neces- sary 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, the Convulsive, and the Gan- grenous,—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, formication of the skin all over the body, loss of sensibility and abolish- ment of the special senses, bullae of blood and ichor, followed by dry or moist gangrene of the lower extremities, buttocks and other parts, epi- leptiform 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 probably come nearest to it in action are the Ergotinine of Tanret and Sclerotinic Acid. Analogues of Ergot are Ustilago (see under Zea), Gossypii Radicis Cortex (Cotton-root Bark), and Caulophyllum (Blue Cohosh). They are each described under their respective titles. Amyl Nitrite, Aconite, Veratrum Viride, Tobacco and Lobelia antagonize its action on the circulation. Caustic alkalies and metallic salts are chemically incompatible. Antagonists and Incompatibles. 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 dangerous 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. Therapeutics. ERIGERON ERIODICTYON. 277 The tendency, however, of obstetrical teaching, is against its employ- ment at all in labor; while, in practice, the teaspoonful of Ergot is almost invariably administered as soon as possible after the child is born. In many uterine affections, as chronic metritis, subinvolution, congestive dysmenorrhcea, menorrhagia, fibroids and polypi, Ergot is well employed, producing firm contraction of the womb and promoting absorption of inflammatory products. It is extremely useful in amenorrhoea due to plethora, and in the atonic form of spermatorrhoea. In conjunctivitis, gonorrhoea, and inflammations of mucous membranes generally, it is of striking benefit, if used both locally and internally. It is also an excel- lent remedy in acute and chronic dysentery, chronic diarrhoea, atonic hemorrhages of arterial type, mania due to cerebral hypersemia, head- ache and migraine of congestive form, myelitis, spinal congestion, cerebro-spinal meningitis, splenic enlargement, lax sphincters of the 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 conges- tion. In aneurism it aids coagulation by slowing the blood current, and in cardiac 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 subin- volution 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 Erigeron 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, tTLx-^ss. 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. ERIODICTYON,—the leaves of Eriodictyon glutinosum, or Yerba Santa, a Cali- fornian shrub of the nat. ord. Hydrophyllacese. They contain an acrid Resin and an aromatic Volatile Oil. 278 EUCALYPTUS. Extractum Eriodictyi Fluidum, Fhiid Extract of Eriodictyon,—Dose, rqxv-gj. Extractum Eriodictyi, Extract of Eriodictyon (Unofficial),—Dose, gr.ij-x. Eriodictyon is expectorant, and covers the taste of Quinine in a remarkable manner, for which purpose it is combined in mixture with Glycyrrhizin, under the title “ Vela- tine," as a proprietary preparation (see ante, page 242). 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. EUCALYPTUS,—the leaves collected from the older parts of the tree, of Eucalyptus globulus, or Blue Gum-tree (nat. ord. Myrtacese), a native of Australia, now grown in California, Italy, etc. 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 the official substance named Eucalyptol, Ci0H18O, which by the action of Phosphoric Acid is converted into Eucalyptene, a sub- stance allied to Cymene, and Eucalyptolen. Preparations. Extractum Eucalypti Fluidum, Fluid Extract of Eucalyptus,—is three-fourths alcohol. Dose, h\,x~£>j- Oleum Eucalypti, Oil of Eucalyptus,—the volatile oil, is distilled from the fresh leaves of various species of Eucalyptus, that from E. amygdalina being considered wanting in Eucalyptol. Is soluble, in all proportions, in alcohol, carbon disulphide, or glacial acetic acid. Dose, in emulsion or capsules. Eucalyptol, C10H18O,—is a neutral body obtained from the volatile oil; a colorless liquid, of aromatic, camphoraceous odor, and pungent, cooling taste; soluble in all pro- portions in alcohol, carbon disulphide and glacial acetic acid. Dose, Tt\iij-x. Physiological Action. The taste of Eucalyptus is warm, aromatic, bitter and camphoraceous. It increases 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 temper- ature, 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. In toxic dose it is a nar- cotic poison, and a fatal dose causes paralysis of respiration by direct action on the respiratory centre in the medulla. Eucalyptus is powerfully antiseptic, and destructive to low forms of life, a stimulating 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 Catnpagna. EUONYMUS EUPATORIUM. 279 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. 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 bronchorrhoea, in cachectic states generally, and in convales- cence from acute diseases. In epidemic influenza (grippe) the oil has been used internally with good results, and sprinkled on blotting-paper placed in offices and stores has seemed to act as a prophylactic on persons employed therein. In hysteria, chorea and asthma it is beneficial, in the latter affection being advantageously smoked in cigarettes with Stramo- nium or Belladonna leaves. In malaria as a reconstructant it is better than Quinine, and it has considerable utility in obstinate intermittents where it is desirable to stop the use of Cinchona preparations. As an antiseptic it is highly valuable 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 solution 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. Celastrineae, growing in the U. S. It contains an amorphous, bitter principle named Euonymin, also Resins, Euonic Acid, and Asparagin, fixed oil, etc. Extractum Euonymi, Extract of Euonymus,—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-astringent and resin- bearing purgative. It is said to be also diuretic and expectorant, 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 irritation. EUPATORIUM, Thorough-wort (.Boneset),—the leaves and flowering tops of Eupatoriumperfoliatum, an American plant of the nat. ord. Compositse. It contains a neutral, bitter principle, named Eupatorin, tannic acid, a volatile oil, etc. Extractum Eupatorii Fluidum, Fluid Extract of Eupatorium,—Dose, Eupatorium is a bitter tonic and efficient diaphoretic, also in full doses, emetic and aperient. It has been supposed to have antiperiodic and teeniafuge powers. A warm 280 EUPHRASIA FEL BOVIS—FERRUM. infusion (Boneset tea) is a popular diaphoretic 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 advantage in dyspepsia and general debility. Its common name is derived from its sup- posed 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 de- cided power over the uric acid diathesis. EUPHRASIA, Eye-bright (Unofficial),—is a small annual plant of the nat. ord. Strophulariacese, growing in Europe and the U. S., 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 efficient. In hay-fever also it is of decided utility in miti- gating the catarrhal symptoms, and in the acute coryza of measles it will be found an ex- cellent remedy. A tincture (1 to 9) of the fresh plant should be used, and given in doses of ny-v. FEL BO VIS, Ox-gall (Fel Tauri),—the fresh gall or bile of Bos Taurus, is a dark-green, viscid liquid, of peculiar odor, bitter taste, and neutral or faintly alkaline re- action. It contains Sodium Glycocholate, Sodium Taurocholate, Cholesterin and color- ing matter. Fel Bovis Purificatum, Purified Ox-gall,—3 of Ox-gall and 1 of Alcohol evaporated to pilular consistence after standing 24 hours. Dose, gr.v-xv. 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. Re- cently it is found to act well in stimulating the resolution of hypertrophies when locally applied to the part, as the mammae, tonsils, pannus, etc. It is used as a laxative in con- stipation when the natural secretion of bilfe is deficient, but has no advantage 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. Salts of Iron and their Preparations. Liquor Ferri Acetatis, Solution of Ferric Acetate,—is an aqueous solution, contain- ing about 31 per cent, of the anhydrous salt, and corresponding to about 7 y2 per cent, of metallic iron. A dark, red-brown, transparent liquid of acetous odor, sweetish and faintly styptic taste, reaction slightly acid. Dose, rt\_ij-x. Used chiefly in pharmacy. Ferri Carbonas Saccharatus, Sacckarated Ferrous Carbo?iate,—has at least 15 per cent, of ferrous carbonate. A greenish-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. Massa Ferri Carbonatis, Mass of Ferrous Carbonate ( Pallet's Mass),—Ferrous Sul- phate loo, Sodium Carbonate 100, Honey 38, Sugar 25, Syrup and Distilled Water each, to make 100. Has 42 per cent, of Ferrous Carbonate. An astringent, non-irritant, fer- ruginous tonic. Dose, gr. j-v, after food. Pilulse Ferri Carbonatis, Pills of Carbonate of Iron (Ferruginous Pills, Chalybeate Pills, Blaud’s Pills),—made by mixing Ferrous Sulphate, about 2]/2 grains for each pill, with Potassium Carbonate, Sugar, Tragacanth, Althaea, Glycerin and Water. Dose, j-ij pills, after food. Mistura Ferri Composita, Compound Iron Mixture {Griffith's Mixture),—has of Ferrous Sulphate 6, Myrrh 18, Sugar 18, Potassium Carbonate 8, Spirit of Lavender 60, Rosewater to 1000. Is really a solution of the Carbonate formed by reaction between the two principal constituents. Is an excellent chalybeate. Dose, 3 ij-iv. Ferri Chloridum, Ferric Chloride [Perchloride of Iron), Fe2Cl6 -f- I2H20,—orange- yellow, deliquescent, pieces, of styptic taste and acid reaction, freely soluble in water, alcohol or ether. Action,—strongly astringent, hemostatic. Never used internally. Liquor Ferri Chloridi, Solution of Ferric Chloride,—an aqueous solution of the pre- ceding, containing 37.8 per cent, of the anhydrous salt, with some free HC1 acid. Action,—strongly astringent and styptic. Dose, trpij-x, well diluted. Tinctura Ferri Chloridi, Tincture of Ferric Chloride,—a hydro-alcoholic solution of Ferric Chloride, containing about 13.6 per cent, of the anhydrous salt, corresponding to about 4.7 per cent, of metallic iron. Has of the preceding solution 25 in Alcohol to make 100. 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, ff\v-xx, in water, syrup or glycerin. Ferri Citras, Ferric Citrate, Fe2(C6H507)2 + 6H20,—garnet-red, transparent scales, slowly soluble in water, not in alcohol. Action,—mildly stimulant. Dose, gr. ij-v. Formed by evaporating the following :— * Liquor Ferri Citratis, Solution of Ferric Citrate,—an aqueous solution, containing about 35 per cent, of the anhydrous salt, corresponding to about 7 )A per cent, of metallic iron. Solution of Ferric Sulphate 105, Citric Acid 30, Ammonia Water 88, Water to 100. A dark-brown liquid, of slightly ferruginous taste and acid reaction. Dose, rrpv-xv. Vinum Ferri Citratis, Wine of Ferric Citrate,—made from Iron and Ammonium Citrate 4, Tincture of Sweet Orange Peel 15, Syrup 10, White Wine to 100. An Elixir of Iron. Dose, 3 j-ij. • Ferri Hypophosphis, Ferric Hypophosphite, Fe2(H2P02)6,—a white or grayish-white powder, odorless, tasteless, slightly soluble in water, freely so in HC1 acid or in a solu- tion of sodium citrate.' Action, ferruginous tonic. Dose, gr.v-x. Ferri Iodidum Saccharatum, Saccharated Ferrous Iodide,—a yellowish-white powder, very hygroscopic, odorless, of sweetish, ferruginous taste, and slightly acid reac- tion, soluble in 7 of water, insoluble in alcohol. Action,—ferruginous tonic. Dose, gr. v-xxv in pill or elixir. Pilulae Ferri Iodidi, Pills of Ferrous Iodide,—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, I or 2 pills ter in die. Syrupus Ferri Iodidi, Syrup of Ferrous Iodide,—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, rrpv-xxx. Ferri Lactas, Ferrous Lactate, Fe(C3H503)2 -f- 3H20,—pale, greenish-white, crystal- line grains, soluble in 40 of water, freely in solution of an alkali citrate, yielding a green solution, almost insoluble in alcohol. Action that of a feeble ferruginous tonic. Is a constituent of Syrupus Hypophosphitum cum Ferro. Dose, gr. j-iij, in pill or syrup. Liquor Ferri Nitratis, Solution of Ferric Nitrate,—an aqueous solution of Fe2- (N03)6, containing about 6.2 per cent, of the anhydrous salt, corresponding to about 1.4 per cent, of metallic iron. A transparent, amber-colored liquid, of acid, styptic taste and acid reaction. Action,—medium as to irritation, astringent and hemostatic. Dose, H\v -xv, well diluted. Ferri Oxidum Hydratum, Ferric Hydrate (Ferric Hydroxide, Hydrated Oxide of Iron), Fe2(OH)fi,—a brown-red magma, wholly soluble in IIC1 without effervescence. Should be freshly prepared by mixing together Solution of P’erric Sulphate 100, Ammonia Water no, and Water to 250. The two solutions aforesaid should be kept in separate FERRUM. 281 282 FERRUM. bottles, on hand, ready for mixing, in quantity of 200 cubic centimeters of ‘the first and 220 of the latter, and wheh required the precipitate may be washed by pressing in a wet muslin strainer, until no more liquid passes, then diluting as directed. It is the chemical antidote for Arsenic. Dose, g) in water, frequently repeated. Ferri Oxidum Hydratum cum Magnesia, Ferric Hydrate with Magnesia (Arsenic Antidote),—is a more convenient and more efficient antidote for Arsenic than the preced- ing, as the excess of the alkaline precipitant is non-irritant, and is itself an Arsenic anti- dote. The two following solutions should be kept ready: (1) Solution of Ferric Sulphate 50 Cc. in Water 100 Cc. (2) Magnesia, 10 grammes rubbed up with Water 750 Cc. in a bottle of 1000 Cc. capacity. When wanted, shake the latter to a homogeneous magma, add it gradually to the former, and shake them together to a uniform, smooth mixture. Should be given in large doses (Jj j) and frequently repeated. Emplastrum Ferri, Iron Plaster (Strengthening Plaster),—has of Ferric Hydrate, dried, 9, Olive Oil 5, Burgundy Pitch 14, Lead Plaster 72. Trochisci Ferri, Troches of Iron,—each troche has of Ferric Hydrate gr.v, with Vanilla, Sugar and Tragacanth. Dose, j-iij troches, thrice daily. Ferri Phosphas Solubilis, Soluble Ferric Phosphate,—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 reactionary constipation. Dose, gr.v-x. Made by reaction between Ferric Citrate and Sodium Phosphate. Ferri Pyrophosphas Solubilis, Soluble F'erric Pyrophosphate,—green, transparent scales, of acidulous taste, soluble in water but not in alcohol. Is almost tasteless and unirritating, and non-constipative. Dose, gf. ij-v. Made by reaction between Ferric Citrate and Sodium Pyrophosphate. Ferri Sulphas, Ferrous Sulphate, FeS04 + 7H20,—large, pale, bluish-green prisms, efflorescent, 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 Sulphas Exsiccatus, Dried Ferrous Sulphate, 2FeS04 + 3H20,—a grayish- white powder, nearly soluble in water, consisting of the preceding salt, heated gradually 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 Granulatus, Granulated Ferrous Sulphate, FeS04 -j- 7H20,—is the same salt as above described, precipitated by Alcohol from solution in dilute sulphuric acid. Dose, gr. ss-ij. Liquor Ferri Subsulphatis, Solution of Ferric Subsulphate (Mouse!s Solution),— is an aqueous solution of Basic Ferric Sulphate, 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 and powerfully astringent, chiefly used locally as an astringent and hemostatic, but may be given internally in doses of lT^iij—x, well diluted. Liquor Ferri Tersulphatis, Solution of Ferric Sulphate,—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 prepara- tions of Iron. Ferri Valerianas, Ferric Valerianate, Fe2(C5H902)6,—a dark, tile-red, amorphous powder, of faint, valerianic odor, and mildly styptic taste, insoluble in cold water, decom- posed by hot water, readily soluble in alcohol. Of doubtful value as a valerianate. Varies somewhat in chemical composition. Dose, gr. j—iij, in pill. Liquor Ferri et Ammonii Acetatis, Solution of Iron and Ammonium Acetate (Basham's Mixture),—prepared from Tincture of Ferric Chloride 2, Diluted Acetic Acid 3, Solution of Ammonium Acetate 20, Aromatic Elixir 10, Glycerin 12, Water to 100. An excellent and very pleasant preparation, having some diuretic and diaphoretic powers. Dose, g ij-v, well diluted. Ferri et Ammonii Citras, Iron and Ammonium Citrate,—prepared from Solution of Ferric Citrate 10, Ammonia Water 4, mixed and evaporated. Transparent, garnet-red scales, deliquescent, readily soluble in water, insoluble in alcohol. Dose, gr.ij-v. Compotmd Iron Salts and their Preparations. 283 FERRUM. Ferri et Ammonii Sulphas, Ferric Ammoniu?n Sulphate (Ammonio ferric Alum')— pale, violet crystals, efflorescent, of styptic taste and slightly acid reaction, soluble in 3 of water, 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, Iron and Ammonium Tartrate (Ammonioferric Tar- trate'),—transparent, reddish-brown scales, slightly deliquescent, of sweetish and slightly ferruginous 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, Potassioferric Tartrate,—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 Quininse Citras, Iron and Quinine Citrate,—prepared from Ferric Citrate 85, Quinine, dried, 12, Citric Acid 3, Aq. Destil. q. s. ad 100, mixed and evaporated. Thin, transparent, yellowish-brown scales, slowly deliquescent, of bitter taste, slowly sol- uble in water, slightly soluble in alcohol. Contains II f2 percent, of dry quinine. Action, astringent and stimulant to the digestive tract. Dose, gr. iij-v. Ferri et Quininse Citras Solubilis, Soluble Iron and Quinine Citrate,—Ferric Citrate 85, Quinine, dried, 12, Citric Acid 3, Ammonia Water, Distilled Water, to 100. Thin, transparent scales, of greenish, golden-yellow color, rapidly soluble in cold water, partially soluble in alcohol. Dose, gr. iij-v. Vinum Ferri Amarum, Bitter Wine of Iron,—has of the preceding 5 parts, Tinct. Aurantii Dulcis, 15, Syrup 30, White Wine to 100. May replace the various “ elixirs of iron and calisaya.” Dose 3 j—iv. Ferri et Strychninse Citras, Iron and Strychnine Citrate,—Ferri et Ammonii Citras 98, Strychninse 1, Ac. Citric I, 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, Quininae et Strychninse Phosphatum, Syrup of the Phosphates of Iron, Quinine and Strychnine. [Described uncjer PHOSPHORUS.] Syrupus Hypophosphitum cum Ferro, Syrup of Hypophosphites with Iron. [De- scribed under Phosphorus.] Unofficial Preparations of Iron. Ferratin, Acid Albuminate of Iron,—is a patented preparation, which is claimed to be the characteristic iron compound of the liver, but this is denied by competent authority. It is artificially prepared from albumen, is insoluble in water and dilute acids, but is sol- uble in water having a slight alkaline reaction. It causes no digestive disturbance, and has given good results in anaemia, chlorosis, and allied affections. Dose, gr. jss-viij, in powder or in milk. Ferri Albuminas, Iron Albuminate,—a cinnamon-brown powder, soluble in water acidulated slightly with HC1. Dose, gr. x-xxx, in simple aqueous solution, or in pill. Ferri Arsenas, Ferrous Arsenate, Fe3As208,—a green, tasteless powder, insoluble in water, soluble in HC1 acid. Its activity is due to the arsenic alone. Dose, gr.y^-^. Ferrum Dialysatum, Dialysed Iron,—composition varies from Fe2Cl6+ i2Fe203 to Fe2Cl6 4- 95Fe2Os, and is a IO per cent, solution of Ferric Oxychloride in water. Pre- pared by treating a solution of Chloride of Iron with Ammonia, ferric hydrate being precipitated, 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 prepara- tion. Dose, rrpx-xxx. Syrupus Ferri et Manganesii Iodidi, Syrup of Iron and Manganese Iodide,—is a pale, straw-colored liquid, containing a little sulphate of potassium, and in each fluid g has 50 grains of the mixed iodides in the proportion of Iron Iodide 3 parts to I of Man- ganese Iodide. Dose, TTLx-xxx- 3j. 284 FERRUM. Syrupus Ferri et Manganesii Phosphatis, Syrup of Iron and Manganese Phos- phate,—as used by Dr. Simpson, of Edinburgh, contains in each 3 of syrup 2 grains of Iron Phosphate and 1 grain of Manganese Phosphate. Dose, gj. Mistura Ferri Aromatica, Aromatic Iron Mixture,—Pale Bark 4, Calumba 2, Cloves 1, Iron Wire 2, Tr. Cardamomi 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 parts. Dose, ,^j-ij. Mistura Ferri Laxans, Laxative Iron Mixture,—Ferri Sulph. gr. ij, Magnesii Sulph. 3j, Ac. Sulphurici Dil. rrpiij, Spt. Chloroformi rtpxx, Aq. Menth. Pip. ad 33. Dose, J;j. Mistura Ferro-salina, Ferro-saline Mixture,—Magnesii Sulph. 3], Potassii Bitart. 3_j, Ferri Sulph. Exsic. gr. x, Aquae quart j. Dose, a wineglassful. Notes on the Preparations of Iron. 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 hematinic action of iron with but little astringency, and are therefore selected to restore the blood in anaemia, chlorosis and amenorrhcea, with tendency to dyspepsia and constipation. The Hydrated Oxides are only used as antidotes in arseni- cal 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 §j, 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 with alcohol. Of the Phosphates the best is the Pyrophosphate, which is easily assimilated, readily soluble and entirely unirritating. Vegetable Acid Salts and their preparations comprise the Lactate, the Citrate and its preparations, also 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 mixtures. Other Compounds are those in which Iron is combined with substances FERRUM. 285 equally active, as the preparations of the Iodide, those with Quinine, Strychnine, etc. Generally these preparations are used for a twofold purpose, namely, to relieve anaemia and at the same time act upon the specific ailment on which the anaemia depends. The Albuminate is considered by several authorities to be the most readily assimilated of all the iron preparations. 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 hematin, which is not formed without it. It is also found in the bile, lymph, chyle, gastric juice, in the pig- ment 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 alkaline Albuminate, entering the blood along the whole length of the alimentary canal. Only a small portion of iron is absorbed, the rest being eliminated by the intestinal canal, blackening the feces 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. Iron in large doses, or small ones long-continued is directly unfavor- able to digestion, nausea and vomiting being produced by the soluble preparations ; the per-salts are actively irritant; the Iodide, Chloride, Nitrate and Sulphate being active poisons, are highly astringent, and act injuriously on the teeth. Locally most of the iron salts are more or less constringing to the tis- sues 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 Chloride is considered diuretic. 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 and their carbonates, astringent vegetable infusions, and by mucilage of acacia, which latter produces therewith a brown, semi-transparent jelly. Incompatibles. Therapeutics. The chief indication for the internal administration of Iron is anaemia, when plethora exists it is contraindicated. It should always be given 286 FICUS 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 stimulat- ing action upon 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-leucocythsemia, chorea of anaemic girls at the age of puberty, epi- lepsy and neuralgia of the anaemic, amenorrhcea and other menstrual dis- orders 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 exten- sively employed in erysipelas and diphtheria with good results. In albu- minuria with chronic disease of the kidneys the Tincture of the Chloride is a useful chalybeate diuretic. In many cardiac diseases of the anaemic, fatty heart, weak heart, dilatation, mitral disease, etc., ferruginous prepa- rations 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 incon- tinence of children the Syrup of the Iodide is one of the most efficient remedies. In all chronic affections of the respiratory organs, when hem- orrhage is not existing or threatened, the Iron, Quinine and Strychnine Phosphate 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 (gj ad gviij), used in the form of spray, is the most serviceable astringent in obstinate epistaxis, and in hematemesis the same solution may be swal- lowed 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 Arsenous Acid an almost insoluble compound. The solutions used in its preparation should be kept on hand and only mixed when wanted for use. 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. Urticacese 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. FCENICULUM—FORMALIN. 287 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 may be employed as an ingredient of demulcent decoctions, and locally as a poultice to gum-boils. FCENICULUM, Fennel, —is the fruit of Fceniculum capillaceum, a European cultivated plant of the nat. ord. Umbelliferae. It contains a volatile oil, united with a terpene, and is a constituent of Pulvis Glycyrrhizae Compositus. Oleum Fceniculi, Oil of Fennel,—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 Spiritus Juniperi Compositus. Dose, rrpij-v. Aqua Fceniculi, Fennel Water,—contains 2 parts of the oil in 1000 of distilled water. Dose, tjss-^j. Fennel is an aromatic stomachic and a mild stimulant. It is chiefly used as an agree- able carminative in flatulence and colic, and as a corrigent to Senna, Rhubarb, and other disagreeable medicines. An infusion is often used as an enema to expel flatus in infants. FORMALIN (Unofficial),—is the proprietary name given by its patentees to a 40 per cent, aqueous solution of Formic Aldehyde (see ante, page 107), which solution has heretofore been used mainly as a pre- servative of meat and in histological work as a fixing agent. It is one of the most powerful germicides, equal if not superior to corrosive subli- mate and practically non-toxic in the strength employed. It is also a most energetic disinfectant, and sprayed over floors and walls or dropped on hot plates or sheets of metal, will disinfect a room more effectually than any other agent. As a deodorant it is equally efficient, completely destroying the peculiar methyl-mercaptan odor of the feces, and entirely deodorizing sulphuretted hydrogen. It is rapidly becoming the favorite surgical antiseptic. It mixes with water in all proportions, so that any dilution required can be easily prepared. To make a 1 per cent, solution one part of Formalin is added to forty parts of water (1 oz. to 2)4 pints), it being itself a 40 per cent, solution. Solutions of 1 per cent, strength are sufficiently strong for most purposes, and when sprayed above the patient’s head by a steam-atomizer for 20 minutes thrice daily have proved highly efficient in whooping-cough and chronic bronchitis. Weaker solutions (f/2 per cent.) are used as gargles and mouthwashes and for the irrigation of cavities, and stronger ones (2 y2 percent.) for psoriasis, lupus and other skin diseases. Solutions of 1 part in 2,000 or 3,000 are highly recommended by Dr. Davidson for local application in the septic abrasions of the cornea ending in hypopyon ulcers, which form so large a part of ophthalmological work in manufacturing communities. Formalin has a tannin-like effect upon the skin, producing a leathery condition which passes into that of a localized necrosis without suppuration, leaving the surface with the appearance of a newly-healed superficial wound. It has marked toxic properties when inhaled in quantity. 288 FRANGULA FUCHSIN—GALBANUM—GALLA. FRANGULA, Buckthorn,—the bark, collected at least one year before being used, of Rhamnus Frangula, or Alder Buckthorn, a European shrub of the nat. ord. Rhamneae. It contains several principles, of which the only important one is Franguliti, or Rhamno- xanthin, a lemon-yellow, odorless and tasteless glucoside, insoluble 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 Rhamnus Purshiana. Extractum Frangulse Fluidum, Fluid Extract of Frangula.—Dose, Frangula-bark when fresh is a violent irritant to the gastro-intestinal tract, producing vomiting, purging, and much pain. The old dried bark is a safe purgative without irri- tant qualities, and is much used in the constipation of pregnancy, and other conditions requiring purgation. The fluid extract is the best form for administration. FUCHSIN, Rosei'ne, 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 therewith 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 Liquorice or Gentian, and in doses of gr. y^—iv, according to age. FUCUS VESICULOSUS, Bladder-wrack, Sea-wrack (Unofficial),—is a peren- nial 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 administration. 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 (Unofficial),—is a gum-resin obtained from Ferula galbanijlua, 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 isomeric with Turpentine, a Gum, and a mixture of Resins which yield by dry distillation a blue oil and U7nbelliferon, a tasteless substance in satiny crystals. Dose, gr. x-xx, in pill or emulsion. Galbanum is stimulant, expectorant and antispasmodic, acting much like Ammonia and Asafetida, and usually given with either of these substances. It is used in chronic bronchitis and catarrh of mucous membranes generally, in amenorrhcea and chronic rheu- matism. GALLA, Nutgall,—is an excrescence on Quercus lusitanica, the Dyer’s Oak, a shrub of the nat. ord. CupuliferEe, growing in Western Asia, and is caused by the punc- ture and deposited ova of the insect Cynips Gallce tinctoria. Galls are hard, globular bodies, 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 Gallae, Tincture of Nutgall,—strength 20 per cent. Dose, gss-iij. Unguentum Gallae, Nutgall Ointment,—strength 10 per cent. The action of Nutgalls is powerfully astringent, due to the Tannic and Gallic Acids GAULTHERIA GELSEMIUM. 289 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 94 and 84. GAULTHERIA, Wintergreen (Unofficial),—is the leaf of Gaultheria procumbens, an American evergreen plant of the nat. ord. Ericaceae. Its active principle is the Vola- tile Oil, which is official. It also contains Tannic Acid, Arbutin, Urson, Ericolin, etc. Oleum Gaultheriae, Oil of Wintergreen,—is the volatile oil, a liquid of peculiar and aromatic odor, sweetish, warm taste, and a slightly acid reaction. It is readily soluble in alcohol, and consists of Methyl Salicylate 90 per cent., and Gaultherilene, a hydrocar- bon, 10 per cent. Dose, n\hj-x. It is nearly identical with the Volatile Oil of Betula. Spiritus Gaultheriae, Spirit of Gaultheria,—has of the oil 5 per cent., dissolved in 95 of alcohol. Used for flavoring. Dose, 3 ss—ij. Gaultheriae 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 of Methyl Salicylate or Methylsalicylic Acid, is powerfully antiseptic and antipyretic. In large doses it is irritant to the stomach, in one case j having caused death by violent gastritis. Oil of Gaultheria is used successfully as a substitute for Salicylic Acid in many condi- tions, especially in rheumatic and gouty disorders. The plant has been used as an emmenagogue and a galactagogue, but its principal employment is in the form of the spirit as an agreeable flavoring agent. GELSEMIUM, Gelsemium ( Yellow Jasmine),—is the rhizome and roots of Gelsemium sempervirens, a climbing plant of the nat. ord. Loganiacese, with showy yellow flowers, which grows in the forests of the southern U. S., forming festoons from one tree to another. It contains a volatile oil, a resin and an alkaloid, Gelsemine, in combination with Gelsemic Acid. Dose, gr. ij-xx. Extractum Gelsemii Fluidum, Fluid Extract of Gelsemium.—Dose, Tinctura Gelsemii, Tincture of Gelsemium,—strength 15 percent. Dose, Gelsemina, Gelsemine, CuH,9N02 (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. Preparations. Gelsemium is a powerful motor-depressant, causing paralysis of motility and depression of sensibility by central action on the spinal cord. It is also antispasmodic 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 dia- phoresis, loss of articulation, and death by asphyxia from paralysis of the muscles of respiration, consciousness being preserved until C02 narcosis Physiological Action. 290 GENTIANA. sets in. Convulsions, with backward movements, occur in animals but not in man. Motion is affected before sensibility in warm-blooded ani- mals, sensibility before motion in frogs. Gelsemium is not an arterial depressant, 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. 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 pro- duction 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 especial 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 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. Gentianeae), inhabiting the mountainous districts of Europe. An American species, G. Catesbcri, Blue Gentian, is considered nearly equal in value to the GERANIUM GLYCERINUM. 291 official species. It contains an active, bitter glucoside, Gentopicrin or Gentianin, C20H30O12, which is crystalline and soluble in water, also an inert, amorphous body, Gentianic or Gentesic Acid, gum, considerable sugar, and a trace of volatile oil, but no tannin. Preparations. Extractum Gentianae, Extract of Gentian,—aqueous. Dose, gr. j—v. Extractum Gentianae Fluidum, Fluid Extract of Gentian,—Dose, 3ss-j. Tinctura Gentianae Composita, Compound Tincture of Gentian,—Gentian 10, Bitter Orange Peel 4, Cardamon 1, Alcohol and Water to 100. Dose, 3 ss—ij. Unofficial Preparations. Infusum Gentianae Compositum, Compound Infusion of Gentian,—contains Gen- tian 10, Bitter Orange Peel 2x/z, Coriander 2x/2, Alcohol 40, Water to 320. Dose, Mistura Gentianae Alkalina, Alkaline Mixture of Gentian,—Ac. Hydrocyan. Dil. TTyij, Sodii Bicarb, gr. xv, Infusum Gentianae Co. to gj. One dose. Mistura Gentianae et SennaMixture of Gentian and Senna,—Infusum Sennae 3 iij, Tr. Cardamomi Co. Infusum Gentianae Co. One dose. Gentian is a simple bitter without astringency or aroma, its action cor- responding to that of Calumba (see ante, page 203), 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 feb- rifuge. 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 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 chaly- beates, 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. Physiological Action and Therapeutics GERANIUM, Cranesbill, —is the rhizome of the indigenous perennial Geranium maculatum (nat. ord. Geraniacese). Its active constituents are tannic and gallic acids. Extractum Geranii Fluidum, Fluid Extract of Geranium.—Dose, Tt^v-gj. Geranium is an efficient astringent, and its. action corresponds with that of Tannic Acid (see ante, page 94). 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, hemor- rhages, relaxed conditions of mucous membranes, gleet and leucorrhoea. GLYCERINUM, Glycerin,—is a liquid, obtained by the decom- position of vegetable or animal fats or fixed oils, containing not less than 95 per cent, of absolute Glycerin, C3H5(HO)3, which is a sweet principle existing in fats and fixed oils in combination with the fatty acids. 292 GLYCERINUM. Glycerin is a clear and colorless liquid, 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 the 6 Glycerites, Pilulae Phosphori, Mucilago Tragacanthse, Massa Hydrargyri, and several extracts and fluid extracts. Dose, diluted. Preparations. Suppositoria Glycerini, Suppositories of Glycerin,—each has Sodium Carbonate, grains 4Stearic Acid, grains dissolved by heat in 90 grains of Glycerin, cooled in a mould, and wrapped in tin-foil. Used per rectum in chronic constipation. Glycerites of Carbolic Acid, Tannic Acid, Starch, Boroglycerin, Hydrastis, Yolk of Egg,—are described under the titles of their respective ingredients. Glycozone (Unofficial),—is described under Oxygenium. Physiological Action and Therapeutics, 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 hemo- 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 authori- ties. 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 dia- betes, 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 the official suppositories thereof. As a vehicle it is used for many drugs, and is a good ingredient of solutions for hypodermic use, promoting the solubility of many alkaloids and acting as an antiseptic. It is also em- ployed 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 tinc- ture of Benzoin it is an excellent application to chapped hands or lips GLYCYRRHIZA. 293 and fissured nipples. In the external auditory canal it is usefully em- ployed to soften cerumen, diminish the secretion of pus, deplete the tissues, and keep the surface moist. GLYCYRRHIZA, Glycyrrhiza, Liquorice Root,—is the root of Glycyrrhiza glabra, var. glandulifera, a plant of the nat. order Legumi- nosse, native in southern Europe and Asia, but largely cultivated in many other parts. It contains a yellow, amorphous glucoside, Glycyrrhizin, C24H36O9, also Glycyrrhizic Acid, Asparagin, sugar, resin, gum, etc. Glycyrrhizin when boiled with dilute acids yield glucose and a very bitter substance named Glycyrretin. Preparations. Extractum Glycyrrhizae, Extract of Glycyrrhiza,—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. Extractum Glycyrrhizae Purum, Pure Extract of Glycyrrhiza,—made with Aqua Ammonias and Water, by percolation and evaporation to a pilular consistence. Dose, indefinite. Extractum Glycyrrhizae Fluidum, Fluid Extract of Glycyrrhiza,—made with Aqua Ammoniae and diluted Alcohol. Dose, indefinite. Mistura Glycyrrhizae Composita, Compound Mixture of Glycyrrhiza,—Brown Mixture,—has of the Pure Extract 3 parts, Syrup 5, Acacia 3, Tr. Opii Camph. 12, Vinum Antimonii 6, Spt. Nitrosi 3, and Water to 100. Dose, 3j-^j. Pulvis Glycyrrhizae Compositus, Compound Powder of Glycyrrhiza,—Senna 18, Glycyrrhiza Oil of Fennel 4, Washed Sulphur 8, Sugar 50 parts. Dose,3j. Trochisci Glycyrrhizae et Opii, Troches of Glycyrrhiza and Opium,—each has of Extract of Glycyrrhiza gr. ij, Powdered Opium gr. y 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 Velatine, for which see page 242. 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, Ammonium Chloride, the 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 most active ingredient. The Troches are used for cough, but must be carefully prescribed to children, as each troche contains gr. of Powdered Opium. 294 GOSSYPIUM. GOSSYPIUM, Cotton, —is the hairs of the seed of Gossypium herhaceum, and of other species of Gossypium (nat. ord. Malvaceae), freed from adhering impurities and deprived of fatty matter. In this form it is official as Gossypium Purificatum, Purified Cotton, Absorbent Cotton, insoluble in ordinary solvents, but soluble in copper ammonium sulphate solution. Cotton-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 Cellulose, 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-3 j. Extractum Gossypii Radicis ¥\nidnm, Fluid Extract of Cotton Root Bark,—made with Qlycerin and Alcohol, by maceration and percolation. Dose, npxxx- 3 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 used in the official Liniments of Ammonia and Camphor. Pyroxylinum, Pyroxylin, Soluble Gun-cotton, Colloxylin,—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 3, in Ether 75 and Alcohol 25. Collodium Flexile, Flexible Collodion, Collodion 92, Canada Turpentine 5, Castor Oil 3, mixed thoroughly. Collodium Stypticum, Styptic Collodion,—Ether 25, Alcohol 5, Tannic Acid 20, Collodion to 100. Collodium Cantharidatum, Cantharidal Collodion, Blistering Collodion,—Canthar- ides 60, Flexible Collodion 85, Chloroform q. s. to 100. 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. Pyroxylin 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 crack, making it an excellent protective application. Styptic Collo- dion is a solution of Tannin, and is an excellent hemostatic. Canthari- dal Collodion is a convenient blistering agent, suitable for cases where the patient is inclined to remove a blister if applied in the ordinary way. Physiological Action. GRANATUM. 295 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 is then used as an antiseptic dressing for wounds, ulcers, etc. It is employed by the pharmacist in funnels to filter oils, and for the prepara- tion 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 dysmenorrhcea 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 with considerable force in drying. 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 epispastic for uneven surfaces, the therapeutics of which are detailed under Cantharis. Therapeutics. GRANATUM, Pomegranate,—is the bark of the stem and root of Punica Granatum, a small tree of the nat. ord. Lithrariese, cultivated in subtropical countries. It contains Tannic and Punico-tannic Acids, Mannite and an active liquid alkaloid Pelletierine, C8Hi3NO, which is soluble in water, alcohol, ether, chloroform, etc., and has strong basic properties. There are no official preparations. Extractum Granati Fluidum, Fluid Extract of Pomegranate.—Dose, gss-jss. Decoctum Granati, Decoction of Pomegranate,— g xvij of bark from the fresh root in % xvij of boiling water, boiled down to J xij and strained. Dose, iv-vj every hour, preceded and followed in a few hours by a brisk cathartic. The decoction of the Br. Phar. is of I to 8 strength and is given in doses of ij-iv. Pelletierinae Tannas, Pelletierine Tannate.—Dose, gr.v-xx, taken fasting and fol- lowed in 15 minutes by a sharp purgative. Unofficial Preparations. Physiological Action and Therapeutics. Granatum and its alkaloid are taeniafuge, and very efficiently so, rarely failing to bring away the whole worm. The decoction is usually em- 296 grindelia. 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 increase of the quantity of urine. For the expulsion of tape-worm a mixed treatment by Pomegranate-root bark, Pump- kin seeds and Oleoresin of Male-fern is preferred by many practitioners. The following formula has proved very efficient. [ but it is gen_ erally used as a local application, or for injection into cavities. Liquor Iodi Compositus, Compound Solution of Iodine, Lugol’s Solution,—has of Iodine 5, Potassium Iodide 10, in Distilled Water to 100. Dose, TT\j-x, well diluted. Unguentum Iodi, Ointment of Iodine,—has of Iodine 4, Potassium Iodide 1, Water 2, Benzoinated Lard 93. Iodized Phenol, Carbolated Iodine (Unofficial),—is a mixture of Iodine and crystal- lized Carbolic Acid in varying proportions, generally 1 of the former to 4 of the latter: for local use, especially in gynecology. 316 IODUM Iodides and their Preparations. Ammonii Iodidum, Ammonium Iodide, NHJ,—a deliquescent, granular, white salt; soluble in I of water and in 9 of alcohol at 590 F. Dose, gr.ij-x or more. Potassii Iodidum, Potassium Iodide, KI,—a colorless, deliquescent, crystalline salt, of saline and bitter taste; soluble in 0.8 of water and in 18 of alcohol. of this salt dissolved in )§j of water makes nearly Jjjss of fluid, so that of the solution would be required to obtain gr.v, a fact to be remembered in prescribing. Dose, gr.v-^j. Unguentum Potassii Iodidi, Ointment of Potassium Iodide,—has of the Iodide 12, Sodium Hyposulphite I, Hot Water 10, Benzoinated Lard 77. Sodii Iodidum, Sodium Iodide, Nal,—minute, deliquescent crystals; soluble in 0.6 of water and in 1.8 of alcohol. Dose, gr.v-^j. Strontii Iodidum, Strontium Iodide, SrI2(H20)6,—colorless, hexagonal plates, of bitter, saline taste; very soluble in water and in alcohol. Dose, gr.v-xxx. Iodoformum, Iodofortyi (Formyl Iodide), CIII3,—small, lemon-yellow, lustrous crys- tals, of saffron-like and very penetrating odor ; very slightly soluble in water, soluble in about 52 of alcohol, 12 of boiling alcohol, and in 5.2 of ether; very soluble in chloroform, benzin and fixed and volatile oils. Its solutions have neutral reaction. Dose, gr. j-v. To remove its odor without forming a compound the best agents are Thymol (gtt. ij ad £]), Oil of Mirbane (gtt. vj ad gr. xv), Oil of Bitter Almonds, or Oil of Rose (gtt. j ad 3 j). Oil of Turpentine is particularly serviceable in removing the odor from the hands, or from spatulas, mortars, etc. Unguentum Iodoformi, Iodofomn Ointment,—Iodoform, finely pulverized, 10, Ben- zoinated Lard 90, thoroughly mixed by trituration. Other Iodides and preparations thereof are—Argenti Iodidum, Arseni Iodidum, Liquor Arseni et Hydrargyri Iodidum, Hydrargyri Iodidum Rubrum, Hydrargyri Iodidum Flavum, Syrupus P'erri Iodidi, Pilulae Ferri Iodidi, 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 Argentum, Hydrargyrum, etc.) Ethyl Iodide or Hydriodic Ether is described under Hither (see ante, page 99). Preparation of Hydriodic Acid. Syrupus Acidi Hydriodici, Syrup of Hydriodic Acid,—contains i per cent, of abso- lute Hydriodic Acid, HI. Dose, 3 j-iv, 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 exfoliation of the epidermis. Vesication may be quickly produced if the quantity used be large. Inhaled its vapor irritates the respiratory mucous membrane, producing sneezing, cough, dyspnoea, also pain in the chest and 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 phospho- retted 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. The Iodides of Sodium, Potassium, etc., are very diffusible and are as rapidly excreted; setting free nascent oxygen (Ozone) and Iodine at the IODUM 317 points of 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. Intravenous injections of these salts produce at first a rapid elevation of arterial pressure with acceleration of the cardiac rate; followed by slowing of the heart, and later on, lowered blood-pres- sure with increased heart rate. If used for any length of time they induce great waste and rapid elimination of waste products, causing anaemia, emaciation and mental depression; but these effects are credited chiefly to the metallic constituent, being most severe from the potassium salt. They combine with certain poisons in the system, particularly Lead, Mercury, and the products of the syphilitic disease, hastening their elimination. Iodism 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. It is less apt to result from the use of the Strontium Iodide than from that of the others. The copious dilution of these preparations with water promotes their excretion, and to a great extent prevents the development of unpleasant results. The ptyalism occasionally produced by iodides is not a direct result of their action, and only occurs in persons who have previously taken mercurials. In such the mercury, which had .been deposited in the tissues as an albuminate, is set free by the iodide, and coming again into the circulation, it produces its constitutional effects. (Murrell). Potassium Iodide occasionally gives rise to some peculiar symptoms in certain susceptible persons. Among these are diuresis, cerebral ex- citement as from alcohol, hemorrhages from the urethra and the vagina, glossitis (Gross), also laryngitis and sudden oedema of the glottis. The latter may be of so intense a character as to require the instant perform- ance of tracheotomy in order to avert death. On the circulation it pro- duces marked and important effects in most cases. It causes acceleration of the pulse and vascular dilatation, leading to abundant secretion from several glands. It reduces the temperature a degree or more, and slows the rate of the respiration. 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, 318 IODUM 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 inter- nally it is considered 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. In medicinal doses internally administered for any length of time it may cause profuse salivation. Ethyl Iodide (see ante, pages 99 and 102) is used by inhalation to bring the system rapidly under the influence of Iodine. It is a good anti- spasmodic and general stimulant and a very slow anaesthetic. Starch is the antidote to free Iodine, but the stomach must be evacuated, as the re- sulting iodide is active. Albumen, starch, lime-water, tannin and soap, maybe used in poisoning by the iodides, and free emesis should be induced. In chronic iodide poison- ing a free salivary flow, brought on by chewing Pyrethrum root, will hasten elimination of the drug. Restoratives and vaso-motor tonics, as Quinine, Digitalis, etc., are thera- peutically antagonistic. Incompatibles with Iodine and the Iodides are the Mineral Acids, Metallic Salts, Alkaloids and their salts, Ammonia, etc. If Potassium Iodide is combined in solution with Potassium Chlorate a poisonous compound will result. As Potassium Iodide decom- poses nearly all the metallic salts, and is incompatible with so many substances, it is best prescribed alone, or in some simple vehicle, a favorite one being the Compound Syrup of Sarsaparilla. It may be prescribed with Tincture of Cinchona, an ounce of which dis- solves 30 grains, or in combination with Liquor Potassii Arsenitis, which prevents the iodic eruption to some extent. In the “ mixed treatment ” of syphilis it is combined with the Biniodide of Mercury. It is better borne when combined with Nux Vomica or Po- tassium Acetate, or alternately with Iodide of Iron (Squire). Its efficacy is increased by uniting it with Ammonium Carbonate, 2 parts of the latter to I or of the Iodide (Gull). Antidotes, Antagonists and Incompatibles. The tincture and 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, 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, and fissures, 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 prepara- Therapeutics of Iodine. IODUM. 319 tion combined 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. Potassium Iodide is the most frequently used of the Iodides, and is the form in which Iodine is generally administered internally. It is usually administered in simple solution or in the compound infusion or syrup of Sarsaparilla. Though its mode of action has never been explained satis- factorily, it is known by clinical experience to counteract many patholog- ical conditions, 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 neuralgise, 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 improvement. So in mercurial poisoning and other chronic metal- lic toxsemise, the best treatment is by rapid saturation with Potassium Iodide. The products left behind by pneumonia, pleurisy and pericar- ditis often yield to moderate doses (5 grains), which if used for a pro- longed 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 Potassium Iodide, the sac becoming 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 to the 3) is a good gargle, and in large doses it is often efficient in spasmodic asthma induced by bronchial catarrh. Ammonium Iodide in grain dose repeated frequently is an excellent remedy in acute catarrh, hay-fever, duodenal catarrh and its accompany- ing jaundice, in chronic and capillary bronchitis, and in catarrhal pneu- monia to prevent caseation of the products. In the first stage of hepatic cirrhosis and in chronic malarial poisoning it is equally efficient adminis- tered in conjunction with Arsenic. Being somewhat more irritating than the other iodides it is usually given in smaller quantity, but being less stable it is more energetic in action. Sodium Iodide may be used instead of the potassium salt, in all affec- tions in which the latter is indicated ; but requires to be administered in somewhat larger doses, being less active and less toxic. Strontium Iodide is still less liable to produce eruptions, and has been used with benefit in scrofulous, rheumatoid and cardiac disorders. 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 320 IODUM. 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. 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. Tuberculosis is success- fully treated by Iodoform, which certainly does check the activity of the bacillus of that disease. Diabetes has been apparently cured by Iodoform, and syphilis may be combated successfully thereby in lieu of Potassium Iodide. Aristol, Dithymol Iodide,—is a combination of Iodine and Thymol, containing nearly 46 per cent, of the former, and is prepared by adding an alkaline solution of Thymol to a solution of Potassium Iodide and Iodine. It occurs as an amorphous, odorless, unstable, non-toxic powder, of a brown-red or fawn color, insoluble in water or glycerin, sparingly soluble in alcohol, freely so in ether, chloroform and fatty oils. As its Iodine leaves it readily, no heat should be used in dispensing it, and it should not be mixed with alkalies, metallic oxides, or starch. It is used locally as a substitute for Iodoform. Aristol is highly praised by those who have used it in the local treatment of ulcers, wounds, and other breaches of the tissues; in which it is considered nearly, if not quite, as efficient as Iodoform, with the great advantage of being odorless. Excellent results have been obtained with it in the treatment of indolent soft ulcers, lupus, psoriasis, syphilitic ulcerative processes, eczema, severe burns, affections of the ear, nose and pharynx, as well as in the various cases in gynecological and dermatological practice in which Iodoform has hitherto stood supreme. Its prolonged use may give rise to chronic iodine poisoning. Aristol is best applied in powder, in solutions in Oil or Ether (5 to 10 per cent.), or as ointments with a base of Lanolin or Vaselin (5 to 10 per cent.). A useful application is a liniment, prepared by dissolving 5 grains of Aristol in 3 ij of a mixture of equal parts of Ether and Alcohol, then incorporating of soft Soap therewith. Europhen, Isobutyl-orthocresol Iodide,—is produced by the action of Iodine upon Isobutyi-orthocresol in a solution of Potassium Iodide, and contains about 27 per cent, of Iodine, which it gives up to metallic oxides and mercury salts, and when brought into contact with aqueous liquids. It occurs as a very fine, amorphous, yellow powder, of faint, aromatic odor like that of saffron; insoluble in water and in glycerin, soluble in alcohol, ether, chloroform and fatty oils; readily decomposed by heat and by starch, slowly by light. It is five times lighter and more bulky than Iodoform, and is used as a substitute therefor in all local applications where a dry antiseptic is required. Like Aristol, it should be kept in a dry place, and protected from the action of light. Europhen is a recent addition to the list of substitutes for Iodoform, and is perhaps the most highly vaunted of them all. Compared with the latter substance, its freedom from unpleasant odor, its greater bulk and lightness, and its powerful antiseptic and bactericidal qualities, make it an ideal application to sores and wounds, as also for the many protective requirements of minor surgery. Its virtues are probably due to the Unofficial Substitutes for Iodoform. IPECACUANHA. 321 readiness with which it liberates free, nascent Iodine, -when in contact with aqueous liquids ; being fully equal in this respect to Iodoform. Used externally, it is dusted on in powder, or applied as a 5 to 10 per cent, ointment with Lanolin as a base. It must not be combined with metallic oxides or mercurials, nor with zinc starch paste. For hypodermic use a 3 to 10 per cent, solution in Olive Oil is employed. A mixture of Europhen and Aristol, equal parts of each, is highly recommended for adhesiveness. Bismuthi Subiodidum, Bismuth Subiodide, BiOI,—is a heavy, amorphous, brick-red powder, insoluble in any reagent without decomposition. (See ante, page 185.) Bismuthi Subgallas, Bismuth Subgallate {Dermatol),—is a very fine saffron-yellow, odorless powder. (See ante, page 187.) These are two of the very best among the agents proposed as substitutes for Iodoform in local applications. They are non-irritant, powerfully bactericidal, and entirely odor- less. In the author’s experience the Subiodide is exceedingly efficient in stimulating the growth of granulations in a large wound, such as that often nacessary in the surgical treatment of fistula in ano. They are described under Bismuth [ante, page 186). Iodol, Tetra-iodo-pyrrol,—is obtained by treating Pyrrol, (a coal-tar product), with a solution of Iodine in Potassium Iodide, usually known as Potassium Iodo-iodide solution. It occurs in very long, minute, delicate, prismatic crystals, of a yellowish tint, sparingly soluble in water, but readily in alcohol. When even slight decomposition is going on the crystals take on a brown tinge, due to the free iodine. Its odor is very slight, it being practically odorless when pure; and, unlike Iodoform, it has no toxic properties when undecomposed. It contains about 89 per cent, of Iodine. Dose, gr. ss-v, in tablet. Though insoluble practically in water, Iodol dissolves readily in the gastric juice, and is rapidly absorbed and as quickly diffused throughout the system. It has the same general action as Iodoform, except that it is devoid of toxic power. Iodol is a very close rival to Iodoform, and is used in almost every instance where the latter agent is applicable (Squibb). It should replace Iodoform largely as a topical application, on account of its freedom from unpleasant odor. Internally it is highly esteemed as a remedy in chronic gastric catarrh, intestinal catarrh, and in ulceration of the gastro-intestinal mucous membrane. It has been found to be highly useful in bronchitis, bronchial catarrh, and in various respiratory neuroses; and has seemed to render good service in the treatment of tuberculosis and syphilis. In eczema of the ear Iodol has recently proved very efficient. In moist confluent eczema of the pinna, extending within the auditory canal, the powder should be blown into the canal and upon the sur- rounding parts, after the surfaces have been thoroughly cleansed. In the dry, external form, it is best applied as an ointment with Lanolin. The inflammation disappears generally within two weeks, but irrigation should be kept up for a short time afterward in order to complete the treatment. (Chatellier.) IPECACUANHA, Ipecac, —is the root of Cephaelis Ipecacuanha, a small shrubby plant of the nat. ord. Rubiacese, growing in Brazil. 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 Ipecacuanhse Fluidum, Fluid Extract of Ipecac,—Dose, try-v. Syrupus Ipecacuanhse, Syrup of Ipecac,—strength 7 per cent. Dose, 3 j—iv. Vinum Ipecacuanhse, Wine of Ipecac,—strength 10 per cent. Dose, TT\j-->j. Pulvis Ipecacuanhse et Opii, Powder of Ipecac and Opium, Dover's Powder {Pulvis Doveri),—has of Ipecac 10, Powdered Opium 10, Sugar of Milk 80, triturated together to a fine powder. Dose, gr. ij-xv or xx. Tinctura Ipecacuanhse et Opii, Tincture of Ipecac and Opium,—has of Tincture of Deodorized Opium 100 evaporated to 80, Fluid Extract of Ipecac 10, Diluted Alcohol to 100. Is a fluid representative of Dover’s powder. Dose, nyj-xx or xxx. Trochisci Ipecacuanhse, Troches of Ipecac,—each troche contains of Ipecac about gr- x/s- Dose, j-iij. 322 IPECACUANHA. Trochisci Morphinae et Ipecacuanhae, Troches of Morphine and Ipecac,—each troche contains about gr. of Morphine Sulphate, about gr. of Ipecac, with Oil of Gaultheria, Sugar, etc. Dose, j-iij. Emetina, Emetine (Unofficial),—a crystalline alkaloid, white, becoming yellow, odor- less, bitter, nearly insoluble in water, but forming with acids salts which are readily soluble. Is powerfully poisonous in large doses. Dose as an expectorant, gr. ; 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 exciting 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 hypersemic lungs with patches of hepatization. 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. Antagonists and Incompatibles. 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- IRIS—jalapa. 323 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 roots of Iris versicolor, an indigenous plant of the nat. ord. Iridese, growing in moist meadows and on the borders of swamps, having large blue flowers. It contains tannin, sugar, starch, gum, an acrid resin, fixed oils and traces of an alkaloid. Dose of the powdered root, gr. v-xx. Extractum Iridis, Extract of Iris.—Dose, gr. j-v. Extractum Iridis Fluidum, Fluid Extract of Iris.—Dose, Ttpv-^j. Iridin or Irisin (Unofficial),—is a so-called resinoid found in the shops, of undeter- mined composition, but probably an oleoresin precipitated by water from an alcoholic preparation. Dose, gr. j-v. Preparations. Physiological Action and Therapeutics. 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. 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 intestinal disorders as a cholagogue and purgative of mild but efficient action, also as a diuretic in dropsies. In small doses (npj 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 Ipomoea Jalapa, a Mexican plant of the nat. ord. Convolvulacese. 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. Extractum Jalapae, Extract of Jalap.—Dose, gr. ij-x. Is an ingredient of Pil. Cathartics Co., and Pil. Catharticse Vegetabiles. Resina Jalapae, Resin of Jalap,—prepared from a tincture by precipitation by water. Is insoluble in water, soluble in alcohol. Dose, gr. ij-x. Pulvis Jalapae Compositus, Compound Powder of Jalap, (Pulvis Purgans),—has of Jalap 35, Potassium Bitartrate 65, rubbed together until thoroughly mixed. Dose, gr- x~3j- 324 JAMBUL JUGLANS. Physiological Action and Therapeutics. 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 con- tained principles, but all the active constituents are found in the resin. Compared with other agents of the same class its action most resembles that of Scammony. It is more drastic than Senna and less irritant than Gamboge, 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 feces, and is there- fore probably destroyed in the system by oxidation. 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 cor- rective may be used with advantage at the onset of fevers and inflam- mations. As the compound powder it is much employed to produce free watery evacuations 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 gss). 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 con- ditions of the intestinal mucous membrane, but in proper doses it is one of the most manageable and efficient cathartics. JAMBUL, Jaraun (Unofficial),—the seeds and bark of the Eugenia Jambolana, a native tree of India, has a very varied history of successes and failures in the treatment of diabetes. The British Medical Association has directed its Committee on Therapeutics to investigate thoroughly the claims made for and against this agent, so that some reliable information may be expected concerning this very important question. One writer con- tends that any efficient preparation should be made from the fresh seeds, discarding the pericarps, and avoiding the application of heat; also that a weak alcoholic menstruum exhausts the drug and gives a stable preparation. Late reports, from observers abroad and in this country, show that favorable results are obtained with Jambul in many cases of diabetes, even after the unsuccessful use of all the usual remedies. In two severe cases, in which 7 and 3 per cent, respectively of glucose was excreted, the urine was brought back to normal and kept there for two years, by the use of this remedy. It should be given with or after meals, in water or wine sweetened with a small quantity of saccharin, and accompanied by general treatment. JUGLANS, Butternut,—is the bark of the root, collected in autumn, of Juglans cinerea, the Butternut or White Walnut, an indigenous forest tree of the nat. ord. Juglandacese. It contains an orange-yellow, crystalline and acrid substance named JUNIPERUS. 325 Juglandic Acid or Nucin, resembling Chrysophanic Acid, also some resin, volatile acid, etc., but neither tannin nor any alkaloid. Extractum Juglandis, Extract of Juglans.—Dose, gr.v-xx or more. Juglans is a mild cathartic operating without the production of pain or irritant symp- toms. It is never used in substartce, 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,—the source of the official Oleum Juniperi, is the fruit of Juniperus communis, an evergreen shrub of the nat. ord. Coniferae, growing in Europe and N. America. It contains a Volatile Oil, which 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. The Oil, a Spirit, and a Compound Spirit are official. Preparations. Oleum Juniperi, Oil of Juniper,—is the volatile oil, a colorless or faintly greenish- yellow liquid, sp. gr. 0.850 to 0.890; of terebinthinate and sweetish taste, and the odor of juniper ; soluble in 4 times its vol. of alcohol, and in an equal vol. of carbon disul- phide. Dose, rrpv-xv. Spiritus Juniperi, Spirit of Juniper,—has of the Oil 5 in Alcohol 95. Dose, gj-iv or more, according to the quantity of alcohol desired. Spiritus Juniperi Compositus, Compound Spirit of Juniper,—has of the Oil 8, Oil of Caraway I, Oil of Fennel 1, Alcohol 1400, Water to 2000. It approximates closely to a good grade of Gin. (Szeante, page 108.) Dose, 3j—iv, or more, according to the quantity of alcohol desired. Oleum Cadinum, Oil of Cade (Empyreumatic Oil of Juniper),—is a product of the dry distillation of the wood of Juniperus Oxycedrus. It is a tar-like substance, of un- certain composition and purity : a dark-brown, clear, thick liquid, of tarry odor and a somewhat bitter, burning taste ; insoluble in water, partially soluble in alcohol, com- pletely so in ether, chloroform or carbon disulphide. Used locally as a stimulant in pso- riasis and chronic eczema. In usum Juniperi, Infusion of Juniper (Unofficial),—has of Juniper Berries £j in Oj of boiling water. Dose, ijj-ij. 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 strangury, priapism, hematuria, suppression of the urine, and uraemic convulsions. It imparts a violet odor to the urine, and will produce diuresis when inhaled. 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, prostatorr’noea, gleet, etc., but it is contraindicated in all cases where acute inflammation of the kidneys exists. 326 KAMALA—KAVA-KAVA KINO—KRAMERIA. Oil of Cade is used locally in chronic skin diseases as a stimulant appli- cation. It is too active for acute eruptions, but has been used with benefit in chronic eczema and psoriasis. The Oil of Tar (see under Pix) is equally efficient for all the purposes to which the Oil of Cade has been applied. KAMALA, Rottlera,—the glands and hairs from the capsules of Mallotus piiilip- pinensis, or Rottlera tinctoria, a small tree of the nat. ord. Euphorbiacese, 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, 3 ss-iij. Kamala is anthelmintic and purgative, sometimes causing nausea and colic, seldom vomiting. It is used as a tseniafuge, 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 tincture ( 2; vj in xvj of alcohol) may be used in doses of 3 j- ss. 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. KAVA-KAVA, Ava-Kava (Unofficial),—the root of Piper methysticum, a shrub of the nat. ord. Piperacese, growing in South America and the South Sea Islands. It 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, 3 ss-j, macerated in water, or the same quantity of a fluid extract. Kava is intoxicant, diuretic and motor-depressant. A beverage is prepared 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 headache. 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. Leguminosae, growing in India. It contains 75 per cent, of a variety of tannin named Kino-tannic Acid, ClgH1808, which gives a greenish precipitate with persalts of iron, also a crystalline, neutral substance, Kinoin, C14II1206, and Kino-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. Tinctura Kino, Tincture of Kino,—strength 10 per cent. Dose, rtpx— gij. Pulvis Kino Compositus (Unofficial).—Kino 15, Opium 1, Cinnamon 4 (has of Opium 1 in 20). Dose, gr.v-xx. The action of Kino is the same as that of Tannic Acid, though less powerful (see ante, page 94), and it 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. The tincture, in drachm doses, is one of the most efficient means of combating the atonic diarrhoea which results from disuse of opium or morphine. KRAMERIA, Rhatany ,—is the root of Krameria triandra and Krameria Ixina, shrubs of the nat. ord. Polygalese, growing in S. America, the first-named in Peru and the latter in New Granada. It contains 20 to 45 per cent, of Rhatania-tannic Acid, C54H24021, and Rhatanine, C10H13NO3, an alkaloid,—also, wax, gum, etc. Extractum Krameriae, Extract of Krameria,—aqueous. Dose, gr. v—x. Extractum Krameriae Fluidum, Fluid Extract of Krameria.—Dose, rtpv-^ss. Tinctura Krameriae, Tincture of Krameria,—20 per cent. Dose, upv-^j. KUMYSS. 327 Syrupus Krameriae, Syrup of Krameria,—Fluid Extract 45, Syrup 55. Dose, 3 SS-3 ss. Trochisci Krameriae, Troches of Krameria,—each troche contains gr. j of the extract, with Tragacanth, Sugar and Orange-Flower Water. Krameria possesses the same astringent qualities as Tannic Acid (see ante, page 94), 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. Its successful preparation depends on its undergoing slow fermentation in a cold room, at 50° F. or less. If the temperature be higher, the fermentation will be of the acetous variety, and will result in sour milk with heavy curd, feeble effervescence and repulsive taste. Wolff’s Formula, for its preparation in small quantity, is as follows:—Dissolve ss (a tablespoonful) of grape sugar in 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 two 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 twice 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. Kumysgen is a powder containing the elements necessary for the preparation of Kumyss, for which a special bottle and tap are also furnished by the manufacturers. It is a very convenient manner of making this preparation, and the product tastes just as well as that made in the ordinary way. Whether it acts as well therapeutically remains to be ascertained. 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 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 cachexise. In cases of feeble digestive power §j 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. Each quart is esti- mated to contain four ounces of solid food, besides from i to 3 per cent, of alcohol. 328 LACTUCARIUM LAPPA. 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 Moun- tains. It is used by the natives of the Asiatic plains as a remedy for struma, ansemia, lung and stomach diseases. Kefir is richer in albumen than Kumyss, is less alcoholic and less acid. The following table of analysis shows the average composition of Milk, Kumyss and Kefir Cow’s milk. Kumyss. Kefir. Albumen, 48 11.2 38 Butter, . 38 20.5 20 Sugar of milk, 41 22. 20 Lactic acid, — 11.5 9 Alcohol, — 16.5 8 Water and salts, 873 918.3 905 LACTUCARIUM, Lettuce ,—is the concrete milk-juice of Lactuca virosa, or Acrid Lettuce, a biennial European plant, of the nat. order Compositse. It is partly soluble in alcohol and in ether, and yields 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, amorphous, but crystallizes after long standing. Tinctura Lactucarii, Tincture of Lactucarium,—50 per cent. Dose, according to the activity of the drug. Syrupus Lactucarii, Syrup of Lactucarium,—has of the Tincture 10 per cent. Dose, 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. LAPPA, Burdock ,—is the root of Arctium Lappa, and of some other species of Arctium, the common Burdock, a coarse-looking biennial weed of the nat. ord. Composite, found in waste places and along roadsides in Europe, Asia and N. America. Three varieties are recognized, formerly known as Lappa major, L. tomentosa, and L. minor, of which the first- named is most frequently met with in this country. It contains a bitter principle, traces of a volatile oil, also inulin, resin, tannin, mucilage, sugar, etc. Extractum Lappse Fluidum, Fluid Extract of Lappa,—made with diluted alcohol. Dose, Zj-ij. Dr. Squibb recommended a Tincture of the seed; lb. j of ground seed to gall, j of whiskey, allowed to stand for two weeks before decanting, and used in doses of 3 ij-iij before meals. LAVANDULA LEPTANDRA LICOPERDON. 329 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 source of the official Oil of Lavender Flowers, is the fresh flowers of Lavandula officinalis, 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 fragrant odor, and an aromatic, camphoraceous taste; and contain resin and tannin, also a Volatile Oil. Oleum Lavandulae Florum, Oil of Lavender Flowers,—is a volatile oil distilled from fresh Lavender, and having the fragrant odor of the flowers. It is soluble in alco- hol in all proportions, also in 3 times its volume of a mixture of alcohol 3 and water I, also in glacial acetic acid. Sp. gr. 0.885 to 0-897 at 59° F- Dose, tip j-v. Spiritus Lavandulae, Spirit of Lavender,—has of the Oil 5, in Deodorized Alcohol 95. A perfume and flavoring. Dose, Tinctura Lavandulae Composita, Compound Tincture of L^avender,—an aromatic stimulant, composed of the Oil 8, Oil of Rosemary 2, Cassia Cinnamon 20, Cloves 5, Nutmeg 10, Red Saunders 10, Alcohol 700, Water 250, Diluted Alcohol to 1000. Is a constituent of Liquor Potassii Arsenitis. Dose, 75 ss—ij. 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 Laven- der, 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 Veronica virginica, an indigenous perennial plant of the nat. ord. Scrofularineae. 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 Leptandrae, Extract of Leptandra,—is a constituent of Pil. Catharticse Yeg. Dose, gr. j-iij. Extractum Leptandrae Fluidum, Fluid Extract of Leptandra.—Dose, j. Leptandra is tonic, laxative, and like other resin-bearing purgatives is decidedly chola- gogue. 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 secretions. LICOPERDONGIGANTEUM, Puff-Ball (Unofficial),—is a common fungus of the nat. ord. Trichogastres, found in hilly and wooded districts. The dust, which con- sists 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 useful 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. 330 LIMON, LIMON, Lemon,—is the fruit of Citrus Limonum, a tree of the nat. ord. Rutacese, 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. Aurantium), the Citron (Citrus medico,), and the Lime (Citrus acris), all belong to the same genus as the Lemon (Citrus Limonum). Limonis Cortex, Lemon Peel,—is the rind of the recent fruit, and contains a Volatile Oil, C10H1B, 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 1 fluid ounce. It contains about 7 per cent, of free Citric Acid, besides Phosphoric and Malic Acids, Citrates of Potassium and of other bases, etc. Dose, t^ss-iv. Acidum Citricum, Citric Acid, H3C6H507 + H20,—is obtained from the juice of the Lemon or the Lime by adding chalk to form Calcium Citrate, 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 gss of water corresponds to §ss 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 Ammonium, Iron and Quinine, Iron and Strychnine, Lithium, Magnesium, Potassium, nine in all, are official. They are described under their respective bases, to which their medicinal qualities are due. 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 Aurantii Compositus, and Spiritus Ammonise Aromaticus. Dose, TT\j-v. Spiritus Limonis, Spirit of Lemon, Essence of Lemon,—is prepared by macerating 5 of the Oil and 5 of the Peel, freshly grated, in Deodorized Alcohol to 100. Used for flavoring. Dose, according to the amount of alcohol desired to be given. Syrupus Acidi Citrici, Syrup of Citric Acid,—has of Citric Acid 10, Water 10, Spirit of Lemon 10, Syrup to 100. Dose, indefinite. Preparations. Physiological Action and Therapeutics. 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 vegetable acids. [See under Acidum Aceticum, ante, page 70.] It is wholly decomposed in the blood, and appears to be LINUM. 331 non-toxic in man, but used internally 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, effer- vescing 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 inorganic matter and to aid its ex- cretion. 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 hem- orrhage, and as a gargle in diphtheritic sore throat. LINUM, Linseed, Flaxseed,—is the seed of Linutn usitatissimum (flax), a cultivated annual plant of the nat. ord. Linese. It contains 15 per cent, of Mucilage in the epithelium, also 30 to 40 per cent, of Fixed Oil in the embryo. Ground Linseed should yield not less than 25 per cent, of the fixed oil. Oleum Lini, Linseed Oil,—the fixed oil expressed from Linseed without the use of heat. A yellow, oily liquid, of slight odor, bland taste, and neutral reaction, soluble in about io of absolute alcohol and in X x/z of ether. Consists chiefly of the Glyceride of LAnoleic Acid, C16H2804, which having a powerful affinity for oxygen becomes resinoid on exposure to the air, making it a “ drying oil.” Dose, 3jss-ij. Infusum Lini, Linseed Tea (Unofficial),—Linseed Liquorice-root Boiling Water 3 x, infused for four hours and strained. Dose, indefinite. Linimentum Calcis, Lime Liniment, Carron Oil,—consists of equal volumes of Linseed Oil and Lime-water, emulsified by agitation. A favorite application for burns. Preparations. Physiological Action and Therapeutics. Linseed is demulcent, emollient, expectorant and diuretic. The oil is laxative in a dose of gj, 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 332 lithium. 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, and has considerable reputation as a remedy for hemorrhoids in doses of g'j twice daily. For laxative purposes (especially in children) it is usually administered as an enema. Externally it is a favorite appli- cation to burns, when made into an emulsion with lime-water, as in the official Linimentum Calcis. The ground seed (linseed or flaxseed meal), is one of the best agents for making poultices, and is universally employed for that purpose. [Compare the article on Poultices in Part III.] 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. Lithii Benzoas, Lithium Be?izoate, LiC7H502,—is classed with the Benzoates and described under Benzoinum. (See ante, page 184.) Lithii Bromidum, Lithium Bromide, LiBr,—is classed with the Bromides and de- scribed under Bromum. (See ante, page 187.) Lithii Carbonas, Lithium Carbonate, Li2C03,—a light, white powder, permanent in the air, odorless, of alkaline taste and reaction, soluble in 80 of water, insoluble in alcohol. Dose, gr. ij-xv. Lithii Citras, Lithium Citrate, Li3CfiH507,—a white, deliquescent powder, odorless, of faintly alkaline taste and neutral reaction, soluble in 2 of water, almost insoluble in alcohol. Dose, gr.v—xxx. Lithii Citras Effervescens, Effervescent Lithium Citrate,—prepared from the Car- bonate 7, with Sodium Bicarbonate 28, Citric Acid 37, and Sugar to 100. Dose, 3 j-ij, in water, as an effervescent drink. Lithii Salicylas, Lithium Salicylate, 2LiC7H503,—is classed with the Salicylates and described under Salix. Salts of Lithium. Physiological Action and Therapeutics. 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 urine. Lithium Urate is the most soluble of the alkaline 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 should be given in carbonic acid water, and the Citrate in dilute solution. The latter may be extemporaneously prepared by adding citric acid to an LOBELIA. 333 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 grain o.oi 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. Lithium Carbonate and Citrate are extensively used in gout and the lithaemic diathesis, for the purpose of holding the uric acid in solution as lithium urate, and preventing its deposit in the tissues as sodium urate 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, Lobelia, Indian Tobacco,—the leaves and tops of Lobelia inflata (nat. ord. Lobeliaceae), 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, and small, pale-blue flowers. 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. Extractum Lobeliae Fluidum, Fluid Extract of Lobelia.—Dose, npj-x. Tinctura Lobeliae, Tincture of Lobelia,—20 per cent. Dose, n\v-xxx. 4 Infusum Lobeliae, Infusion of Lobelia (Unofficial),— to a pint. Dose, 3j-§j- Lobelinum, Lobelin (Unofficial),—an impure resinoid. Dose, gr. ss-j. Preparations. Physiological Action and Therapeutics. Lobelia has an acrid, nauseous taste, and a heavy, unpleasant odor. It is expectorant, diaphoretic, emetic, purgative, antispasmodic, motor-de- pressant 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 therapeutically, the 334 LYCOPODIUM—MAGNESIUM. 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 responsi- ble party escaped conviction on the plea that he gave the drug in igno- rance of its qualities. Antidotes and Incompatibles. 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. 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 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 children’s use. LYCO PODIUM, —is a very mobile, pale-yellow, fine powder, consisting of the spores of the Club-moss, Lycopodium clavatum, and of other species of Lycopodium (nat. ord. Lycopodiacese), a native of Europe and the U. S. Lycopodium is odorless, tasteless, floats on water, which does not wet it, and burns quickly when 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 lycopodium spores being about -gfa of an inch in diame- ter, four-sided and reticulated, with short projections on the edges. They contain about 47 per cent, of a bland, fixed oil. 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 adhe- sion 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 liber- ate their oily contents. In their first centesimal trituration (X^T) it is said to have pro- duced symptoms of high excitement of the circulation and irritation of the urinary organs, and they profess to use it with benefit in many affections of the mucous tracts, dyspepsia, pyrosis, flatulence, constipation, ileo-colitis of infants, hepatic congestion, aneurism, chronic affections of the lungs and bronchi, diphtheria, lithiasis, intertrigo, porrigo capitis, plica polonica and pruritus ani, in all of which as an internal remedy and in high attenua- tion. MAGNESIUM, Mg.—This metal is represented by its Oxide, Carbonate, Citrate and Sulphate, of which the latter occurs native in sea- MAGNESIUM. 335 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 color- less, and those which are official are as follows:— Magnesia, Magnesia, Magnesium Oxide, MgO,—made by heating the light carbon- ate in a crucible to expel nearly all the carbonic acid. A white, light and very fine powder, almost insoluble in water, insoluble in alcohol, and gelatinizes with 15 of water after standing ]/z hour, having become hydrated. Is a constituent of Pul vis Rhei Com- positus, Massa Copaibae and Ferri Oxidum Hydratum cum Magnesia. Dose, gr. x-gj. Magnesia Ponderosa, Heavy Magnesia, Magnesium Oxide, MgO,—is a white, dense and very fine powder, corresponding in other properties and reactions with Mag- nesia, except 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, §r- x-3i- Magnesii Carbonas, Magnesium Carbonate, (MgC03)4Mg(H0)2 -(- 5H20,—light, friable masses, or powder, odorless and tasteless, insoluble in alcohol, almost insoluble in water. Dose, gr. x-^j. Magnesii Sulphas, Magnesium Sulphate, Epsom Salt, MgS04 4- 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, Official Salts of Magnesiutn. Preparations. Magnesii Citras Effervescens, Effervescent Magnesium Citrate,—is prepared from the Carbonate 10, Citric Acid 46, Sodium Bicarbonate 34, Sugar 8, Alcohol and Distilled Water, as required. A coarsely granular, white, deliquescent salt, of acid taste and reaction, soluble in 2 of water, insoluble in alcohol. Dose, 3 j— 3 j. Liquor Magnesii Citratis, Solution of Magnesium Citrate,—prepared from the Car- bonate 15, Citric Acid 30, Syrup of Citric Acid 60, Potassium Bicarbonate Water to 360. Dose, iv-vj, repeated for catharsis. Mistura Magnesise et Asafcetidse, Magnesia and Asafetida Mixture, Dewees' Car- minative (Unofficial),—contains of the Carbonate 5, Tincture of Asafoetida 7, Tincture of Opium I, Sugar 10, and Distilled Water to 100. Dose, 3 ss-iv. Used for flatulent colic and diarrhoea in infants. Magnesia and the Carbonate are mildly laxative and antacid, neu- tralizing free acids in the stomach and forming therewith laxative salts. If used in large quantity for any length of time Magnesia may become hydrated and produce intestinal concretions. The freshly-precipitated Hydrate (see above under 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 Oxidum Hydratum cum Magnesia. (See ante, page 282.) Magnesia may also be used in poisoning by acids or phosphorus. The Citrate and Sulphate are saline cathartics, the Sulphate being the most powerful, on account of its bitterness. If administered in plenty of water it usually produces a prompt and free discharge from the intes- tines, with but little irritation or griping, but often accompanied by a sense of coldness and depression. The purgative action is chiefly due to Physiological Action. 336 MAGNOLIA. its causing a greatly increased secretion of intestinal fluids, not by out- ward osmosis from the vessels, as was formerly taught, but by stimulation of the intestinal glandular appendages. If the purgative action should not take place a diuretic one may result, but to secure the desired cathar- sis the drug should be administered in a considerable quantity of water. Magnesium Sulphate is the principal aperient constituent of many of the popular laxative mineral waters, as Friedrichshall, Piillna, Hunyadi, etc. When injected into the circulation it is powerfully toxic, paralyzing first the respiration and then the heart. It abolishes sensation and paralyzes the sensory-motor reflex centres (Murrell). Therapeutics. 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 one of the most efficient of the saline cathartics and has a wide field of application. In acute inflammatory conditions, renal and cardiac dropsy, 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. As it has but little influence on intestinal peristalsis it is usually combined with Senna, as in the official Black Draught, which in- creases its purgative action. Acute dysentery is well treated by Magne- sium 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. In acne vulgaris and other obstinate eruptions due to derangement of the stomach and intestinal canal, good results are often obtained by a purgative dose of the Sulphate daily before breakfast, or by doses of 5 grains in water three or four times a day. The same salt, finely triturated, makes an excellent dusting powder for cases of acne rosacea. The ferro- saline mixture (see ante, page 284) is a very useful laxative in the consti- pation of anaemic women. The bitter taste of Epsom Salt is best covered by coffee. MAGNOLIA (Unofficial),—is the bark of Magnoliaglauca (Sweet Bay, Swamp Sassafras), M. actmiinata (Cucumber-tree)', and M. tripetala (Umbrella-tree), all of which belong to the nat. ord. Magnoliacese, and are indigenous to the Eastern and Southern States. It contains a crystalline principle named Magnolin, which is insoluble in water, but soluble in alcohol, ether, etc. Dose of the powdered bark, Magnolia is an aromatic bitter tonic and diaphoretic, usefully employed in chronic rheumatism, remittent and intermittent fever. In the latter affection it will arrest the paroxysms if used freely. M ALTUM—MANACA MANGANUM. 337 M ALTUM, Malt (Unofficial),—is the seed of Hordeum distichum, Barley (nat. ord. Graminacese), 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 Glu- cose. 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. Extractum Malti, Extract of Malt (Unofficial),—is 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, gj-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. 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 olea- ginous foods it aids their digestion and assimilation. It may be used to form a syrupy mixture with preparations of Iron or Cinchona. MANACA (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 Vege- table Mercury, a name applied by charlatans to a number of widely differing plants. Very little is known about Manaca, but it has been 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 Dispensatories, 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 purgative, diuretic and emmenagogue. In large doses it is an acrid poison.” A fluid extract is on the market, the average dose of which is three or four times daily. MANGANUM, Manganese, Mn.—This metal is represented in the Pharmacopoeia by three of its salts, the native Black Oxide, the Sul- phate, and the Permanganate of Potassium. Mangani Dioxidum, Manganese Dioxide (Black Oxide of Manganese'),—is the native, crude Dioxide of Manganese, containing at least 66 per cent, of the pure Dioxide, Mn02. A heavy, grayish-black powder, odorless and tasteless, insoluble in water or alco- hol, giving olf 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, Manganese Sulphate, MnS04 -(- 4ll20,—colorless prisms, of slightly bitter and astringent taste, faintly acid reaction, very soluble in water, insoluble in alcohol. Dose, gr. ij-v. Potassii Permanganas, Potassium Permanganate, KMn04,—deep, purple-violet prisms, of sweet and astringent taste, neutral reaction, soluble in 16 of water with a scanty, brown residue, decomposed by alcohol and by heating to 464° F. 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 pill. Unofficial Preparations. Syrupus Mangani Iodidi, Syrup of Manganese Iodide,—contains about gj of the Iodide in each £. Dose, ttlx-xxx. For formula see U. S. Dispensatory. Syrupus Ferri et Mangani Iodidi, Syrup of Iron and Manganese Iodide,—each 3 contains gr. 50 of the mixed iodides in the proportion of 3 of the Iodide of Iron to I of that of Manganese. Dose, rrLx-xxx. For formula see U. S. Dispensatory. 338 MANGANUM. Ferri et Mangani Carbonas Saccharatus, Saccharated Iron and Manganese Car- bonate,—is a tasteless, reddish-brown powder. Dose, gr.v-xx. For formula see U. S. Dispensatory. Pepto-mangan, Liquor Mangano-ferri Peptonatus,—a proprietary preparation, advertised to contain in each half-ounce “ the equivalent of 3 grains of metallic Iron and 1 grain of metallic Manganese (as Peptonates) in organo-chemical combination.” It is claimed for this preparation that it does not have the astringent effect of the inorganic salts of these metals upon the glands of the stomach, and that it does not affect the alka- linity of the bowels. Dose, £ ss, three to four times a day, in white wine or milk, or alone. Condy’s Red Fluid,—is a solution of Potassium Permanganate in Distilled Water, of about 2 per cent, strength, namely gr.viijss to the £, or gr. 176 in 20. It is used as a deodorant and disinfectant, for closets, bed-pans, and to wash the hands and utensils. Is non-irritant, and has the advantage of showing by its change in color when it has lost its efficacy. 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. Maganese is closely associated with Iron in the blood, bile, etc., in the proportion of about i to 20. The Black Oxide is an efficient emmenagogue. Potassium Permanganate 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 manganese dioxide. 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 is probably not absorbed in its own state, as it must be quickly decomposed by the contents of the stomach ; at the same time oxidizing any oxidizable substance therein. Therapeutics. The salts of Manganese are used by those practitioners who affect to see a manganese-anaemia in cachectic subjects, but they are always comhined with ferric preparations. In amenorrhcea, gastrodynia and pyrosis the dioxide is a good remedy, and the same salt 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. Manganese is becoming more of an acknowledged remedy in derangements of the menstrual function, as irregular or scanty menstruation, amenorrhcea, menorrhagia, and even metrorrhagia. By some authorities, the emmenagogue power of potassium permanganate is ascribed to its large proportion of oxygen, which it is supposed to give up to the uterus ; as, until recently, potassium chlorate was supposed to do to the system at large. According to the views of others who have studied its action, Manganese should be classed MANGANUM. 339 with the excito-motors, increasing arterial tension, and specifically acting upon the uterus. The best preparation is the Dioxide, in freshly-made pills of two grains each, of which i to 3 or 5 pills may be taken twice or thrice daily. Potassium Permanganate 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 symptoms, it is a difficult matter to get patients to take it for any length of time. Potassium Permanganate is employed as an antiseptic and oxidizing agent in such affections as diphtheria, scarlatina, septicaemia, erysipelas, etc., in which it may be given internally and used locally at the same time. It is given with apparent benefit in dyspepsia, 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. For internal use it should be given in pill, as the taste of a solution is very disagreeable. Locally it is frequently employed (gj 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 corrigent for organic im- purities in drinking water. The stain left by it on fabrics may be re- moved by sulphurous acid, but, as sulphuric acid is formed in the reaction, the fabric should be immediately washed or rinsed in water. Potassium Permanganate has lately come into use as an antidote against morphine or opium in the stomach, for which purpose it was recom- mended in 1884 by an English physician, Mr. J. Barker Smith. Little attention was paid to his suggestion until it was practically tested by Dr. William Moor, of New York, on himself, in 1895. After a light supper he swallowed 3 grains of morphine sulphate, followed almost immediately by 4 grains of potassium permanganate dissolved in water, and expe- rienced no ill effects, although, being highly susceptible to the drug he would have been affected if even gr. y% of morphine had been absorbed. On another occasion, two hours after breakfast, he took 5 grains of mor- phine sulphate in an ounce of water, and also 8 grains of the permanganate in 8 ounces of water soon afterward, without experiencing any symptoms of morphine action. It was long known that morphine is readily deoxid- ized and rendered innocuous by this agent, but it was supposed that the presence of albumen in the stomach would prevent this reaction. It is now shown that the permanganate reduces morphine sulphate more rapidly than it does albuminous matter, and, in fact, exhibits a marked selective affinity for morphine and also for physostigmine (eserine), but gives up its oxygen more quickly to albuminous substances than to strychnine, oxalic acid, colchicum or hydrocyanic acid. It exerts no oxidizing effect, 340 MANGO MARRUBIUM MASTICHE—MATICO. in the presence of albumen, on atropine, hyoscyamine, hyoscine, caffeine, cocaine, aconitine, veratrine, pilocarpine, muscarine or phosphorus. (Murrell.) MANGO (Unofficial),—is the bark of Mangifera indica, an Indian tree of the nat. ord. Guttiferse. 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 discharges from the intestines, uterus, vagina and bronchi. A fluid extract is sold, which may be used in doses of x-^j. Mango-Fruit, or Mangosteen, is the fruit of Garcinia mangostana, nat. ord. Gutti- ferse, 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 FraxinusOrnus, 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. It contains from 40 to 90 per cent, of Mannit, C6H1406, 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 fluorescent glucoside Frax'in, C16H18O10. There are no official preparations, but Manna itself may be given in doses of j-ij. Manna is a mild laxative, with some tendency to produce flatulence and colic. It is usually combined with other purgatives, as Senna, Rhubarb, Magnesia, etc., to disguise the taste and increase the effect. It is a constituent of the official Infusum Sennse Com- positum. Manna may be eaten by children if of good quality, or may be readily dissolved in milk and so administered. MARRUBIUM, Horehound,—the leaves and top of Marrubium vulgare, a plant of the nat. ord. Labiatse, native in Europe, but naturalized in America. It contains a bitter principle named Marrubiin, also a volatile oil, resin, tannin, lignin, etc. There are no official preparations. Dose, 3 ss-j. 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 soothing effect, and is much employed in confec- tionery as an ingredient in “ cough drops.” MASTICHE, Mastic, —is a concrete, resinous exudation from Pistacia Lentiscus, a tree of the nat. ord. Anacardiese, growing in the island of Scio. Alcohol dissolves about 90 per cent, including the resin Alastichic Acid, C20H32O3, the remainder consisting of another resin Alastichin, 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 119). Mastic was formerly used for supposed properties analogous to those of other oleore- sins, but now its application is confined to dentistry, being employed as a temporary fill- ing for carious teeth. A solution in ether is applied on cotton with moderate pressure, and remains as a firm plug after evaporation of the solvent. MATICO,—the leaves of Piper angustifolium, a Peruvian shrub of the nat. ord. Piperaceae. It contains a crystallizable acid Artanthic Acid, also resin, tannin, and a volatile oil. Its odor is aromatic, and its taste astringent, spicy and somewhat bitter. Extractum Matico Fluidum, Fluid Extract of Matico.—Dose, % ss-ij. Tinctura Matico, Tincture of Matico,—io per cent. Dose, ss-ij. Matico is an aromatic tonic and stimulant, also aphrodisiac, vulnerary and hemosta- tic. It acts, like cubeb, on the urinary passages, and is an excellent alterative stimulant MATRICARIA—MEL. 341 to mucous membranes. It has been used with considerable success in mucous catarrhs, as gonorrhoea, leucorrhcea, chronic cystitis, etc., also in epistaxis, hemorrhoids, menor- rhagia, hemoptysis, 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 it is a good local hemostatic for trivial cuts or wounds. MATRICARIA, German Chamomile,—the flower-heads of Matricaria Chamo- milla, a European annual plant of the nat. ord. Compositse. They contain th per cent, of a blue Volatile Oil (the color of which is due to Azulen), also a bitter extractive, tannin, etc. There are no official preparations, but the flowers may be eaten or a decoction used almost ad libitum. 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 Ger- man people, who use it in infusions as a diaphoretic, etc. This plant is the “ Chamo- milla ” 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, aggravated at night and by warmth, clonic spasms of pregnancy, irritability of teething children, flatu- lent 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 may be detected by the official tests (see U. S. Phar.). Dose, indefinite. Preparations. Mel Despumatum, Clarified Honey,—is honey heated, skimmed and strained, with Glycerin added in the proportion of 5 Per cent. It is an ingredient of Confectio Rosae, Mel Rosae, and Massa Ferri Carbonatis. Dose, indefinite. Mel Rosae, Honey of Rose.—Fluid Extract of Rose 12, Clarified Honey to 100. Dose, indefinite ; generally used as a local application to the throat for its astringency and flavor, in combination with more active agents. 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 astringent, and is used in gargles and in washes, for the treatment of inflammation and ulceration of the mucous membrane of the nasal passages, the mouth and the throat. 342 MELISSA MENISPERMUM MENTHA PIPERITA. MELISSA, Balm,—the leaves and tops of Melissa officinalis, a European plant of the nat. ord. Labiatse, growing also in America. It contains gum, tannin, bitter extrac- tive, and a fragrant essential oil in very small quantity f/% t° X Per cenL). There are no official preparations. 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, the Yellow Parilla, or Canadian Moonseed, a woody, climbing plant of the nat. ord. Menis- permacese, native of the eastern U. S. It contains starch, Berberine, and a white alka- loid, which is soluble in alcohol and in ether. Extractum Menispermi Fluidum, Fluid Extract of Menispermum,—is %rds alcohol. Dose, rrpv-xx. Menispermum is reputed to have tonic properties, and is used in some of the Southern States in domestic practice as a substitute for Sarsaparilla in scrofulous conditions. Little is known about it of a definite character. MENTHA PIPERITA, Peppermint, —the leaves and tops of Mentha piperita, a perennial herbaceous plant, of the nat. ord. Labiatse, a native of Britain, but largely cultivated elsewhere. They contain 1 to per cent, of a Volatile Oil, which is official, and a little tannin. Menthol, C10HWOH,—is a stearopten (having the character of a sec- ondary alcohol), obtained from the official oil of peppermint, or from Japanese or Chinese oil of peppermint (from Mentha arvensis and Men- tha canadensis) ; by deposit therefrom on exposure to cold. It occurs in colorless, acicular crystals, of the odor of peppermint, and a warm, aromatic taste, followed by a sensation of cold when air is drawn into the mouth. Soluble only slightly in water, freely in alcohol, ether, chloroform,'carbon disulphide or glacial acetic acid. Dose, gr. ss-iij, in pill or spirituous solution, several times a day. Preparations. Oleum Menthse Piperitae, Oil of Peppermint,—is the volatile oil distilled from the fresh herb ; a colorless or pale yellow fluid, having the odor of peppermint, and a strongly aromatic taste followed by a cold sensation when air is drawn into the mouth. It consists of a liquid terpene, and the stearopten Menthol (see above). Dose, Tty-v. Aqua Menthae Piperitae, Peppermint Water,—has of the oil 2 parts in 1000 of Dis- tilled Water. Dose, indefinite. Spiritus Menthae Piperitae, Spirit of Peppermint, Essence of Peppermint,—is an alcoholic solution containing 10 percent, of the Oil and I percent, of the powdered herb. Is an ingredient of Mistura Rhei et Sodse. Dose, ttpx-xxx. Trochisci Menthae Piperitae, Peppermint Troches,—each troche contains 1 per cent, of the Oil, with Sugar and Mucilage of Tragacantli. Dose, indefinite. Physiological Action and Therapeutics. Peppermint is an aromatic stimulant, also carminative and antispas- modic. The oil possesses these qualities in greater degree and is also a local anodyne and ansesthetic when applied locally, especially if its evap- oration be prevented. The Chinese oil contains a large quantity of MENTHA VIRIDIS METHYLENE BLUE. 343 Menthol and is particularly anodyne. Menthol is antiseptic and locally anaesthetic, but not corrosive, and acts also as a vascular stimulant when applied to the surface. 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 and counterirritant. Menthol is highly praised as an external application in various neural- gise, sciatica, pleurodynia, toothache, etc. For neuralgia it is used in saturated alcoholic solution painted over the affected nerve. For tooth- ache a crystal introduced into the carious cavity is promptly anodyne. 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 applica- tion in neuralgise, and as this oil contains a large quantity of Menthol, the latter preparation will probably prove a very efficient agent in these affections if the cupidity of the manufacturers will allow of its being obtained pure. A spray containing 5 to 20 per cent, of Menthol is highly recommended in epidemic influenza, also in tubercular laryngitis. Men- thol is of marked value in almost all cases of pruritus, from whatever cause. It possesses high power as an anti-emetic, stopping nausea and vomiting after all the usual remedies had failed. For this purpose ten drops of a 20 per cent, solution in olive oil are given on sugar. MENTHA VIRIDIS, Spearmint —the leaves and tops of Mentha viridis, the “ mint” of the kitchen garden, a plant of the nat. ord. Labiatse, 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 Menthae Viridis, Oil of Spearmint,—is the Volatile Oil distilled from the plant. Dose, TT^ij—v. Aqua Menthae Viridis, Spearmint Water,—has 2 parts of the Oil in 1000 of Distilled Water. Dose, indefinite. Spiritus Menthae Viridis, Spirit of Spearmint, Essence of Spearmint,—is an alco- holic solution containing IO per cent, of the Oil and I per cent, of the powdered herb. Dose, npx-xl. 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 flavor- ing for many mixtures. METHYLENE BLUE, Tetramethyl-Thionine Chloride, NS(C6H,)22N- (CH3)2C1 (Unofficial),—is an anilin derivative, which when pure is seen in small, dark blue, scaly crystals, having a copper bronze tinge, soluble in water. Dose, gr. j-iij, four or five times a dav. 344 MEZEREUM MORRHUT. OLEUM. This substance imparts a blue color to nerve tissue and to the urine. From the facts that it manifests a strong affinity for nerve tissue, especially for the axis cylinders of sen- sory nerves, and that it is the best staining agent for the microbe found in the blood of malarial subjects, this agent has been expected to possess anodyne power over neuralgic and rheumatic affections and to act as an antiperiodic in malaria. It has been employed by several observers as an antipyretic and internal antiseptic for rheumatism of the joints and muscles, for malarial fever, diphtheria, acute nephritis and cancer, with varying results. Its best action in malarial affections has been obtained in children, and being tasteless may be administered to them with greater ease than quinine, besides being free from the vomiting and headache which so often result from the latter drug. In diphtheria and in simple, non-diphtheritic ulceration of the throat a ten per cent, solution is used locally with great benefit so far as yet reported. It has lately been employed successfully in two cases of chronic cystitis. MEZEREUM, Mezereum (Mezereon),—is the bark of Daphne Mezereum and of other species of Daphne, plants of the nat. ord. Thymeloeacese, growing in mountainous districts of Europe and Asia and cultivated as a garden shrub in Britain. It contains an inert, fixed oil, an inactive glucoside, Daphnin, and an acrid Resin, which is the anhy- dride of a resinous acid named Mezereinic Acid. Mezereum is an ingredient of the com- pound decoction and the compound fluid extract of Sarsaparilla. Dose, gr. j-x. Extractum Mezerei Fluidum, Fluid Extract of Mezereum,—is too acrid for internal use. It is an ingredient of the Linimentum Sinapis Compositum. Mezereum is a sialogogue, and an intensely acrid, irritant poison, producing violent vomiting, purging, nephritis and gastro-enteritis. In small doses it is laxative and diu- retic, and has had considerable reputation as an alterative. Externally the recent bark is a powerful local irritant, speedily producing vesication. Mezereum is rarely used internally by itself, but is employed in mixtures with Sarsa- parilla, 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 of the tongue. Its principal use is as a local irritant to keep up the discharge from issues or blisters, and to stimulate indolent ulcers. MORRHUSE OLEUM, Cod-liver Oil (Oleum Jecoris Aselli),— 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. It consists chiefly of Olein and Margarin, with a peculiar prin- ciple named Gaduin, also Trimethylamine, free fatty Acids (oleic, palmitic, 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, 3j-ij on a full stomach, increased as assimilated. Unofficial Preparations. Glyconin Emulsion of Cod-liver Oil,—Ol. Morrhuse Glyceritum Vitelli Aromatic Spirit of Ammonia %j, Sherry Wine ij, Diluted Phosphoric Acid p,\\, Es- sence of Bitter Almond of the Volatile Oil in Oss Alcohol) gij. 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. Hydroleine, Hydrated Oil,—is said to contain, in each dose of 55 ij, Cod-liver Oil rr8o, Distilled Water Pancreatin gr. 5, Soda gr. Salicylic Acid gr. 'f. MORRHU/E OLEUM. 345 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 quantity 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 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 been offered until recently for the dif- ference between its action and that of other animal or vegetable oils. Physiological Action. Gautier and Mourgues of Paris have made an exhaustive series of analytical researches upon Cod-liver Oil, and find that it contains—(i) Fixed Bases, Asellineand Morrhuine, the latter constituting about l/$ of the total alkaloids, and being probably one of the most efficient principles in the oil. (2) Volatile Bases, Butylamine, l/(, of the total bases ; A my famine, of the whole; Dihydrotoluidine, Iff of the total alkaloids; Hexylamine, a small amount. (3) Acids, Morrhnic Acid, Iy2 per cent., also a mixture of For?nic and Butyric Acids ; and a small proportion of Phosphoric Acid, derived from the phos- phates, phospho-glycerates and lecithins of the extracts. As to the properties of these con- stituents they state that Butylamine, Hexylamine, and particularly Amylatnine increase the urinary secretions. Dihydrotoluidine is a convulsivant toxic base. Aselline in suf- ficient doses produces dyspnoea, stupor, convulsive disturbances, and, if continued, death. Morrhuine, the most important of the extractive principles, is a powerful stimulant of the functions of nutrition and assimilation, promoting metabolic changes ; it produces a rapid circulation of the extractive residues of cell life toward the excretory organs, where they are eliminated, provoking in their way indirectly a powerful movement of assimilation correlative of the losses consequent upon the inverse movement of de-assimi- lation. This is considered to be proved by the super-excitation of appetite in animals brought under its influence. The physiological experiments with these substances dem- onstrate that cod-liver oil is a reconstituent of the tissues through its richness in phos- phates, phospho-glyceric acid, and organically combined phosphorus. Bromine and iodine, which are present in small quantities, also contribute to the reparative action, but chiefly to the active principles butylamine, amylamine, and especially morrhuine and mor- rhuic acid does the oil owe its true medicinal value. Therapeutics. The value of Cod-liver Oil is wholly that of a nutrient, its action being 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- 346 MOSCHUS. ployment. It is found to be of most value in the chronic forms of phthisis, in chronic bronchitis and emphysema, chronic rheumatic disorders, atheroma of the arteries, strumous skin diseases and diarrhoea, syphiloder- mata, neuralgia, 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 en- dangers 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 proportion of 1 part to 100 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 afterward, would be a good routine in most cases, the latter agent preventing the fishy eructations which often give so much trouble. Extemporaneous emulsions may be prepared with Glyconin (see ante, page 344), 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 3 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 absorbed, 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 bitterish taste, contained in oval sacs about 2 inches in diameter, membranous on one side, hairy on the other. About io 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 Hydrocyanic Acid also destroys it. The odorous principle has not been MYRCIAS OLEUM MYRISTICA. 347 isolated, but 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. Tinctura Moschi, Tincture of Musk,—5 per cent. Dose, rrpxx-^jss. 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 employed with benefit in general prostration of the system with nervous agitation or irregular muscular action. It has been used with advantage in laryngismus stridulus, insomnia, the collapse of typhoid and typhus fevers, spasmodic affections of the stomach, obstinate hiccough and convulsions 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. MYRCIAE 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. Myrtaceae, native of the West Indian Islands. It is a yellowish brown liquid, of aromatic odor, pungent taste, slightly acid reaction, and soluble as a slightly turbid solution in an equal weight of alcohol. It contains a hydrocarbon and Eugenic Acid. Used only as a perfume. Spiritus Myrciae, Spirit of Myrcia, Bay Rum,—contains Oil of Myrcia 16, Oil of Orange-peel 1, Oil of Pimenta I, Alcohol 1220, Water to 2000. 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 per- fume, and is thought to relieve headache, faintness, etc., by application to the forehead or to the nostrils. MYRISTICA, Nutmeg, —is the seed of Myristica fragrans de- prived of its testa. The Nutmeg-tree is cultivated extensively in the East and West India Islands-, belongs to the nat. ord. Myristicaceae, and is a native of the Banda Islands in the Malayan Archipelago. The nutmeg 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 Myrislic Acid, some resin and volatile oil. Dose, gr. v-xx. Macis, Mace,—is the arillode (or fleshy covering) of the seed 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. Dose, gr. v-xx. Oleum Myristicae, Oil of Nutmeg,—is the volatile oil, and consists chiefly of a ter- pene and an oxygenated oil, Myristicol. It is colorless or pale-yellow, of hot, spicy taste and neutral reaction, and is soluble in alcohol. Dose, Tt\j-v. Spiritus Myristicae, Spirit {or Essence) of Nutmeg,—is a 5 per cent, solution of the oil in alcohol. Dose, Nutmeg is an ingredient of Acetum Opii, Pulvis Aromaticus, Tr. Lavandulae Co., Trochisci Cretae, 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 348 MYRRHA—MYRTI OLEUM. 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 purposes, and generally in substance, grated as required, but has been employed as a carminative, anodyne and astringent in diarrhoeas and dys- entery, as well as to relieve nausea and vomiting. Strangury is efficiently treated by small doses of powdered nutmeg given several times a day ; and the same remedy is often used in the south of Germany to relieve the uncomfortable feeling experienced after drinking an excessive quantity of new beer. The Volatile Oil is decidedly rubefacient when used exter- nally, 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. MYRRH A, Myrrh, —is a gum resin obtained from Commiphora Myrrha, an Arabian tree of the nat. ord. Burseracese, collecting spontaneously 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 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, Dose, gr. x-xxx. Tinctura Myrrhae, Tincture of Myrrh,—20 per cent. Dose, rrpx-xxx. Myrrh is also contained in Mistura Ferri Co., Pil. Aloes et Myrrhae, Pil. Rhei Co., and Tinctura 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 emmena- gogue, 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 influence 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 ex- cellent disinfectant and stimulant gargle in ulcerated sore-throat. Myrrh has long been used as an ingredient of dentifrices. M YRTI OLEUM, Oil of Myrtle, Myrtol(Unofficial),—is a volatile oil distilled from the leaves of Myrtus communis, the Myrtle, nat. ord. Myrtacese ; and consists of a mixture of Pinene, another hydrocarbon, and Cineol; the latter being identical with eucalyptol, and probably the active medicinal ingredient. Dose, ftp j-iij in capsules, several times a day. Myrtol is a very active antiseptic and parasiticide. Applied to a raw surface it is sufficiently irritant to excite inflammation, but it does not so affect the unbroken skin. Internally, in small doses, it excites a sense of NAPHTALINUM. 349 warmth in the mouth, increases the saliva, and acts as a tonic to the stomach. Full doses are sedative to the nervous system, but large ones act as an irritant. It is eliminated by the lungs and kidneys, acting as an expectorant and as an antiseptic and stimulant to the mucous mem- branes at the points of elimination. It imparts a smell like that of violets to the urine of the person taking it. Administered in small doses, Myrtol aids digestion, and is an efficient disinfectant and alterative in bronchorrhoea, fetid bronchitis and gan- grene of the lung; and in cystitis and urethritis it acts similarly through the urine on the local mucous membrane. It may be expected to give good results in chronic and capillary bronchitis, whooping-cough and humid asthma. It has rendered good service in hematuria not due to acute congestion, and in passive hemorrhages generally. Locally it has proved curative in favus, herpes, pityriasis and parasitic skin diseases; also in otorrhoea, ozsena and other foul discharges from ulceration of the mucous membranes. It has been employed successfully against ascarides and the round worm. Chekan (Unofficial),—the leaves and shoots of Myrtus Chekan, nat. ord. Myrtaceae, a native of Chili. They contain a Volatile Oil resembling that of eucalyptus, also Chekanine a volatile alkaloid, and tannin. Chekan is antiseptic, tonic, expectorant and diuretic ; and is chiefly used in catarrh of the mucous membranes, especially those of the bronchi and the bladder. It has been employed with benefit in cases of phthisis, and in bronchitis with thick, purulent expectoration. The expressed juice diluted with water makes a good lotion for conjunctivitis, and a decoction of the bark is valued as an astrin- gent in dysentery. A fluid extract is marketed, the dose of which is NAPHTALINUM, Naphtalin, (Naphtalene), Ci„H8,—is a hy- drocarbon product formed during the manufacture of ordinary coal gas. Chemically, it is one of the benzene derivatives, being formed by the union of two benzene groups in an overlapping ring. (See ante, page 239). When redistilled, it crystallizes in colorless, rhomboid plates, of slightly tarry but strong odor, and burning, aromatic taste ; insoluble in water, soluble in 15 of alcohol, very soluble in boiling alcohol, ether, chloroform, carbon disulphide, and fixed or volatile oils. It is seen frequently in the form of moulded blocks, under such names as Alabastrine and Camphylene, for preserving furs and flannels from moths, and for placing in urinals for disinfectant purposes. The dose of Naphtalin is from gr. ij to gr.viij, up to gr. lxxx per diem for adults;—and for children gr. j to 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. Naphtol, Beta-(orlso-)naphtol, C10II;OH,—a phenol occurring in coal-tar, but usually prepared artificially from Naphtalin. It is one of several naphtols, and occurs in color- less, shining, crystalline laminae, or a whitish, crystalline powder, of faint, phenol-like 350 naphtalinum. odor, and sharp taste. Soluble at 590 F. in of alcohol, and in about 1000 of water, in 75 of boiling water, and very soluble in boiling alcohol, in ether, chloroform, olive oil and petrolatum. Used as ointment, I to 5 for adults, but for children should be not over 2 per cent, strength. Hydronaphtol, C16II7OH (Unofficial),—glistening, micaceous scales, sparingly solu ble in water, freely soluble in alcohol, oils, etc. Used as an antiseptic, and in ointment or powder locally, diluted with oxide of zinc, 1 to 50. Naphtolum Camphoratum, Camphorated Naphtol, Naphtol Camphor (Unofficial),— is prepared by heating carefully one part of beta naphtol with two of camphor; the product being a homogeneous, oily fluid, which is insoluble in water, and decomposes readily on exposure to light and air. Used as parenchymatous injection, the undiluted fluid being well borne, or in Olive oil, in doses of Trpij-v. Naphtalin 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 sparingly soluble, but little of it is absorbed, and hence it does no injury to the organism. What is taken up by the blood is excreted by the urine, partly unchanged, partly as naphtol and perhaps some as phenol. Naphtol is more easily absorbed, and may induce vomiting, hematuria, convulsions and unconsciousness. An ointment containing 2 per cent, applied with friction for scabies to two brothers, aged 6 and 8 years respectively, caused nephritis in both and death in one, the diagnosis of nephritis being verified at the autopsy. Hydronaphtol is a powerful and non-irritating antiseptic, non-poisonous, non-corrosive, freely soluble in alcohol, glycerin, fixed oils, etc., in cold water, 1 to 2000; and in hot water 1 to 100, precipitating as the water cools, but leaving a saturated solution of 1 to 1000, which is perfectly inhibitive of the germs of putre- faction 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). Physiological Action. Naphtalin is employed as an antiseptic for the intestinal canal in typhoid fever, diarrhoea, both acute and chronic, tubercular diarrhoea, dysentery, 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. It has recently come into prominence as an all-round anthelmintic, having been given for all kinds of intestinal worms, with prompt and complete results invari- ably obtained (Mirowicz). In pertussis the best possible results have been obtained from the burning of this agent in the patient’s room ; giving Therapeutics. NUX VOMICA. 351 force to the belief that the well-known benefit resulting from taking children to gas-works for whooping-cough, is due to the naphtalin fumes rather than to the gas-tar. Locally, Naphtalin has high value as an anti- septic for indolent ulcers, sloughing wounds, open cancers, pus cavities, etc. Painted over organic remains it effectually prevents the ravages of insects. Naphtol is employed like tar for therapeutic action upon the skin in hyperidrosis, scabies, eczema and local sweating, in to 5 per cent, alcoholic solution, or as a 10 per cent, ointment, but is a dangerous application. Hydronaphtol is also highly esteemed for antiseptic pur- poses 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. Camphorated Naphtol has been employed hypodermically in tuberculous adenitis, with permanent improvement in nine cases, and improvement in six others, out of a series of 32 cases so treated by Reboul, of Marseilles. In five cases of tuberculosis of the testis, so treated by the same observer, very gratifying results were obtained; the injection appearing to be perfectly harmless, and to act beneficially, both locally and generally. It has also been extensively used in the irrigation of joints, bony cavities, tendinous sheaths, cold abscesses in the pleural and uterine cavities, and also in tuberculosis of the bladder: all which localities seem to bear the undiluted fluid well. (Squibb.) NUX VOMICA, Nux Vomica, {Poison Nut, Quaker Button),—is the seed of Strychnos Nux-vomica, a tree of the nat. ord. Loganiacese, growing in India, Cochin-China, and the neighboring countries, all parts of which are bitter and poisonous. The seeds are flattened and nearly circular, about one inch in diameter, ashy-gray in color, covered with short, satiny hairs, internally translucent, tough and horny, with a large cavity, inodorous, but of intensely bitter taste. They contain the alka- loids Strychnine and Brucine (see below), in combination with Igasuric (or Strychnic) Acid, also the glucoside Loganin, a yellow coloring matter, a concrete oil, gum, starch, wax, and earthy phosphates. Preparations of Nux Vomica. Extractum Nucis Vomicae, Extract of Nux Vomica,—has of total alkaloids 15 per cent. Dose, gr. up to a maximum in 24 hours of gr.ij. Extractum Nucis Vomicae Fluidum, Fluid Extract of Nux Vomica,—has 11/2 per cent, of total alkaloids. Dose, n\j-v. Tinctura Nucis Vomicae, Tincture of Nux Vomica,—has 0.3 per cent, of total alka- loids. Dose, T1bv-xx. Alkaloids and their Salts. Strychnina, Strychnine, C21PI22N202,—is an alkaloid obtained from Nux Vomica, Ignatia, and other plants of the order Loganiaceae ; crystalline, intensely hitter even in X to 700,000 solution, of alkaline reaction, soluble in 7 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 Quininae et Strychninae Phosphatum. Dose, gr.^-^. Strychninae Sulphas, Strychnine Sulphate (C21H22N202)2H2S04 + SHaO,—crystal- line, efflorescent, odorless, of intensely bitter taste, even in 1 to 700,000 solution, neutral 352 NUX VOMICA. reaction, soluble in 50 of water, 109 of alcohol, and in 2 of boiling water, but is almost insoluble in ether. It contains 75 per cent, of Strychnine. Dose, gr. fa, but after tolerance is attained much larger doses may be safely used. Strychninae Nitras, Strychnine Nitrate (Unofficial),—forms colorless needles of a silky lustre and very bitter taste, soluble in 90 parts of cold water, 3 of boiling wUter, 70 of alcohol, and in 26 of glycerin, but is insoluble in ether. It contains 84 per cent, of Strychnine, and is preferred to the sulphate for hypodermic use, being less irritant. Dose, gr. yj, or more after tolerance is attained. ThePhar. Ger. gives the maximum single dose as gr. the daily maximum as gr.^. Strychninae Hydrochloras, Strychnine Hydrochlorate (Unofficial),—is used in the form of Liquor Strychninae Hydrochloratis (B. P.), which is about 1 per cent, solution. Dose, rt^v-x. Strychninae Arsenis, Strychnine Arsenite (Unofficial),—is soluble in 35 parts of cold water, in 10 of boiling water, also in alcohol, less so in ether. Dose, gr. £5—35, but as it is highly toxic, the initial dose should never exceed the minimum given. Brucina, Brucine, C23H26N204 (Unofficial),—occurs in colorless prisms, pearly flakes or masses, bitter, soluble in 850 parts of water and in \]/2 of alcohol. It is separated with difficulty from Strychnine, in many samples of which it occurs as an impurity. It is seldom used. Dose, gr. Strychnine and its salts dissolve without color in concentrated Sulphuric Acid, but, on adding to the solution some deoxidizing substance, a play of colors results, Lead Peroxide producing a beautiful blue, passing into violet, then red, and finally yellow (Marcliand). A minute quantity of Potassium Bichromate produces similar results (Otto), while Ceroso-ceric Oxide causes a blue, changing to violet and then to a permanent cherry-red. If these tests are carefully applied, as minute a quantity as I part in 900,000 of the solu- tion may be detected (Wenzell). Brucine is detected by the red color which it yields with Nitric Acid. Neither Nitric nor Sulphuric Acid colors Strychnine unless Brucine is present as an impurity, a test which distinguishes this alkaloid from several others. Brucine does not decompose Iodic Acid, and is thereby distinguished from Morphine. Tests for Strychnine and Brucine. The action of Nux Vomica is that of its principal alkaloid Strychnine. Externally, the latter is a very powerful antiseptic, but is too poisonous for safe use ; and in concentrated solution, hypodermically, it has a de- cided irritant action on the tissues. Internally, in small doses, its bitter quality makes it a good stomachic tonic. Increasing the vascularity of the gastric mucous membrane and promoting the secretion of gastric juice, also the pancreatic and biliary secretions, it aids digestion and sharpens the appetite; but, like all other bitter tonics, it deranges digestion when used excessively or for a long time. It stimulates the muscular coat of the intestines increasing peristalsis, and thus acts as a pur- gative, but it restrains the fecal discharges when their frequency is due to atony of the bowel. It stimulates the motor nerve-cells of the spinal cord, the cardiac motor ganglia, the respiratory and vaso-motor centres in the medulla, contracting the arterioles all over the body (though by full doses they are relaxed), also the excitability of the sensory nerves and their terminal elements. The result is that respiration is deepened and quickened, the action of the heart is increased and the blood-pressure raised, the field of vision is enlarged, the sight and hearing are sharpened, Physiological Action. NUX VOMICA. 353 and the sense of touch is rendered more acute, but the cerebral con- volutions are not affected. Excreted chiefly by the kidneys, it causes increased frequency of urination, and when taken in excess produces spasm of the neck of the bladder. It probably excites some degree of uterine contraction, but undoubtedly promotes menstruation, disposes to sexuality, and provokes erections of the penis. The most marked feature of the action of Strychnine is the great in- crease which it causes in the reflex excitability of the spinal cord and other reflex centres, such as the vaso-motor and respiratory centres in the medulla. When the dose is large this increase is so great as to induce convulsions and cause death by asphyxia. After a full dose (gr. the pupils become dilated, the limbs take on jerking movements, respira- tion becomes spasmodic and the lower jaw stiff, a sensation of cerebral tension may be felt, and sudden shuddering and anxiety follow, the face taking on an unmeaning smile, the risus sardonicus. A toxic dose (gr. to gr. ij) produces powerful and characteristic convulsions of a tetanic character. Within an hour after its administration, sometimes after only a few minutes, the patient feels a sudden sense of suffocation and dyspnoea, the head and limbs begin to shudder and jerk, the limbs are suddenly stretched out rigidly, with hands clenched and feet arched, then the head is bent backward, and at last the whole body becomes stiffly arched, resting on the head and the heels, the belly hard and tense, the chest muscles fixed and the breathing all but arrested. In the height of the paroxysm the face is dusky and congested, and the eyeballs project. Nearly all the muscles of the body are affected, but those of the jaw are not seriously implicated until near the end, and never so powerfully as in tetanus. The pulse is very rapid and the body temperature is above nor- mal, but the intellect remains unclouded and the patient often expresses a sense of impending dissolution. After the paroxysm has lasted a minute or two it usually relaxes for a time. In the interval the patient suffers from soreness of the muscles, feels exhausted and sweats profusely, but be- fore long becomes aware that the spasm is returning and may cry out for some one to hold him or to rub his limbs. The convulsions rapidly in- crease in severity, a breath of wind, the slightest noise, even a bright light, being sufficient to bring them on, and in one the patient may jerk himself out of the bed. At last the respiration stops in the middle of a fit, and the heart soon after ceases to beat. Death occurs, after two or three hours at most, by exhaustion and 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 selec- tive action on the large multipolar ganglia in the anterior columns, which 354 NUX VOMJCA. it first stimulates and finally paralyzes by over-stimulation, in this respect illustrating the rule that small and large doses of an active agent act antagonistically to each other. A massive dose seems to destroy the spinal and medullary functions as by a single blow. The spasms of Strychnine may be distinguished from those of tetanus by their intermit- tency (the latter being constant), by the meaningless smile, the less-marked trismus, the absence of a wound, and the rapid course of the symptoms. Thebaine, the tetanizing alkaloid of opium, is also a spinal exaltant, and acts much the same as strychnine. Strychnine does not directly affect the muscular tissue, the motor nerve- trunks or nerve-endings, or the cerebral convolutions. Occasionally, however, large medicinal doses cause a greatly heightened sensibility of the optic and auditory nerves, so that brilliant lights and loud sounds pro- duce painful impressions; and in a few cases there occurs a true cerebral intoxication resembling a slight degree of drunkenness. It probably affects all the nervous centres in some degree, the sensory, however, much less than the motor and vaso-motor ones. It is to some extent oxidized and destroyed in the body, the remainder being eliminated by the urinary, salivary and cutaneous channels. As it contracts the renal arteries, it hinders its own excretion by the kidneys, and, being rapidly absorbed, it may accumulate in the system if even a small dose is frequently and con- tinuously administered. It is much more poisonous when injected into the rectum than when swallowed. The fatal dose of Strychnine is placed by Taylor at gr. 1 to gr. ij for an adult, but recovery has taken place after larger doses, even 7 and 8 grains, cases probably of imperfect absorption, due, perhaps, to the pres- ence of fat or tannin in the contents of the stomach. A child, aged 2x/2 years, died in four hours from a dose of gr.Jg-. After death from this poison cadaveric rigidity is marked, with opisthotonos, clenched hands, and arms flexed across the chest. The muscular rigidity may persist for several months after death. The face is usually pale, but sometimes livid, the internal organs are gorged with dark blood, and the bladder is gener- ally contracted. The cause of death is primarily asphyxia produced by rigidity of the muscles of respiration, with possible factors in spasm of the heart or exhaustion thereof. On animals Strychnine acts as it does upon man, but in different de- grees. Birds, guinea-pigs and perhaps monkeys, are comparatively insus- ceptible to it, while ruminants are less easily affected than other quadrupeds, and cats resist it singularly. Very minute portions in the soil will destroy the life of growing plants. Antidotes, Antagonists and Incompatibles. The antidotes are Tannic Acid to form the very insoluble tannate, and Iodine in dilute solution, or a soluble Iodide. Animal Charcoal should be given freely, also Fats and NUX VOMICA. 355 Oils, to retard absorption. Potassium Permanganate has been used successfully after the ingestion of gr. of strychnine without any symptom of strychnine poisoning result- ing (Fahr.). Evacuation of the stomach should follow the administration of any antidote, and the bladder should be emptied frequently to prevent reabsorption. The most reliable antagonist is Chloral Hydrate, of which gr. xxx should be given at once, and doses of gr. xx may be repeated at hourly intervals as long as reflex exaltation continues. Quiet, as perfect as possible, is an antagonistic measure of great importance. Other antagonists are Hydrastinine Hydrochlorate, gr.j, hypodermically, Nicotine, Chloroform, Amyl Nitrite, Physostigma (dangerous), Veratrum Viride, Oil of Chamomile, and Valerian. Potassium Bromide is antagonistic, but too slow of action to be of service. Curare has been recommended, but its value is doubtful. Incompatibles are Bromides, Iodides and Chlorides in the same solution, precipitating the strychnine as a hydrobromide, etc. Strychnine salts in solution are decomposed by Alkalies and their Carbonates, and by Tannic (not by gallic) Acid, but are not affected by ferric salts. Oils and fats retard their absorption. Nux Vomica and its chief alkaloid, Strychnine, are exceedingly useful remedies, having a wide range of therapeutic efficacy. They are chiefly employed as stomachic tonics, and as stimulants to the heart, the respira- tory apparatus, and the muscular and nervous systems. As the quantity of strychnine in nux vomica varies greatly, it is best to use the alkaloid when its physiological action is desired, as more definite dosage may be thus ob- tained. 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 pregnancy the tincture is frequently an efficient remedy, and in the vomiting of phthisis Strychnine is one of the very best agents. In the condition clinically known as that of torpid liver, where the stools are of pale color and very offensive odor, showing absence of bile therein, the tongue coated with a thick, perhaps yellowish fur, and the patient complaining of headache, lassitude, anorexia, and a bad taste in the mouth ; small doses of Strychnine (gr. twice or thrice daily, will frequently act as well as a mercurial, restoring the bile to the stools, and correcting the other symptoms. Epidemic diarrhoea and dysentery are often controlled by Strychnine, and in anaemia and chlorosis it is an invaluable remedy, especially when combined with iron and qui- nine. In intermittents, as an adjunct to quinine it is always useful, and in neuralgia, especially of the viscera, and infraorbital and other forms accompanying anaemia and general debility, it is highly efficient, but in these affections very small doses (gr. should be employed. Headaches are often controlled by Nux Vomica, especially the sick headache of gastric origin, in which minim-doses of the tincture every ten or fifteen minutes frequently give marked relief, and a dose of npx before each meal will prevent frontal headache in many persons liable thereto- A sense of heat and weight on top of the head, accompanied or not by flatulence, and usually occurring in women at the climacteric, will often Therapeutics. 356 NUX VOMICA. yield to the tincture in doses of before each meal. Its undoubted in- fluence on the pneumogastric makes it a most valuable remedy for many kinds of cough, even those of phthisis, bronchitis, pneumonia or emphy- sema, but it is particularly efficient in coughs of neurotic origin, such as periodical cough, night cough, and the paroxysmal laryngeal cough with- out lung or bronchial symptoms, but characterized by a persistent tickling sensation in the throat. In all these, drop-doses of the tincture frequently repeated are much more serviceable than larger doses at longer intervals. In bronchial asthma, and asthma of neurotic origin, in the dyspnoea of pulmonary affections and that with cardiac palpitation in hysterical sub- jects, in irregular action and over-action of the heart, in functional anaes- thesia, hypochondriasis, abdominal cramps, nervous movements accom- panying pregnancy, cold hands and -feet due to languid capillary circula- tion, prolapsus ani and urinary incontinence in children, and paralysis of the bladder in old people, small doses of strychnine or nux vomica frequently repeated are remarkably beneficial. In many of these affections the therapeutic action of the drug is unmistakably that of an antispas- modic, illustrating the opposite effects of large and small doses of an active agent, a thoroughly established fact in many cases, though not one of uni- versal application. Nux Vomica is a most efficient remedy in impending cardiac failure from almost any cause. Even with the pulse imperceptible, the extremi- ties cold, and death apparently imminent, the administration of a drop of the tincture every five minutes has frequently given renewed strength to the cardiac contractions after five or six doses, and initiated an improve- ment which resulted in eventual recovery. Local paralyses of various forms are well treated by the hypodermic injection of Strychnine into the substance of the affected muscles, and diphtheritic paralyses are almost in- variably cured by its internal administration. It may prove useful in hemiplegia when degeneration has not set in, and when the paralyzed muscles are completely relaxed; but it is of no avail in recent cases or when electrical contractility is lost. If used early in cerebral paralyses, especially when due to hemorrhage, it may do serious harm ; and in the early stage of organic spinal lesions it may be decidedly injurious, par- ticularly if given in large doses. It should never be used in spinal paralysis when there are symptoms of congestion or inflammation of either the cord or its membranes. In hysterical paralysis and that caused by lead it is decidedly beneficial, and also in the form which is limited to one or two groups of muscles, especially infantile paralysis of long standing, even when the atrophic process has gone so far as to greatly impair the electri- cal sensibility. In multiple peripheral neuritis the hypodermic injection of strychnine has proved eminently serviceable. Strychnine is very useful in cases of nervous impairment of the sight, NUX VOMICA. 357 especially in amblyopia from lead, tobacco or alcohol, from atrophy of the optic nerve, and from functional disorders of the retina without ap- parent lesion, also in muscular asthenopia. In these affections it maybe used internally, but it is usually administered by injection into the tissues around the temple, beginning with gr. and gradually increasing the dose up to or y>. Improvement may not be apparent until the larger doses are reached. In acute and chronic alcoholism, Strychnine is undoubtedly of great service. In small doses it is an effective remedy for the morning vomit- ing and dyspepsia of drunkards, for the tremor of chronic dipsomaniacs, in the forming stage of delirium tremens, and for the depression due to enforced abstinence from alcohol. The nitrate, in doses of gr. -fa to fa, hypodermically three or four times daily for a week, and less frequently for two weeks longer, removes the craving for stimulants, counteracts the vaso-motor paralysis to which most of the injurious effects of alcohol are due, and is probably in other respects a true antagonist to the action of that narcotic poison on the human organism. The published reports of its efficacy in dipsomania, by Luton, Dujardin-Beaumetz, Portugaloff and others, have been fully confirmed by recent observers, so that Strychnine is now the acknowledged remedy for inebriety, and the efficient con- stituent of the numerous “cures ” therefor so widely advertised in the religious and secular press. Strychnine is a physiological antagonist to Chloral, Physostigmine and Morphine, and may be used as a respiratory stimulant in poisoning by these drugs, also in narcotic poisoning by any agent when the respiration is failing. It has been employed in Australia as an antagonist to serpent venom with great success in the hands of Mueller and others, and with doubtful efficacy in the experience of many observers. From the results of experiments made by Dr. Elliot, of the Indian army, it would seem that its use in poisoning by cobra venom is of no service whatever and may actually hasten death. Strychnine Arsenite possesses strong antiperiodic power, and may prove to be an efficient remedy for any intermittent disease rebellious to the influence of quinine. As it is highly toxic, the minimum dose (gr- iV) should not be exceeded at first, and its effects should be care- fully watched upon repetition. Brucine was formerly supposed to have an action analogous to that of strychnine though weaker. Dr. Mayshas shown that pure Brucine is a power- ful local anaesthetic in 5 to xo per cent, solutions on mucous membranes, and in a 20 per cent, solution on the skin. In the latter strength it has been employed with satisfaction for chronic pruritus, and in a weaker solution (5 per cent.) for inflammations about the external ear, in which Dr. Burnett claims for it more satisfactory results than are obtained with cocaine. 358 NYMPH7EA ODORATA OLIV.E OLEUM. NYMPHjEA ODORATA, Sweet-scented Water-lily (Unofficial),—is a well- known American plant of the nat. ord. Nymphaeaceae, 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 decoction of 3 j to the pint may be used in doses of %ss-j, ora fluid1 extract in doses of 3ss-j. For the physiological actions and therapeutics of this vege- table astringent see under Tannic Acid, ante, page 94. OLIV./E OLEUM, Olive Oil, (Sweet Oil, Salad Oil), is a fixed oil expressed from the ripe fruit of Olea europata, the olive tree (nat. ord. Oleacege), 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 Pahnitin (a solid oil or stearopten), which are compounds of the base Glyceryl, C3H5, with Oleic Acid, C19H3402, and Palmitic Acid, CI7H3102, respectively. It is frequently adulterated with cheaper fixed oils, especially poppy oil, lard oil, and cotton-seed oil, quantities of the latter being exported every year to Italy, whence it is returned to us as Olive Oil under a French label. (See Gossypium.) It is an ingredient of Ceratum Cetacei, Em- plastrum Plumbi, and Unguentum Diachylon, and is the source of the official Soap. Dose, 25 ss-j. Physiological Action and Therapeutics. 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 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 heat and force, and lessen the waste of nitrogenous tissue, but are unable of themselves to support life. 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. There is much clinical evidence to prove that, administered internally, it is a very effi- cient remedy in both nephritic and biliary colic; but how it acts therein has not been explained. • It is chiefly employed as a local application. Applied to burns and acute inflammatory affections of the skin it is an ex- cellent 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 desqua- mative stage of scarlet fever is a very useful and grateful application. As OPIUM 359 an antidote in corrosive poisoning it acts mechanically by protecting the mucous membrane of the stomach and preventing absorption. In phar- macy its bland, unirritating qualities have procured its common employ- ment as an ingredient of liniments, plasters, ointments and cerates, but the foreign article is so frequently adulterated with inferior oils that Cot- ton-seed Oil is now directed in its place in many official preparations. OPIUM ,—is the concrete, milky exudation, obtained by incising the unripe capsules of the White Poppy, Papaver somniferum, an annual herb of the nat. ord. Papaveracese, 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 distin- guishes 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 official process. 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 :— Morphine, C17H19N03,—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 and expectorant. Codeine, C18H21NOs,—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,—o. 15 to o. 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,—I 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, Rhceadine, Meconidine, Laudanosine, Lanthopine and Gnoscopine. Many of them are probably to be regarded as derivatives of Morphine. Besides the above-named alkaloids the most important of the constit- uents of Opium are the following acids and neutral principles, viz. : — Acids are—Meconic Acid, C7H407, 4 per cent., and Lactic Acid, C3H603, 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. 360 OPIUM Neutral Principles are—Meconin, C10H10O4, 0.01 per cent., is 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. Official Preparations of Opium. Opii Pulvis, Pozvdered Opium,—is Opium dried at a temperature not exceeding 185° F., and reduced to a very fine powder. It should contain not less than 13 nor more than 15 per cent, of crystallized Morphine, when assayed by the official process. Dose, gr. ss-iij, an average adult dose being about 1 grain. Opium Deodoratum, Deodorized Opium [Denarcotized Opium),—is powdered Opium freed from the constituents thereof which are soluble in Ether, namely Narcotine and the odorous principles, which are supposed to cause the unpleasant after-effects of the drug. It should yield 14 per cent, of Morphine, and is a good preparation, being a purified opium with a fixed morphine standard. The proprietary article named Svapnia is a similar preparation. Dose, gr. ss-iij; an average adult dose being about I grain. Extractum Opii, Extract of Opium,—an aqueous extract containing 18 per cent, of Morphine, and freed from some disturbing principles which are insoluble in water. Dose, gr-X-'j- Pilulae Opii, Pills of Opium,—each pill contains about gr. j of powdered Opium incorporated with Soap. Dose, j-iij pills. Tinctura Opii, Tincture of Opium [Laudanum),—Opium-strength 10 per cent., average Morphine-strength gr.vj (equaling gr.vijss of the Sulphate) to the fl 3. Has about gr.xliv of Opium to the § . rrpxj (gtt.xxij) = gr. j of Opium or gr.y& of Morphine Sulphate. Sixty minims yield on the average 120 drops. Dose, rtpv-xxx, according to the effect desired. Tinctura Opii Deodorati, Tincture of Deodorized Opium,—an aqueous extract is prepared and shaken with ether, which being separated the residue is dissolved in water, and enough 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 another proprietary nostrum named Papine. Opium-strength 10 per cent., average Morphine-strength gr.vj to the fl . Dose, as of Tinctura 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 I per cent., in Alcohol and White Wine. A vinous tincture decreased somewhat in strength from the wine of 1870. Dose, as Tinctura 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 Nutmeg and Sugar in Dilute Acetic Acid. Is now weaker than formerly, having the same strength and dose as Tinctura Opii. Tinctura Opii Camphorata, Camphorated Tincture of Opium [Paregoric),—has of Powdered Opium 4, Benzoic Acid 4, Camphor 4, Oil of Anise 4, Glycerin 40, Diluted Alcohol to iooo. % 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 zj—:iv. Is an ingredient of Mistura Glycyrrhizm Composita. Emplastrum Opii, Opium Plaster,—contains of Extract of Opium 6 parts, Burgundy Pitch 18, Lead Plaster 76, Water 8. Pulvis Ipecacuanhae et Opii, Powder of Lpecac and Opiiwi [Dover's Powder),— has of Ipecac 10, Powdered Opium 10, Sugar of Milk 80, rubbed together into a very fine powder. Dose, gr.v-xv ; ten grains equalling 1 grain each of Ipecac and Opium. Tinctura Ipecacuanhae et Opii, Tincture of Lpecac and Opium,—has of Tincture of Deodorized Opium 100 evaporated to 80, Fluid Extract of Ipecac 10, Diluted Alcohol to 100. Is intended to represent Dover’s Powder in liquid form. Dose rt^v-xv. Trochisci Glycyrrhizae et Opii, Troches of Glycyrrhiza and Opium,—each troche contains of powdered Opium gr. y with Extract of Glycyrrhiza, Acacia, Sugar and Oil of Anise. Dose, j-iv troches. [Note.—According to the U. S. Pharmacopoeia of 1890 the official dried Opium should contain 13 to 15 per cent, of Morphine instead of 10 per cent, as required by the Phar- macopoeia of 1870. The liquid preparations, except Paregoric, are now directed to be of OPIUM 361 the uniform Opium-strength of 10 per cent., and to yield, on being assayed, 1.3 to per cent, of crystallized morphine, making the Wine less strong by 2 per cent., the Acetum fully less in strength, and the other liquid preparations stronger by ]4 in Mor- phine than formerly. So that if the full anodyne dose of Tincture (1870) be taken at 24 minims, equalling gr. % of Morphine Sulphate, the corresponding dose under the present system will be 16 minims.] Morphina, Morphine, CnH19N03 H20,—white, prismatic crystals, or fine needles, or a crystalline powder, odorless, of bitter taste and alkaline reaction, almost insoluble in W'ater, soluble in 300 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. 5'— gr. j. Gr. is about equal to one grain of Opium of medium Morphine-strength. [Compare Morphines Sulphas, below.] Morphinse Acetas, Morphine Acetate,—a white, crystalline or amorphous powder of faintly acetous odor, bitter taste, neutral or faintly alkaline reaction, soluble when fresh in 2)4 of water and in 47.6 of alcohol at 590 F. Dose, gr.^-j. Morphinse Hydrochloras, Morphine Hydrochlorate,—white, feathery crystals of silky lustre, of bitter taste and neutral reaction, soluble in 24 of water and in 62 of alcohol at 590 F. Dose, gr. Morphinse Sulphas, Morphine Sulphate,—white, feathery, acicular crystals of silky lustre, of bitter taste and neutral reaction, soluble in 21 of water and in 702 of alcohol at 590 F., and in o. 75 of boiling water. Contains about 80 pdr cent, of Morphine. Dose, gr. 2g-gr. j ; being a small dose for an adult, a moderate one, X—X a dose, and )4~) a large one. Pulvis Morphinse Compositus, Compound Powder of Morphine {Tully's Pow- der),—has of Morphine Sulphate 1 part to 19 of Camphor and 20 each of Liquorice and Calcium Carbonate. A similar preparation to Dover’s Powder minus the Ipecac. Dose, gr. v-xv, ten grains containing gr. of Morphine Sulphate. Trochisci Morphinse et Ipecacuanhse, Troches of Morphine and Ipecac,—each troche contains gr. M of Morphine Sulphate with about gr. yk of Ipecac, also Sugar, Oil of Gaultheria and Mucilage of Tragacanth. Dose, one every hour or so; cautiously with children. Injectio Morphinse Hypodermica, Hypodermic Injection of Morphine (B. P.),— is a solution of the Acetate, containing gr.j. in each ten minims, being thrice as strong as Magendie’s solution. Dose, rip, j-iij. Tinctura Chloroformi et Morphinse, Tincture of Chloroform and Morphine, (B. P.),—a substitute for Chlorodyne. See ante, page 227 and also the table on Chlorodyne in the Appendix. Official Preparations of Morphine. Unofficial Preparations of Opium and Morphine. Liquor Opii Compositus, Compound Solution of Opium (Squibb),—has the same strength as the official tinctures, namely gr.vj of Morphine (equalling gr.vijss of the Sulphate) to each fluidounce. npxvj = gr. of Morphine Sulphate. Tinctura Opii Composita, Compound Tincture of Opium {Squibb's Diarrhoea Mix- ture),—has of Tinct. Opii, Spt. Camphorse and Tinct. Capsici of each, Purified Chloroform 3 iij, Stronger Alcohol q. s. ad p v. Each fl 3 or teaspoonful contains about 100 drops or ttpxij 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 3 j. Liquor Morphinse Sulphatis, Solution of Morphine Sulphate {Magendie's Solu- tion),—has gr. xvj of Morphine Sulphate in each flf, or gr.j in rtpxxx, or gr. f in trp vijss. If made with Benzoic Acid, the solution will not spoil, and is not irritant hypo- dermically. The same result is attained by adding of Carbolic Acid, rrpiij to the . Oleatum Morphinse, Oleate of Morphine,—Morphine-strength 10 per cent, with Oleic Acid 90. For local use. Liquor Opii Sedativus, Sedative Solution of Opium (Battley's Sedative'),—is about 50 per cent, stronger than the tincture of opium. It was formerly a favorite prepara- tion. 362 OPIUM Dalby’s Carminative,—contains Opium, about gr.£ to the ounce, also Oil of Pep- permint, Nutmeg, Anise, and Magnesium Carbonate. Godfrey’s Cordial,—contains Laudanum, Sassafras and Treacle, its opium strength being to the ounce. Nepenthe,—is a purified alcoholic solution of Morphine Meconate in sherry wine. Chlorodyne,—(see ante, page 227, and Appendix),—contains Morphine in varying proportion, that of J. Collis Browne having gr.vj to the ounce. Mrs Winslow’s Soothing Syrup,—contains Morphine, with Essence of Anise and Syrup of Tolu. After years of persistent denial, its proprietors have recently admit- ted that it contains grain of Morphine in each fluid-ounce (Squibb). Official Derivative of Morphine. Apomorphinae Hydrochloras, Apomorphine Hydrochlorate, C17H17N02HC1,—is the hydrochlorate of an artificial alkaloid (Apomorphine) which is prepared from mor- phine or codeine by the action of strong acids or zinc chloride, the morphine losing in the process a molecule of water. The Hydrochlorate occurs in minute, colorless crystals, odorless, of bitter taste, and neutral or faintly acid reaction ; soluble in about 45 of water and in the same quantity of alcohol at 59° F-, almost insoluble in ether or chlo- roform ; decomposed by boiling water or boiling alcohol. Dose, gr. to tV hypoder- mically, gr. y to \ by the mouth. For young children, gr. N to 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 prevent decomposition. Preparations of Other Alkaloids. Codeina, Codeine, C18H21N03 -f- 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 is sufficiently soluble for hypodermic use, and comparatively unirritant. One part in twenty of water forms the usual solution for hypodermic employment. Narcotinae Hydrochloras, Narcotine Hydrochlorate (Unofficial),—Dose, gr.ij-x, as an antiperiodic. 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 Ferric Chloride (meconic acid); forms precipitates with Lead Acetate and Subacetate, Silver Nitrate, 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 nar- cotine). 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. Vaughn has shown that certain intestinal ptomaines will give the same reactions with these reagents. OPIUM. 363 Physiological Action. Opium is analgesic, hypnotic, antispasmodic, diaphoretic and narcotic. It first stimulates and afterwards depresses the cerebrum, heart and respir- atory apparatus, 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 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 functions 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 paraly- sis 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 coma produced by opium-narcosis, when deep and when a history of the case cannot be obtained, is almost impossible of differential diagnosis from that due to alcohol, apoplexy, uraemia, epilepsy, etc. [See under Alcohol, ante, page 1x4.] The odor of the breath may point to laudanum or some other preparation of opium. The pupils are very much contracted in opium poisoning (also from physostigma and chloroform), but 364 OPIUM they may dilate just before death (as with chloroform), due to the irritation of the centres by the excessive venous condition of the blood. In alcoholic coma they may be either contracted or dilated ; and in apoplexy generally they are unequally contracted, though in apoplexy of the pons varolii they may be equally and minutely contracted. The rectal temperature may be an important sign, for in most cases of apoplexy there is an initial fall of temperature with a subsequent rise. A previous history of convulsions points to epilepsy, and the presence of albumen in the urine, with sometimes oedema of the legs, indicates uraemia as the cause of the coma. 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 im- paired,—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. 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 diabe- tics, when the drug is given by the stomach. The vaso-motor centre is slightly, if at all, affected by small doses of Opium, but large doses paralyze it. On the vessels of the skin the first effect of the drug is to cause their dilatation, shown by turgescence of the vessels of the external ear and a sense of heat therein, and often giving rise to a roseolous cutaneous eruption accompanied by itching. The long-continued use of opium causes a marked contraction of the capillaries and arterioles throughout the body, the skin is excessively pale and the subject always feels cold at the ordinary temperature of the atmosphere. 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, but the female organs of generation suffer atro- phy from its long continued use. In one case, intra-uterine measurements, taken during a period of two years, showed a diminution in the size of the cavity from 5.1 to 1.9 inches. 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 les- sening their demand for blood. Its constipating action is shown experi- OPIUM. 365 mentally to be produced by stimulation of the inhibitory nerves of the intestines through the splanchnics. Morphine was discovered bySerturner in 1817. Its action is generally similar to that of Opium, it being the principal alkaloid therein, but when used by itself its influence is not complicated with the effects of the con- vulsive alkaloids (thebaine, codeine and narcotine) which must influence the action of opium to a considerable degree. As compared with the latter, Morphine acts more quickly, and for a shorter time, has less influ- ence on the intestines and skin, is less constipating, less stimulating, less convulsant and less diaphoretic, but more sedative, more anodyne and hypnotic and produces more intense pruritus. Its elimination commences quickly but may not be completed for as much as 48 hours, and is effected by the intestines, the urine, and the salivary glands. It is also eliminated by the gastric mucous membrane, and constantly reappears in the stomach until finally excreted. When injected hypodermically more than one-half the amount administered may be recovered by repeatedly washing out the stomach. It is probably retained in the organism to a great extent when the action of the kidneys is defective, and when given continuously in renal disease may accumulate with fatal result. Apomorphine in dose of gr. y1 given hypodermically 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. Jy having caused death in a weak adult by cardiac failure), and produces paralysis of the motor and sensory nerves, delirium, convul- sions, and depression of respiratory power. Small doses (gr. given by the mouth are expectorant. Morphine in solution kept for a long time may become changed into Apomorphine. Codeine differs chemically from Morphine in having the radical methyl (CH3) replacing an atom of hydrogen, and may be considered a methyl- morphine. Like all methyl compounds it possesses motor-paralyzant power, like that of Curare. On man it has some hypnotic action, but far less than that of morphine. It exalts the spinal cord more than mor- phine does, producing muscular tremor in excess of its sedative action. It has a special sedative influence on the pneumogastric nerve, contracts the pupils, and is remarkably analgesic to the nerves of the abdominal and pelvic viscera. When administered for several consecutive days it lessens the irritability of the digestive tract to such an extent that arsenic produces neither vomiting nor purging (Murrell). It markedly reduces the amount of sugar excreted by diabetes, but has no advantage over mor- phine in that respect. Narcotine should be named Anarcotine, as it has little or no narcotic power. It is a convulsant in animals and an antiperiodic in man. 366 OPIUM, Narceine is said by some observers to be remarkably hypnotic, and free from convulsant action—by others equally deserving of credit it is considered almost inert. This alkaloid is difficult to obtain pure ; hence the samples heretofore used have probably been contaminated with other alkaloids. It is said to possess laxative properties. Thebain'e is a powerful convulsant, exalting the spinal cord almost like Strychnine and Brucine. It is not used medicinally. Cryptopine is said to dilate the pupils, a remarkable property, if true. P'atal Doses. In a child one day old TT\J 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. of Morphine in one case, and gr. iv of crude Opium in another, have proved fatal. Antidotes, Antagonists and Treatment of Poisoning. Potassium Permanganate is the best antidote to Opium or Morphine in the stomach, given in dose about one-half greater than the quantity of morphine present, and repeated in less quantity from time to time in cases where the poison has been administered hypo- dermically so as to neutralize the morphine excreted by the gastric mucous membrane. If an Opium preparation has been taken, or the alkaloid Morphine itself, Vinegar should be added to the permanganate solution in order to convert the alkaloid into a soluble salt. [For other antidotes see the Appendix.] 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. hypodermically every 15 minutes for three doses, is generally sufficient. It is unsafe to be guided in this respect by the pupils. Caffeine is also physiologically antago- nistic, and is generally used in the form of strong black coffee frequently administered. The Chief Indications in opium or morphine poisoning are—to antidote any of the poison in the stomach, and to wash out that viscus repeatedly at short intervals, to main- tain respiration and keep up the circulation. [See the Appendix for minute directions.] 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. Capsicum, the tincture, by injection into the rectum, is said to give almost instantaneous results in antagonizing the stupor of opium poisoning. Therapeutics. The chief indications for the use of Opium are (x) 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- OPIUM 367 nitis and inflammations of other serous membranes, used freely even to 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. with gr. 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 chronic mania and melancholia, nervous prostration and the delirium of fevers, Opium is probably one of the best hypnotics. In acute mania it does not act nearly so well as Hyoscine, and in delirium tremens it should only be used in cases which show great prostration, and then for temporary effects alone, as a stimulant. In chronic melancholia small doses of Opium three times a day give better results than any other treatment. Severe pain from any cause (except cerebritis) is relieved by Opium with an efficiency possessed by no other drug, as the pain of sci- atica, 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 expectoration it should not be used, as the lowering of excitability of the respiratory cen- tre 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 circulation 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 even 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 cardiac disease, especially aortic stenosis or insufficiency, with dyspnoea, paroxysms of angina pec- toris, or signs of cerebral anaemia,—Morphine hypodermically presents the greatest advantages. Apomorphine, though a derivative of Morphine, is neither hypnotic nor narcotic in any degree. Administered by the mouth in small doses (gr. -5-5—zV) it a valuable expectorant and given hypodermically in doses of gr. * it is a powerful emetic. Its therapeutic value depends on these two properties and has many applications in practice. As an emetic it is of much service in poisoning, especially when swallowing is difficult, and it may be used with advantage in narcotic poisoning before narcosis has blunted the vagus centre. It is a very valuable agent in any case of poisoning where time is of great importance. As an expectorant it is one of the most efficient and useful agents at our command. In catarrh 368 OPIUM of the bronchi gr. fa by the mouth every three or four hours is very beneficial, but the drug must be used in all cases with caution, especially in young children, who bear it very badly. In hacking coughs without expectoration it will prove very serviceable, if given in very minute doses, not exceeding gr. in the entire 24 hours. In phthisis it may be given in combination with morphine with great advantage, especially in cases where there is dyspnoea, continual and harassing cough, and thick, tena- cious expectoration. The two agents do not destroy each other’s action, but from the combination we get increased secretion from the mucous membrane, with diminished irritability of the respiratory centre and con- sequently lessened cough (Brunton). Apomorphine has been used success- fully, by hypodermic injection, as an antidote to strychnine in dogs; and in one case, in which it was given in mistake for morphine, it entirely dissipated an acute and severe attack of sciatica. Codeine is much employed as a palliative for cough, especially the irritable, hacking cough of phthisis unaccompanied by much expectora- tion. It seems to have a special influence on the nerves of the larynx, and will relieve a tickling cough better than any other form of opium, if given in one dose of gr. y an hour before bed-time. In vomiting from almost any cause, doses of gr. y, repeated two or three times at hourly intervals, are usually very efficient. In the milder forms of diarrhoea, gr. y to gr. j will generally check the disorder without inducing any un- pleasant after-effects. In diabetes Codeine lessens the amount of sugar in the urine and often removes it entirely therefrom, but it must be given in large doses, beginning with gr. ij-iv, and rapidly increasing to gr. xv or xx. It is highly efficient in abdominal and pelvic pain, especially when ovarian in origin. Applications of the Various Preparations, 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. Intense pain, as from the passage of calculi, is best met by the hypodermic injection of Morphine Sulphate in full doses (gr. y~y) with Atropine Sulphate (gr. T-^T). Either the solution of Morphine or the liquid preparations 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. Sedative action is obtained by different preparations for different organs. The stomach is best affected by the Solution of Morphine in effervescing OPIUM 369 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. j to gr. ij for an adult in severe pain. To produce sleep the most efficient preparations are the Tinctures, the Solution of Morphine, Pil. Opii and Dover’s Powder, in doses corre- sponding to the degree of insomnia and restlessness present. Cough is relieved by the two Trochisci, the Tinctures, and by the Solu- tion of Morphine in small doses with Syrup of Wild Cherry or Syrup of Tolu ; also by Codeine in the last-named Syrup. Diaphoresis is obtained by the use of Dover’s Powder in either of its forms. A dministration. 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 other 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 administra- tion, which may even produce alarming symptoms of collapse. In sub- jects 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 Spiritus Athens Compositus, or Spiritus iEtheris Nitrosi, an equal part with Tinctura Opii Deodorati, will prevent the nausea often excited by the latter, and correct the “ drying up ” effects of opium, due to its checking secretion. 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. 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 pro- 370 ORIGANUM OXYGENIUM. cedure 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- °f the former. By this means the anodyne and hypnotic qualities of Morphine are increased, while the nausea and depression with the subsequent dys- pepsia and constipation due to it are avoided. Moreover, as in the doses above mentioned Atropine is a cardiac and respiratory stimulant, it will counteract the depressing tendency of Morphine on the heart and respi- ration in subjects who have undue susceptibility to its action. ORIGANUM, Wild Marjoram (Unofficial),—is the plant Origanum vulgare, a perennial herb of the nat. ord. Labiatse, native of Europe and America. 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 superseded by the Oil of Thyme. Origanum is an ingredient of Vinum Aromaticum. Dose, gj-ij, in infusion. Origanum is gently tonic, also carminative, stimulant, and emmenagogue. It was formerly much employed as a diaphoretic, etc., but is now rarely administered. OXYGENIUM, Oxygen, O. This element is not official though it is extensively used in medicine. Its two combinations with Hydrogen, Water, H20, and Hydrogen Dioxide, H202, are official, as are also nine other Oxides, namely—those of Antimony, Barium, Ethyl, Iron, Lead, Manganese, Mercury, Silver and Zinc. It enters into the composition of most of the acids and their salts, many of the organic bases, and all the alkaloids except a few. Oxygen is the most universally diffused element in nature, forming about one-fifth of the atmosphere, one-third of water, and a great part of the earth and of the tissues of plants and animals. It is a colorless, odorless, and tasteless gas, of sp. gr. 1.1057, and can be liquefied by subjection to extreme cold and pressure combined. It was discovered by Priestly in 1774, and given its name, Oxygen (acid producer) by Lavoisier in 1778. It may be obtained pure from many of its combinations, but is usually prepared by heat- ing Manganese Dioxide or Potassium Chlorate, or preferably both together. It is furnished by manufacturing chemists in all large cities, compressed in iron cylinders furnished with a rubber bag and mouth-piece by which to administer it. Ozone, 03 (Unofficial),—is an allotropic form or condensed condition of Oxygen, three atoms of which are contained in a molecule of the former, instead of two as in the molecule of oxygen. Ozone exists in the atmosphere in the general proportion of 1 part in 10,000, but it is more abundant in the open country and on the ocean than in the air of cities. It is formed when an electric spark is passed through air, being then manifested by its peculiar smell. In the sick-room it may be pro- duced by dissolving in water a mixture of Manganese Dioxide, Potassium Permanganate and Oxalic Acid. Official Preparations. Aqua Hydrogenii Dioxidi, Solution of Hydrogen Dioxide (Solution of Hydrogen Peroxide'), commercially known as “ Peroxide of Hydrogen,”—consists of water to which nascent oxygen has been presented, whereby an additional atom thereof has entered into OXYGENIUM. 371 combination with the hydrogen, producing H202. It is officially described as a slightly acid, aqueous solution of Hydrogen Dioxide, containing when freshly prepared about 3 per cent, of the pure dioxide, corresponding to about 10 volumes of available oxygen ; and is directed to be prepared by agitating Barium Dioxide in cold distilled water, add- ing Phosphoric and Dilute Sulphuric Acids, filtering and diluting to the required strength. The commercial article is said to contain about 15 volumes of available oxygen, and to be permanent at ordinary temperatures; but it undergoes decomposition in time, especially if agitated. It occurs as a colorless liquid, without odor, slightly acidulous, producing a peculiar sensation and soapy froth in the mouth, of sp. gr. 1.006 to I.OI2 at 590 F., and liable to deteriorate by age, heat or protracted agitation. Dose, 3 j—iij, diluted with 3 to 4 parts of water. Aqua, Water, H20,—is described under its own title. Oxides of Antimony, Ethyl, Iron, Lead, Mercury, Silver and Zinc, and the Dioxides of Barium and Manganese, are described under the titles of their respective metallic bases. Unofficial Preparations. Glycozone is claimed to be a stable compound resulting from the reaction between chemically pure glycerin and 15 times its volume of ozone; and not a mixture of hydro- gen dioxide with glycerin. It is very hydroscopic, and must be kept tightly corked, to prevent deterioration. It is said to act upon diseased tissue in the same manner as Hydrogen Dioxide (which see), but more slowly; and may be used in full strength as an application to wounds and suppurating surfaces, to stimulate healthy granulations, and generally as an antiseptic surgical dressing. It is mixed with water (1 to 10) as a rectal injection; and maybe administered internally, in doses of 3 j—ij in a wineglassful of water, in gastric affections,—as dyspepsia, pyrosis, ulcer and catarrh of the stomach. Pyrozone is the name given by a well-known manufacturer to a concentrated solution of Hydrogen Dioxide in Ether. It professes to contain about 50 per cent, of the dioxide, and is a very potent and efficient oxidizer, intended for external use only. It has abund- ant applications in the practice of surgeons. (Squibb.) Sanitas is a proprietary solution for disinfecting purposes, containing Hydrogen Diox- ide, and described under Terebinthina. Physiological Action. Oxygen is essential to respiration, blood-formation, nutrition and tis- sue-change, in fact, to life itself, and to fully describe its physiological ac- tion would involve a complete description of these processes, which would be a treatise on physiology. Applied to the unbroken skin it has no ap- parent effect, but when applied to a wounded tissue it increases the circu- lation therein and acts as a stimulant. Inhaled in the pure state (not as air) it causes very little constitutional disturbance. A slight sense of heat is felt in the mouth and may extend downward along the larynx, trachea and bronchi. The pulse is usually quickened, but it may be lessened in frequency, the appetite is increased, the temperature is slightly raised and the cardiac action is stimulated, and a sense of mental exhilaration and a disposition to greater bodily activity are produced, but no constant in- fluence on the excretions has been noticed. In some persons it seems to cause nervous symptoms similar to those produced by nitrous oxide gas (Brunton). Ozone is a powerful oxidizing and destructive agent. It attacks metals, destroys organic substances and the coagulability of albumen and decom- poses blood. It is highly irritant to the tissues, and sets up an acute ca- 372 OXYGENIUM. tarrh of the respiratory mucous membrane if inhaled in quantity. When present in small quantity in the air it is breathed without any unpleasant effects and is decidedly soporific (Binz). It is exceedingly poisonous to low organisms, and is therefore an energetic antiseptic and disinfectant. In animals it sometimes quickens and often slows respiration, and pro- duces excitement followed by exhaustion, sometimes by convulsions, and death. Hydrogen Dioxide, in fresh solution, is one of the most powerful oxi- dizing agents known, by reason of the facility with which it parts with oxygen to oxidizable substances brought in contact with it. It is, con- sequently, a powerful, yet non-toxic antiseptic, destroying morbid pro- ducts and organized ferments to which it is applied. In contact with a suppurating surface, it generates a white foam, as the result of its action on the pus. This soon subsides, leaving the subjacent tissue cleansed of all morbid secretions. One part added to 1000 of water containing sew- age or infectious microbes, is sufficient to destroy the various organisms therein, if allowed to act thereon for 24 hours. Therapeutics. Oxygen is efficient as an application to the surface in atonic, scrofulous, and syphilitic ulcers, also in cases of senile and other forms of gangrene. Its application to the scalp, by means of a rubber cap fitted to the head, has restored the hair in a case in which it was lost by reason of alopecia areata. Its principal use has been in cases of disease of the respiratory apparatus characterized by dyspnoea, as emphysema, bronchial dilatation, phthisis and gangrene of the lungs, also spasmodic asthma, and asphyxia from the inhalation of toxic gases or due to opium and chloroform nar- cosis. It has been employed with benefit in uraemic coma, and in the dyspnoea of cardiac disease and that of anaemia from loss of blood or from protracted suppuration. It has given good results in diseases char- acterized by defective oxidation, as gout and diabetes; in the latter af- fection the sugar sometimes disappears entirely from the urine during its inhalation. It has been used in the treatment of epilepsy and spasm, and is recommended in cholera. Ozone has been recommended in cases similar to those for which oxy- gen is used; also in infectious diseases, as diphtheria, in which it is ex- pected to destroy the pathogenic microbes exposed to its influence. Hydrogen Dioxide in solution has long been employed as a bleaching agent for delicate fabrics, and on the human hair for the production of the “ bleached-blonde ” hue so fashionable lately in certain circles of society. As a cleansing agent for foul wounds, ulcers, sores, and the like, it is highly efficient; and has been used with great benefit as a gargle or spray to the throat and nasal passages, in quinzy, croup, diphtheria, scar- PARALDEHYDUM. 373 let fever, ozaena, and other morbid conditions of these parts. As a diag- nostic agent in determining the presence of pus, it is injected into the part in which suppuration is suspected, and indicates its contact with pus by causing an almost immediate swelling up of the part. If such a spot is cut into at once, pain is not felt. In this manner a number of suppu- rating buboes have been treated with great success. As a disinfectant of drinking water suspected of pollution it is highly recommended, as it does not impair the taste or other potable qualities of the water, in the small quantity (1 to 1000 parts) needed for its efficient action. Used internally, it imparts oxygen to the blood, improves digestion, and relieves spasm of the respiratory apparatus,—aborting the paroxysms of whooping-cough. It gives great relief in chronic bronchitis with dyspnoea, and operates well in phthisis by promoting digestion, palliating cough, and giving increased activity to chalybeate remedies. PARALDEHYDUM, Paraldehyde, C6H1203,—a polymeric modification of Ethylic Aldehyde, (C2H40),—is a colorless liquid (at ordinary temperatures), obtained by treating Aldehyde with dilute sul- phuric or nitric acid; aldehyde being the oxidation product of alcohol just preceding the formation of acetic acid. When cooled to 320 F. Paraldehyde solidifies to a crystalline mass, which becomes liquid again at 510 F. It is soluble in 8}4 of water, and miscible, in all proportions, with alcohol, ether, and fixed or volatile oils. The dose of Paraldehyde may be placed at £ ss- 3 ijss, but the latter quantity has fre- quently been exceeded without any ill effects, with no digestive or cerebral disturbances following, nor any unpleasant symptoms resulting, other than a disagreeable odor to the breath. Very few cases of poisoning therefrom, acute or chronic, are recorded. One case, under treatment by Dr. Mackenkie, of Douglas, in the Isle of Man, recovered from a dose of 3)4 ounces, after 34 hours of sleep, furnishing “a striking testimony to the safety of Paraldehyde as a hypnotic.” The average hypnotic dose for an adult is about 3jss, given in gj of simple elixir. Physiological Action and Therapeutics. Paraldehyde is a reliable hypnotic, almost equal in this respect to Chloral, though its hypnotic action is not so persistent as that of the latter drug, and it requires more frequent repetition to produce sustained sleep. It is also diuretic but not diaphoretic, and is unquestionably safer than chloral, strengthening and slowing the heart’s action, instead of weaken- ing it. Its administration is followed by a well-marked stage of excite- ment, after which it produces a sound sleep, which is described as refresh- ing. It does not interfere with the appetite or digestion, but occasionally causes an erythematous eruption ; and may give rise to cerebral conges- tion and vaso-motor paralysis, if used for any long period of time. A toxic dose paralyzes the medulla and the respiratory centre therein. 374 PAREIRA PEPO. Paraldehyde is used as a hypnotic in fevers, rheumatism, acute mania, hysteria and insomnia from various causes. Several cases of tetanus have been treated successfully with it, and it has lately been found useful as a diuretic and hypnotic in a case of senile arterial degeneration with double aortic and mitral regurgitant murmurs, mental depression and very marked insomnia and restlessness. Cases of Paraldehyde habit are occasionally seen, and exhibit a train of symptoms similar to those observed in delirium tremens. There is great emaciation and anaemia, weak and irregular action of the heart, a soft and intermittent pulse, general muscular weakness, tremulousness and restlessness, the gait feeble and unsteady, mental anxiety, agitation and confusion, temporary loss of memory and incoherent speech, also hallucina- tions of sight and hearing and delusions, all of an unpleasant kind. There is marked gas- tric derangement, but an abnormally large appetite, excessive flatulence and constipation. The treatment of such a case generally takes about three months, and should be con- ducted in an inebriate asylum. PAREIRA, Pareira (Pareira Brava),—is the root of Chondoden- dron tomentosum, a climbing, woody vine of the nat. ord. Menispermacese, with very large leaves and grape-like fruit, inhabiting Peru and Brazil. It contains Pelosine or Cissampeline, an alkaloid identical with the Ber- berine of Nectandra and the Buxine of Buxus sempervirens (Boxwood). Several other Pareiras are on the market, that from the West Indies (Cis- sampelos Pareira) being the plant formerly official in the British Pharma- copoeia. Extractum Pareirse Fluidum, Fluid Extract of Pareira.—Dose, Infusum Pareirae, Infusion of Pareira (Unofficial),—1 in 17. Dose, J j-ij. Preparations. 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 gonor- rhoea 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 oiCucurbita Pepo, or common Pumpkin (nat. ord. Cucurbitacese). The active principle is a resin contained in the endopleuron or en- velope 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, 3 j—ij, beaten up into an emulsion with sugar and water. Pumpkin-seed is an efficient agent for the removal of tapeworm (a tseniafuge), and its use is not followed by unpleasant symptoms. The outer coat of the seed should be removed, and an emulsion then made by trituration with sugar and water. This, if taken on an empty stomach and followed by a brisk cathartic, will generally prove effective. Dr. PEPSINUM. 375 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 ss repeated twice or three times, and followed 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 various preparations, official and unofficial, being mere approximations, and varying much from each other. It is officially described as a proteo- lytic ferment or enzyme, obtained from the glandular layer of fresh stomachs from healthy pigs, and capable of digesting not less than 3000 times its own weight of freshly coagulated and disintegrated egg albu- men, when tested by the official process. Pepsin is a fine, white, or yellowish-white, amorphous powder, or thin, pale-yellow, translucent grains or scales, free from any offensive odor; soluble in about 100 of water, more soluble in water acidulated with HC1, insoluble in alcohol, ether or chloroform. It usually has a slightly acid reaction, and may be neutral,'but should never be alkaline. Commercial Pepsin is 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. It is then precipitated by Chloride of Sodium {Scheffer), Acetate of Lead (.Bon- dault), 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. Jensen’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. Pepsinum Saccharatum, Saccharated Pepsin,—is Pepsin I, triturated with 9 of Sugar of Milk. One part should digest at least 300 parts of .egg-albumen, when tested by the official process. Dose, gr.v-sjj, shortly after meals. Liquor Pepsini, Liquid Pepsin (Unofficial),—contains of Saccharated Pepsin 40 parts, Hydrochloric Acid 12, Glycerin 400, Water q. s. ad 1000 parts. Dose, 3 ij-iv, after meals. Every manufacturer of Pepsin has his own preparation, and his peculiar name there- for, such as “ Liquid Pancreopepsine,” “ 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. Lactopeptine (Unofficial),—is claimed to contain Pepsin, Diastase or Ptyalin, Pan- creatin, Lactic and Hydrochloric Acids, and that will digest viij-x of albumen, fibrin, casein, or gelatin, will emulsionize of cod-liver oil, and convert J;iv of starch into glucose. A proprietary preparation. Dose, gr.v-xv. Peptenzyme (Unofficial),—is prepared from the peptic, pancreatic, salivary, Lieber- kuhn’s and Brunner’s glands and the ferment extract of the spleen and liver, slightly benzoated and mixed with sugar of milk and citric acid. It is claimed for it that it con- tains the active ferments and undeveloped (“mother”) enzymes of all the digestive organs or glands, in the same physiological condition as they exist in nature ; that it digests food in an acid, an alkaline or a neutral menstruum; and that it will digest all kinds of food. It is best administered before meals. Preparations. 376 pepsinum. Analogous Products. Pancreatinum, Pancreatin,—is officially described as a mixture of the enzymes naturally existing in the pancreas of warm-blooded animals, usually obtained from the fresh pancreas of the hog (Sus scrofa). It occurs as a yellowish-white or grayish, amorphous powder, of faint odor, and meat-like taste ; slowly soluble in water, insoluble in alcohol. It consists of four ferments, viz. : (1) Trypsin, the proteolytic ferment, (2) Pancreatic Diastase, the amylolytic ferment, (3) a fat-emulsifying, and (4) a milk-curdling ferment. Besides the above-described official form it is marketed in various preparations, as Pancreatic Emulsion, and the fol- lowing— Liquor Pancreaticus, Pancreatic Solution (Unofficial),—prepared by digesting a finely-chopped pig’s pancreas with 4 times its weight of dilute alcohol. It is a nearly clear alcoholic solution, with little taste or smell. Dose, 3 j- ss. Ingluvinum, Ingluvin (Unofficial),—is obtained from the gizzard of the domestic fowl, and owes its activity to a peculiar, bitter principle, and not to any ferment corresponding with pepsin. Dose, gr. x-xxx. Unofficial Vegetable Digestives. Papain, Papaiva,—is a vegetable ferment obtained from the milky juice of Carica Papaya, a S. American fruit-tree of the nat. ord. Papayaceae. It is soluble in water but not in alcohol, and has active digestive powers. It is composed essentially of a mixture of vegetable globulin, albumoses and peptone, with which are associated the ferments characteristic of the preparation. It is marketed under the name Papoid. Dose, gr. j-iij. 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. Bromelin,—is an active digestive ferment contained in the fresh juice of Ananassa Saliva, the Pineapple. It is more nearly related to trypsin than to pepsin, and is de- cidedly active in the presence of either acids or alkaline carbonates, but is most energetic in neutral solutions, and is a very constant and powerful digestant of vegetable and animal proteids. Dose of the fresh juice, Physiological Action and Therapeutics. 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 cavities, as the rectum, if warmth, acidity and moisture are 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 Pancreatin after that period, to be effective. Alcohol destroys the activity of pepsin, Alkalies and many mineral salts precipitate it. 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 the vomiting of pregnancy. It is added to nutritive enemata, PETROLATUM. 377 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. Pancreatin digests albuminoids and converts starch into sugar and proteids into peptones, also emulsifies fats in the presence of an alkaline solution (Pepsin requiring an acid one). Prolonged contact with mineral acids renders it inert. It is digested by pepsin, and hence probably never passes into the duodenum in its own character. Pancreatin is used to partially digest (peptonize) milk, gruel, soups, and other foods, before their administration in cases of great digestive debility. These peptonized foods may be administered by the stomach or the rectum, and are valua- ble in intestinal dyspepsia, wasting diseases, and convalescence from acute affections. A teaspoonful of Pancreatin solution taken after the adminis- tration of Cod-liver Oil will prevent the disagreeable 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. It affects albuminoids even in a slightly acid solution. Ingluvin is particularly useful against vomiting and has been found exceptionally efficient in the vomiting of pregnancy, given in 20-grain doses before meals. Papain, (Papoid), has the power of digesting to a greater or less extent all forms of proteid or albuminous matter, both coagulated and uncoagulated. It is peculiar in that its digestive power is exercised in either acid, alkaline or neutral media, in which respect it differs greatly from the other digestive ferments. It acts more rapidly than Pepsin and at higher temperatures. It is a rapid solvent of false membranes and intestinal worms; and has been injected into neoplasmic tumors, dissolving their tissues in its immediate vicinity, but with much pain and considerable febrile reaction. Papoid has been used as a paste locally in diphtheria, to destroy and remove the false membrane ; internally, in gastric and gastro-intestinal catarrh, the diarrhoea of infancy, and various dyspeptic con- ditions, with very great success. Its power over both gastric and intestinal indigestion renders it much more useful than either pepsin or pancreatin in cases of doubtful diag- nosis, in which it is difficult to decide as to the location of the trouble. Papoid may be obtained in powder or tablets, either alone or in combination with Sodium Bicarbonate, Boracic Acid, and Nux Vomica ; also as a glycerole, which is said to be a permanent liquid preparation. The dose of Papoid is from I to 3 grains, but 5 grains or more may be given in special cases. Pineapple Juice is one of the most efficient digestive aids at our command, and has the advantage of being pleasant to the patient. The author directs the fruit to be cut into slices as required, and the juice to be squeezed out immediately before administra- tion. It has long been used by the natives of South Africa as a remedy for diphtheria and diphtheritic sore throats with unusual success, according to the testimony of competent observers; and has been employed by Dr. Chambers, the Coroner of Calcutta, in this disease with marked benefit. He has the patient sip the juice all day at short intervals, or else masticate slices of the fruit and swallow the juice; but as he employed Papaya fruit in the same cases, it is impossible to give all the credit of his success to the pine- apple. PETROLATUM, —is a mixture of hydrocarbons, chiefly of the marsh-gas series, obtained from Petroleum, by distilling off the lighter 378 PHENACETINUM. portions and purifying the residue. It is colorless or yellowish in color, and in the latter case is more or less fluorescent; amorphous, odorless and tasteless, of neutral reaction, insoluble in water or alcohol, soluble in ether, chloroform, benzin, fixed and volatile oils, etc. Commercially it is known as Cosmoline, Vaselin, Petroleum Ointment, etc., and is largely prepared from residuums or sediments deposited in tanks containing crude petroleum. It is official in the following three forms, all of which, when heated, give off a faint odor of petroleum, viz. : — Petrolatum Liquidum, Liquid Petrolatum,—an oily, transparent fluid, of sp. gr. 0.875 to °-945- P.etrolatum Molle, Soft Petrolatum,—a fat-like mass, of the consistence of an oint- ment, sp. gr. about 0.820 to 0.840, melting-point between 104° and 1130 F. Petrolatum Spissum, Hard Petrolatum,—a fat-like mass, of about the consistence of a cerate, sp. gr. 0.820 to 0.850, melting-point between 1130 and 1250 F. 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. PHENACETINUM, Phenacetin, Oxy-ethyl-acetanilid, (Para- acet-phenetidin) C10H13NO2, (Unofficial),—is a crystalline substance, closely allied in chemical composition to Acetanilid, and produced by the action of glacial acetic acid on para-phenetidin, a body obtained from phenol. Phenacetin occurs in colorless, tasteless, inodorous, glistening, scaly crystals, sparingly soluble in cold water, more freely in boiling water, also in about 16 fluid parts of alcohol. Dose, gr. ij-xx;—as an antipyretic, gr. viij—x hourly or every two hours, in powder or tablets ; against neuralgia and rheumatism, gr. xv, repeated if necessary up to 3 jss in 24 hours. The physiological action of Phenacetin is analogous to that of Acet- anilid. It is probably the safest of the new synthetical antipyretics, yet in sufficiently large doses it is undoubtedly as poisonous as any of its analogues. Dr. Cerna reports a case in which a baby, five days old, re- ceived seven 2-grain doses of phenacetin in three days, by mistake for bismuth, and was deeply cyanosed for three days, and less so for nearly a month, notwithstanding the repeated employment of oxygen inhalations. There was also marked jaundice, grave anaemia, and pronounced loss of weight. Phenacetin reduces pyrexia gradually and causes perspiration without producing collapse. It is also analgesic and hypnotic in action, soothing pain and inducing sleep. It has been administered with benefit, in 2- Physiological Action and Therapeutics. PHENACETINUM. 379 grain doses with y? grain of citrated caffeine at short intervals, for mi- graine; and also in epidemic influenza, both as a prophylactic and as a remedy. As an antipyretic it is extensively employed in phthisis, peri- tonitis, polyarthritis, etc., also in endocarditis, typhus and typhoid fevers ; and as an analgesic in vaso-motor neuroses, for the lancinating pains of locomotor ataxia, and in neuralgia and hemicrania. It is highly praised in whooping-cough, rheumatic and other fevers, and, though slower in action than Antipyrin or Acetanilid, is deemed fully as efficient in reducing pyrexia, while usually free from the depressant after-effects of these latter agents. Lactophenin, Lactyl-para-phenetidin (Unofficial),—is another phenetidin derivative, containing a lactic acid constituent instead of the acetic acid one of phenacetin. Its action is antipyretic, analgesic and hypnotic; and it has been recommended as a substi- tute for phenacetin on account of its greater solubility. It has been used with especial benefit in abdominal typhus (Jaksch) ; also in acute rheumatism, chorea and locomotor ataxia (Yon Roth). Dose, gr.viij-xv or more, up to gjss daily, in wafers. Methacetin, Oxy-methyl-acetanilid (Unofficial),—derives its name from its analogy to Phenacetin, from which it differs only in containing a methyl group in place of an ethyl one. From Acetanilid it differs in the substitution of the oxy-methyl group for a hydrogen atom. It occurs as lustrous, scaly, colorless, odorless crystals ; soluble in 12 of hot water, in alcohol, chloroform, glycerin and fatty oils ; scarcely soluble in cold water. Dose, gr.iij-v, or more. Methacetin was introduced as an antipyretic for children and feeble persons, and promised at one time to supersede phenacetin. It is well borne, and no malaise, tinnitus, cardiac weakness or exanthem follow its ingestion ; but it often gives rise to a violent and exhausting perspiration. It has been used successfully in typhoid fever, all forms of rheumatism, neuralgias, pneumonia, and in most forms of pyrexia, but has not as yet equaled the results obtained by either phenacetin or antipyrin. Its employment in phthisis was not favorable, chiefly by reason of the profuse sweating induced by it. Its advantages, over all the other antipyretics of its class, are its lack of toxic properties, and its com- paratively ready solubility in water, being five times more soluble than its rival, phenacetin. Malakin, Salicyl-para-phenetidin,—is described under SALICINUM. Phenocoll Hydrochloride (Unofficial),—is another synthetical antipyretic, closely allied to Phenacetin, both chemically and medicinally, and distinguished by its com- paratively free solubility. It is produced by the interaction of Phenetidin and Glycocoll (amido-acetic acid), and occurs as a white, micro-crystalline powder, soluble in about 16 of water, therein forming a neutral solution. The pure base, Phenocoll, is precipitated from the solution by ammonia, the fixed alkalies and their carbonates. Phenocoll Hydrochloride may be looked upon as a soluble Phenacetin, 15 grains dis- solving readily in of water. With decided antipyretic, antirheumatic and analgesic powers, it possesses a marked advantage over the other members of its class, in that it has no injurious effect upon the blood corpuscles, even when in direct contact with them. It is promptly absorbed, readily excreted, and reduces the hyperpyrexia of fever without producing very profuse sweating, or other unpleasant by effects. The fall in temperature is very decided, and occurs within an hour after the administration of the drug ; being due to great diminution of heat-production, without any alteration of heat-dissipation. In ordinary doses it has no effect on the circulation, but large doses diminish the blood- pressure and reduce the pulse-rate, by stimulating the cardio-inhibitory centres. This drug has been employed, with marked success, as an antipyretic in hectic, malarial, typhoid, and other fevers: also in acute rheumatism, neuralgia, epidemic influenza, and for the neuralgic pains of the latter affection. In combination with Piperazin, 15 grains of each daily, in a pint or more of carbonated water, it has rendered excellent service in gouty and rheumatic affections, especially when accompanied with pain and fever. The same combination has proven of service in a case of obstinate gastric irritability with uncontrollable vomiting, which had resisted every known remedy. The dose is gr. v-xxx, an average dose being about 12 grains, thrice or four times a day. 380 PHOSPHORUS. 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 disulphide. It has a disagreeable odor and taste, melts at m° 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 pharma- copoeia! tests. Dose, gr. thrice daily. Pilulae 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. Oleum Phosphoratum, Phosphorated Oil,—has of Phosphorus 1 part, Ether and Expressed Oil of Almond to 100. Dose, ff\j-v thrice daily. Acidum Phosphoricum, Phosphoric Acid, and Acidum Phosphoricum Dilutum, are described on pages 91, 92, ante. Acidum Hypophosphorosum Dilutum, Diluted Hypophosphorous Acid,—a liquid composed of about 10 per cent, of the absolute acid (HPH202), and about 90 per cent, of water. Used in the preparation of Syrupus Hypophosphitum. Spiritus Phosphori, Spirit of Phosphorus (Tincture of Phosphorus'),—has of Phos- phorus 1.2, dissolved in Absolute Alcohol 1000. Elixir Phosphori, Elixir of Phosphorus,—has of the preceding 210, Oil of Anise 2, Glycerin 550, Aromatic Elixir to 1000. Each cubic cm. represents about milligramme of Phosphorus (each 3 contains about gr. Dose, 3 ss- ss. Tinctura Phosphori (Thompson's), Unofficial,—Phosphorus gr. j, Absolute Alcohol 3 v, Glycerin Alcohol 3 ij, Spt. Menthce Piperitre rt\xl. Of this 3j contains gr. of Phosphorus. Dose, 3ss-3jss. Tinctura Phosphori [Bellevue Hospital), Unofficial,—Phosphorus gr. xxxij, Absolute Alcohol xlvj, Essence of Vanilla % j, Oil of Orange 3 iij, Alcohol q. s. ad % xlviij. Of this 3j contains gr. Xxj of Phosphorus. Dose, 3ss-j. Zinci Phosphidum, Zinc Phosphide, Zn3P2,—crystalline fragments or a gray-black powder, insoluble in water or alcohol, but completely soluble in hydrochloric or sulphuric acids with evolution of hydrogen phosphide. Is very irritant. Dose, gr. tjV-zV Preparations of Phosphorus. Calcii Hypophosphis, Calcium Hypophosphite, Ca (PH202)2,—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(H2P09)s,—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, Potassium Hypophosphite, KH2P02,—white masses, or a white, granular powder, deliquescent, odorless, of saline taste and neutral reaction. Sol- uble in 0.6 of water and in 7.3 of alcohol at 590 F. Dose, gr. v-x. Sodii Hypophosphis, Sodium Hypophosphite, NaPH.,02 + H20,—small plates, or a white, granular powder, deliquescent, odorless, of sweetish, saline taste, and neutral reac- tion. Soluble in 1 of water and 30 of alcohol at 590 F. Dose, gr. v-x. Preparations of Phosphites. PHOSPHORUS. 381 Syrupus Hypophosphitum, Syrup of Hypophosphites,—has of Calcium Hypophos- phite 4^,of Potassium and Sodium Hypophospbites \ )/2 each, percent. Dose, 3j-^ss. Syrupus Hypophosphitum cum Ferro, Syrup of Hypophosphites with Iron,—has of Ferrous Lactate 1, Potassium Citrate 1, in Syrup of Hypophosphites to 100 parts. Dose, SJ-^ss. Preparations of Phosphates. Calcii Phosphas Praecipitatus, Precipitated Calcium Phosphate, Ca,,(P04)2,—a light, white, amorphous powder, odorless and tasteless, insoluble in water or in alcohol. Dose, gr. ij-x. Syrupus Calcii Lactophosphatis, Syrup of Calcium Lactophosphate,—has of the preceding 2]/2 per cent. The Calcium Phosphate is dissolved by Lactic and Phosphoric Acids, but does not form the chemical combination suggested by the title. Dose, ss. Sodii Phosphas, Sodium Phosphate, Na.2HP04 -f- I2H20,—large, colorless, mono- clinic prisms, efflorescent, of saline taste and alkaline reaction; soluble in 6 of water, insoluble in alcohol. Dose, Sodii Pyrophosphas, Sodium Pyrophosphate, Na4P207 -f- ioH20,—colorless, mono- clinic prisms, of saline taste and alkaline reaction ; soluble in 12 of water, insoluble in alcohol. Dose, gss-ljss. Syrupus Ferri, Quininse et Strychninae Phosphatum, Symp of the Phosphates of Iron, Quinine and Strychnine,—has of Soluble Ferric Phosphate 2, Quinine Sulphate 3, Strychnine -fa, Phosphoric Acid 4.8, Glycerin 10, Water 5, Syrup to 100. A power- ful tonic. Dose, gj-iij. Syrupus Phosphatum Compositus, Compound Syrup of Phosphates, Parrish’s Chemical Food, (Unofficial),—has in each 3 , of Ferric Phosphate gr. 2 f2, Calcium Phosphate gr. j. Dose, 3 j—iij. Melachol (Unofficial),—is a proprietary preparation, advertised to contain in each f3 eighty-five grains of Sodium Phosphate, with Citric Acid and Sodium Nitrate. Dose, 3 in water. Ferri Phosphas Solubilis, Soluble Ferric Phosphate, and Ferri Pyrophosphas Solubilis,—are described under Ferrum, ante, page 282. 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, but produces eructations of Hydrogen Phosphide. Its fumes cause necrosis of the upper or lower maxillae, especially in those whose teeth are decayed ; but this may be prevented by the inhalation of the fumes from old acid turpentine. In poisonous doses it is a powerful irritant of the gastroin- testinal 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 by producing fatty degeneration of the arterial walls, also rapid steatosis of the stomach, liver and heart, accompanied by 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 dis- tinguish between them. Its effect on metabolism is to increase the nitrog- enous products, to diminish the excretion of carbonic acid, to reduce the glycogen of the liver to almost nothing, and to raise the temperature. 382 PHOSPHORUS. While generally increasing metabolism it so influences that process as to arrest it at the stage of the conversion of proteids into urea and oil, in- stead of allowing it to proceed to the final oxidation of oil into carbonic acid and water, hence leading to fatty degeneration of epithelial, gland- ular and muscular protoplasm throughout the body. Calcium Phosphate is an essential ingredient of all the tissues and fluids of the body, and forms more than 50 percent, 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. Sodium Phosphate acts on the blood and on the excretion of urea similarly to the calcium salt. It increases secretion generally, especially that of the bile, being an excellent cholagogue and thereby aiding in the digestion of fats. In half-ounce doses it is laxative. It is a normal con- stituent of the blood, and possesses the property of increasing the capa- city of any fluid to hold carbonic acid in solution. The Hypophosphites are generally tonic in action, and are supposed to constitute a safer form in which to administer Phosphorus than in the unoxidized state. They are probably converted into phosphates in the stomach. Antidotes and Antagonists to Phosphorus. Antidotes are Hydrated Magnesia, Lime-water, powdered Charcoal, Copper Sulphate and old acid Turpentine. Hydrated Magnesia as a quickly-acting purgative, Lime- water or Charcoal to prevent the action of the poison on the tissues. Potassium Perman- ganate may have antidotal action. No Oils or Fats should be used, as they dissolve phosphorus and promote its absorption. Opium to antagonize the depression of the heart and system. Transftision has proved efficient when the blood is seriously affected as a result of phosphorus poisoning. Copper Sulphate, as an emetic and to form the comparatively insoluble phosphide of cop- per, also Crude French Acid Turpentine, given rapidly in an emulsion of gum, are gener- ally placed among the antidotes, but are both practically useless. The first has caused death more rapidly than the phosphorus, and the second is generally unobtainable, and has proved useless when employed. 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 other drug does, and in paraplegia of myelitic origin from excessive venery it is often very efficient. Progressive pernicious anaemia has some- times 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 anaemia 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. Neural- gia is often cured by Phosphorus, but large doses are necessary, at least Therapeutics. PHYSOSTIGMA. 383 gr. every four hours. The solution of Phosphorus in Retinol is very stable, and is strongly recommended for the external and internal use of that substance. Calcium Phosphate 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. Sodium Phosphate in doses of gj-ij thrice daily for adults (gr. x-xxx for children) is extremely useful as a laxative in conditions depending 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 in- fantile 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 valuable water in hepatic colic and kindred conditions. Hypodermic injections of So- dium Phosphate have been used with highly beneficial results in syringo- myelitis and in unilateral astasia-abasia. Drs. Crocq and Luton of Rheims advocate the hypodermic use of this salt as a substitute for the organic extracts, and maintain that it is equally efficient in all cases in which these extracts have'proved to be of value. [Compare the article on Animal Extracts, page 129.] Crocq’s solution contains Sodium Phosphate X part, Alcohol 5, Glycerin 20, Distilled Water 25 ; the dose of which is 3 cc. (about 45 minims) hypodermically, with aseptic precautions, once daily or on alternate days. Luton uses a solution of the crystallized Sodium Phosphat'e and Sodium Sulphate. PHYSOSTIGMA, Calabar Bean,—is the seed of Physostigma venenosum (nat. ord. Leguminosse), a woody creeper of Calabar, West Africa, where it is used by the natives as an ordeal for witches, etc., vom- iting after its ingestion being held to establish the innocence of the accused. It contains two alkaloids, Physostigmine (or Eserine), C15H21 N302, and Calabarine, which is antagonistic to the former and is allied to strychnine in its action, while Physostigmine resembles gelsemium. 384 PHYSOSTIGMA. Preparations. Extractum Physostigmatis, Extract of Physostigma,—an alcoholic extract, of which the usual dose is from gr. Tlg to \, but gr. j-iv are used in tetanus. Tinctura Physostigmatis, Tincture of Physostigma,—15 per cent. Dose, Tt^v-xx. Physostigminae Salicylas, Physostigmine Salicylate (Eserine Salicylate'),—color- less, columnar crystals, of bitter taste and neutral reaction, soluble in 150 of water and in 12 of alcohol. Dose, gr. ygg-gV Physostigminae Sulphas, Physostigmine Sulphate (.Eserine Sulphate),—a white, micro-crystalline powder, of bitter taste, very deliquescent in moist air, very soluble in water and in alcohol. Dose, gr. yfoj— Physiological Action. 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. It 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. The alkaloids of Phyostigma have opposite actions, and different or even contradictory results may be obtained from the drug according to the proportion of each in the preparation employed. Physostigmine repre- sents the action of the bean, paralyzing the nervous centres and stimulat- ing muscular fibre, while Calabarine causes convulsions like strychnine (Brunton). Physostigmine, in its action on the cord is allied to gelse- mium and antagonistic to strychnine and to picrotoxin, but Calabarine is allied to both (Murrell). Antagonists and Incompatibles. 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. 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, but large doses (2 to 4 grains) must be given, and its effects must be carefully watched. In small doses it is a useful remedy in many nervous affections, such as locomotor Therapeutics. PHYTOLACCA. 385 ataxia, writers’ cramp and the paraplegia due to myelitis, also in progres- sive paralysis of the insane which is apparently retarded by it. The ex- tract should be given in these diseases, in doses of gr. y in pill every three hours ; and if the treatment is kept up for six months or longer the results will prove very satisfactory, though the improvement will be slow (Murrell). While theoretically antagonistic in poisoning by atropine or strychnine, practically it is not of much value therein. Physostigmine (Eserine) is used locally by ophthalmologists for many purposes in affections of the eye. In a solution of gr. ij to the § 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 pho- tophobia, etc., and empties the vessels of the eye. It is very useful in keratitis, glaucoma, strumous ophthalmia, and neuralgia of the eye-ball. The salts of Physostigmine in neutral solution may be used for these pur- poses, as well as to counteract the effects of atropine on the pupil. Gelatin disks medicated therewith may be obtained in the shops, and are a con- venient form in which to use the drug for ophthalmic purposes. In dose of gr. hypodermically it has proved remarkably efficient as an occa- sional substitute for morphine, after the final withdrawal of that drug in the treatment of its habitues. PHYTOLACCA, Poke, —is official under two forms, the fruit and the root of Phytolacca decandra, a plant of the nat. ord. Phytolaccacese, 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. The official titles are as follows, viz. :— Phytolaccae Fructus, Phytolacca Fruit (Poke Berry),—a depressed- globular, dark purple, compound berry, about inch in diameter, inodorous, taste sweet, slightly acrid. Dose, gr. x-xxx. Phytolaccae Radix, Phytolacca Root {Poke Root),—large, conical, branched, fracture fibrous, inodorous, sweetish and acrid. Dose, as emetic, gr. x-xxx,—as an alterative, gr. j-v. Preparations. Extractum Phytolaccae Radicis Fluidum, Fluid Extract of Phytolacca Root.— Dose, n\j-xxx. Tinctura Phytolaccae, Tincture of Phytolacca (Unofficial).—Dose, rtpx-^j. 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 respiration, Physiological Action and Therapeutics. 386 PICHI PICROTOXINUM. preceded by tetanic convulsions. Several cases of poisoning by this plant have occurred. Its action is antagonized by Alcohol, Ether, Opium, Digitalis, etc. 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 un- doubtedly cured cases of granular conjunctivitis. Mastitis is sometimes 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. Phytolacca has long been known to promote the absorption of adipose tissue, and was suggested as a remedy for obesity as early as 1858. A resinoid preparation of the berries is on the market as an “anti-fat” remedy, under the name Phytoline, the dose of which is six times a day, before and after each meal. PICHI, Pichi (Unofficial),—is the shrub Fabiana imbricata, a member of the nat. ord. Solanacem 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 blad- der. 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 constituents 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, 3 j, but it should not be added to water. PICROTOXINUM, Picrotoxin (Picrotoxic Acid), C30H34O13,—is a poisonous, neutral principle obtained from the seeds contained in the berries ( Cocculus Indicus, Fish-berries), of Anamirtapaniculata (Anamirta Cocculus, Menispermum Cocculus), a climbing shrub of the nat. ord. Menispermacese, a native of the East Indies. The berries contain, be- sides Picrotoxin, a large quantity of fixed oil and other substances of less interest. In the shell are found Menispermin, an alkaline principle Paramenispermin, which is neutral and crystalline, and Hypopicrotoxic Acid. There are no official preparations. Picrotoxin occurs in colorless, flexible crystals, of prismatic form, bitter taste and neutral reaction, soluble in 240 of water and in 9 of alcohol, also in acids and in alkaline solutions. Dose by the stomach gr. fa-fa, cautiously. For hypodermic use a solution in water of gr. ij in may be used, in doses of gr. fa-fa of the principle, n\, iv equalling gr. fa. PICROTOXINUM. 387 Unofficial Preparations of Cocculus. Tinctura Cocculi, Tincture of Cocculus,—I in 8. Dose, npij-xv. Extractum Cocculi Fluidum, Fluid Extract of Cocculus. — Dose, tt\j-iij. Planat’s Tincture of Cocculus,—I in 4. Dose, rr\J-v. Physiological Action. Picrotoxin is a cerebro-spinal exaltant, affecting especially the centres in the medulla oblongata, and in its action representing the combined action 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 accelera- ting both. It causes muscular twitching, incodrdination, stupor, delirium, epileptiform convulsions, tonic spasms of the flexor muscles alternating with clonic ones, exalted reflexes and trembling,—then coma, insensibil- ity and death by paralysis of the heart, which is arrested in diastole. 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 cerebellum and spinal cord, paralyzing the first-named centres and stimulating the reflex centres in the cord. It is eliminated by all the excretory channels, chiefly by the kidneys. The spasms caused by Picrotoxin are choreic and chiefly affect the flexor muscles,—those from Strychnine are tetanic, af- fecting principally the extensors. The order, succession and character of the phenomena produced by Picrotoxin resemble in marked degree those of the epileptic paroxysm. 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. Therapeutics. 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-larvngeal 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. Dysmenorrhcea is often benefited by Cocculus administered for two days before the period ; and leucorrhcea, when the discharge is sero-purulent, with lumbar 388 PILOCARPUS. pains, is frequently controlled by it. Parasitic skin diseases are well treated by an ointment of Picrotoxin (gr. x to the 3), 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 undiluted as a wash to kill body-lice. PILOCARPUS, Jaborandi, —the leaflets of Pilocarpus Selloanus, and of Pilocarpus Jaborandi, Brazilian plants of the nat. ord. Rutaceae. The word Jaborandi is applied in Brazil to any tree or shrub which pos- sesses the power of inducing sweating, and a number of plants are so designated, but the true leaves are known by their numerous pellucid dots, easily recognized when the leaf is held between the eye and alight. They contain the four alkaloids Pilocarpine, CnH16N202, a syrupy fluid, slightly soluble in water, and forming salts; Jaborine, isomeric with pilocarpine, but antagonistic thereto in action, and does not form crystallizable salts; Pilocarpidine, which acts like pilocarpine; and Jaboridine, which is anal- ogous in action to jaborine. Extractum Pilocarpi Fluidum, Fluid Extract of Pilocarpus.—Dose, Pilocarpinae Hydrochloras, Pilocarpine Hydrochlorate, CnH,6N202HCl,—small, white, deliquescent crystals, odorless, of faintly bitter taste ; very soluble in water and in alcohol, almost insoluble in ether or chloroform. Dose, gr Preparations. 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 per- spiration (§ix-xv in quantity) and salivation (§x-xxvij), after a prelim- inary flushing of the skin. The nasal, bronchial and lachrymal secretions are much increased; sometimes watery diarrhoea occurs ; the action of the heart, at first increased, is afterwards lowered, the arterial tension is reduced, and the temperature falls from i° to 40. Drowsiness, pallor, chilliness and debility succeed, and last several hours; the pupils are con- tracted and accommodation is 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. Pilo- carpus 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 contrac- tions of the bladder, uterus and spleen, in the latter case whether the organ is enlarged or of normal size. The desire to urinate, which is Physiological Action. PILOCARPUS. 389 experienced after a full dose, is due to the drug causing contraction of the bladder. Pilocarpus is not a diuretic but tends rather to diminish the quantity of urine as a result of its powerful diaphoretic action. 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 dif- ferent molecular arrangement. Atropine is the antagonist to Pilocarpine in dose of gr. for gr. 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. Antagonists and Incompatibles. Therapeutics. Pilocarpus 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 work on the skin. In the acute and chronic forms of Bright’s disease it has been used with advantage, but being very depressant it must be em- ployed 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. which, acting specifi- cally on the same gland, may correct the morbid action thereof; and similar doses used thrice daily will check profuse perspiration. The hy- podermic use of Pilocarpine will arrest a paroxysm of spasmodic asthma, and is equally efficient in hiccough. Atropine-poisoning is best combated by the use of Pilocarpine hypodermically. Diphtheria has been treated by Pilocarpine with a high degree of suc- cess, Guttmann having reported eighty-one cases without a single death, but other clinicians have not found it so efficient, and Lashkewitz and Jacobi condemn it absolutely. In children above the age of five years, in whom the condition of the heart does not contraindicate it, this drug often gives pronounced satisfaction in detaching the false membrane and preventing its reformation ; but care must be taken to give full support by food and alcohol throughout its use, and to avoid it altogether in cases which manifest cardiac weakness or great depression. In erysipelas it is often highly efficient, and for the purpose of breaking up a common 390 PIMENTA—PIPER. cold it is one of the best agents at our command. For the latter purpose the fluid extract may be used in doses of n^x-^j, according to age, given at bed-time and repeated once or twice during the night if necessary. Children bear it well in respect of all its physiological actions. 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 Physostigmine as a myotic. Pilocarpine is highly efficient as an aid to sorbifacient remedies in re- moving inflammatory exudations and promoting the absorption of effu- sions. When iodides and mercurials are being used for these purposes their action is greatly aided by this drug administered occasionally for a few days at a time. It has lately been suggested by Dr. Waldstein as a remedy in phthisis, for the purpose of inducing leucocytosis and stimu- lating glandular activity, and is one of the ingredients in a new “ cure ” for consumption named Aseptolin. (See ante, page 78.) PIMENTA, Allspice,—is the nearly ripe food of Pimenta officinalis, a West Indian tree of the nat. ord. Myrtacese. The berries contain a Volatile Oil which is official, a green fixed oil, fat, tannin, gum, resin, etc. Dose, gr. x-xl. Oleum Pimentae, Oil of Pimenta,—the volatile oil, colorless or pale yellow, of aro- matic odor, pungent taste and slightly acid reaction. Is a constituent of Bay Rum (Spt. Myrcise). Dose, IT\Jj-vj. Allspice is a warm, aromatic stimulant, very useful as a condiment, improving digestion by increasing the vascularity of the gastric mucous membrane, 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, growing in India, Siam, Java, Borneo, etc. It contains a principle, Piperin, which is official, also a green, acrid, concrete oil, a balsamic volatile oil, starch, lignin, gum, extractive, etc. Dose, gr.v—xx. Oleoresina Piperis, Oleoresin of Pepper,—contains almost all the volatile oil and acrid resin extracted by ether, with little of the Piperine. Dose, Piperinum, Piperin, CnH19N03,—a neutral principle 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. Dose, gr. j—x. 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 kidneys somewhat, and toning up the mucous mem- brane 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 inter- mittents. Its chief medicinal use is to correct flatulence, and to excite action of the stomach, being very commonly taken as a condiment with food. It is occasionally em- ployed in gleet, but more extensively in hemorrhoids and other diseases of the rectum. Its active constituents are the concrete oil or resin and the volatile oil, Piperin having very slight action on the system, except as an antiperiodic and antipyretic, qualities which it certainly possesses. PIPERAZINUM. 391 PIPERAZINUM, Piperazin, C4H10N2 (Unofficial),—is a syntheti- cal basic compound which is formed by the action of Ammonia upon Ethylene Bromide or Chloride ; and occurs as a white, crystalline powder, readily soluble in water, and liquefying when exposed to the air, from which it greedily absorbs water and carbon dioxide. Dose of the base or its hydrochloride, gr.v-x. It may be injected hypodermically in 3 to 5 per cent, solution. Piperazin possesses the valuable property of forming with uric acid a very soluble compound, piperazin urate being seven times more soluble in water than is lithium urate, the former requiring but 50 parts and the latter 368 parts of water for solution. It is non-toxic, and devoid of powerful physiological effects, being well borne without ill results, even when administered for prolonged periods. It is non-irritant to mucous membranes, is readily absorbed from the stomach, and circulates in the blood unchanged, reaching the parts affected by gouty deposits in a con- dition in which it readily neutralizes and dissolves the latter, thus facilitat- ing their removal from the body. The administration of Piperazin in gout promptly reduces the redness and swelling of the affected joints, and is frequently followed by a dis- charge of gravel. The minimum daily dosage for this purpose is about 15 grains, which should be dissolved in half a pint of water, and the solu- tion should be added to a pint or more of any convenient carbonated water, and be taken in divided doses through the day. When there is much pain and fever present, an equal quantity of Phenocoll Hydro- chloride may be added,—but in preparing them, each agent should be dissolved separately and then mixed together, otherwise a precipitate will form in the solution. It gives marked relief in the pruritus of the uric acid diathesis due to the irritation of imperfect nitrogenous elimination. In solution it may be introduced into the bladder in order to dissolve vesical calculi of the uric character, and in gout it may be locally em- ployed by hypodermic injection. A one per cent, solution, applied locally to open gouty sores, relieves the pain and reduces the inflammation. It should be tried in rheumatic arthritis of difficult diagnostic differentia- tion. As a solvent for uric acid and urate concretions Piperazin is prob- ably superior to all other agents. It is patented, which fact, together with its extremely high price, prevents its general use. It is supplied by the manufacturers in vials containing xo grammes (150 grains), which is suffi- cient for ten days’ dosage, and may be prescribed in gviij of water, of which solution the daily dose would be §j (equal to grains), taken in a quart or more of any carbonated water during the day in broken doses. Lysidin (Unofficial),—is a new base obtained by the action of Sodium Acetate upon Ethylene-diamine Hydrochlorate, and is said to possess a solvent power on uric acid five times greater than that of Piperazin. It has been tried in cases of chronic gout with ex- 392 PISCIDIA PIX. cellent results. The stiffness of the joints was lessened, and there was a conspicuous reduction in the bulk of the tophi around the joints, and on the epiglottis in one case. The dose is of the 50 per cent, alkaline solution in a glassful of carbonated water. Lycetol, Dimethyl-piperazin Tartrate (Unofficial),—is a new uric acid solvent, which is said to combine the solvent properties of Piperazin with the alkaline and diuretic effects of Tartaric Acid. The dose is gr. xv-xxx daily, administered in carbonated water or in the form of a lemonade. PISCIDIA, Jamaica Dogwood (Unofficial),—is the bark of the root of Pisddia erythrina, a tree of the nat. ord. Leguminosae, growing in the West Indies. It occurs as a tough, fibrous bark, of a heavy, narcotic odor, and contains a yellowish, resinoid sub- stance named Pisddin. Its active principle has not yet been isolated. A fluid extract is on the market, of which the dose is 3 ss-j, carefully increased. 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 sensibility, increased action of the heart and increase of the arterial tension by stimulation of the vaso-motor centre. Soon, however, the heart is weakened, 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-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 animals. In man its action is probably the same, but in decidedly less marked degree. Piscidia 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. PIX, Pitch ,—is a resinous exudation from the stem of certain trees of the genera Pimis (Pines) and Abies (Firs and Spruces) ; and may also be obtained by the evaporation of wood-tar. [See Pix Liquida below.] The first two of the following varieties are official. Pix Burgundica, Burgundy Pitch,—the prepared resinous exudation of Abies excelsa or Norway Spruce (nat. ord. Conifer®), a native of Europe and Northern Asia. It occurs in hard, brittle, opaque or translu- cent mass, with a shining, conchoidal fracture, 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 Liquida, Tar,—is an empyreumatic oleo-resin obtained by the destructive distillation of the wood of Pinus palustris and other species of Pinus, (nat. order Conifer®). 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 Tar yields an acid liquor named Pyroligneous Add and an empyreu- matic oil called Oil of Tar, (see Oleum Picis Liquidse, below), the residue being pitch. Its granular appearance is due to crystals of Pyrocatechin, C8H4(OH)2, which occur either in the Pyroligneous Acid or in the tarry mixture. Dose, gj-ij daily, in ten-grain doses. PIX. 393 Pix Canadensis, Canada or Hemlock Pitch (Unofficial),—is the pre- pared resinous exudation of Abies canadensis (nat. ord. Coniferge), the Hemlock Spruce of the U. S. and Canada. Its properties are much the same as those of Burgundy Pitch. Preparations. Emplastrum Picis Burgundicse, Burgundy Pitch Plaster,—has of Burgundy Pitch 80, Olive Oil 5, Yellow Wax 15. Emplastrum Picis Cantharidatum, C.antharidal Pitch Plaster, Warming Plaster, has of Cerate of Cantharides 8, Burgundy Pitch to 100. Oleum Picis Liquidae, 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 Creosote and Carbolic Acid. Is used locally and as an atomized inhalation. Syrupus Picis Liquidae, Syrup of Tar,—has of Tar per cent.; and is a sweet- ened Tar-water. Dose, Unguentum Picis Liquidae, Tar Ointment,—contains of Tar 50 parts, Yellow Wax 121/2, Lard 37 Is irritating unless mixed with finely levigated chalk. Infusum Picis Liquidae, Tar Water (Unofficial),—made by shaking Tar I with Water 4 frequently during 24 hours, decanting and filtering. Is stimulant and diuretic. Dose, Oj-ij daily. Vinum Picis Liquidae, Wine of Tar (Unofficial),—Tar Jjxvj, Glycerin, White Wine, Honey, Acetic Acid i|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 in- halation (gss to Oj of boiling water), or locally. Retinol, Kesinol (Unofficial),—obtained by the distillation of Burgundy pitch, occurs as a yellowish, oily liquid, boiling at temperatures above 536° F. Used as a solvent for a number of the newer remedies, as Cocaine, Aristol, Iodol, also Carbolic Acid, Creosote, Phosphorus and many alkaloids. Concentrated Extract of Pinus Canadensis (Unofficial),—is an aqueous, non-irri- tant 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 exten- sively 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. 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 plas- ters, and is of benefit in lumbago, rheumatism, chronic pleurisy, painful joints, superficial neuralgise, 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 rem- edy for hemorrhoids. In applying adhesive plasters the hair should first Physiological Action and Therapeutics. 394 PLANTAGO PLUMBUM. 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 pur- poses as the preceding. A volatile oil obtained from the same tree (Oil of Spruce, Oil of Hemlock) has been used for abortifacient purposes, endangering the life of the subject. Tar is a complex mixture of resins and hydrocarbons, containing Creo- sote 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, 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 bronchi- tis, pharyngitis, laryngitis and winter cough. Internally it may be em- ployed with advantage in these affections, in hemorrhoids, bronchial ca- tarrh, 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),—is the leaf of Plantago major, and Plantago lanceolata (nat. ord. Plantaginaceae), the common “ Ribbed Grass.” The pounded leaves applied as a paste, or the dry leaf powdered, are actively hemostatic, stopping hemor- rhages speedily. Among the ancients it had a good reputation as a remedy for toothache and earache, which still adheres to it in Switzerland and other parts of Europe. In many other painful affections it is extremely efficient, especially in mastitis, rhus-poison- ing, 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 rrpv-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 vari- ous other combinations (salts). Plumbi Acetas, Lead Acetate, Sugar of Lead, Pb (C2H302)2 3H20,—colorless, shining, prismatic crystals or scales, efflorescent, of faintly acetous odor and acid reaction, and a sweetish, astringent and metallic taste. Soluble in 2.3 of water and in 21 of alco- hol at 590 F., in 0.5 of boiling water and in 1 of boiling alcohol. Dose, gr. ss-v. Official Salts of Lead. PLUMBUM. 395 Plumbi Carbonas, Lead Carbonate, White Lead, (PbC03)2Pb(H0)2,—a heavy, white, opaque powder, odorless, tasteless and insoluble in water or alcohol, but soluble with effervescence in acetic or in diluted nitric acid. Used locally as ointment, powder, or white paint. Plumbi Iodidum, Lead Iodide, Pbl,2,— 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, Lead Nitrate, 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 I per cent., also as an escharotic and a disinfectant. Plumbi Oxidum, Lead Oxide, 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 char- coal it is reduced to metallic lead. Used as Lead-Plaster and sometimes with oil as an external application. Liquor Plumbi Subacetatis, Solution oj Lead Subacetate, Goulard's Extract,— an aqueous solution containing about 25 per cent, of the salt, prepared from Acetate of Lead 170, Oxide of Lead 100, and Distilled water to 1000. It is a clear, colorless liquid, of sweetish, astringent taste and alkaline reaction, of sp. gr. 1.195, and when added to a solution of acacia it produces a dense, white precipitate. Used locally as an astringent and cooling lotion, diluted usually with an equal quantity of water. Liquor Plumbi Subacetatis Dilutus, Diluted Sohition of Lead Subacetate, Lead Water,—has of the preceding 3, in Distilled Water to 100. Used locally as a mildly astringent and cooling lotion. Ceratum Plumbi Subacetatis, Cerate of Lead Subacelate, 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 astringent 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 tena- cious, 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 50, Olive Oil 49, Oil of Lavender Flowers I. Used locally in eczema and other cutaneous disorders. Unguentum Plumbi Carbonatis, Ointment of Lead Carbonate,—has of the Carbon- ate in very fine powder 10, Benzoinated Lard 90. Used as a dressing for burns. Unguentum Plumbi Iodidi, Ointment of Lead Iodide,—has of the Iodide in very fine powder IO, 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. Preparations. Physiological Action. 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 printing-type, working in the smelting of lead ores, etc. It produces loss of appetite, emaciation, pallor and constipation, followed 396 PLUMBUM. 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 aphonia, vertigo, gastralgia, headache, stupor and convul- sions 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 margins 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 contraction of the smaller vessels, and may affect any muscles of the body, also the brain, producing delirium, coma, and con- vulsions. 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 extension of the paresis to the muscles of respiration, from gradual impairment 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, and is again excreted by the intestinal glands, escaping with the feces as a sulphide. It lessens the excretion of uric acid. In acute poisoning by lead salts, as by the Acetate, the antidotes are Sodium or Mag- nesium Sulphate and Sodium Phosphate. The stomach should be evacuated, and albu- minous drinks and Opium given to allay irritation. Chronic poisoning is best treated by Atropine and Iodides, the latter to saturation of the system. Sulphurated Potassa Baths (£ j or more in water) are also very useful. Incompatibles are Mineral Acids and their salts, vegetable acids, alkalies, vegetable astringents, Potassium Iodide, albuminous solu- tions, Opium, and all natural waters containing Lime, Sulphates, Carbonates, and Car- bonic Acid. Antidotes, Antagonists and Incompatibles. 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 urethra, particularly in gonorrhoea and leu- corrhoea. Inflammations of external parts are constantly treated by the lotion of “ Lead water and Laudanum ” (Liquor Plumbi Subacetatis Di- lutus, 7 parts to 1 of Tinctura Opii). Though the constituents of this PODOPHYLLUM. 397 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 choleriac 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. The Carbonate is only used externally, to protect irritated surfaces, 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 applied on the broken cuticle it may prove rapidly poisonous. The Iodide is employed externally as an ointment to enlarged lymphatic 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 §j of glycerin. In powder, dusted over unhealthy granulations, and sanious 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 J) it is a most efficient deodor- izer against the fetor from gangrenous sores, ozsena and other offensive discharges. Pharmaceutically it is used in the preparation of the Iodide. The Oxide is used in the preparation of plasters, and most of the other salts of lead. 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 Podophyllumpeltatum (the Mandrake), an herbaceous perennial of the nat. ord. Berberidese, 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. Its active principle is a Resin which is official, and is a com- pound of several resins. It probably contains the alkaloid Berberine, which is also found in Berberis, Hydrastis and several other plants. Dose, gr.v-xx. Preparations. Extractum Podophylli, Extract of Podophyllum.—Dose, gr.v-x. Extractum Podophylli Fluidum, Fluid Ext. of Podophyllum.—Dose, rt\j-xxx. 398 POLYGONUM PONGAM1A POTASSIUM. Resina Podophylli, Resin of Podophyllum, Podophyllin,—is precipitated from a concentrated tincture by acidulated water. Soluble in alkaline liquids and partly so in ether. Contains Podophyllotoxin, Picropodophyllin, Podophyllinic and Protocatechuic Acids. Dose, in pill. Is an ingredient of Pilulse Catharticse Vegetabiles. Podophyllum is a tonic-astringent and resin-bearing purgative, having 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 griping pain and some nausea. The powder is irritant to the respiratory passages and to the skin. The Resin is an excellent purgative in cases of habitual constipation or portal congestion, and is a useful cholagogue. Laxative effects are pro- duced by small doses but grain-doses are necessary for its full action. It should be combined with Hyoscyamus, Belladonna or Can- nabis Indica, in order to counteract its griping tendency. It is an effi- cient derivative in cases of catarrhal or malarial jaundice, and is recom- mended 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, Smart-Weed, Water-pepper (Unofficial),—is the plant Polygonum Hydropiperoides, nat. ord. Polygonaceae, indigenous to the U. S., having narrow, lance- olated 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. Extractum Polygoni Fluidum, Fluid Extract of Polygonum (Unofficial).—Dose, hlx-3J- Extractum Polygoni, Extract of Polygonum (Unofficial).—Dose, gr. j-v. Smart-weed a pungent, acrid taste, producing a sensation of heat in the stomach, and a peculiar tingling throughout the system. It stimulates the action of the heart, raises the arterial tension, increases the warmth of the surface, promotes the cutaneous, bronchial and renal secretions and the menstrual flow. It is an efficient diuretic, emmenagogue and aphrodisiac. The juice applied to the skin excites inflammation and vesication. Amenorrhoea from functional inactivity of the uterine system is remarkably benefited by this remedy in 7, ss doses of the fluid extract four times daily for a week before the expected period. It has considerable influence 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 and 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. Leguminosae. It has been used for many years in India for skin affections, 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 soluble readily in water. The metal itself is not official. The chief POTASSIUM. 399 source of its salts is the ash remaining after the combustion of plants or trees, which contains the Carbonate, from which most of the other salts 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 Argot, 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 Salts and their Preparations. Potassa, Potassium Hydrate, Caustic Potash, KOH,—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, deliques- cent powder, consisting of equal parts of Potassa and Lime rubbed together. A milder and more manageable caustic than the preceding. Liquor Potassse, Solution of Potassa,—contains about 5 per cent, of Potassium Hy- drate, and is prepared by dissolving Potassium Bicarbonate 85, in 400 of Distilled Water, 40 of Lime in the same quantity of Distilled Water, boiling, mixing the solutions gradu- ally, again boiling, and when cold adding Water up to 1000 parts, straining, 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, nqv-gss, well diluted with water. Potassii Acetas, Potassium Acetate, KC2H302,—a white, satiny, crystalline mass, very deliquescent, odorless, of pungent, saline taste, and a neutral or faintly alkaline reaction, soluble in 0.4 of water and in 1.9 of alcohol at 590 F. Dose, gr.v-^j. Potassii Carbonas, Potassium Carbonate, K2C03,—a white, crystalline or granular powder, very deliquescent, odorless, of alkaline taste and reaction, soluble in 1.1 of water at 590 F., insoluble in alcohol. Dose, gr. ij-xx. Potassii Bicarbonas, Potassium Bicarbonate,—KHC03,—colorless prisms of saline and alkaline taste and alkaline reaction, soluble in 3.2 of water at 590 F., decomposed by boiling water, almost insoluble in alcohol. Dose, gr.v-xxx. Potassii Chloras, Potassium Chlorate, KC103,—colorless prisms or plates, of pearly lustre, of cooling, saline taste and neutral reaction, soluble in 16.7 of water at 590 F. and in 1.7 of boiling water; slightly soluble in mixtures of alcohol and water, insoluble in absolute alcohol. Dose, gr.v-xx. Potassium Chlorate should be kept in glass-stoppered bottles, and great caution should be observed in handling the salt, as dangerous explosions are liable to occur when it is mixed with organic matters (cork, tannic acid, sugar, etc.), or with sulphur, antimony sulphide, phosphorus, or other easily oxidizable substances, and either heated directly or subjected to trituration or concussion. It should not be mixed with glycerin in the presence of a free acid. Trochisci Potassii Chloratis, Troches of Potassium Chlorate,—each troche contains about 4)/2 grains of the salt, with sugar, tragacanth, and spirit of lemon. Dose, j-iij, slowly dissolved in the mouth. Potassii Citras, Potassium Citrate, K3C6H507 -)- H20,—transparent, prismatic crys- tals, odorless, of cooling, saline taste, and neutral reaction, soluble in 0.6 of water, very soluble in boiling water, sparingly soluble in alcohol. Dose, gr. x-xxx. Potassii Citras Effervescens, Effervescent Potassium Citrate,—consists of Pot. Bicarb. 90, Citric Acid 63, Sugar 47, powdered, mixed to a paste, dried and again pow- dered. Dose, gj-ij, in a glass of water, as an effervescent drink. Liquor Potassii Citratis, Sohition of Potassium Citrate, Mistura Potassii Citratis,— contains about 9 per cent, of the anhydrous salt, together with small amounts of citric 400 POTASSIUM. and carbonic acids. Prepared by dissolving Citric Acid 6, and Pot. Bicarb. 8, each in water 40, filtering the solutions separately, and adding in each case enough water to bring to 50 parts, then mixing the two together. Dose, 3 ss- 3 j or more. Potassii Nitras, Potassium Nitrate, Saltpetre, Nitre, KN03,—colorless, transparent prisms of 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, Potassium Nitrate 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, Potassium Sulphate, K2S04,—colorless, hard, rhombic prisms, of sharp, saline and bitter taste and neutral reaction, soluble in about 9.5 of water at 590 F., and in 4 of boiling water, insoluble in alcohol. Dose, gr. ss, well diluted. Potassii Bitartras, Potassium Bitartrate, Acid Tartrate of Potash, Cream of Tartar, KHC4II406,—colorless rhombic crystals, or a white, gritty powder, of acidulous taste and acid reaction; soluble in about 201 of water at 590 F., and in about 16.7 of boiling water, very slightly soluble in alcohol. Is a constituent of Pulvis Jalapse Com- positus. Dose, gr. xx-3 j (diuretic and refrigerant), ss-j (purgative). Potassii et Sodii Tartras, Potassium and Sodium Tartrate, Rochelle Salt, KNaC4H406 + 4H20,—colorless, rhombic crystals, or a white powder, of cooling and slightly saline and bitter taste, and neutral reaction ; soluble in 1.4 of water at 590 F., very soluble in boiling water, almost insoluble in alcohol. Is a constituent of the following preparation. Dose, 3 ss-j. Pulvis Effervescens Compositus, Compound Effervescing Powder, Seidlitz Pow- der,—each powder 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, Potassium Silicate, Soluble Glass, K2Si03 (Unofficial),—is used in solution of a syrupy consistence for the preparation of immovable dressings for fractured limbs, etc. [See under Silicates.] The Arsenite is described under Arsenum,—the Bromide under Bromum,—the Bichromate under Acidum Chromicum,—the Iodide under Iodum,—the Cyanide and Ferrocyanide under Acidum Hydrocyanicum,—the Hypophosphite under Phosphorus,—the Permanganate under Manganum,—the Nitrite under Amyl Nitris,—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, converting the tissue to which it is applied into a moist, gray slough, with considerable surrounding inflammation. Internally it acts as a pow- erful corrosive poison, destroying the mucous membrane of the parts with which it comes in contact, and giving rise to intense pain, diarrhoea, con- vulsions and delirium. Unless speedily rejected or neutralized it causes death from inflammation of the larynx, from the gastro-intestinal lesions, or after some time from stricture of the oesophagus. Liquor Potassa:, containing over 5 per cent, of the pure Potash, possesses in a degree the 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 sub- ject anaemic. POTASSIUM. 401 Potassium Salts in large doses are cardiac poisons, muscular para- lyzers, poisonous to protoplasm, especially nerve tissue, and destructive to the ozonizing functions 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 in- creased oxidation. The Mineral Salts (Nitrate, Chlorate, etc.) are not decomposed in the blood, but are eliminated in their own form, the Ni- trate 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 Chlo- rate 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. Antidotes 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 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. Therapeutics. Caustic Potash is used locally to destroy morbid or cicatricial 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, malignant pustules, nsevi, warts, etc. Its action is deep and severe, and it is best employed in the form of Potassa cum Calce, which is a far more manageable preparation. 402 potassium. 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 axillae, 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 to the 3) is said to be effectual as a remedy for pruritus vulvae, 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 3iv, 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 for any length of time to alkalinize the urine, it having the least injurious effect on the blood or on the digestion. In lithaemia 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. In cases of acute dysentery with scorbutic symptoms, as seen among miners, sailors, etc., a full purgative dose of this salt (gss or more), has acted most bene- potassium. 403 ficially as a preliminary to other treatment; and in many cases has proven to be the only remedy required. Potassium Chlorate is much employed locally in solution (gss to the 5) 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 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 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 Potassium Iodide 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 decompose it, and it forms explosive compounds with easily oxidizable substances, as Sugar, Sulphur, Tannin, Sodium or Potassium Hypophosphites, Catechu, Glycerin, etc. For the combination of Potassium Chlorate with the Tinc- ture of the Chloride of Iron, as a gargle, see under Chlorum. The Nitrate has been much employed as a refrigerant diaphoretic 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 Nitratis) are a useful inhalation in some forms of spasmodic asthma. The 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. Potassium and Sodium Tartrate, or Rochelle Salt, is the chief aperient agent in Seidlitz Powders. In doses of j$ss-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. 404 PRINOS—PRUNUM—PRUNUS VIRGINIANA. The therapeutics of the other Potassium Salts are described under the titles mentioned on page 346. PRINOS, Black Alder (Unofficial),—is the bark of Prinos verticillatus, or Winter- berry, a shrub of the nat. ord. Aquifoliaceae, 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. It contains an amorphous, yellow and bitter principle, also tannin, sugar, starch, wax, resin, etc. The bark may be given in substance in doses of 3 ss, or a decoction (3 ij in Oiij boiled to a quart) in doses of % j-ij. 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 Prunusdomestica, the Plum tree (nat. ord. Rosa- ceae), indigenous to Western Asia, but cultivated in most countries of temperate climate. Prunes contain sugar, pectin, albumen, malic acid and salts. They are a constituent of Confectio Sennae. 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 indigestibility 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 VIRGINIAN A, Wild Cherry,—is the bark of Pru- nus serotina, or Wild Cherry, a large forest tree of the nat. ord. Rosaceae, growing in Canada and the U. S. On maceration in water it develops a distinct odor of bitter almonds. It contains tannin, gallic acid, resin, starch, etc., also Atnygdalin 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, pages 87 and 125.] Dose of the powdered bark, gss-j. Preparations. Extractum Pruni Virginianae Fluidum, FI. Extr. of Wild Cherry.—Dose, 3 ss-j. Infusum Pruni Virginianae, Infusion of Wild Cherry,—4 percent. Dose, 3 ss—ij. Should be made with cold water. Syrupus Pruni Virginianae, Syrup of Wild Cherry,—15 per cent. Dose, gj-iv. Physiological Action and Therapeutics. Wild Cherry is an aromatic bitter tonic, increasing appetite, aiding digestion, and thus promoting the constructive metamorphosis. The pres- ence 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 re- duce the action of the heart. The preparations of Wild Cherry are used in catarrhal conditions of the bronchial mucous membrane, in the hectic of phthisis and scrofula, with palpitation of the heart, and a debilitated stomach; a collection of PULSATILLA. 405 symptoms often observed in consumptive subjects, to whom it is a very useful palliative. Cough is supposed to be especially amenable to its in- fluence, and hence it has become a matter of daily routine to prescribe the syrup as an ingredient of cough-mixtures. The infusion is an excel- lent stomachic tonic, and may be administered with great benefit in dys- pepsia and in convalescence from acute disease. PULSATILLA ,—is the herb, collected soon after flowering, of Ane- mone Pulsatilla and Anemone pratensis {Pulsatilla nigricans'), the Pasque- flower or Meadow Anemone, small herbal plants of the Ranunculacese, to which order Aconite also belongs. They inhabit Europe and Siberia, and have large, purple flowers, which are inodorous and very acrid. Pulsatilla contains an acrid yellow oil, which in the presence of water is gradually changed into Anemonin, C15H1206, or Pulsatilla camphor, the active prin- ciple, and Anemonic Acid, C15H1407, a white, crystalline, tasteless and apparently inert substance, which may also be formed by the action of alkalies on Anemonin. The herb should be carefully preserved and not kept longer than one year. Dose, gr.j-v. Anemone patens or Pulsatilla nuttaliana, is an inhabitant of the United States, some- times has whitish-colored flowers, and was formerly one of the official sources of the drug. The herb alone is official, but a tincture may be prepared according to the pharmaco- poeial directions for Tincturse Herbarum Recentium (i part in 2 of alcohol), the dose of which is y1^— several times a day. The imported German homoeopathic tinc- ture contains equal parts of the expressed juice and alcohol, and is an efficient preparation ; but tinctures or fluid extracts made from the imported dried plant are not trustworthy. Anemoninum, Anemonin (Unofficial),—a volatile, unstable, camphoraceous prin- ciple, crystallizable, soluble in chloroform and in hot alcohol, almost insoluble in water and in ether. Dose, gr. in pill; but much larger doses may be taken without inconvenience, as much as two grains producing no physiological symptoms in man (Schroff). Preparations. Physiological Action. Pulsatilla is an active irritant when locally used ; the oil vesicates the skin, and the fresh juice produces tingling and burning sensations in a part to which it is applied. It may excite a violent dermatitis, with a vesicular or pustular eruption, and inflammation and even gangrene of the entire limb has followed the application of the bruised root to the calf of the leg for rheumatism. Inhalation of its dust has produced itching of the eyes, colic, vomiting and diarrhoea ; and swallowing the fresh herb may cause severe irritation of the gastro-intestinal mucous membrane. The fresh juice applied to the tongue gives rise to tingling and burning sensations followed by numbness, symptoms very like those caused by Aconite. Internally administered Pulsatilla is diuretic, diaphoretic and emmen- agogue, and also acts as a cardiac and vascular sedative, lowering the action of the heart, the arterial tension and the body temperature. In overdoses 406 PULSATILLA. it strongly affects the mucous membranes, and produces nausea and vom- iting, slimy diarrhoea, bloody urine, profuse and offensive sweats, coryza and cough, also vesicular and pustular eruptions on the skin and peculiar pains in the eyes and dimness of vision. Its primary action is that of a spinal irritant, secondarily it produces exhaustion and paralysis of both motion and sensation. Stupor, coma and convulsions may be caused by a toxic dose, also paralysis of the cord and medulla. Most of these effects have been observed on rabbits, and the pharmacology of the drug is not yet accurately worked out. The homoeopathic writers credit it with specific influence on the synovial membranes, the veins, the ears, and the generative apparatus of both sexes. Anemonin was discovered in 1771 by Storck, and has been studied to some extent on animals. When applied to the conjunctiva it caused slight inflammation thereof, and placed on the human tongue it left a slight burning sensation. When melted, its vapor produced intense in- flammation of the eyes and pricking sensations in the tongue followed by numbness and white patches thereon. The symptoms following its in- ternal administration in fatal doses were a slow and feeble pulse, slow respiration, lowered body temperature, frequent diarrhoea, paralysis of first the hind- and then the fore-legs, dyspnoea, mydriasis followed by myosis, stupor and death without convulsions. The absence of the latter is thought to be due to a paralyzing action of this principle on the cerebral motor centres, as in poisoning by extract of Pulsatilla convulsions are al- ways present. The autopsies showed congestion and oedema of the lungs, also marked hypersemia of the cerebral and spinal membranes, especially in the vicinity of the medulla. The heart walls were relaxed, and its cavities and the great vessels filled with dark and clotted blood, while the blood elsewhere was fluid. The liver, spleen, kidneys and ab- dominal viscera were found to be healthy. Alcohol, Opium and Digitalis are its physiological antagonists. Tannic Acid, the caustic alkalies and the metallic salts are chemically incompatible with preparations con- taining Pulsatilla or Anemonin. Antagonists and Incompatibles. Therapeutics. The ancient writers credited different species of Anemone with many medicinal virtues, but the modern use of this drug dates from the time of Baron Storck and his contemporaries (1770-1800) who highly praised the Pulsatilla nigricans as a remedy for corneal opacities, cataract, paralysis, rheumatism, amenorrhcea, melancholia, secondary syphilis, old ulcers and scaly skin diseases. Later therapeutists differ widely as to the medicinal value of this drug, some giving it extravagant praise, and others finding no efficacy in it. It is quite possible that no effects whatever would be obtained if an old preparation or even a fresh one from the dried herb PULSATILLA. 407 were employed. It has proved very efficient in acute catarrhal affections of the mucous membranes, especially rhinitis and conjunctivitis, in the early stage of the purulent ophthalmia of children and in gonorrhoeal ophthalmia, also in subacute and chronic bronchitis of delicate persons accompanied with profuse mucous expectoration, and in chronic catarrh of the bladder. It is used with benefit in chronic nasal catarrh with a thick though bland discharge, also in acute and subacute inflammation of the middle ear and the lining of the external auditory canal so often seen in children, where the membrane is red and swollen, with severe pain, and later on a thin, acrid discharge, which is often bloody and soon be- comes puriform. In these affections medium doses (upv) of the tincture may be given internally every four hours to adults, and a lotion composed of 3j-ij in of warm water may be applied to accessible parts. A similar use of this agent has been of decided benefit in many cutaneous affections, especially eczematous eruptions, syphilides, and indolent ulcers. In acute and chronic dyspepsia, characterized by gastric catarrh or sub- acute gastritis with a white-coated tongue, no taste or a greasy sensation in the mouth, nausea, flatulence, heart-burn, sick headache, anorexia, de- pression, diarrhoea, etc., Pulsatilla is a very efficient remedy, given in medium doses, of the tincture every four hours. It does good service in intestinal catarrhs, shown by passive, mucous diarrhoea with little pain, and frequently seen in the febrile affections of childhood, especially measles, mumps, chicken-pox and remittent fever. Pulsatilla is generally credited with specific therapeutical action on the generative organs of both sexes. Epididymitis and orchitis have been often controlled and entirely dissipated by its administration in very small doses, a few drops of the tincture in a glass of water, of which gj is given every two hours (Piffard, Sturgis). In more than 24 cases of acute uncomplicated epididymitis, doses of pvo drops of the tincture every two hours gave immediate relief, the patients wearing a suspensory bandage but not being confined to bed (Borcherin). Doses of five drops aggravated this disorder, while those of rt^y every three hours proved curative (Piffard). In functional amenorrhoea, in scanty or delayed menstruation, and in suppression thereof from fright or cold, in ovaritis and in simple leucorrhoea with back-pains and nervous depres- sion, it has been found to be an excellent remedy. Dysmenorrhoea has been removed in several cases by two-drop doses of the tincture given thrice daily for several days before the menstrual epoch (Piffard). Ex- travagant opinions as to its virtues in the puerperal state and during par- turition are promulgated by the homceopathists, and their authorities on materia medica credit this drug with power to rectify false presentations during labor by causing version of the child. Besides the catarrhal affections of the ocular mucous membrane already 408 PYRETHRUM—QUASSIA. mentioned, Pulsatilla has remedial power in certain affections of the eye- lids. Its internal administration is said to effectually blight a stye if given early, but will not prevent its recurrence. It is an efficient remedy in recent blepharophthalmia, with profuse lachrymation and meibomian secretion; and it is said to stop twitching of the lids accompanied by photophobia. It has been used with decided benefit in the earache of children and in recent catarrhal deafness, also in acute cerebral and spinal meningitis, eclampsia from various causes, asthma, subacute rheumatism of the small joints, acute rheumatic gout, left-sided clavus, hemicrania and infra-mammary pain. Denian used this drug with benefit in several nervous affections, and concludes that it is a direct sedative of nervous irritability, but only indirectly a sedative to the circulation. Tucker found it especially serviceable in the nervous headache produced by over- taxing the mind. An extract of the root has proved to be an efficient taeniafuge. Coughs which are loose by day, but dry and tickling in character on lying down at night, are greatly benefited by small doses of the tincture frequently repeated; and Anemonin, in doses of gr. ss—j, has been ex- tremely useful in whooping-cough and coughs of irritative character. PYRETHRUM, Pellitory,—is the root of Anacyclus Pyrethrum, a plant of the nat. ord. Composite, native of Northern Africa, but cultivated in Europe. It contains an alkaloid, Pyrethrine, also inulin, tannin, mucilage, etc., with a brown Resin and two fixed oils. Dose, as a masticatory, 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. Tinctura Pyrethri, Tincture of Pyrethrum,—20 per cent. Not used internally. 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. Applied to the skin it acts as a rubefacient, the powder inhaled as a sternutatory. 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, rheu- matic 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 (3 iij 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 elimina- tion of Iodine from the system in chronic poisoning thereby. QUASSIA ,—is the wood of Picrcena excelsa, a large tree of the nat. ord. Simarubeae, indigenous to Jamaica and other West Indian islands. Surinam Quassia, used in Europe, is the wood of Quassia arnara. Both 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- QUERCUS ALBA. 409 or bitter-cups. It contains a bitter principle, Quassin, C34H4209, 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 Quassiae, Extract of Quassia,—aqueous. Dose, gr. j-iij. Extractum Quassiae Fluidum, Fluid Extract of Quassia.—Dose, 3 ss-j. Tinctura Quassiae, Tincture of Quassia,—strength 10 percent. Dose, tqv-gj. Infusum Quassiae, Infusion of Quassia (Unofficial),—made with cold water % x, Quassia chips £j, macerated for hour and strained. Or water poured into a quassia- cup and left standing will give a good infusion. Dose, 3 j-iij. Preparations. Physiological Action and Therapeutics. 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. 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 intes- tinal mucous membrane. It is useful in convalescence to promote the appetite and digestion, and with Sodium Bicarbonate in gastric vertigo. As an erfema 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. QUERCUS ALBA, White Oak,—is the bark of Quercus alba, the White-oak tree (nat. ord. Cupuliferae). It contains a variety of Tan- nin named Quercitannic Acid, C28H24012, also Pectin and a bitter principle named Quercin, but no Gallic Acid. There are no official preparations, but a decoction (§j ad Oj) may be used in doses of 3ss-j. 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 under Galla). Oak-bark is astringent and tonic, but is seldom used internally. Its action and uses are those of Tannic Acid. The decoction 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 410 QUILLAJA RESINA. into dropsical cysts, and as a lotion for flabby ulcers and suppurating wounds. The powdered bark as a poultice has proved an excellent appli- cation in gangrene, and in finely pulverized state it is a useful ingredient of tooth-powders. A concentrated fluid extract is used in the Heaton- 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. QUILLAJA, Soap Bark,—is the inner bark of Quillaja Saponaiia, a tree of the nat. ord. Rosacese, indigenous to Peru and Chili. It contains Calcium Sulphate crystals, starch, and the glucoside, Saponin, C32II54018, a white, amorphous, sternutatory powder, soluble in water and in dilute alcohol. The Infusion of Quillaja foams like soap-water. The only official preparation is the tincture. Tinctura Quillaja, Tincture of Quillaja,—20 per cent. Dose, rr^v-xxx. Quillaja 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 stimulate the growth of the hair in alopecia. Its properties are due to the glucoside 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 according to age, as a substitute for Senega in the treatment of diseases of the respiratory organs where a pleasant expectorant is indicated. Its expectorant properties are well established, and children take it readily. It does not provoke diarrhoea or vomiting, and has a sweet- ish, agreeable taste. RESINA, Resin (Colophony), C44H6204,—is the residue left after distilling off the volatile oil from Turpentine. It is a transparent, amber- colored substance, 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 Abietic Acid, C44H6405, into which acid it is converted by agitation with warm diluted alcohol. Silvic, Pinic, and Palmaric Acids are decomposition products, not constituents of resin as was formerly taught. For the definition of a Resin see ante, page 22, also the title Resina, in Part II. Other official resins are Resina Copaiba, Resina Resina Podophylli and Resina Scammonii, which are severally described under the titles of the plants forming their respective sources. Preparations. Ceratum Resinse, Resin Cerate, Basilicon Ointment,—consists of Resin 35, Yellow Wax 15, and Lard 50 parts. It forms 65 per cent, of Turpentine Liniment. Emplastrum Resinae, 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 Cantharides Cerate. Resin gives consistence and adhesiveness to plasters and cerates, and generally acts as a mild local stimulant, but the writer has seen persons RESORCINUM. 411 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 (.Resorcinol, Metcidioxybenzol'), C6H4- (OH)2—is a diatomic phenol, isomeric with Pyrocatechin and Hydro- quinone, obtained by fusing certain resins with a caustic alkali, but best prepared by fusing Potassium Benzol-disulphonate 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, very soluble in water, also in alco- hol, ether, etc. Dose, gr.v-xv ;—as an antipyretic gss-j, not repeated for several hours, or gr.v every 2 hours. Physiological Action. Resorcin is closely allied to Carbolic Acid, but possesses an advantage over the latter in that it is odorless, more soluble and almost non-irritant. It is equally powerful as an antiseptic and antiferment, arresting decom- position and destroying low organisms. Injected beneath the integument in solution it produces very little irritation, and never causes inflammation or abscess. Vesication results from its application to the mucous mem- brane. Internally a 30- to 60-grain dose causes a sense of heat, discom- fort and oppression, followed by profuse perspiration and languor ; if fever be present the temperature of the body is lowered several 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 35 ozs. 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. 412 RHAMNUS PURSHIANA. 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, gastritis, gastric ulcer and cancer, fermentative indigestion, etc. In ulcer of the stomach its analgesic property is so marked that the stomach is enabled to tolerate food. It has given very great satisfaction in the treat- ment of diarrhoea of children; and is highly recommended by some observers in intermittent fevers and malarial diseases generally, while others have been much disappointed with its action therein. As an anti- pyretic it has been used in erysipelas, puerperal fever, septicaemia, and diphtheria, and in the latter disease it has been locally employed in crys- tals with decided benefit. As a local application to tuberculous and other ulcerations of the larynx, in diphtheria, tonsillitis, pharyngitis, chronic rhinitis, etc., strong, even supersaturated solutions are employed with increasing satisfaction, being highly efficient and quite painless. Applied to the peri-laryngeal mucous membrane, it has proved very use- ful in the treatment and prophylaxis of pertussis. A 2 per cent, solution has given great satisfaction as a local antiseptic application to wounds, parasitic skin diseases, cystitis, gonorrhoea, anthrax, and syphilitic sores of unhealthy character. As spray a similar solution is well applied to catarrhal or ulcerative 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. A paste of equal parts of Resorcin and Zinc Oxide has been lately applied to the face to promote peeling of the skin in the treatment of acne rosacea. In three or four days the skin becomes like parchment, when the application must be stopped, in order to avoid the cracking of the skin, which begins at that stage. A dressing of gelatin, glycerin, zinc oxide and hot water is then applied, covered with cotton wool. In a few more days the dressing comes off, bringing the epidermis with it. Some few dangerous and unfavorable results have followed this method, but a number of very satisfactory cases are reported. Freckles and other superficial spots on the skin may be removed by the same treatment. RHAMNUS PURSHIANA, Cascara Sagrada (Chit tern Bark, Sacred Bark),— is the bark of Rhamnus Purshiana, the California Buckthorn, a small tree of the nat. ord. Rhamnese, growing on the Pacific coast of the United States. It contains a Volatile Oil, a neutral crystalline substance, several Resins, with tannic, malic and oxalic acids. It has been found very serviceable in the treatment of chronic gout and 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. Another species of the same order, Rhamnus Frangula, is official under the title Fran- gula, which see. RHEUM. 413 Extractum Rhamni Purshianae Fluidum, Fluid Extract of Cascara Sagrada,— is made with diluted alcohol. Dose, 3 ss-jss, two or three times a day. Cascara Cordial is a trade preparation, intended as a remedy for constipation, dys- pepsia and hemorrhoids, and as a pleasant excipient for nauseous and bitter drugs. A similar preparation may be made by combining the fluid extract with the official Elixir Aromaticum in the proportion of to ij, of which teaspoonful doses or more may be administered. RHEUM, Rhubarb ,—is the root of Rheum officinale, a perennial plant of the nat. ord. Polygonacese, a native of Thibet. There are many other undetermined species of Rheum, several of which are cultivated in Europe and America, their leaf-stalks being used as a fruit. The com- monly accepted medicinal Rhubarb is the Chinese variety, and is imported from Shanghai and Canton. It imparts its virtues to water and alcohol, and contains several substances of greater or less activity, the least im- portant being PhcBoretin, C32H32014, the rhubarb-resin,—Erythroretin, C38H36014, and Chrysophan, H27O30C14, the latter of which is split by acids into sugar and Chrysophanic Acid. (See Chrysarobinum.) It also con- tains Rheo-tannic Acid, C52H52028, Rheumic Acid, C40H32Oi8, 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-xxx. Preparations. Extractum Rhei, Extract of Rhubarb.—Dose, gr. j-x. Extractum Rhei Fluidum, Fluid Extract of Rhubarb.—Dose, rrpx-^j. Pilulae Rhei, Pills of Rhubarb,—are composed of Rhubarb 60, Soap 6, Water to 100 ; each pill containing about 3 grains of powdered Rhubarb. Dose, j-v pills. Pilulae Rhei Compositae, Compound Pills of Rhubarb,—each pill contains of Rhu- barb about 2 grains, Aloes 1%, Myrrh x, Oil of Peppermint grain. Dose, ij-v pills. A safe and efficient laxative. Tinctura Rhei, Tincture of Rhubarb,—has of Rhubarb 10, Cardamom 2, Glycerin 10, Alcohol and Water to 100. Dose, Tinctura Rhei Aromatica, Aromatic Tincture oj Rhubarb,—has of Rhubarb 20, Cinnamon 4, Cloves 4, Nutmeg 2, Glycerin 10, Alcohol, WTater and Diluted Alcohol to 100. Dose, 3j-iv. Tinctura Rhei Dulcis, Sweet Tincture of Rhubarb,—has of Rhubarb 10, Glycyr- rhiza 4, Anise 4, Cardamom I, Glycerin 10, Alcohol, Water and Diluted Water to 100. Dose, ss-ij. Syrupus Rhei, Syrup of Rhubarb,—has of the Fluid Extract 10, Spirit of Cinnamon 0.4, Potassium Carbonate I, Glycerin 5, Water 5, Syrup to 100. Dose, for an infant,gj ; for older children, 3 ij-iv. Syrupus Rhei Aromaticus, Aromatic Syrup of Rhubarb,—has of the Aromatic Tincture 15, Syrup 85. Dose, as the Syrup. Pulvis Rhei Compositus, Compound Powder of Rhubarb,—has of Rhubarb 25, Magnesia 65, Ginger 10. Dose, a teaspoonful. Mistura Rhei et Sodae, Mixture of Rhubarb and Soda,—has of Sodium Bicarb. Fluid Extract of Rhubarb Fluid Extract of Ipecac y3, Glycerin 35, Spirit of Peppermint 3j4> Water to 100. Dose, 3 ij— ij. 414 RHINACANTHUS—RHUS AROMATICA. Physiological Action and Therapeutics. Rhubarb is classed among the tonic-astringent and resin-bearing pur- gatives, which increase the circulation 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, 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, Phseo- retin. 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. 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. The 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 Sodium Bicar- bonate, 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 Sodse. RHINACANTHUS (Unofficial),—the leaves and root of Rhinacanthus communis, a shrub of the nat. ord. Acanthacese, indigenous to India and China. The root contains a quinone-like body named Rhinacanthin, CuH]g04, which forms with alkalies intensely red compounds which are decomposed by benzin. It is known in China as Hong-Pang- Chong, 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 indigenous sluub of the nat. ord. Terebinthaceae, growing about 5 feet high, and having yellow flowers in spikes. The root-bark contains a volatile oil, several resins, fat, tannin, etc. A fluid extract is RHUS GLABRA—RHUS TOXICODENDRON. 415 prepared from the bark of the root according to the general pharmacopceial rule, and may be given in doses of nyx-xxx, every 2 or 3 hours. Rhus Aromatica has astringent properties, and seems to possess a selective 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 considerable attention, having been extremely efficient in doses of hyxv of a good fluid extract four times daily, administered in glycerin and water, or any other suit- able excipient. It is reported to be equally effective in hysterical enuresis of adults, but larger doses (Tiyxx-xxx several times a day) are required. Diabetes insipidus is remark- ably benefited by its continued use, and even in diabetes mellitus its employment has occasionally seemed to have been followed by curative results. RHUS GLABRA, Smooth Sumach,—is the fruit of Rhus glabra, an indigenous shrub of the nat. ord. Anacardiea, growing in rocky and barren soil to a height of 8 to 12 feet. The leaves and bark have an astringent and bitter taste, and are also used medicinally. It contains tannin, coloring matter, potassium and calcium malates. Extractum Rho'is Glabrae Fluidum, Fluid Extract of Rhus Glabra.—Dose, 55 j—ij. Sumach-berries form a useful acidulous and astringent drink or gargle in catarrhal pharyngitis, stomatitis, aphthae, etc. An infusion ( §j to the pint) or the official fluid ex- tract may be used 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 Ivy,—is the fresh leaves of Rhus radicans, a plant of the nat. ord. Anacardietz, indigenous to Canada and the greater part of the eastern United States. This climbing plant is not by itself a distinct species, but a variety of the erect shrub, Rhus Toxicodendron, the Poison Oak, formerly official as a source of the drug ; both of which when wounded exuding a poisonous, acrid, milky juice which turns dark on exposure. 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. The 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. Tinctura Rho'is Toxicodendri, Tincture of Rhus Toxicodendron (Unofficial),—may be 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, n\, TV—n\ij. Extractum Rho'is Toxicodendri, Extract of Rhus Toxicodendron,—has been used in France in large doses. It is probably 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. 416 RHUS TOXICODENDRON. 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 lower extremities is frequently experienced. Similar phe- nomena attend its internal administration, but fatal results have not followed 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. Cocaine Hydrochlorate, in 4 to 8 per cent, solution, is the best lotion to relieve the in- tolerable itching and burning. Grindelia Rohusta makes one of the best local applica- tions, and a solution of Mercuric Chloride is also a very serviceable lotion, also Lime- water with Linseed-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. Antidotes atid Antagonists. 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 Therapeutics. RICINI OLEUM. 417 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 of the 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. Euphorbiaceae, indigen- ous to India, but extensively cultivated in the United States. The oil is an almost colorless, transparent, viscid liquid, of faint odor, bland or slightly acrid taste, neutral reaction, soluble in an equal weight of alcohol, and congealing at about —o. 40 F. It consists mainly of Ricinolein, the glyceride of ricinoleic acid, also palmitin, stearin and myristin in small quantities, and an acrid principle. The seeds contain a highly toxic ferment or phytalbumose named Ricin, and an alkaloid, Ricinine, which seems to be inert. Castor Oil is an ingredient of Collodium Flexile in the proportion of 3 per cent., also of Linimentura Sinapis Compositum, 15 per cent., and of Pilulae Antimonii Composite. Used externally pure Castor Oil is perfectly bland. Internally admin- istered it is non-irritant until it reaches the duodenum, where it is decom- posed by the pancreatic juice, setting free the Ricinoleic Acid, which produces purgation by a mildly irritant action on the bowel, stimulating the intestinal glands and muscular coat, but not the liver. It is a simple purgative, 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. Ricin, given either hypodermically or by the mouth, produces violent gastro-enteritis, nephritis and cystitis, also inflammation of the mucous lining of the biliary duct. To it is ascribed the jaundice and anuria ob- served in some cases of poisoning by castor-oil seeds. Physiological Action. Castor Oil is one of the best of the 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. Infants bear a larger relative dose than adults, prob- Therapeutics. 418 ROSA ably 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, nephritis 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 Oil of Turpentine 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 neutral- izing 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. 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. Admin istra t ion. ROSA, Rose,—is represented in pharmacy by the petals of two species and the volatile oil from a third. Rosa Centifolia, Pale Rose,—is the petals of Rosa centifolia, the Cabbage Rose, a well-known and cultivated shrub of the nat. ord. Rosa- cese. The odor is due to a minute quantity of a volatile oil, 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 one-half its weight of Sodium Chloride and pressed into a jar, which should be kept in a cool place, well closed. Rosa Damascena, Damask Rose,—is the source of the official Oil of Rose, which is distilled from the fresh flowers. This variety of the nat. ord. Rosacese is largely cultivated in Roumelia, on the southern slope of the Balkan mountains, from which section comes nearly all of the oil supplied to commerce. Rosa Gallica, Red Rose,—is the petals of Rosa gallica, collected before expanding. They contain an aromatic oil, Tannic and Gallic Acids, Quercitrin, coloring matter, salts, etc. ROSMARINUS. 419 Preparations of Rosa Damascena. Oleum Rosae, Oil of Rose, Attar of Rose,—is a volatile oil distilled from the fresh flowers of Rosa damascena. 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. It consists of an aromatic oxygenated elaeopten 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, and as the basis of the following: Aqua Rosae Fortior, Stronger Rose Water, Triple Rose Water,—is water saturated with the volatile oil of Rose petals, obtained as a by-product in the distillation of Oil of Rose. An agreeable excipient and flavoring agent. Dose, gss-j. Aqua Rosae, Rose Water,—consists of equal volumes of the preceding and distilled water, mixed together immediately before use. It is an ingredient of Mistura Ferri Com- posita. Dose, 3 j—ij - Unguentum Aquae Rosae, Ointment of Rose Water, Cold Cream,—has of Stronger Rose Water 19, Expressed Oil of Almond 60, Spermaceti 12y2, White Wax 12, and Sodium Borate ]/2. For local use. Preparations of Rosa Gallica. Extractum Rosae Fluidum, Fluid Extract of Rose,—prepared with glycerin and diluted alcohol. Dose, rqv-^j. Confectio Rosae, Confection of Rose,—has of Red Rose 8, Sugar 64, Honey 12, Stronger Rose Water 16, beaten together into a mass, which is used as a basis for pills. Dose, gr. x-3 j. Mel Rosae, Honey of Rose,—has of the Fluid Extract 12, and Clarified Honey to 100. Dose, 3j—ij - Syrupus Rosae, Syrup of Rose,—has of the Fluid Extract with Syrup Dose, jj—ij, for flavoring. Red Rose is an ingredient of Pil. Aloes et Mastiches. Pale Rose petals are only used for odoriferous purposes. Rose Water has no strictly medicinal properties, but is an agreeable excipient for lotions, collyria and urethral injections. The ointment, commonly termed “ cold cream,” is a pleasant emollient and protective, generally used for chapped hands and other superficial skin affections. Red Rose is classed among the astringents, as it contains an appreciable amount of tannic and gallic acids. A Compound Infusion, containing 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 source of the official Oil of Rosemary, is the leaves of Rosmarinus officinalis, a shrub of the nat. ord. Labiatse, cultivated in gardens for the sake of its large, pale-blue flowers. They are pungently aromatic and somewhat camphoraceous, and contain the volatile oil, a little tannin, some resin and a bitter principle. Oleum Rosmarini, Oil of Rosemary,—is the volatile oil distilled from Rosemary, a colorless or yellowish liquid, 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, Cj0H16, and a body allied to camphor. It is an ingredient of Linim. Saponis, Spir- itus Odoratus and Tinct. Lavandulae Comp. Dose, rr\J-v. Rosemary was formerly considered emmenagogue, galactagogue and diuretic, but is 420 RUBIDIUM RUBUS RUMEX. 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. RUBIDIUM, Rubidium, Rb, (Unofficial),—is one of the rarer metals, belonging to the group of alkaline metals of which potassium and sodium are typical. It has a molecular weight of 85, that of Potassium being 39, and that of Sodium 23. Its salts are supposed to act more promptly and efficiently than those of the latter, upon the theory that the physiological action of salts is as much a periodic function of the atomic weights of their elements as are their physical and chemical characters. The principal salt of Rubidium is— Rubidii Iodidum, Rubidium Iodide, Rb I, (Unofficial),—occurs in white, non-efflor- escent crystals, odorless, of milder taste and greater solubility in water than Potassium Iodide. Dose, gr.v-xxx or more. Rubidium Iodide has generally the same physiological and therapeutical action as Potassium Iodide, but has a far less toxic action upon the cardiac muscle. It is well borne by the stomach, does not disturb the appetite or give rise to digestive derangements, and does not affect the circulation. It rarely produces iodism, and even when the iododerma and catarrh were present as a result of the administration of potassium iodide, the change to the rubidium salt has resulted in decrease of these symptoms. It has been employed in lieu of the potassium salt, with greater efficiency and less disturbance, in most of the affections for which the iodides are indicated. In eye affections requiring an absorptive treatment it is employed internally and externally as a 5 per cent, vaselin ointment or in the form of 5 per cent, drops ( 3 j in 3ijss). RUBUS, Blackberry-Bark,—is the bark of the root of Rubus villosus, the common Blackberry, Rubus canadensis, the Dewberry, and Rubus trivialis, the Bush Blackberry of the Southern States, all of the nat. ord. Rosacese. It contains over io per cent, of Tannin. Dose, gr. xv-xxx. Extractum Rubi Fluidum, Fluid Extract of Rubus.—Dose, n^x-^j. Syrupus Rubi, Syrup of Rubus,—has of the Fluid Extract 25, Syrup 75. Dose, Syrupus Rubi Aromaticus, Aromatic Syrup of Rubus (Unofficial),—contains Rubus, Cinnamon, Cloves and Mace. Each fl 5 has 30 grains of the drug. Dose, Blackberry-bark derives its virtues from its tannin. It is strongly astringent, and may be used in decoction, wine or the above-named preparations. It is highly esteemed in summer and infantile diarrhoeas. RUBUS ID./EUS, Raspberry,—is the fruit of Rubus idceus, the Raspberry bush, nat. ord. Rosacese. It contains sugar, malic and citric acids, proteids, pectin, etc., also a Volatile Oil consisting of compound ethers, to which the odor is due. Its sole use in medicine is to prepare a pleasantly flavored syrup. The closely allied, light-red fruit of Rubus strigosus, the wild Red Raspberry, and the purplish-black fruit of Rubus occident- als, the Thimble-berry, may be employed in place of the above. Syrupus Rubi Idsei, 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, to the pint, are a popular domestic remedy for diarrhoeas. RUMEX, Yellow Dock,—is the root of Rumex crispus, and of some other species of Rumex, plants of the nat. ord. Polygonacese, growing as common weeds along roadsides. Several species of Rumex have sour leaves, and are popularly called Sorrel to distinguish RUTA. 421 them from the others which are called Dock. The official root contains tannin, mucilage, starch, calcium oxalate, and two principles named Rumicin and Lapathin, which are shown to be identical with Chrysophanic Acid. Its constituents are nearly identical with those of Rhubarb. Dose, gr. xv-gj. ExtractUm Rumicis Fluidum, Fluid Extract of Rumex.—Dose, rr^xv-gj. Decoctum Rumicis, Decoction of Rumex (Unofficial),— 3 ij of the fresh root, or 5 j of the dry root to Oj of water. Dose, Jj-ij. 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 strumous 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 popular reputation as a local appli- cation for cancer. RUTA, Rue (Unofficial),—is the source of Oil of Rue, which is dis- tilled from the leaves of Ruta graveolens, an herbaceous perennial of the nat. ord. Rutacese, 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 Rutse, Oil of Rue (Unofficial),—the volatile oil distilled from Ruta graveo- lens; a colorless, or greenish-yellow liquid, of disagreeable but aromatic odor, pungent acrid taste and neutral reaction, soluble in an equal weight of alcohol. Dose, TT\j-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, and the symptoms of a narcotic poison ensue if the dose is large enough. Abor- tion may be produced by large doses, but with great danger to life. Rue is an efficient emmenagogue, and in men aphrodisiac; it is also con- sidered antispasmodic and carminative. The Oil of Rue is employed internally in amenorrhcea, menorrhagia and metrorrhagia, hysteria, convulsions and flatulence. As an emmena- gogue 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 gland- ular enlargements. Used as an abortifacient it has frequently caused death, preceded by symptoms of irritant and narcotic poisoning. Even 422 SABINA. in poisonous doses its abortifacient action is very uncertain, so that only the most ignorant criminals employ it with such purpose. It was formerly official, but has been dismissed from the last edition of the pharmacopoeia. SABINA, Savine,—the tops of Juniperus Sabina, a small evergreen 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 contains a Volatile Oil (which is official), also tannin, resin, extrac- tive matters, chlorophyll, etc. Dose, gr.v-x. Preparations. Extractum Sabinae Fluidum, Fluid Extract of Savine.—Dose, n^v-xv. Ceratum Sabinae, Savine Cerate (Unofficial),—may be prepared by incorporating the Fluid Extract 25 in Resin Cerate 90, melted and cooled. Formerly official, but dismissed from the last edition of the pharmacopoeia. Oleum Sabinae, Oil of Savine,—a volatile oil distilled from Savine, existing in the fresh tops in the proportion of 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, and soluble in an equal volume of alcohol. Dose, n\j-v. 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, hyperse- 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. Toxic doses produce the symptoms of an irritant and narcotic poison. 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. 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 ex- tremely 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. Physiological Action and Therapeutics. SACCHARINUM SACCHARUM. 423 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 combination with burnt alum or cupric subacetate. The Oil is the most efficient preparation for internal administration. SACCHARINUM, Saccharin (Unofficial),—is a sweet imide de- rivable from a coal-tar product, Toluene, from which it is prepared by a complicated process. It has the chemical title Benzoyl-sulphonic-imide, and the formula C6H4(C0)(S02)NH. It occurs as a white, amorphous powder, with a very sweet taste, and a faint flavor of bitter almonds, is soluble in alcohol and in ether [Sugar is not soluble in ether], sparingly in cold water, more so in hot water. Saccharin is official in the British Pharmacopoeia under the title Glusidum, Gluside (Glucusimide). Saccharin 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 is useful as a substitute for sugar in cases of diabetes, but it has no curative action upon that disease. Dose, gr. xx-xxv daily, given with sodium bicarbonate (3 parts to 2) which renders it soluble. Dulcin, Paraphenetol Carbamide (Unofficial),—is an aromatic urea derivative, allied to phenacetin. It has a pure, sweet taste, and excels Saccharin in sweetness some 200 to 250 times. In reasonable doses it is harmless and does not bring about any decom- position of the blood. It is soluble in 800 parts of water, in 50 of hot water, and in 25 of alcohol. In diabetes it must be used in relatively small doses, not exceeding gr. xxx daily. SACCH ARUM, Sugar (Cane-sugar) ,CV2HnOn,—is the refined sugar obtained from Saccharum officinarum, the Sugar-cane, a perennial plant of the nat. ord. Graminese, indigenous to India and adjoining countries, but cultivated in tropical regions throughout the world. It is also obtained from various species or varieties of Sorghum (nat. ord. Graminese), and from one or more varieties of Beta vulgaris, the Sugar-beet (nat. ord. Chenopodiacese). It is present in several other grasses, as Zea Mays, Maize; in the juice of various trees (maple, birch, palm, etc.); and in many roots. 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 I gram in 10 Cc. of boiling water, then mixing with the solution 4 or 5 drops of test- solution of Silver Nitrate and about 2 Cc. of Aqua Ammonia, 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. 424 SACCHARUM. Other Sugars. Saccharum Lactis, Sugar of Milk, Lactose, C12H22On -(- H20,—see next page. Glucose, Dextrose, Grape-sugar, Starch-sugar, C6H1208, or hydrated C6H]206 + 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 ger- mination of grain. Boiling solutions of the alkalies convert it into a brown substance (melassic acid). Levulose, Fruit-sugar, C6H]206 (Unofficial),—frequently found with grape-sugar in fruits, also in honey. See also Diabetin, below. Inosit, Phaseo-mannit, C6H1206 -f- 2H20 (Unofficial), exists in the juice of some meats, in asparagus, etc. Is very sweet, but does not undergo alcoholic fermentation. Allied Substances. Theriaca, 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. Amylum, Starch, C6H10O5,—when boiled with dilute mineral acids or when subjected to the action of diastase, ptyalin, or pancreatin, starch is converted into glucose. (See ante, article AMYLUM.) Cellulose, C6H10O6 (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, 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. Sugar and sugar-forming food constitute more than one-half of the nourishment needed by a healthy person, and when withheld, as in diabetes, the patient is actually starved, and undergoes progressive and rapid emaciation. Levulose is found to be more easily consumed in the system than is cane-sugar, and in the treatment of diabetic patients may be used with benefit for some time. Heretofore its cost has been very SACCHARUM LACTIS SALICINUM. 425 great, but it is now being manufactured in large quantities, and sold at a reasonable price, under the trade-name Diabetin. SACCHARUM LACTIS, Sugar of Milk, Lactose,—CKHBOn -f 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, solu- ble in about 6 of water at 590 F. and in I of boiling water, insoluble in alcohol, 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 brownish, 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. S6e 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 dis- advantages 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 Dover’s Powder, Deodorized Opium, etc., as a diluent. Being much harder than cane-sugar it is considered a valuable exci- pient 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 stomach and bowels is better than the latter for use with infants’ food. SALICINUM, Salicin, C13H1807,—is a neutral principle obtained from several species of Salix (Willow) and Populus (Poplar), trees of the nat. ord. Salicacese. It is found also in Gaultheria procumbens, Winter- green (nat. ord. Ericaceae), and in Betula lenta, the Sweet Birch (nat. ord. Betulaceae), the volatile oils of which, distilled from the leaves of the former and from the bark of the latter, consist almost entirely of methyl salicylate. (See below.) 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 thrice daily, as a sexual sedative. Salicin occurs in colorless or white and silky, shining crystalline needles, or a crystal- line powder, odorless, of very bitter taste, permanent in the air, of neutral reaction; soluble in 28 of water and in 30 of alcohol, in 0.7 of boiling water and in 2 of boiling alcohol; almost insoluble in ether or chloroform. Dose, gr. x-^j. Acidum Salicylicum, Salicylic Acid, HC7H503,—is an organic acid, existing naturally in combination in various plants, but most largely pre- pared synthetically from carbolic acid. It occurs in light, fine, white, prismatic needles, or a crystalline powder, odorless, of sweetish, after- wards acrid taste and acid reaction, permanent in the air; soluble in about 450 of water, but readily soluble in water containing 8 per cent, of Borax or 10 per cent, of Sodium Phosphate. It is soluble in of 426 SALICINUM. alcohol, in 14 of boiling water, in 2 of ether, in 80 of chloroform, and is very soluble in boiling alcohol. Dose, gr.v-^j. Salicylic Acid is a derivative of Salicin, probably by double oxidation ; but may also be considered as a substitution-derivative of Benzene, formed by replacing 2 atoms of its hydrogen, the one by hydroxyl, and the other by carboxyl. (See page 239, ante.) It is obtained, therefore, either synthetically by combining the elements of Carbolic Acid with those of Carbonic Acid, and subsequent purification,—or from natural Salicylates as the Oils of Wintergreen and Sweet-Birch,—or from Salicin, by heating with caustic potash and treating the mass with hydrochloric acid. The acid prepared from natural sources is purer and more efficient than that prepared artificially, and will often be tolerated by a patient who cannot bear the latter. Official Preparations. Salol, Salol {Phenyl Salicylate), C6H5C7H503,—is the salicylic ether of phenol, now obtained from salicylic acid by heating up from 320° to 464° F., excluding the air; by which process the acid is converted into Salol, Water and C02. It is a white, crystalline powder, odorless and almost tasteless, nearly insoluble in water, soluble in 10 of alcohol, and very soluble in ether, chloroform and oils. On being warmed with an alkali it splits up into Salicylic Acid 60, and Carbolic Acid 40. Dose, gr.v-xv, frequently repeated, in compressed tablets or in cachets, or suspended by mucilage of acacia or of tragacantli. Lithii Salicylas, Lithium Salicylate, LiC7H503,—a white, or grayish-white powder, odorless, sweetish, deliquescent, very soluble in water and in alcohol. Dose, gr.v-^j. Sodii Salicylas, Sodium Salicylate, NaC7H503,—a white, amorphous powder, odor- less, sweetish, permanent; soluble in of water and in 6 of alcohol, also in glycerin. Dose, gr.v-^j. Physostigminae Salicylas, Physostigmine {or Eserine) Salicylate,—is described under Physostigma. Dose, gr. T^-*V Methyl Salicylas, Methyl Salicylate, Artificial {Synthetic) Oil of Wintergreen, CIi3- C7H503,—is a colorless liquid, having the characteristic odor and taste of Oil of Gaultheria, with the essential constituent of which it is identical. It is wholly identical with Oleum Betulee Volatile, and is soluble in all proportions in alcohol, carbon disulphide, or glacial acetic acid. Dose, rtpv—xv, suspended in water or in sugared water. Oleum Betulae Volatile, Volatile Oil of Betula, Oil of Sweet Birch,—is a volatile oil distilled from the bark of Betula lenta, the Sweet Birch. It is identical with Methyl Salicylate (see above), and nearly identical with Oil of Gaultheria. Russia leather derives its odor from this oil. Dose, rt\v-xv. Oleum Gaultheriae, Oil of Gaultheria, Oil of Wintergreen,—consists almost en- tirely of Methyl Salicylate, and is nearly identical with the preceding. It is described under the title Gaultheria. Unofficial Preparations. Salophen, Para-amidophenol Salicylate,—contains the equivalent of nearly 51 per cent, of Salicylic Acid, and occurs as minute, white, crystalline scales, odorless and taste- less, insoluble in water, soluble in alcohol; decomposed by alkalies into Salicylic Acid and Acetyl-para-amidophenol; also by the organism as demonstrated in the urine. Dose, gr.v-xv, up to 3 j or jss in the 24 hours. Salipyrin, Antipyrin Salicylate, C18H18N204,—is produced by the combination of Salicylic Acid 57.7, and Antipyrin 42.3 parts. It is a white, crystalline, odorless powder, very soluble in alcohol, insoluble in water. Its claims to preference are based upon its comparative harmlessness ( 7, ijss having been taken within 3 or 4 hours without the slight- est ill effect) ; also its freedom from unpleasant after-results. Dose, gr. x-xxx every hour or 2 hours until 3 ij have been taken. It is best administered in wafers as a powder, or in mixture, rubbed up with glycerin and flavored with raspberry syrup. Malakin, Salicyl-para-phenetidin,—is a combination of Salicyl anhydride and Phena- cetin. Its effects on the system are those of Salicylic Acid but are very mild,—hence its name (from malakos, miid). It has proved valuable in acute rheumatism and other febrile affections, as an antipyretic and analgesic. As it may be given for a long time without causing any disturbance, it is of especial service in habitual headaches. Dose, gr.viij-xv, repeated about six times in 24 hours. salicinum. 427 Physiological Action. Willow-bark is highly astringent and antiperiodic and feebly tonic, but is never employed medicinally, owing to its bulk. Salicin is a bitter tonic, also antifermentive, antiseptic, and 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 87), and also that of Ptyalin, etc., on Starch (see page 128). 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 Sodium Salicylate, but a portion is again set free and uniting with glycocoll forms Salicyluric Acid (HC9H8N04), coloring the urine green. It is slowly excreted with the secretions generally, especially in the urine, sweat, saliva and bile. It stimulates the kidneys, at the same time disinfecting them and increas- ing the acidity of the urine, but may so irritate the kidneys as to produce albuminuria and hematuria. Salicylic acid is destructive to the torula and 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. Sodium Salicylate is remarkably antipyretic in doses of gr. xv, given 4 or 5 times in 24 hours. It is a powerful diaphoretic, and an efficient cholagogue, and it is supposed to possess the curious property of increas- ing the fluidity of the bile, at the same time that it promotes its secre- tion,—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 428 SALICINUM. Antipyrin, 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 effi- cient they should be abandoned. The acid is much used as an antipy- retic in fevers, especially those of septicaemic character. It is a useful local application 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. Sodium Salicylate is more soluble than the acid and less irritant to the stomach, while in doses about 50 per cent, larger it is equally efficient. It is employed in 3- to 5-grain doses internally after meals, to arrest gas- tric fermentation, and to prevent acidity and flatulence. It is used instead of the acid in acute and chronic rheumatism, to relieve headaches, and for phlegmasia alba, in which it is considered very efficient,—also in cases where there is a tendency to the formation of gall-stones. It is consid- ered a very efficient remedy to cut short an attack of tonsillitis, a “bad cold,” and also other acute affections of the respiratory mucous membrane. Lithium Salicylate 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 one of the most efficient remedies for duodenal catarrh, catarrh of the bile-ducts and catarrhal jaundice; also in the bilious form of sick- headache, and in some forms of neuralgia. Its therapeutic value depends chiefly upon its property of splitting up in the alkaline fluids of the in- testine into Salicylic Acid and Phenol compounds, whereby it effects the thorough antisepsis of the intestinal tract and performs the work of its constituent elements upon the organism. In all affections associated with micro-organisms in the intestines, as acute diarrhoea, cholera, dysentery, etc., it has done most excellent service; even in Asiatic Cholera. It is highly praised in epidemic influenza (grippe), having proven itself re- markably efficient in the treatment of recent epidemics of that affection. Salol is a remedy of very great value in typhoid fever; disinfecting the ulcerated intestines, it promotes the healing process therein, and hinders reinfection. It is highly recommended in dysentery, in cholera, and in infantile diarrhoea. Given in the latter affection, a dark staining of the SALVIA. 429 child’s diapers is often noticed, which is due to the development of car- bolic acid from the remedy. 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 sub- sided. In large doses, however, it is liable to induce symptoms of car- bolic acid poisoning, which may be met by administering sodium sulphate or any other sulphate. It proves to be an efficient disinfectant in catarrh of the bladder, its constituents being excreted with the urine, and coming in contact with the vesical mucous membrane for a considerable length of time. It is much quicker in its action upon the urine than ammonium benzoate, as in a day or two, ordinarily, the urine loses its foul odor and alkalinity and becomes clear. Dissolved in Retinol, it is considered especially useful in subacute cystitis, having conquered cases in which other remedies had proven ineffectual. Externally, it is employed as an antiseptic and deodorant powder, against impetigo, eczema, sycosis and other skin diseases ; and has done good service as an insufflation in the treatment of ozsena. In spirituous solutions (5 per cent.) it is used with various flavoring agents in the prepa- ration of mouth-washes, and dentifrices ; and it also enters into the composition of soaps, face powders, and other toilet articles. A mixture of equal parts of Camphor and Salol, heated together, has given good results in the treatment of suppurations of the middle ear; giving no pain and setting up no inflammation of the parts. Salophen is considered non-toxic in action upon the organism, while affording all the medicinal qualities of Salol. It has been employed with success, in dosage of gj to gjss daily, in the treatment of acute rheumatism, acute rheumatic arthritis, typhoid fever, cholera and allied conditions ; also in neuralgia and sciatica, gastro-enteritis, pyelitis, and cystitis. In intestinal dyspepsia, with flatulence, and in gastrectasis it has been used with decided benefit, in the latter affection chiefly for the relief of the fermentive disturbances to which the dilated stomach is so liable. Salipyrin has been employed with excellent results in acute and chronic rheumatism, rheumatic sciatica, neuralgia, and influenza. In rheumatic fever 15-grain doses are given at short intervals hour to I hour), until about 3ij have been taken, continuing with smaller doses for a long time after convalescence, to prevent relapses. A dose of 8 grains is often sufficient against neuralgia. It was extensively used during the epidemic of in- fluenza in 1891, and highly extolled for efficiency therein, as well as for its freedom from cardiac action. It has proved highly efficient in the treatment of metrorrhagia, espe- cially in that following labor or abortion. Orthmann employed it with most excellent results in 50 cases of metrorrhagia from various causes, giving gr. xv thrice daily up to a total of 3 ijss in some cases. In no instance were unpleasant effects observed. As it is not obtainable in this country, by reason of a legal conflict between its paten- tees and those of Antipyrin, and as it is a very loose combination at best, Dr. Squibb sug- gests that there is no good reason whatever why as good results should not be obtained from the administration of its constituents in conjunction, in proper doses to suit each in- dividual case, and in the proportion of about 3 of Salicylic Acid to 2 of Antipyrin. SALVIA, Sage,—the leaves of Salvia officinalis, the common garden Sage, a peren- nial plant of the nat. ord. Labiatse, native in Southern Europe, but cultivated in our gar- dens for its strong, fragrant odor. They contain tannin, resin, etc., and a volatile oil 430 SAMBUCUS SANGUINARIA. which consists of Salviol (C10H16O), camphor and terpenes. There are no official prepa- rations. Dose of the powdered leaves, gr. 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 influ- ence over enteralgia and flatulence. It makes a good astringent and stimulating gargle. SAMBUCUS, Elder,—the flowers of Sambucus canadensis, the common Elder, a shrub of the nat. ord. Caprifoliaceae. The plant contains a small quantity of a volatile oil, also a resin and valerianic acid. The common Elder of Europe (5. nigra) is more of a tree, and is official in the B. P. There are no official preparations. Dose, gr. xxx-cjj, 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 rheumatism 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. Papaveracese, 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. It contains 3 alkaloids,—Sanguinarine, CnH15N04, which is probably iden- tical with Chelerythrine (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 an expectorant, gr. j-v ; as an emetic, gr. x-xxx ; best given in pill. Extractum Sanguinariae Fluidum, Fluid Extract of Sanguinaria.—Dose, irpj-v as expectorant and stimulant; rqx-lx as emetic, cautiously. Tinctura Sanguinariae, Tincture of Sanguinaria,—strength 15 per cent. Dose, as expectorant, tt\v— as emetic 3j—iij. Sanguinarina, Sanguhiarine, C17H15N04 (Unofficial),'—is the chief alkaloid and prob- ably the active principle of the plant. Dose, as an expectorant, gr. ; as an emetic, gr. x/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 poison and an alterative. Its taste is bitter and acrid. It causes violent sneezing 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- SANTALUM ALBUM. 431 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. Antagonists and Inco?npatibles. Amyl Nitrite, Opium, Atropine, etc., to antagonize the depression of the circulation and the local irritant action. Incompatibles are alkalies, Tannin, and most of the metallic salts. 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 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 amenorrhcea 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. -jL- to are expectorant without irri- tating the stomach ; and still smaller doses (gr. to y are stimulating to the gastric and intestinal secretions. Therapeutics. 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. Santalacege, 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. 432 SANTALUM RUBRUM SANTONICA. Preparations. Oleum Santali, Oil of Santal, Oil of Sandalwood,—a volatile oil distilled from the wood of Santalum album; a pale-yellow liquid, soluble in alcohol, of peculiar and aro- matic odor, pungent taste and acid reaction. Dose, rrpx-xxx, in emulsion or capsule. Extractum Santali Fluidum, Fluid Extract of Santal (Unofficial),—made with alcohol as a menstruum. Dose, 3 j-iij. 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 santalinus, a tree of the nat. ord. Leguminosse, native in India. It comes in chips or as a coarse powder, nearly inodorous and tasteless, not imparting any red color to water when mac- erated 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, —is the unexpanded flower- heads of Artemisia pauciflora, a small, perennial plant of the nat. ord. Compositse, which grows in Asia Minor, Turkestan, etc., and contains a volatile oil and the peculiar, crystalline principle, Santonin (see below). Dose, gr. x-lx. Santoninum, Santonin, C15Hls03,—the neutral principle obtained from Santonica. Occurs in colorless, prismatic crystals, turning- yellow on ex- posure 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 alco- hol, 3 of boiling alcohol, 140 of ether, 4 of chloroform, also in solutions of the caustic alkalies. Dose, for a child, gr. j-v for an adult, not repeated too soon, as the action of the drug is slow. Preparation. Trochisci Santonini, Troches of Santonin,—each troche contains about grain of Santonin, with Sugar, Tragacanth, and Stronger Orange Flower Water. Dose, j-v troches, as per age. Santonin and its preparation are sensitive to light and should be kept in amber-colored bottles tightly corked. 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 Sodium Santoninate, and affects the cerebral Physiological Action and Therapeutics. SAPO. 433 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 reddish-purple, and produces considerable enuresis. 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 it 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, White Castile Soap,—is Soap prepared from soda and olive oil; a whitish solid, hard, yet easily cut when fresh, of faint, peculiar odor free from rancidity, a disagreeable, alkaline taste, and alkaline reaction ; readily soluble in water and in alcohol. Is an ingredient of several of the official pills. Sapo Mollis, Soft Soap, Green Soap,—is Soap prepared from potassa and linseed oil; a soft, unctuous mass, of a yellowish-brown color, soluble in about 5 of hot water and in 2 of hot alcohol. The name Green Soap is a misnomer, as it is not green in color. 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). Saponification is a process of double decomposition between a fat (stearate, palmitate 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 palmitates of 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 Olivse, Adeps, Acidum Oleicum, Glycerinum, etc.] Sapo Animalis, Curd Soap,—official in the Br. Phar.,—is made with Soda and a purified animal fat, consisting chiefly of Stearin. Used in pills and suppositories. Unofficial Soaps. 434 SARSAPARILLA. Sapo Medicatus,—official in the Fr. Codex,—is a Soda soap prepared from expressed Almond Oil. Preparations. Emplastrum Saponis, Soap Plaster,—has of Soap 10, Lead Plaster 90, Water q. s. Linimentum Saponis, Soap Liniment,—has of Soap 7, Camphor Oil of Rose- mary 1, Alcohol 75, Water to 100. Opodeldoc is a similar preparation. Soap Liniment is an ingredient of Chloroform Liniment. Linimentum Saponis Mollis, Linitnent of Soft Soap, Tincture of Green Soap,— has of Soft Soap 65, Oil of Lavender 2, Alcohol 30, Water to 100. 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. Soft 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 oint- ment. 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. Physiological Action and Therapeutics. SARSAPARILLA ,—is the root of Smilax officinalis, Smilax medica, and of other undetermined species of Smilax, plants of the nat. ord. Liliacese, growing in Mexico, Central America, Brazil, etc. There are six commercial varieties on the market, which are generally put up in differ- ently formed bundles. It contains starch, resin, calcium oxalate, an essential oil, and an acrid neutral principle named Parillin or Smilacin, which when acted on by dilute sulphuric acid affords another principle, Parigenin. Preparations. Extractum Sarsaparillae Fluidum, Fluid Extract of Sarsaparilla.—Dose, 3 ss-j. Extractum Sarsaparillae Fluidum Compositum, Compound Fluid Extract of Sarsaparilla,—has of Sarsaparilla 75, Glycyrrhiza 12, Sassafras 10, Mezereum3, Glycerin 10, Water and Alcohol to 100. Dose, 3 ss-j. Syrupus Sarsaparillae Compositus, Compound Syrup of Sarsaparilla,—has of the Fluid Extract 20, FI. Ext. of Glycyrrhiza FI. Ext. of Senna xy2, Sugar 65, Oils of Sassafras, Anise and Gaultheria, each 0.01, Water to 100. Dose, 3 j-3 j. A good vehicle for Potassium Iodide. Decoctum Sarsaparillae Compositum, Compound Decoction of Sarsaparilla,—has of Sarsaparilla 10, Sassafras 2, Guaiacum Wood 2, Glycyrrhiza 2, Mezereum 1, Water to 100. Dose, 3j-iv. SASSAFRAS SCAMMONIUM. 435 Syrup of Sarsaparilla (Unofficial),—so much used in flavoring soda-water, is a mix- ture of the oils of sassafras and gaultheria in syrup. 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 negative 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, especially in debilitated subjects ; while the other preparations are com- monly employed as vehicles for Potassium Iodide and Mercuric Chloride in syphilis of any form. Whenever used, the compound decoction will give the best results, the hot water and its other constituents having medicinal value, if the principal ingredient has none. Physiological Action and Therapeutics. SASSAFRAS,—is the root-bark of Sassafras variifolium, an indigenous tree of the nat. ord. Laurinese. The volatile oil is official, and contains, as its principal constituent, Safrol, which is largely used to disguise the odor of the fatty bases in soap manufacturing. Sassafras Medulla, Sassafras Pith,—is the pith of the tree described above. Macer- ated in water it forms a mucilaginous liquid which is not precipitated on the addition of alcohol. Mucilago Sassafras Medullae, Mucilage of Sassafras Pith,—has of the pith 2, in water ioo. Dose, indefinite. Oleum Sassafras, Oil of Sassafras,—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. Treated with cold nitric acid it becomes of a dark red color, and is finally converted into a red resin. Dose, rr\j-iv. Infusum Sassafras, Infusion of Sassafras (Unofficial),—is a popular “ tea ” which may be taken ad libitum. When made from the bark, and taken internally as well as applied locally, it is almost a specific for the rash produced by poison oak (Hinton). Sassafras is a constituent of the three compound Sarsaparilla preparations. It acts as 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 combination 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 suspen- sion 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, in syrup. Dr. J. Bartlett, of Chicago, in a paper on the toxic properties of Sassafras, published in the Pharmaceutical Journal, says that it appears to have some resemblance to three familiar drugs—opium, strychnine, and ergot; for it has a narcotic and sudorific action ; a property of inducing tetanic and clonic spasms followed by paralysis, and a probable stimulant effect on the muscle of the uterus. SCAMMONIUM, Scammony,—is a resinous exudation from the root of Convolvulus Scammonia, a plant of the nat. ord. Convolvulaceae, growing chiefly in Syria and Asia Minor. It contains about 80 per cent. 436 SCILLA. 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. Resina Scammonii, Resin of Scammony,—soluble in ether. Dose, gr. iij-viij. Extractum Colocynthidis Compositum,—(see ante, page 250) contains 14 per cent, of Resin of Scammony, and is an ingredient of the Compound Cathartic Pill. Preparations. Scammony is an active cathartic, stimulating the liver and the intestinal glands, and causing free purgation in a few hours, with considerable grip- ing. 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 maritwia, a peren- nial plant of the nat. ord. Liliacese, growing on the shores of the Medi- terranean. Its active principle 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 Scillae Fluidum, Fluid Extract of Squill.—Dose, TT\j-v. Tinctura Scillae, Tincture of Squill,—15 percent. Dose, Tt\v-xxx. Acetum Scillae, Vinegar of Squill,—10 per cent. Dose, rt\,x-3.b Syrupus Scillae, Syrup of Squill,—has of the Acetum 45 parts, with Sugar 80, and Water to 100. Dose, Syrupus Scillae Compositus, Compound Syrup of Squill,—has of the fluid extracts of Squill and Senega, each 8, Tartar Emetic 0.2, Calcium Phosphate 1, Sugar 75, Water to 100. Is known popularly as Coxe’s Hive Mixture, and contains a little less than one grain of Tartar Emetic to the fluid ounce (15 grains in 17 fl. ozs.). Dose, for chil- dren, rrpv-gj, the latter being an emetic dose ; for adults, as an expectorant, tr^xx-xxx. Physiological Action and Therapeutics. In small doses Squill is expectorant, in larger doses emetic and diuretic, and in overdoses it is a violent irritant poison, producing nausea, vomiting, SCOPARIUS. 437 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, in which it maybe associ- ated 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 action and uses of Squill should be studied in connection with those of Digitalis and Ipecacuanha. SCOPARIUS, Broom,—the tops of Cytisus Scoparius, the Broom- plant, a common garden shrub of the nat. ord. Leguminosse, having small, downy leaves and numerous large golden-yellow flowers. It con- tains Scoparin, C21H22O10, a neutral, crystallizable principle; and Spar- teine, C15H26N2, a volatile, liquid alkaloid, having no oxygen, but possess- ing very decided basic qualities and being highly poisonous. Preparations. Extractum Scoparii Fluidum, Fluid Extract of Scoparius,—made with diluted alcohol. Dose, 3ss_ij- Decoctum Scoparii, Decoction of Broom-tops (Unofficial),— 5-j to the pint. Dose, every three hours until a diuretic effect is produced. Sparteinae Sulphas, Sparteine Sulphate,—white, prismatic crystals, or a granular powder, of slightly saline and bitter taste, very soluble in water and alcohol. Dose, gr. tV"5> hypodermically ;—gr. y^-ij per orem. Small doses, gr. every five hours, for cardiac action ;—larger, gr. j-ij, for diuresis. (Clarke.) Larger doses are necessary, say gr. iss-iij, ter die. (Prior.) 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 Physiological Action. 438 SCOPARIUS. excitability 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 cir- culation, so that the surface becomes flushed and moist, and in some cases marked diuresis and diaphoresis occur. The respiration, at first quick- ened, is soon slowed and deepened,—the patient having a sense of in- creased warmth and well-being, and if suffering from irregular cardiac action, prsecordial distress and dyspnoea, these symptoms are promptly re- lieved. 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 tension, prse- cordial 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 respi- ration. 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 increasing the circulation in the skin and kidneys, and raising arterial tension generally. Its diuretic power on healthy persons is denied by some observers and affirmed by others, though all acknowledge it in disease. It is accompanied 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.*4~gr. ij. The action of Sparteine upon the circulation is manifested quickly as compared with that of other similarly acting drugs. In *4 hour after its ingestion the pulse is markedly slower,—in another y2 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. T*g- 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.) 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. SCUTELLARIA—SENEGA. 439 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, praecordial pain, palpita- tion and oedema. In such cases small doses, gr. Dg- to \, are best, and as the influence of the drug is remarkably sustained, they need not be re- peated 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 remarkable relief to all the symptoms. For cardiac palpitation and arrhythmia, 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. Labiatae, growing in moist places and along ditches. It contains a little volatile oil, traces of a bitter principle, besides fat, tannin, sugar. Extractum Scutellariae Fluidum, Fluid Extract of Scutellaria.— Dose, 3 ss-ij. Scutellaria produces no very obvious effects when taken internally. By some practi- tioners 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, twitchingof the muscles, hypersesthesia, etc., as chorea, delirium tremens, nervous exhaustion from fatigue or over-excitement, hydrophobia, hysteria and 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 gr. j-iv. SENEGA, —is the root of Polygala Senega, an indigenous, perennial plant of the nat. ord. Polygaleae, having small, white flowers in a close spike at the summit of the stem. Its principal constituent is the glucoside Senegin, C32H51018, 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 decomposed by HC1 into sugar and Sapogenin, C14H2202. Preparations. Extractum Senegae Fluidum, Fluid Extract of Senega.—Dose, tt\x-xx. Syrupus Senegae, Syrup of Senega,—has of the fluid extract 20, Aqua Ammoniae ]/2, Sugar 70, Water to 100. Dose, 3 j-ij. Syrupus Scillae Compositus, Compound Syrup of Squill, — contains 8 percent, of Senega. (See page 436.) Dose for children, > f°r adults as an expectorant, rrLxx- 3 ss. 440 SENNA. 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. 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 the 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 benefit in amenorrhoea, given in saturated decoction for two weeks before the expected period. In chronic rheumatism and in rheumatic 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. Physiological Action and Therapeutics. SENNA,—the leaflets of Cassia acutifolia (Alexandria Senna), and of Cassia angustifolia (India Senna), shrubs of the nat. ord. Legutninosse, growing in Egypt and India. They contain an amorphous glucoside, Cathartic Acid, C180Hi92N2SO82, which forms salts with bases and may be decomposed into glucose and Cathartogenic Acid. Other constituents are Sennapicrin and Sennacrol, both glucosides;—Catharto-mannite, a peculiar unfermentable sugar; also a coloring matter allied to Chrysa- robin and various vegetable salts. Extractum Sennae Fluidum, Fluid Extract of Senna,—an excellent preparation. Dose, 3 ss- § ss. Syrupus Sennae, Syrup of Senna,—has of Alexandria Senna 25, Oil of Coriander y, Alcohol 15, Sugar 70, Water to 100. Dose, 3j-§j- Confectio Sennae, Confection of Senna,—has of Senna 10, Cassia Fistula 16, Tama- rind io, Prune 7, Fig 12, Sugar S5/4, Oil of Coriander y2, Water to IOO. Is sold under the trade names “ Tamar-Indienf “ Tropical Fruit Laxative,” etc. Dose, g j-ij. Infusum Sennae Compositum, Compound Infusion of Senna, Black Draught,— has of Senna 6, Manna 12, Magnesium Sulphate 12, Fennel 2, Boiling Water 80, Cold Water to 100. Dose, Pulvis Glycyrrhizae Compositus,—Compound Liquorice Powder (See under Gly- cyrrhiza),—contains 18 per cent, of Senna. Dose, gss-^jss. Syrupus Sarsaparillae Compositus, Compound Syrup of Sarsaparilla (See under Sarsaparilla),—contains \l/2 per cent, of the fluid extract of Senna. Dose, Preparations. SERPENTARIA. 441 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 quality 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, and drastic purgation with severe tenesmus, but its effects are never poisonous. It may cause hemorrhoids and increase the menstrual flow in women. Given to a nursing mother her milk will acquire purgative powers. In some very susceptible persons 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. 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 England 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 ten- dency to hemorrhoids exists, the use of this drug in cathartic doses 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 in- flammation of the intestinal mucous membrane, hemorrhoids, menorrhagia, abortion, etc. The least disagreeable of its preparations are the Confection of Senna and the Compound Liquorice Powder. Physiological Action and Therapeutics. SERPENTARIA, Virginia Snake-Root,—is the rhizome and roots of Aristolochia Serpentaria and of Aristolochia reticulata, indigenous herbaceous plants of the nat. ord. Aristolochiacese, growing in rich, shady woods, with purple flowers arising from joints near the root. 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. Preparations. Extractum Serpentariae Fluidum, Fluid Extract of Serpentaria.—Dose, rtyx-xxx. Tinctura Serpentariae, Tincture of Serpentaria,—io per cent. Dose, g ss-ij. Tinctura Cinchonae Composita, Compound Tincture of Cinchona,—has two parts of Serpentaria in 100. (See ante, under Cinchona.) Dose, 442 SESAMI OLEUM—SEVUM SILICATES. 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 characteristic. Small doses promote appetite and digestion, increase the bronchial and intestinal secretions, the action of the heart, the cutaneous circulation and the surface temperature, and produce considerable mental exhilara- tion. Large doses are irritant, causing nausea and vomiting, vertigo and headache, colic, borborygmi, rectal tenesmus, flatulent distention and fre- quent 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 ammonium carbonate, and in the exanthemata is extremely useful when much depression exists. It is indicated in typhoid conditions generally, and in the amenorrhoea of antemia 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 frequently checks the nausea and settles the stomach. It is used as a vehicle for cin- chona in remittent fever. In diphtheria, scarlatina, etc., an infusion forms an excellent gargle. Its diaphoretic and diuretic properties, though slight, are sometimes of avail in chronic rheumatism. Physiological Action and Therapeutics. SESAMI OLEUM, Oil of Sesamum, Teel Oil, Benne Oil,—is a fixed oil ex- pressed from the seeds of Sesamum indicum, or Benne plant (nat. ord. Pedaliacese), which is a native of India, but is cultivated in the southern portion of the U. S. It is a yellow- ish or yellow, oily liquid, inodorous or nearly so, having k bland, nut-like taste and a neutral reaction. 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 per cent.) and keeps better than olive oil. It is chiefly employed as a hair-oil. SEVUM, Suet, Mutton 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 neutral reaction, insoluble in water or cold alcohol, soluble in 44 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. 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 under Oleum and Oleum, ante.) SILICATES of Sodium (Na2Si03), of Potassium (K2Si03), and of Magnesium (2Mg03Si02) are used in medicine and surgery, a solution of the Sodium Silicate being official. SINAPIS. 443 Liquor Sodii Silicatis, Solution of Sodium Silicate, Soluble Glass Solution,—is a semi-transparent, 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, Solution of Potassium Silicate (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 Potassium Silicate has been applied locally in erysipelas, gonorrhoea, cystitis, vaginitis, etc., as an antiseptic, and with good results. Magnesii Silicas Hydratus, Hydrated Magnesium Silicate, Meerschaum, 2MgO,- 3SiOa -f- 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 pow’der and in doses of 5jj-iv per diem. SINAPIS, Mustard ,—is official under the two following titles, but the pharmacopceial preparations are directed to be made from Black Mus- tard only :— Sinapis Alba, White Mustard,—the seed of Brassica 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. 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 Brassica nigra, an annual plant of the nat. ord. Cruciferae, 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. 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, Volatile Oil of Mustard, Sulpho-cyanide of Ally l, C4H5- NS,—a colorless or pale yellow liquid, of very pungent and acrid odor and taste and 444 SODIUM. neutral reaction, sp. gr. 1.018 to 1.029, 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 Compositum, Compound Liniment of Mustard,—has of the Volatile Oil 3, FI. Ext. of Mezereum 20, Camphor 6, Castor Oil 15, Alcohol to 100. For local use. Physiological Action and Therapeutics. 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. 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 pericar- dium, also as a derivative in headache, cerebral congestion, and suppressed menstruation. It may also be used as a stimulant to the heart, vascular system and respiratory apparatus. When action of a mild character 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 produces 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 liniments, but may be employed internally in small doses. SODIUM, Natrium, Na.—This metal is represented 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 transiently red when observed through a blue glass, which cuts off the yellow rays but allows the violet ones of Potassium to be seen. Soda, Sodium Hydrate, Caustic Soda, NaOH,—a white, hard, opaque solid, deliques- cent in moist air, efflorescent in dry air, odorless, of intensely acrid and caustic taste and Sodium Compounds and their Preparations. SODIUM. 445 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 Sodae, Solution of Soda,—contains about 5 percent, of the hydrate, and is pre- pared by dissolving Sodium Carbonate 170, in 400 of boiling Distilled Water, also 50 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, 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, TTLv— 3 ss, well diluted with water. Sodii Acetas, Sodium Acetate, NaC2H302-(- 3H20,—large, transparent prisms, efflo- rescent in dry air, odorless, of saline, bitter taste and a neutral or faintly alkaline reaction, soluble in 1.4 of water and in 30 of alcohol at 590 F., in of boiling water and in 2 of boiling alcohol. Dose, gr. xx-gj. Sodii Carbonas, Sodium Carbonate, Na2COs -(- 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 10*4 grains of Tartaric Acid. Dose, gr. v—xxx. Sodii Carbonas Exsiccatus, Dried Sodium Carbonate,—is the Carbonate 200 parts dried at a heat of II30 F., until it is converted into a white powder weighing 100 parts. Is chiefly used for pharmaceutical purposes. Sodii Bicarbonas, Sodium Bicarbonate, NaHC03,—an opaque, white powder, per- manent in the air, odorless, 0/ cooling, saline taste, and a slightly alkaline reaction ; solu- ble in 11.3 of water at 590 F., insoluble in alcohol, decomposed by hot water and con- verted int® normal Carbonate. It is distinguished from the Carbonate by its solution in cold water giving a white and not a colored precipitate 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 Sodae and of Pulvis Effervescens Compositus. Dose, gr. x-^j. Trochisci Sodii Bicarbonatis, Troches of Sodium Bicarbonate,—each troche contains of the Bicarbonate about 3 grains, with Sugar, Nutmeg and Mucilage of Tragacanth. Dose, as of the Bicarbonate. Sodii Chloras, Sodium Chlorate, NaC103,—colorless, transparent tetrahedrons of the regular system, permanent in dry air, odorless; of cooling, saline taste and neutral re- action, soluble in 1.1 of water and in about 100 of alcohol at 590 F., also in 0.5 of boil- ing water and in about 40 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 mixed or heated or triturated with readily oxidizable or combustible substances. Dose, gr.v-xx. Sodii Chloridum, Sodium Chloride, Common Salt, NaCl,—white, hard, cubical crystals or a crystalline powder, permanent in the air, odorless, of a purely saline taste and neutral reaction; soluble in 2.8 of water at 590 F., and in 2.5 of boiling water. Al- most insoluble in alcohol. Dose, gr. x-sjj. Sodii Nitras, Sodium Nitrate (Cubic Nitre, Chili Nitre, Chili Saltpetre), NaN03,— colorless, transparent crystals, slightly deliquescent, odorless, of cooling, saline and bitter taste, and neutral reaction; soluble in 1.3 of water at 590 F., in 0.6 of boiling water, scarcely soluble in cold alcohol. Dose, §j-ij. Sodii Sulphas, Sodium Sulphate, Glauber's Salt, Na2S04 ioH20,—large, color- less, 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 93.2° F., and in 0.47 of boiling water, insoluble in alcohol. Dose, gr.v-xx ; as a purgative 75 ss-j or a third of a teaspoonful in a large glass of water. Sodii Ethylas, Sodium Ethylate, 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 alcohol and caustic soda. An alcoholic solution is made by dissolving sodium in absolute 446 SODIUM. alcohol, and is used as a caustic. Chloroform decomposes it at once into ether and sodium chloride. It should be kept in a cool place as it is liable to explode. The Arsenate is described under Arsenum ;—the Benzoate under Benzoinum ;— the Borate under Acidum Boricum ;—the Bromide under Bromum ;—the Solution of Chlorinated Soda under Chlorum ;—the Iodide under Iodum ;—the Hypophos- phite, Phosphate and Pyrophosphate under Phosphorus;—the Nitrite under Amyl Nitris;—the Salicylate under Salicin ;—the Sulphite, Bisulphite and Hyposul- phite under Acidum Sulphurosum;—and the Sulpho-carbolate under Acidum Car- BOLICUM. 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. Sodium Urate is not soluble like the urates of lithium and potassium, and is therefore much less readily excreted, forming the masses called chalk-stones in gouty subjects. Soda is a less active eschar- otic than potash, having less affinity for water. Liquor Soda; renders the blood and secretions more alkaline, but does not alter nutrition to the extent that liquor potassse does. The Acetate is converted into the Carbonate in the blood, and is a less active diuretic than the correspond- ing potassium salts. 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 alka- linity of the blood. The Nitrate is a mild cathartic, and in solution is a solvent of false membranes. The Ethylate is an antiseptic, and a powerful but almost painless caustic. Sodium Chloride (common salt) is one of the most important and abundant of the saline constituents of the animal organism, existing nor- mally in the blood, where it keeps the fibrin and albumen in solution ; hence in inflammation, being thus needed, it accumulates at the seat of the morbid action, disappearing temporarily from the urine; its reap- pearance therein being considered one of the surest signs of the patient’s improvement. In very dilute solution it enables water to dissolve both albumins and globulins, and renders water non-irritant to the animal tissues and harmless to the red blood-corpuscles. For these purposes the solution employed is one of 0.65 per cent., known in experimental physi- ology as the “ normal salt solution.” In substance, however, or in con- centrated solution, the salt is very irritant to cut surfaces, mucous mem- branes, muscle and nerve tissues. Taken into the stomach in quantity it irritates that organ, and induces vomiting ; and, when absorbed in excess of the normal requirements of the body, it causes, in great intensity, the peculiar nervous irritation which is expressed by the sense of thirst; and SODIUM. 447 this is only relieved by the ingestion of water in sufficient quantity to enable the excess to be dissolved and excreted by the kidneys. It is rapidly absorbed, and equally rapidly excreted ; and, when consumed in excess, it increases tissue-change, and consequently the excretion of urea,— and also the excretion of potassium salts. On the other hand, the exces- sive ingestion of potassium salts (as in the cases of herbivorous animals and vegetarian cranks) increases the excretion of sodium chloride, by a double decomposition between these salts in the blood, forming potassium chloride and sodium phosphate, which, being foreign to the blood, are constantly excreted. In this way, by a continuous vegetable diet, the normal amount of sodium chloride in the organism may be greatly reduced ; and the animal will feel the want of it, and will travel hundreds of miles to visit a salt-lick. Besides being emetic, when given internally, Sodium Chloride also acts as a hemostatic, decreases the secretion of mucus, is a vermifuge against ascarides, promotes the absorption of pleuritic serous exudations and of dropsies, and has considerable power as an antiperiodic and an antiseptic. Sodium Sulphate, administered by the mouth in dilute solution, excites active secretion in the intestines, especially in the small intestine, by its bitterness in part, and also by its irritant quality and its specific property of stimulating the activity of the intestinal glands. This action is not an osmotic one, as was formerly taught. The stimulation caused by this salt extends to the liver and the pancreas, especially the former. The absorption of the secretions is impeded by the low diffusibility of the salt, so that the result is a large accumulation of fluid in the intestinal canal, which finds its way to the rectum and produces purgation. The more dilute the solution employed the more prompt will be the effect, but this salt will not produce catharsis if administered in concentrated form. When injected into the blood it excites no intestinal secretion, does not act as a purgative, and produces no toxic effect. [Magnesium Sulphate is toxic when so administered.] The quantity of Sodium Sul- phate to the pint of Carlsbad water (Sprudel) is 20 grains, in Friedrichs- thal 46*4 grains, and in Hunyadi Janos from 122 to 173 grains; the latter being the most active hepatic stimulant of the three. A mixture of the Sulphate and the Bicarbonate is sold as the natural salt obtained by evaporation of Carlsbad water. The action of the other Sodium salts is described under the titles of the respective constituents to which their effects are mainly referable. Poisoning by caustic alkalies is treated by the dilute Vegetable Adds, 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. Antidotes and Incompatibles. 448 SOLANUM CAROLINENSE—SPIGELIA. Therapeutics. The Sodium salts treated of in the first paragraph above are not much used internally, the corresponding Potassium salts being preferred, especi- ally when it is desired to alkalinize the urine or to promote oxidation. In the alkaline treatment of stomach affections the Sodium salts are the most efficient, especially the Bicarbonate, in small doses 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 constipation, the pain being seated at the junction of the forehead with the hairy scalp, also as a wash (gr. ij ad §j) in itching skin affections and as a lotion in burns and eczema. The Chloride is used internally as an antidote in poisoning by Silver Nitrate and as an emetic, and will often relieve hemoptysis and migraine. In bilious diarrhoea it is employed in doses of gr. x-3j, thrice daily. Locally in baths it is a good stimulant to the skin, and in solution to i 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 solu- tion locally to prevent itching, but is chiefly employed in the preparation of the other salts. The Sulphate is a good purgative and hepatic stimu- lant, and is given, either alone or with the Bicarbonate in imitation of Carlsbad Salts, for bilious disorders, gouty affections, chronic constipa- tion, obesity and diabetes mellitus. The Chlorate has similar uses to those of Potassium Chlorate, and 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. The Nitrate is employed as a mild cathartic, and in solution by atomization to destroy the false mem- brane in croup. The Ethylate has been of service as a caustic in cancer, lupus and mevus, for the latter affection being painted over the growth with a glass rod. Caustic Soda is a better escharotic than caustic 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 salts are described as mentioned on the preceding page. SOLANUM CAROLINENSE, Horse-nettle,Sand-brier (Unofficial),—is a weed belonging to the nat. ord. Solanaceae, a native of Florida and Carolina. In epilepsy a 20 per cent, tincture of the berries is highly recommended, in doses of ss-j thrice daily. It has also been used with benefit in convulsions due to the albuminuria of pregnancy and other convulsive affections. SPIGELIA, Pink-root ,—is the rhizome and roots of Spigelia ma- rilandica, the Carolina Pink, an herbaceous perennial of the nat. ord. STAPHISAGRIA STILLINGIA. 449 Loganiacese, native of the Southern States ; having large, showy flowers, scarlet or crimson externally, yellow within. It contains a bitter princi- ple 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 Spigelise Fluidum, Fluid Extract of Spigelia.—Dose for an adult, 3 j—ij; for a child of 3 years, Ttyx-xx. Infusum Spigelise Compositum, Compound Infusion of Spigelia, Worm Tea (Un- official),—has of Spigelia 15, Senna 10, Fennel 10, Manna 30, Water 500. Dose, 1$ 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, Demarara Pink-root, Worm-grass (Unofficial),—produces 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 ori- gin, 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 tr\v-xx. STAPHISAGRIA, Stavesacre,—is the seed of Delphinium Staphisagria, an annual or biennial plant of the nat. ord. Ranunculacese, 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. Unguentum Staphisagriae, Ointment of Staphisagria (Unofficial),—contains of the powdered seeds 1 part with 2 each of olive oil and lard. Delphinina, Delphinine, C22H35N06 (Unofficial),—is the active alkaloid, and exists in the fatty oil which is extracted by ether. Dose, gr. T2~i- Stavesacre is a violent emetic and cathartic, also parasiticide. The alkaloid is irritant to the skin if locally used, producing tingling, burning and inflammation. Internally, it lowers the activity of the heart 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 Veratrine. The ointment is often employed as a parasiticide against pediculi and the acarus scabiei. The fixed oil is probably equally effective. Delphinine has been used internally in asthma, rheumatism and neuralgia, and in the latter affection is well employed as an ointment (gr. xx to j), applied over the course of painful superficial nerves. It has been suggested 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. It contains a resin and a volatile oil, but its active prin- ciple 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-^j. 450 STRAMONIUM. Preparations. Extractum Stillingiae Fluidum, Fluid Extract of Stillingia.—Dose, TTpx— g j. Tinctura Stillingise, Tincture of Stillingia (Unofficial).—Dose, 3 ss-ij. Decoctum Stillingiae, Decoction of Stillingia (Unofficial).— f, j adOj. Dose, 5; j—ij. Syrupus Stillingiae Compositus, Compound Syrup of Stillingia (Unofficial),—is composed of Stillingia, Corydalis, Iris, Chimaphila, Coriander, Xanthoxylum, Sambucus, Sugar, Water and Alcohol. For the formula, see U. S. Dispensatory, 17th edition, page 1286. Physiological Action and Therapeutics. 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, kid- neys, and bronchial mucous membrane; and the gastric, hepatic, intes- tinal and salivary excretions. Full doses often excite epigastric pain, nausea and vomiting. Stillingia is much employed with Sarsaparilla and similarly 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 changes with jaundice following malaria, 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 to ward off an impending paroxysm of ague. The compound syrup, not- withstanding its reputation as a model of polypharmaceutical skill, is still largely used in the West and South. STRAMONIUM, Thornapple. —The plant Datura Stramonium, the 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. It grows wild in Southern Russia and the middle United States, and contains an alkaloid, Daturine (see below), which is generally considered identical with Atropine both physiologically and chemically,—also malic acid, albumen, gum, resin, etc.* Stramonii Folia, Stramonium Leaves,—the leaves of Datura Stra- monium, of bitter and nauseous taste. Dose, gr. ij-xx. Stramonii Semen, Stramonium Seed,—the seed of Datura Stra- monium, of unpleasant odor when bruised and an oily, bitter taste. Dose, gr. j. The official preparations are all made from the seed. Extractum Stramonii Seminis, Extract of Stramonium Seed.—Dose, gr. Extractum Stramonii Seminis Fluidum, FI. Ext. of St. Seed. — Dose, rry-v. Preparations. STRONTIUM. 451 Tinctura Stramonii Seminis, Tincture of Stramonium Seed,—15 per cent. Dose, npv-xxx. Unguentum Stramonii, Stramonium Ointment,—has of the Extract 10, Diluted Alcohol 5, Benzoinated Lard 85. Daturina, Daturine, CnH23N03 (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 Atro- pine. Dose, gr. T^-gV 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 sensory 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 180.] 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. Antidotes, Antagonists and In compatibles. 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. Stramonium is chiefly used as an antispasmodic and to relieve pain. In asthma the leaves are smoked with advantage at the commencement of a 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 frequently 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. STRONTIUM, Sr.—The metal Strontium is represented in the pharmacopoeia by three of its salts, viz.:— Strontii Bromidum, Strontium Bromide, SrBr2 -(- 6H20,—colorless, transparent, hexagonal crystals, very deliquescent, of bitter, saline taste; very soluble in water and alcohol, insoluble in ether. Dose, gr.v-xxx. Therapeutics. 452 STRONTIUM. Strontii Iodidum, Strontium Iodide, Srl2 -\- 6H20,—hexagonal plates, colorless, transparent, of bitter, saline taste ; very soluble in water, also in alcohol and slightly so in ether. Dose, gr.v-xxx. Strontii Lactas, Strontium Lactate, Sr(C3H503)2 -f- 3H20,—a white, granular powder, or crystalline nodules, of slightly bitter and saline taste, permanent in the air; soluble in 4 of water, in less than l/2 part of boiling water, soluble also in alcohol. Dose, gr.v-xxx. Strontii Salicylas, Strontium Salicylate (Unofficial),—is highly recommended by Dr. H. C. Wood. Dose, gr.v-xxx. The Strontium salts are among the most recent additions to the materia medica. Their marked anti-putrescent and antiseptic properties were first noticed in 1891 by Germain See, on patients suffering from gastric dila- tation. He found that, in such cases, the Bromide prevented the acetic and lactic fermentations, and the formation of the gases of decomposition. The toxic action, hitherto attributed to the salts of Strontium, has been ascertained to be due to Barium, which was present in the impure com- mercial products used. When pure, they may be safely employed in the same doses, and in the same cases, as the corresponding preparations of potassium and sodium ; while they are much less liable to cause eruptions, and are more rapidly and completely eliminated by the kidneys. The Iodide is analogous in action to Potassium Iodide, its intravenous injection producing at first a rapid elevation of arterial pressure with acceleration of the cardiac rate ; followed by slowing of the heart, and, later on, lowered blood-pressure with increased heart-rate. It has been used, with good results, in the treatment of scrofulous, rheumatoid and cardiac disorders; especially scrofuloderma, scrofulous otorrhcea, and enlarged lymphatic glands ; also in lupus vulgaris and ozsena. The Lactate has been successfully employed in diabetes, and in albu- minuria. It diminishes the amount of albumen excreted in Bright’s disease, in the parenchymatous nephritis of rheumatic and scrofulous subjects, and in the albuminuria of pregnancy ; for which purpose it should be given in full doses (gr. xxx) thrice daily. It is contraindicated when there is scanty urine or symptoms of ursemia. Da Costa holds that, while the strontium salts are admirable as diuretics in renal affec- tions, they accomplish more good in the acute than in the chronic forms of nephritis. The Salicylate, according to Dr. H. C. Wood, in doses of gr.v, is one of the best intestinal antiseptics, yielding better results than salol, naph- talin and similar agents. In doses of gr. x-xv he says that it acts very decidedly as a salicylate in gouty and chronic rheumatic conditions, without producing gastric disturbance. In chronic gouty conditions and in lithgemia with intestinal indigestion, he considers it to be the most valuable drug we have. Physiological Action and Therapeutics. STROPHANTHUS. 453 The uses of Strontium Bromide are mentioned with those of the other Bromides, on page 190, ante. STROPHANTHUS,—is the seed, deprived of its long awn, of Strophanthus hispidus, an African climbing plant (nat. ord. Apocynacese), from which the natives extract a toxic preparation known as the Kombe arrow-poison. It contains 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. Tinctura Strophanthi, Tincture of Strophanthus, (i in id).—Dose, or frequently repeated. A stronger tincture (i in 8) is on the market. Stropbanthinum, Strophanthin (Unofficial).—Dose, gr. y2ft-At hypodermically: gr. Jy has been used, the influence of the one injection upon the circulation lasting at least eight days. Preparations. Physiological Action. 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 mus- cular 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 mus- cle in the body, it is quickly and markedly affected by the strophanthus- charged fluid, and by regulating the dosage, the cardiac muscle may be affected by a quantity which will 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 circula- tion 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 the muscular tissue, striated and non-striated, by direct contact;—and when contract- ility has 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 powerful cardiac stimulant, differing from Digitalis in not producing vaso-motor constriction of the arterioles. It reduces the pulse, lowers body temper- ature somewhat, is not cumulative in action, and does not cause any gastro-intestinal disturbance. It is diuretic, by direct stimulation of the 454 STYRAX. renal circulation; and has power over rigors, by its rapid cardiac action, stopping them, and preventing their recurrence. Therapeutics. Strophanthus is undoubtedly a valuable cardiac stimulant, from the rapidity and permanence of its action, as well as its non-interference with the calibre of the peripheral vessels. It promptly relieves cardiac dyspnoea, often modifies the pulse-rate in less than an hour, while the influence of a single dose upon the circulation persists for a long time. It may well replace Digitalis in the treatment of chronic Bright’s disease and valvular lesions of the heart, when it is important that the work of the heart should not be increased by any additional resistance in the arterial system. It has been reported as exceedingly useful in the treat- ment of Bright’s disease, for the dyspnoea, orthopnoea, dropsy and uraemia ; also in mitral insufficiency, with great anasarca and dyspnoea; in pal- pitation, exaggerated cardiac action, and in weak heart, and for exoph- thalmos, with tumultuous action of the heart; also in 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 chlorosis, and for rigors due to catheterization, or operations on the urethra. These high claims, made by enthusiastic therapeutists, have not been maintained by the experience of the general profession, so that this drug is gradually falling into disuse, although but recently added to the official pharmacopoeia. Ouabain, C30H46O12 (Unofficial),—is a glucoside obtained from the root and wood of Acocanthera Ouabaio, an apocynaceous tree of the Somali coast; also from the seeds of Strophanthus glabrus, a climbing plant from Gaboon. The former furnishes an arrow poison, much used by the African natives. Ouabain occurs in white, odorless crystals,of feebly bitter taste; soluble in hot water and in spirit, slightly in cold water, insoluble in absolute alcohol, chloroform and ether. Dose, gr. every three hours, in children. Ouabain is an extremely active poison, paralyzing the cardiac muscle by direct action. It is a powerful emetic, especially when given hypodermically ; and a potent local anaes- thetic, being considered by many observers as superior to Cocaine in this respect. In thera- peutic doses it does not seem to affect the body temperature, but increases urination, either by stimulating the blood pressure or by paralyzing the sphincter vesicae. It also pro- motes defecation, probably by stimulating peristalsis. Very small doses give some evi- dence of action similar to that of Digitalis. It has been employed with striking benefit in all stages of pertussis ; and has been used to some extent as a local anaesthetic for the eye. STYRAX, Storax,—is a balsam prepared from the inner bark of Liquidambar ori- entalis, the Oriental Sweet-gum, a tree of the nat. ord. Hamamelacese, 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, CgH8,—a crystalline solid Styracin, which is a cinnamate of cinnamic ether,—two peculiar resins, one hard, the other soft, —and Cinnamic Acid, C9H902, a colorless, odorless, crystalline body, closely allied to Benzoic Acid, excreted in the urine partly as Hippuric Acid, and occurs also in the Bal- sams of Peru and Tolu. Dose of Storax, gr.v-xx. SUCCINUM—SULPHONAL. 455 Tinctura Benzoini Composita, Compotind Tincture of Benzoin, Friar's Balsam, contains 8 per cent, of Storax. Dose, 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 affections 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 (Unofficial),—the source of 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 Pittites succinifer, of which amber represents the exudation. Oleum Succini, Oil of Amber (Unofficial),—is a volatile oil obtained by the destruc- tive distillation of Amber, and purified by subsequent rectification ;—a pale yellow, thin liquid, of sp. gr. about 0.920, of empyreumatic and balsamic odor, warm, acrid taste, and 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. Exter- nally it is irritant and rubefacient. It has been employed with benefit in epilepsy, hysteria, convulsions, amenorrhoea, whooping-cough, etc. As a liniment it is often used in chronic rheumatism, and has been applied along the spine in infantile convulsions, mixed with an equal part of laudanum and diluted with olive oil or brandy. SULPHONAL, S ulph o n al ( Diethylsulphon - dimethyl - methane'), C7H16S204 (Unofficial),—is a synthetical hypnotic which has recently been admitted to an official place in the pharmacopoeias of several countries, though unofficial as yet in the United States. It is produced by the interaction of anhydrous Mercaptan (Ethyl Hydrosulphide) and anhydrous Acetone, in the presence of a stream of dry HC1. The re- sulting Mercaptol is separated, washed and oxidized by potassium per- manganate; yielding Sulphonal in colorless, prismatic crystals, soluble in 15 of boiling water, in about 450 of cold water, and in about 50 of cold alcohol; very soluble in boiling alcohol and in ether. Sulphonal is a very stable body, being unaffected by concentrated acids, alkalies, or oxidizing agents, cold or warm. Dose, gr. xv-xl. Physiological Action and Therapeutics. Sulphonal was introduced about seven years ago as a harmless hypnotic, producing sound and quiet sleep without unpleasant after-effects, without intoxicant or narcotic action, and having no unfavorable effects on the heart or circulation, even in full doses. It rapidly came into general use as a hypnotic in mental diseases, in nervous insomnia, and in sleeplessness from various causes. Recently a number of competent observers have recorded instances of toxic action following its use, and opinions are now greatly divided as to its therapeutical value. If it were not for the very evident advantage of the drug when used with care, and under medical supervision, it would stand a very fair chance of being either excluded 456 SULPHONAL. from practice or restricted by legislative authority (Squibb). In many cases of serious poisoning thereby death has followed; and its prolonged use may give rise to such minor toxic effects as noises in the ears, headache, vertigo, weakness and incapacity for mental or physical exertion. The patient may next pass into a condition of drowsiness or stupor, or he may suffer from difficulty of speech; and ptosis, oedema of the eyelids and cyanosis may be experienced. The stopping of the drug in subjects of sulphonism is followed by vertigo, motor disturbances, general weakness, digestive troubles, etc., a condition resembling that in morphinism when the morphine is suddenly cut off (Lepine). In one reported case, a dose of 20 grains nightly for 15 months was accompanied by complete cessa- tion of menstruation. It has produced persistent skin eruptions in some cases, and severe functional disturbances in others. The chief character- istics of chronic poisoning by this drug are as follows :—disturbances of digestion, shown by vomiting and diarrhoea or constipation ; disturbances of the nervous system, as ataxy and feebleness of the limbs, ptosis and ascending paralysis ; also ischuria and oliguria, sometimes albuminuria, or the presence of hematoporphyrin (Karst). Recovery rapidly follows if the entire alimentary tract be thoroughly purged ; and as long as this is kept free, and the kidneys act efficiently and normally, the drug may be considered harmless (Fuerst). In order to secure elimination and to guard against cumulative action and consequent toxicity, its administration should be interrupted from time to time. Anorexia, vomiting, or pains in the stomach may be regarded as indications for immediate discontinu- ance (Karst). As a hypnotic Sulphonal acts admirably in many instances, if admin- istered in hot fluids and about two hours before its action is required ; but its efficacy decreases with use, and it is of no value whatever against insomnia due to pain. The average hypnotic dose is about 20 grains for a woman and 30 grains for a man. The dose is to be administered only once daily, and should be discontinued at the first sign of toxic action. In no case should its administration be continued over any great length of time. In cases of insomnia due to neuralgia and nervous excitement, the dose of Sulphonal may be advantageously combined with a small dose of Morphine, in proportion to suit individual cases, the mixture forming a safe and efficient hypnotic (Gonzales). Trional, Diethylsiilphon-methyl-ethyl-methane,—differs from Sulphonal only in the sub- stitution of an ethyl for a methyl group. It occurs in lustrous, bitter, tabular crystals, soluble in 320 of cold water, readily soluble in alcohol and in ether. It is an efficient hypnotic, less liable to produce ill effects than Sulphonal, but must be given in doses fully as large, gr. xv-xl. It is said to be peculiarly valuable in cases of slight psychical excite- ment accompanied by obstinate insomnia, and to act promptly and usefully in many forms of delirium. When pain is present it may be administered in conjunction with Phenacetin or Acetanilid. A potent objection to its use is the fact that it is patented in this country, which is also true of the following agent. SULPHUR. 457 Tetronal, Diethylstdphon-diethyl-methane,—contains 4 ethyl groups, to 3 in Trional, and but 2 in Sulphonal. Dr. Lauder Brunton holds of the physiological action of thedi- sulphones, to which group these three substances belong, that only those containing ethyl groups are active, and that the hypnotic activity is increased with the number of such groups. This, if substantiated in practice, would make Tetronal the most powerful hyp- notic of the three. Trional is found to be, generally, more active, however, in this respect, and to be freer from unpleasant by-effects, Tetronal producing vomiting and other diges- tive disturbances in many cases. Neither of them has any value against insomnia due to pain. Dose, gr. xx-xxx, twice or thrice daily. 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-yellow 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 dissolves out any Sulphide of Arsenic which may be present and neutral- izes any Sulphurous or Sulphuric Acid. [For solubility and dose see S. Pr./'ECipitatum, below.] Sulphur Praecipitatum, Precipitated Sulphur, Lac Sulphuris, Milk of Sulphur, S,—is prepared by boiling sublimed Sulphur with slaked lime and water, thus forming the Sulphide and Hyposulphite of Calcium. These are then decomposed by HCl, 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, amor- phous powder, odorless and almost tasteless, insoluble in water or alcohol, but completely soluble in carbon disulphide or a boiling solution of soda. By heat it is completely volatilized. Dose, gr. x-^j. Preparations of Sulphur. Unguentum Sulphuris, Sulphur Oint7nent,—has of Sublimed Sulphur 30, Benzoin- ated Lard 70, rubbed together until thoroughly mixed. Pulvis Glycyrrhizae Compositus, Compound Liquorice Powder (see under Gly- CYRRHIZA ),—contains 8 per cent, of Washed Sulphur. Sulphurous Acid and the Sulphites are described under Acidum Sulphurosum ; the Sulphates under the titles of their respective bases. For Sulphuric Acid see Acidum Sulphuricum. 458 SULPHUR. Sulphides. Sulphuris Iodidum, Sulphur Iodide, Iodine Disulphide, I2S2,—is prepared by fusing together Washed Sulphur I 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 . Calx Sulphurata, Sulphurated Lime, Crude Calcium Sulphide,—is a mixture of Calcium Monosulphide, CaS, Calcium Sulphate, CaS04, and Carbon, in varying propor- tions, containing at least 60 per cent, of the former. A pale, gray powder, of offensive taste and smell, and alkaline reaction, insoluble in alcohol, very slightly soluble in water. Dose, gr. TV-|. Calcii Sulphidum, Calcium Sulphide, CaS (Unofficial),—a constituent of the preced- ing, is named Hepar Sulphuris, Liver of Sulphur, by the homoeopathists, 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. Dose, gr. Potassa Sulphurata, Sulphurated Totassa, Liver of Sulphur,—is a mixture of Potassium Trisulphide with small quantities of Potassium Hyposulphite and Potassium Sulphate; prepared by heating together Sublimed Sulphur I, Potassium Carbonate 2, in a covered crucible until melted. Occurs in irregular pieces, of liver-brown color, gradu- ally changing with age to a greenish- or brownish-yellow, of disagreeable odor, alkaline reaction, and alkaline, repulsive taste. Soluble in 2 of water, except a small residue. Alcohol dissolves only the potassium sulphide, leaving the other constituents undissolved. Dose, gr. ij-x, in pill or solution. Hydrogenii Sulphidum, Hydrogen Sulphide, Sulphuretted Hydrogen, H2S,—is used only for test purposes ; a saturated, aqueous solution being one of the official reagents. It is a colorless gas, having the smell of rotten eggs; and is prepared by the action of dilute sulphuric acid on iron sulphide, the resulting gas being passed into water, a solution is obtained. 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. Carbon Disulphide is described under Carbo ; Antimony Sulphide and Sulphu- rated Antimony under Antimonium. Unofficial Allied Compounds. Ichthyolum, Ichthyol (.Ammonium Sulpho-ichthyolate), C28H36S306(NH4)2,—is pre- pared from the product of the distillation of bituminous rocks from the Tyrol, which contain fossil fishes. It occurs as a viscous, reddish-brown mass, of tarry odor and ap- pearance, and feebly alkaline reaction ; soluble in water and in a mixture of alcohol and ether; mixes in all proportions with glycerin, fats and oils. It contains a large proportion of Sulphur, about io per cent. Dose, internally, gr.v-xxx. Sulpho-ichthyolates of Lithium, Sodium and Zinc are also prepared, and are on the market. Thiolum, Thiol,—is prepared by the sulphuration of certain non-saturated hydrocar- bons, and is a product very similar to Ichthyol. It occurs in both dry and liquid form, the former, Thiolum siccum, as dark-brown lamellae or powder, of bituminous odor, and bitter, astringent taste ; soluble in water and in chloroform, sparingly in alcohol, insolu- ble in ether and in benzin. The liquid form, Thiolum liquidum, is a dark-colored, syrupy fluid, miscible in all proportions with water. Dose, internally, gr.v-xxx. Tumenolum, Tumenol, — is obtained by treating the unsaturated hydrocarbons of mineral oils with concentrated sulphuric acid. It occurs in several forms, solid and fluid, that known as Commercial Tumenol being considered the most generally useful. It is a dark-brown fluid, which can be employed in ointment and in tincture, externally. 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- SULPHUR. 459 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, dis- coloring 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 feces, 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, also peristaltic action, and if used for any length of time they impair the blood, causing anaemia, emaciation, 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 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 quanti- ties, 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 action of Sulphuric Acid, of Sulphurous Acid and of the Sulphites are respectively described on pages 85 and 93, ante. Incovipatibles and Antidotes. 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. Therapeutics. Sulphur is chiefly used as a laxative when pultaceous rather than liquid stools are required, as in hemorrhoids and anal fissure, also in constipa- tion. Scabies has long been treated by its local and internal use, but sul- phur 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 460 sulphur. 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 constipa- tion, 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 ex- tremely 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. y frequently re-- peated. Potassa Sulphurata is only used externally as baths or oint- ment in skin diseases and mucous discharges, also in chronic rheumatism. Ichthyol was introduced about ten years ago, by Dr. Unna, the cele- brated dermatologist, as a promptly efficient remedy in certain chronic skin diseases, particularly eczema and psoriasis. It mixes with vaselin, 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 Vaselin, resulting in the child sinking into a stupor which lasted for 12 hours. A fatal case of poisoning thereby is reported by Bergerio, of Turin, in a woman whose uterus had been curetted the day previous. After the washing out of the uterine cavity with a solution of Ichthyol 33 to Glyceriif 66, she complained of a putrid fish taste in her mouth, her pulse became like that in tachycardia, and symptoms of general depres- sion rapidly supervened, ending in death after about 12 hours. These instances show that this agent is not devoid of danger, and that care must be exercised in its employment. The particular value of Ichthyol, as a local remedy, is due to its non- irritant quality and to the large proportion of sulphur contained therein ; which, in any pharmaceutical combination, would excite a dermatitis. Its application in medicine depends chiefly upon its reducing property, its antiseptic powers, and its contractile action upon the vascular system. Most of the affections for which it has been recommended are caused by anomalous circulation, and especially capillary dilatation. Used internally, it retards the disintegration of albumins and favors their formation and accumulation. Upon exudations it has a remarkable effect, given in- ternally at the same time as applied externally, promoting their reabsorp- tion and promptly alleviating pain. For these purposes it has been highly praised in gynecology, and even in pleurisy. For chronic rheu- matism a 50 per cent, ointment is used locally and the remedy is also given internally. It has done excellent service in erysipelas, and ulcers of the leg, locally applied in ointrtient form with Lanolin, or pure ; and internally in various affections of the digestive and intestinal tract, also SUMBUL TABACUM. 461 in phthisis, syphilis and leprosy. In gynecology it is combined with Gly- cerin (x in io) ; is used for rheumatism with Turpentine as a liniment, or with an equal weight of a mixture of Lanolin and Olive Oil and 30 per cent, of Chloroform ; against erysipelas as a 10 to 20 per cent, collodion, with or without Castor Oil. Thiol, the German artificial Ichthyol, is largely used in place of Ichthyol, by gyne- cologists and dermatologists. It causes no pain, burning, or other irritation, and no bleeding from eroded surfaces; promotes rapid absorption of effusions, and has many advantages over the natural Ichthyol, among which is the ease with which the stains it produces on linen may be removed. The dry form, used as a dusting powder, is of especial service in erysipelas, and is employed with benefit in eczema, erythema, inter- trigo, impetigo, pemphigus and other cutaneous affections ; especially in acute, moist in- flammations of the skin and subjacent tissues, in chilblains, periphlebitis, contusions, subcutaneous hemorrhages and syphilitic ulcers. It is also an efficient application in pelvic exudations and endometritis. It may be applied as a powder, or collodion, in aqueous or glycerin solutions, as ointment, soap, plaster, etc. Internally, it is given in wine, or chocolate (i to 2 per cent.), also in pills containing a grain each. Mixed with Talc, in the proportion of io to 20 per cent, of Thiol, it makes an excellent dusting powder for use on babies’ skin. Tumenol is said to owe its therapeutic action to its powerful reducing property rather than to the sulphur in its composition. The tincture has been almost universally success- ful in all forms of pruritus. Moist eczema is especially benefited by it, and it generally gives good results when employed in erosions, excoriations, and superficial ulcerations. It is not anti-parasitic in action, and is of no service in erysipelas. SUMBUL, —is the root of Ferula Sumbul, a very large plant of the nat. ord. Umbel- liferse, which grows to the height of 8 feet in the mountains of Northern Asia. The root contains Angelic Acid, C5H8Oa, Valerianic Acid, C5H10O2, also a volatile oil, two bal- samic resins, a bitter substance, etc. Dose, gr. xxx-gj or more, in infusion, decoction. Tinctura Sumbul, Tincture of Sumbul,—io per cent. Dose, gj-iv. Sumbul is an efficient nerve tonic, having qualities closely resembling musk and vale- rian. 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,—is the commercial dried leaf of Nicotiana Tabacum, an annual plant of the nat. ord. Solanaceae, native of tropical America, but cultivated in several parts of the world, especially in Cuba and Virginia. The leaves contain a very poisonous, oily fluid alkaloid named Nicotine, C10HUN2, which occurs as a malate, and in quantity varies greatly in different specimens. Tobacco contains also a volatizable, camphoraceous principle named Nicotianin, the existence of which is de- nied by some analysts, besides potassium and calcium salts (nitrates and phosphates), silica, gum, resin, and other substances. There are no official preparations. Nicotina, Nicotine, C10H14N2 (Unofficial),—the alkaloid and active principle ; a colorless, oily fluid, having the odor of tobacco and an acrid taste; readily soluble in water, and forming soluble salts with acids. 462 TABACUM. Dose, np up to npij in two hours, in tetanus and strychnine poison- ing. [Oiher Liquid Alkaloids besides Nicotine are—Coniine, Lobeline, Lupuline, Muscarine, Piperidine, Pyridine, Sparteine, and the alkaloidal compound Trirnethylamine.] The proportion of Nicotine in tobacco is stated at 6 in 10,000 parts (0.06 per cent.) by Posselt and Reimann, but other analysts have found 2 per cent, in Havana tobacco and more than 8 per cent, in French tobacco. Turkish tobacco is said to contain little or none. The effect of curing undoubtedly produces chemical changes in tobacco, but chemists differ as to whether the proportion of nicotine is greater or less after that process. Composition of Tobacco-smoke. According to Zeise (1843), and Vohl and Eulenberg (1872), tobacco-smoke contains no nicotine, but does contain a series of empyreumatic products, the result probably of its decomposition, viz.—pyridine, collidine, picoline, parvoline, etc. Of these, Pyridine, C5H5N, predominates when tobacco is smoked in a pipe, but Collidine, C8HnN, which is far less active, predominates when there is free access of air, as in smoking cigars. Tobacco-smoke also contains Carbon Dioxide, C02, of which Krause determines the aver- age proportion to be 9.3 per cent., and to which he credits much of the injurious effects of smoking in young subjects. It also contains creosote, hydrogen cyanide and sulphide gases, and several acids, including acetic, carbolic and valerianic. Unofficial Preparations and Salts, etc. Enema Tabaci, Enema of Tobacco (B. P. 1867),—gr. xx of the leaf infused in viij of boiling water for an hour, strained, and the whole administered as one enema. Oleum Tabaci, Oil of Tobacco,—is an empyreumatic product and a most virulent poi- son, obtained by distillation at a temperature above that of boiling water. Vinum Tabaci, Wine of Tobacco,— to the pint. Dose, rtpv—t^j. Pyridina, Pyridine, C5H5N,—a colorless, liquid alkaloid, of powerful odor, evaporating when exposed to air, mixing with water in all proportions, and forming salts like those of Chinolin. Dose, 3 allowed to evaporate in an open dish in a small room, in which the patient is exposed for 20 to 30 minutes thrice daily for the relief of asthma (See). Nicotinae Bitartras, Nicotine Bitartrate,—occurs in fine, white crystals, having a ten- dency to aggregate, readily soluble in water. This salt is stable, and keeps well, even in solution. It is recommended as the most suitable form of administering nicotine in tet- anus, strychnine poisoning, etc. Dose, gr. up to a maximum of gr. ij in 2 hours in such affections. Physiological Action. Tobacco is a very depressant nauseant, an emetic by irritant as well as by systemic action, and an antispasmodic; also sternutatory, diuretic, dia- phoretic, cathartic, sedative and narcotic. It first stimulates and after- wards paralyzes the motor nerves of involuntary muscles, and the secret- ing nerves of the glands, also the spinal cord and the vagus; at first stim- ulating both the vagus-roots and its ends in the heart (slowing the pulse- rate), but afterwards paralyzing the latter (causing high pulse-rate). It increases the salivary and intestinal secretions, and produces diuresis, tremor, clonic spasms and a tetanic stage followed by paresis. It contracts the pupils, slows and depresses the heart, lowers arterial tension at first and afterwards raises it, reduces the body-temperature, and causes profuse sweating, cold and clammy skin, collapse, and death usually by paralysis of respiration, sometimes by paralysis of the heart. It does not impair the TABACUM. 463 muscular irritability, nor does it act upon the cerebrum directly. Its em- pyreumatic products act similarly but less powerfully. Fatal results have followed on the inhalation of its vapor into the lungs. The continued use of Tobacco, by smoking or chewing it to excess, pro- duces granular inflammation of the fauces and pharynx, atrophy of the retina, dyspepsia, lowered sexual power, sudden faints, nervous depression, cardiac irritability and occasionally angina pectoris. Used by the young it hinders the development of the higher nervous centres, and impairs the nutrition of the body by interfering with the processes of digestion and assimilation. It has been credited with causing cancer of the lips and tongue, blunting of the moral sense, mental aberration and even insanity. The so-called “tobacco heart ” includes many forms of nervous, painful or oppressed cardiac action, depending on the age of the subject, the quantity consumed, and other circumstances. In mild cases an occasional palpitation or flutter is complained of; in more severe ones there is con- siderable cardiac irregularity and rapidity, and more or less distress experi- enced ; in some there is actual cardiac pain, decided irregularity and occa- sional intermittence of action, and the symptoms may represent those of a case of angina pectoris. There are no physical signs, as a rule, and the diagnosis is made by exclusion. The pathology is unknown, but probably involves some lesion of the vagus. In the young, excessive indulgence in tobacco may lead to cardiac hypertrophy, to dilatation, and even to valvular lesions (Osier). Nicotine in even minute doses causes symptoms of intense gas- tric irritation with an extreme degree of collapse. It abolishes the func- tion of the motor nerves and paralyzes respiration. Its general action is that of tobacco, but it is one of the most powerful and rapidly-acting poisons known, death having occurred within three minutes after its inges- tion, the patient dropping instantly to the floor insensible, with no symp- toms except a wild stare and a deep sigh. The tV of a grain has caused death in a human being, and is fatal to cats and dogs. 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. For the depression due to excessive smoking, the best agent is Spiritus Hitheris Compositus (Hoffman’s Anodyne). Antidotes and Antagonists. 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 principal objects for which it Therapeutics. 464 TAMARINDUS TANACETUM TARAXACUM. is used are to relax spasm of the intestines, and to relieve local pain therein. Intestinal affections, like impaction of the caecum, intussusception and strangulated hernia, may be overcome by a tobacco-enema to relax spasm, but it is a dangerous expedient. In dropsy, especially the renal form, it makes a very efficient diuretic. In tetanus there is no more effective rem- edy 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. Strychnine-poisoning is best met by minute doses of Nicotine (gr. -ff) hypodermically, as a physiological antagonist. It may be employed with advantage in habitual constipation, for the dyspnoea of spasmodic asthma and emphysema, and in nymphomania and chordee. In all forms of asthma the inhalation of the fumes of Pyridine is beneficial, as it has a powerfully sedative action on the respiratory centre. 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 ifidica, a large tree of the nat. ord. Leguminosae, native in the East and West Indies. It contains citric, tartaric and malic acids, sugar, gum, potassium bitartrate, etc. Confectio Sennae, Co7ifection of Senna,—contains Tamarind to the amount of io per cent. Dose, 5jj-ij. (See under Senna.) Tamarind is a laxative and refrigerant fruit. In infusion it may be used by convales- cents 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 Tanacettim vulgare, a perennial, herbaceous plant of the nat. ord. Compositas, 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 prepared according to the general rule and administered in doses of rrpx- The dose of the volatile oil (Oleum Tanaceti) is I to 3 drops. An infusion (Tansy Tea) may be made in the proportion of to the pint, and used in doses of 5Hi- Tansy is emmenagogue, diuretic and anthelmintic, an aromatic bitter and an irritant narcotic poison. Fatal results have frequently followed upon overdoses of the oil 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 officinale, an herbaceous plant of the nat. ord. Compositse. All parts of the plant con- tain a bitter, milky juice, exuding from any break or wound. Its constituents are a bitter amorphous principle named Taraxacin, a crystalline principle Taraxacerin, with potas- sium and calcium salts, Inulin, and resinoid bodies, etc. The French name for the plant is “ Pissenlit.” Extractum Taraxaci, Extract of Taraxacum.—Dose, gr.v-xxx. Extractum Taraxaci Fluidum, Fluid Extract of Taraxacum.—Dose, TEREBINTHINA. 465 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 extract is probably only of value as an excipient for pills. TEREBINTHINA.—A Turpentine means a vegetable exudation, liquid or concrete, consisting of resin combined with a peculiar essential oil named Oil of Turpentine (C10H16), and generally procured from various species of the nat. ord. Coniferae (cone-bearers). Of the many turpen- tines two only are official, viz. : — Terebinthina, Turpentine,—a concrete oleoresin obtained from Firms palustris, the Yellow Pine, and from other species of Pinus, nat. ord. Coniferae. 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; 3ij-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. Coniferae. 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. Pitch and its preparations are described under Pix. Oleum Terebinthinse, Oil of Turpentine, commonly called “ Spirit ” or “ Spirits of Turpentine,”—is a volatile oil distilled from Turpentine. A thin, colorless liquid, of characteristic odor and taste; soluble in 3 times its volume 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 formation of resin. It is a mixture of several hydrocarbons, each having the same formula as itself, viz., C10H16. Oleum Terebinthinae Rectificatum, Rectified Oil of Turpentine,—prepared by shaking Oil of Turpentine with 6 times its volume of Lime Water, distilling three-fourths, and separating. This preparation should always be dispensed when Oil of Turpentine is required for internal use. Dose, as a stimulant or diuretic, trpv-xv, in emulsion, 3 to 6 times daily ;—as a cathartic or anthelmintic £ ss or more, combined with other cathartics. A little glycerin and Oil of Gaultheria will disguise the taste. Linimentum Terebinthinae, Turpentine Liniment,—has 35 parts of the oil with 65 of Resin Cerate. Official Preparations of Turpentine. 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 translu- cent solid. Dose, gr.iij-v in emulsion. Venice Turpentine,—procured in Switzerland from the Larix Europcea or European Larch ;—a viscid liquid of the consistence of honey, 466 TEREBINTHINA. 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 Americanum, Common Frankincense (B. P.),—the concrete turpentine which is scraped off the trunks of Pinus australis and Pinus Tceda, Southern States of N. America. An ingredient of the Emplastrum Picis of the B. P. 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 (C44II6204). See ante, under its own title. Terebenum, Terebene, C10H16,—is a hydrocarbon obtained by the oxidation of Oil of Turpentine by strong Sulphuric Acid, and occurs as a colorless, or light yellow liquid, with the pleasant odor of newly cut pine wood ; practically insoluble in water, but may be emulsified, soluble in an equal volume of alcohol. It consists chiefly of Pinene, and should contain not more than very small proportions of Terpinene and Dipentene (U. S. P.); [consists of Camphene, Cymene, Borneol and Terpilene (Squibb)]. Dose, ttpv -xx on sugar, or suspended in ss of water by the aid of gr.xx of light magnesium carbonate. Terpini Hydras, Terpin Pdydrate, C10Hlg(OH)2. H20,—is the hydrate of the diatomic alcohol Terpin (Terebinthene), obtained by distilling oil of Turpentine with an alkali. Colorless, lustrous, rhombic prisms, nearly odorless, of slightly aromatic and somewhat bitter taste; soluble in io of alcohol and in about 250 of water at 590 F., in 32 of boil- ing water and in 2 of boiling alcohol. Dose, gr.v—x. Terpinol (Unofficial),—an oily body obtained from the preceding, by the action of an acid thereon. Dose, gr. ij-v. Sanitas Disinfecting Fluid (Unofficial),—is an aqueous solution of turpentine which has been oxidized by exposure to the air. It contains Hydrogen Dioxide, Thymol, Camphor and Camphoric Acid, the latter in such small proportion, however, that its action cannot be expected. This proprietary preparation has many combined advantages. It is a good oxidizing agent and antiseptic, is not poisonous, and does not stain the linen, —qualities which strongly recommend it as an external disinfectant, and for use in surgical operations. Derivatives of Turpentine. Official Analogues of Turpentine. These include Juniperus, Juniper, Sabina, Savine, Pix, Pitch, and Pix Liquida, Tar, which are described under their respective titles. Unofficial Analogues of Turpentine. Oleum Succini, Oil of Amber,—a volatile oil obtained by the destructive distillation of Amber (Succinum), a fossil resin, occuring 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, under SUCCINUM.) Oleum Thujae, Oil of Thuja —a volatile oil which is given in doses of rqj-v. A saturated tincture may be used in drachm doses. Obtained from Thuja occidentals, the Arbor Vitae, a coniferous tree. (See under Thuja.) Oleum Pini Sylvestris, Oil of Scotch Fir (B. P.),—a colorless liquid, obtained by distilling the fresh leaves of Pinus sylvestris, nat. ord. Coniferse, and used externally and by inhalation. 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- Physiological Action. TEREBINTHINA. 467 trium, burning in the mouth, and salivation by reflex action. In mod- erate doses it at first stimulates the vaso-motor nervous system, after- wards 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, sometimes 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 in- toxication induced. In toxic dose it acts as a narcotic poison and causes complete muscular relaxation,.profound insensibility, with abolished re- flexes, dilated pupils, cyanosed face, labored and stertorous breathing and death by paralysis of respiration. It is excreted by the various or- gans of excretion, all of which are highly irritated, the kidneys suffering particularly. 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. The Oil, when exposed to the air, readily absorbs oxygen in the form of ozone, which it retains tenaciously. This Ozonized Oil of Turpentine is an antidote to Phosphorus, preventing the formation of phosphoric 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. Antidotes and 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 coun- ter-irritant in many conditions producing pain and inflammation. Cloths wrung out of hot water and then sprinkled with the oil (turpentine stupes) are useful applications in sciatica and other neuralgiae, lumbago, chronic rheumatism, chronic bronchitis, peritonitis with tympanites, pleurisy, renal colic, etc. It is one of the most efficient agents in hospital 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 intes- tines and in hemorrhages of a passive character from other organs. Active bleeding with a plethoric condition and hematuria are states in which it is 468 THEOBROMATIS OLEUM. contraindicated. It is often used with Ether (1 to 3) in biliary and flatu- lent colic, as an anodyne and antispasmodic. As a vermifuge against tape-worm it must be employed in large doses (§ss-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, pneumonia, 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 bene- ficial in chronic affections of the larynx and bronchi. The pure vapor is too irritating for inhalation, but it may be diluted with steam from a steam atomizer. 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, and 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’ ex- perience with this remedy in England, praise it highly as an inhalant remedy in phthisis, bronchiectasis, chronic bronchitis, and other pulmonary affections characterized by profuse, purulent 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. It probably has no superior efficacy to Creo- sote, Venice Turpentine, etc., except that it is without much odor, and has no taste. Terpin 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 proper field for the therapeutical action of this preparation. THEOBROMATIS OLEUM, Oil of Theobroma, Cacao-butter,—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 C7HgN402, 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. Oil of Theobroma consists chiefly of Stearin with a little Olein. Its action is demul- cent, 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. THUJA THYMI OLEUM. 469 Theobromine has the same action and uses as Caffeine. [See under Caffea, for this principle and for Diuretin.] THUJA, Arbor Vitae (Unofficial),—the fresh tops of Thuja occi- dentals, a tree of the nat. ord. Coniferse, commonly though incorrectly called White Cedar, and growing in swampy ground in Canada and the northern U. S. They contain a volatile oil, tannin, wax, resin, etc.; also Pinipicrin, C22H18Ou, a bitter principle, and Thujin, C20H22O12, a yellow, astringent and crystallizable coloring principle, which is separable into glucose and Thujetin, cuhm08. The dose of a saturated, fresh tincture or fluid extract is 3 j, 3 to 6 times daily. The Volatile Oil may be given in doses of TT\J-v. Preparations. Physiological Action and Therapeutics. 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. 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 vulva, for papillomatous growths in general, and for gleets dependent on granular urethritis. It has been used in chronic gonorrhoea and prostatitis 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. This 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; readily 470 THYMI OLEUM. soluble in alcohol. It consists of two portions, the more volatile being a mixture of the hydrocarbons Cymene and Thymene, the less volatile being chiefly Thymol, which is also official. Thymol, C10HuO,—is a phenol 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 when triturated with about equal quantities of camphor, menthol or chloral. Dose, gr. ss-ij. Unofficial Preparations, Thymol Solution,—for antiseptic spray, I in 1000. Thymol Gauze,—contains X 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 iij. A teaspoonful to a pint of water at 150° F. for each inhalation. Volkmann’s Antiseptic Fluid,—has of Thymol I, Alcohol 10, Glycerin 20, and Water 100 parts. 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 dur- ing the process of its excretion. As an antiseptic it is much more power- ful and permanent than Carbolic Acid, and much less poisonous. Physiological Action. 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 ozsena. A solution of i 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 TIGLII OLEUM. 471 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, and a native of India. The oil is of a pale or brownish-yellow color, some- what viscid and slightly fluorescent, of fatty odor, acrid taste and slightly acid reaction ; 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 glycerides of several fatty acids, also a peculiar acid named Tiglinic Acid, C5H802, which is iso- meric with Angelic Acid. Dose, in pill, emulsion or tincture. Physiological Action and Therapeutics. 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 hyperaemia as well as direct inflammation of the intestinal mucous membrane, together with increased 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. Croton Oil is used as a hydragogue cathartic 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 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 or bread, and may be given thus in repeated doses until the desired effect is obtained. It has been used as a vermifuge against tapeworm. Externally it is employed as a counter-irritant in ovaritis, bronchitis, pleurisy, rheumatism, neuralgia, glandular swellings and in laryngeal and pulmonary diseases. The Linimentum Crotonis of the British Pharma- copoeia contains i 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. 472 TONGA—TOXINS. TONGA (Unofficial),—is a mixed drug said to be obtained from the Fiji Islands, con- sisting of thin barks, root-fibres and leaves, tied into long bundles. The fibrous material is believed to be derived from Rhaphidophora vitiensis, a creeping plant of the nat. ord. Araceae, 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. Verbena- cese, and contains a little volatile oil, sugar, pectin, etc. A fluid extract is on the market, which may be given in doses of thrice daily. Tonga was introduced by Drs. Ringer and Murrell as a remedy for neuralgia in 1880, stating that they had used it with gratifying results. Since then reports have differed con- siderably in regard to its efficacy, and from the fact that Dr. Ringer does not mention it in the later editions of his Handbook of Therapeutics, it may be inferred that his further experience with it has not borne out the claims first made. TOXINS (Unofficial).—The toxins are specific poisons produced by bacterial metabolism in suitable media, and when circulating in the animal organism are the immediate causes of the acute infectious diseases. Many of their active principles are of albuminous nature, the so-called Toxalbumins. Toxins have been obtained from ripe cultures of the bacteria of tetanus, diphtheria, tuberculosis, cholera, typhoid fever, anthrax, pneumonia, glanders, and swine-plague, also from cultures of streptococcus erysipelatis, bacillus prodigiosus, etc. The treatment of diseases due to pathogenic microbes by the toxic products of their own particular bacteria is based upon the theory that these germs produce substances in their culture media which are inimical to their own life. The treatment of tuberculosis by Koch’s tuberculin and the inoculations of Haffkine against cholera are examples of true toxin treatment. The vaccinations of Jenner for variola and Pasteur for rabies are of the same nature when employed as remedial methods, the material being obtained from a morbid product of the disease in the one case, and from the diseased tissue itself in the other, the culture medium in both being the blood and tissues of the infected animal organism. It has been frequently observed that patients afflicted with malignant disease have been greatly benefited by an intercurrent attack of erysipelas, in consequence of which the tumors seemed to undergo retrogressive changes. This has suggested the employment of the toxins of streptococ- cus erysipelatis and bacillus prodigiosus in inoperable cancer, and may lead to the treatment of other diseases by the toxins of bacteria hitherto unassociated with them. The injection of a toxin in gradually increasing doses at proper inter- vals will confer immunity in many cases upon the animal so treated against the corresponding disease and its particular bacteria. This im- munity may be transferred to another animal by injecting into its cellular tissue the blood-serum of the immunized one ; and this serum will also act remedially on a subject of the disease if administered early in its course (Behring). The immunizing and curative action of the serum is believed to be due to the existence of an antitoxin in the blood of the TOXINS. 473 inoculated animal, elaborated by the living cells of its tissues as a defence against the action of the toxins. These facts and hypothesis form the basis of the treatment of certain diseases by antitoxic serum (described under the title Antitoxins, ante, page 146 et seqP), which now promises better results than any other system of bacterio-therapy. The toxins produced by any particular bacteria vary greatly in power through very slight circumstances. They may be weakened or increased in virulence by the cultivation of their bacteria on different culture media or on the same media with different surroundings as to oxygen, tempera- ture, etc.; also by passing successive generations of these organisms through a definite series of animals, chosen for their natural insuscepti- bility or susceptibility thereto. The pathogenic microbes of several diseases are now cultivated in test-tubes, forced to acquire an increased or lessened degree of virulence or toxin-producing power as required, are separated from the poisonous products of their metabolic life-work, and by the inoculation of either their progeny or their chemical products (toxins) the corresponding diseases are reproduced upon healthy animals in almost any desired degree of intensity. Repeated efforts have been made in some cases to separate from these bacterial products a germicidal ingredient without its toxic associates, which might prove curative for the corresponding disease. The Tuber- culocidin and Antiphthisin of Klebs-are claimed to be such substances, and are described in the following pages. Tuberculin, or Koch's Lymph, announced as a secret and specific rem- edy for tuberculosis by Professor R. Koch, of Berlin, six years ago, was subsequently stated by him to be an extract of the products of pure cul- tures of the tubercle bacillus, made with glycerin and water. In Koch’s preliminary statement to the Berlin meeting of the International Medical Congress in 1890, the chief point made was that guinea-pigs could be rendered immune to inoculated tuberculosis by means of this agent; but even this has been denied by other observers. In the extended paper published in November, 1890, he stated that the remedy would not di- rectly kill the bacilli, but that it acted powerfully and specifically upon the living tuberculous tissue, caused a necrotic condition thereof and hastened its disintegration ; also that it might be expected to increase the resistant power of healthy tissue and thereby starve the bacilli, check their increase, and lead in many cases to the cure of the disease. The actual result, however, as Virchow and others soon pointed out, was to soften and disintegrate quiescent deposits and to disseminate the bacilli throughout the body, forming new foci of active infection in other situa- tions. The severe reactions, which followed the injections of the lymph in many instances, proved that serious risk must attend its general use ; and that, like most remedies for phthisis, it could do good only in a few 474 TOXINS. carefully selected cases. A sense of profound disappointment succeeded to the enthusiasm at first excited, with the result that the remedial action of tuberculin became thoroughly discredited and its use almost universally abandoned. It has lately become of interest again by reason of the per- sistent efforts to extract from it a germicidal constituent free from toxins (see infra), as also the results obtained in tuberculosis with the blood serum of animals immunized by its repeated inoculation. (See the arti- cle on Tuberculosis Antitoxin, ante, page 153.) The violent action of tuberculin, together with its source, prove it to be a true bacterial toxin. Taken by the mouth it is inert, being proba- bly digested in the stomach. In small dose (0.001 cc. of the original lymph) injected hypodermically upon healthy subjects, it gives rise to slight pains in the limbs and a transient sense of fatigue ; but the same quantity injected upon tuberculous subjects produces a very powerful re- action both locally and generally, the constitutional effects being similar to those accompanying an acute exacerbation of the disease. About three hours after the injection a decided rigor occurs, which is followed by a rapid rise of temperature and pulse-rate, also pains in the limbs, a sense of great fatigue, drowsiness, nausea and loss of appetite, these effects lasting from 12 to 15 hours. In cases of advanced phthisis with cavities, after an injection of tuberculin the temperature has risen to 105.8° F., which sinking suddenly collapse has occurred, and the patients have died. If the case presents a local tuberculous lesion, this swells and becomes tender to the touch, and the skin over it is inflamed. In pulmonary cases the reaction is greater than in those having surgical tuberculous lesions from a similar dose ; the cough increases, there is great distress and dysp- noea, the patient feels decidedly worse, and occasionally suffers from slight collapse. When the reaction has subsided the patient feels com- paratively well, and generally better than before. In cases of lupus, the effect of the injection is very marked. Within three hours there arises a feeling of tightness with heat and burning over the face and nose, and an eczematous exudation sets in which dries into crusts on the surface of the lesion, and continues about 48 hours. After two days these symp- toms begin to subside, and after nine days the crusts have fallen off, and the affected tissue appears shrunken, red and shiny, like the surface of a lupus patch which has been scraped with a Volkmann’s spoon. The principal lessons taught by the history of Koch’s tuberculin are pathological rather than therapeutical, and cannot be mentioned here. An important one is this—that any treatment in tuberculosis which pro- motes destructive changes instead of conservative ones, shown in this case by the breaking down of the lung tissue and its appearance on a large scale in the sputum, cannot be other than detrimental to the patient, as the area of infection, instead of being limited as it was, is thereby con- TOXINS. 475 siderably widened. As a diagnostic agent it is certainly of value in showing the presence or absence of latent tuberculosis, but for this pur- pose it should only be used in veterinary practice, for the ordinary means of diagnosis are already so reliable as not to warrant such a risky proce- dure on human subjects. Professor Koch has acknowledged that tuberculin is only of service in the initial stage of phthisis and in cases of simple infection, and that when the case is complicated by the presence of other microbes it is not only of no service but often does harm. Professor Ewald has stated that so far as clinical and experimental testimony had gone it possesses no specific curative action, and that its use must finally be abandoned on account of the dangers attending its administration. The physicians of the Hospital for Consumption and Diseases of the Chest at Brompton, England, reported on its systematic employment in 30 cases of pulmo- nary tuberculosis and lupus, with the following conclusions : “ That the tuberculin did not favorably influence the course of the disease in the ma- jority of cases; that in some the effects were detrimental; and that even in the stationary and improved cases it was difficult to ascribe any distinct improvement to the injections which might not have been equally attained under the treatment ordinarily employed in the hospital.” Koch’s Tuberculin was distributed in the form of a brown solution, which by evaporation and filtration had been concentrated to one-tenth the volume of the ripe culture fluid. One part of this original lymph, added to nine parts of distilled water containing to I per cent, of carbolic acid, made the so-called “mother solution,” in which form, though too power- ful for use, it will keep a long time, being still further diluted as required. One part of this io per cent, solution added to nine parts of distilled water makes the dilute I per cent, solution used for injection. If, as Koch estimated, the original lymph contains but one per cent, of the dry, active substance, its proportion in the injection solution would be only one in ten thousand. The dose of the latter solution ranged from o.I cc. to I.o cc., corresponding to o.ooi cc. and o.oi cc. of the original lymph ; and was administered by a sterilized hypodermic syringe of special form, under strict aseptic precautions, be- neath the skin of the back between the scapulae. As to the dose, Professor Koch says as follows: “An injection of o.ooi cc. [o.I cc. of the injection solution] was first given to the phthisical patient, and from this a rise of temperature followed; the same dose being repeated once a day until no reaction could be observed. We then increased the dose to 0.002 cc. [0.2 cc. of the injection solution] until this was borne without reaction, and so on, increasing by o.ooi, at most 0.002 to 0.005 cc- This mild course seemed to be im- perative in cases in which there was great debility. By this mode of treatment the patient can be brought to take large doses [1.0 cc. of the injection solution] with scarcely a rise of temperature.” In early lung cases a period of about four to six weeks completes the course of treatment. Koch’s syringe contains I.o cc. and is graduated in tenths, each division representing one minimum dose (o. 1 cc.) of the I per cent, solution. When large doses are reached the stronger 10 per cent, solution may be used in appropriate quantity. For cases of lupus much heavier doses were employed at first, even ten times the quan- tities mentioned above, but necessarily at much longer intervals. These large doses, how- ever, gave rise to most formidable and dangerous symptoms, and caused fatal results in some cases. Dr. Whitla believes that better results would have been obtained by the use of much smaller doses, and suggests that the treatment be commenced by giving two daily doses of not more than of a grain of the original lymph, equal to l/z a minim of the I per cent, solution, for two or three weeks or longer. The of a grain (0.2 cc. of the i per cent, solution) might then be given, and if marked reaction did not occur the dose should be rapidly increased. 476 TOXINS. Tuberculocidin. After Koch’s tuberculin became discredited, its composition became the subject of analytical research with the view of separating out its toxic constituents and obtaining a remedial agent from it. These investigations were principally made by Dr. W. Hunter, Dr. Watson Cheyne and Professor E. Klebs of Zurich. The latter treated the crude tuberculin with platinum chloride, which precipitates the alkaloidal constituents or toxins, leaving a solution which he named Tuberculocidin, on account of its supposed antagonism to the tubercle bacillus. With this solution he treated 75 cases of phthisis, and reported 14 as cured, 45 improved, 14 unimproved, and 2 died. During experiments on animals with it he claims to have observed the complete regression of an appa- rently advanced tuberculosis. Dr. Langermann used it in four cases of pulmonary tuberculosis with varied results. He admits that it does not cause either serious constitutional effects as tuberculin does or irritation at the site of injection, but as to its curative action he has great doubt. Klebs has apparently abandoned this agent in favor of Antiphthisin, his more recent but similar product. Antiphthisin is the latest result of Professor Klebs’ long-continued efforts to extract a non-toxic and curative substance from tuberculin, which, according to his most recent analysis, contains (1) tox-albumins, precipitated by sodic iodide of bismuth, (2) alkaloids, (3) an albuminoid derived from the bodies of the dead bacilli, (4) a soz-albumin, precipitated by absolute alcohol after the removal of the toxic ingredients. It is claimed by Klebs that an aqueous solution of this soz-albumin, prepared by him and named Antiphthisin, possesses the germicidal and curative properties of tuberculin without any of its toxic effects. With this prod- uct he claims to have caused the complete cure of tuberculosis in guinea- pigs, and to have obtained 90 per cent, of good results (whatever that may mean) for all stages of phthisis in the human subject. He states, however, that it will produce its fullest benefits in the very early stages of the disease, for which stages alone it is recommended as a specific remedy; and that in advanced and complicated cases the prospects for its success- ful use are less certain. In asking physicians to give it a trial he requests that they will not try the remedy except in cases of pure tuberculosis, excluding for the present cases of mixed infection, septic cases, and all such as have amyloid degeneration or are so far reduced that they must die of the complications or exhaustion present. These requirements may be good for the reputation of the remedy, but are most difficult to observe in practice, as they confine it to a class of cases which seldom come to the physician in that stage and which are not easily diagnosed with accu- racy when seen. Dr. von Ruck, who is associated with Klebs, reports as his experience of nearly 100 cases of phthisis treated with this remedy, that it has an unmistakable influence over the fever, that under its use TOXINS. 477 percussion dulness becomes perceptibly less, bronchial and harsh breath- ing give place to puerile and then vesicular respiration, the lung-capacity increases, the cough diminishes, the sputum loses its purulent character and lessens in quantity, while the bacilli therein diminish in number and show marked signs of degeneration. Dr. C. Denison, of Denver, reports that most of the cases treated by him with antiphthisin gave evidence of its germicidal and healing effects, “ in the lessening of the number of germs to the field found, and their degenerative or incomplete forms thrown off when good sized doses were reached, as well as in the clearing up of consolidated or infiltrated tubercular lung tissue.” Antiphthisin is prepared by Professor Klebs at the laboratory of the Winyah Sanitarium, Asheville, North Carolina, where he is now located. He explains the process of manu- facture as follows : “ We take the ripe culture of the tubercle bacillus and reduce it to one-tenth of the original amount by evaporation in a vacuum and filter. This really is the tuberculin as prepared by Professor Koch. To the filtrate we now apply an acid solution of sodic iodide of bismuth and obtain a precipitate which is filtered out. This precipitate represents the toxic properties of tuberculin, as proved both in the animal experiment and in its application to the human being for diagnostic purposes. After the tox-albumins are filtered out, we precipitate further by the addition of absolute alcohol an organic substance resembling in its chemic reaction a peptone, and this organic substance redissolved in distilled water is antiphthisin. In the animal experi- ment we find that this alcoholic precipitate does not produce fever or toxic symptoms of any kind. . . . Antiphthisin cannot be given by the mouth, being an albuminoid substance it would be digested in the stomach. The remedy has no diagnostic proper- ties, there is no reaction to its use. I think my remarks will make it plain, that the diagnostic value lies in the toxins, and the curative substance separated from the toxins is antiphthisin.” (From Professor Klebs’ remarks in German, before the Section on Dis- eases of Children at the Baltimore meeting of the American Medical Association, May, 1895, translated by Dr. von Ruck.) The daily dose for an adult is o. 1 cc. at first, increased daily or every other day until 0.5 cc. are reached. This dose may be repeated daily for a week, and is then gradually increased to 1.0 cc. which latter dose is again continued for a time, before being again increased. It is seldom necessary to go beyond 2.0 cc., though a dose of 10 cc. has been given. The administration may be intermitted for a time after 50.0 cc. have been used. If, under a certain dose, the improvement is rapid and satisfactory, there is no reason to increase the quantity given ; and physical examination should constantly accompany and control the future course. The remedy may be administered hypodermically under aseptic precautions, or by rectal injection. It is put up in vials containing 15, 30, and 50 cc., and is sold at the rate of fifty cents per cubic centimeter. Erysipelas and Prodigiosus Toxins. Malignant tumors have occasionally been observed to disappear after the patient had suffered from an intercurrent attack of erysipelas. When the discovery was made that artificial erysipelas could be produced by the inoculation of pure cultures of the streptococcus erysipelatis, this inoculation was practised upon sub- jects of cancer, as a remedial measure. The results, though favorable, were not so complete as in the cases acted upon by accidental erysipelas, and the inoculated disease often proved fatal to the patient. Dr. Coley then employed the toxins of the streptococcus instead of the culture itself, and reported a number of apparent cures of malignant disease thereby. Later it was found by Roger that the bacillus prodigiosus has the power of intensifying the virulence of the streptococcus erysipelatis, and by using 478 TOXINS. a mixture of the toxins of both these germs, Coley obtained a more bene- ficial effect than from the erysipelas toxin alone. The remedial action is much more efficient in sarcoma than in carcinoma, though some cases of the latter disease are reported as apparently cured by this treatment. In- cluding all the cases of sarcoma in which these mixed toxins have been employed by Coley, there are 43 such reported of which n were appa- rently cured. Professor Senn of Chicago has found negative results in his own experience of this treatment, and states that in all his cases these injections failed to effect even temporary improvement. Dr. Coley prepares these toxins in the usual manner, and avoids the danger of inoculating erysipelas itself by subjecting the cultures to a temperature (136.40 F.) sufficient to destroy the germs. The commenc- ing dose is x or 2 minims, injected once daily into the tumor or sub- cutaneously in its vicinity, and gradually increased. This method should be employed only in cases which are manifestly unfit for operative inter- ference. Richet and Hericourt injected a serum obtained from animals inoculated with the fil- tered emulsion of an osteo-sarcoma into a recurrent sarcoma of the chest-wall and also into a supposed carcinoma of the stomach. The tumors were thereby reduced in size and general improvement followed, but in neither case was there any microscopical examination made, hence the diagnoses are uncertain. Emmerich and Scholl claim that excellent results were obtained by them in the treat- ment of both sarcoma and carcinoma by the injection into the growth of an antitoxic serum obtained from sheep inoculated with the toxins of virulent erysipelas streptococci. Other experimenters, including Bruns and Angerer, do not confirm their statements in this respect; and as their observations were limited to a few weeks, it is impossible to regard their cases as presenting evidence of cure. Cholera Toxin. An extended series of inoculations against cholera was carried out in India during the past three years by Dr. Haffkine, whose procedure comprises the preparatory use of a weak virus followed by a second inoculation with a stronger one. He obtained the weak virus by passing air and oxygen over a culture of the comma bacillus on agar at a high temperature, which so modified the microbes that when injected they produced only slight local puffiness, followed by a mild reac- tion. The second inoculation was made five days after the first, and with a virus of such intensity that it killed a guinea-pig in eight hours. This virus, used on the human subject subsequent to the preparatory inoculation, caused only slight local and constitutional disturbance, thereby proving that the first inoculation had conferred a certain degree of immunity against its effects. The symptoms subside in another five days, and not until then can it be said that the operation of preventive inoculation against cholera is complete. Dr. Haffkine made 42,445 such inocula- tions, without a single instance of mishap or injury to health resulting therefrom. The results obtained were highly favorable, the statistics thereof demonstrating for this procedure a remarkably protective power against cholera in the country where that disease is endemic. The figures TOXINS. 479 are furnished, not by Dr. Haffkine, but by responsible British medical officers assigned to the duty of verifying the result in each case. Rabies Toxin. Although no microbe has been yet found associated with rabies, there is abundant evidence to prove that the specific virus of this disease is a micro-organism, inasmuch as it behaves exactly like one. Pasteur found this virus most abundant in the spinal cord of the rabid animal, and showed that its inoculation upon a healthy animal will pro- duce the characteristic symptoms of the disease, and that the virus may be attenuated in virulence by drying the spinal cord containing it. He also found that by inoculating on each successive day the virus from a cord dried during a shorter period than that used on the previous day, the animal so treated may be gradually made almost certainly secure against rabies, either from the bite of a rabid animal or from any method of subcutaneous inoculation. Upon these facts he founded his preventive treatment of this disease, commenced by him in Paris in 1885; which consists in the daily inoculation of the bitten person with emulsions of gradually increasing virulence, made from the dried spinal cords of rab- bits that have died from inoculated rabies. By this procedure, chemical substances (toxins), produced during the life of some specific organism and known to be inhibitory of its growth, are introduced into the system of the patient (V. Horsley). During the eight years from 1886 to 1893 inclusive there were treated by this method at the Pasteur Institute in Paris 14,430 bitten persons from many countries, with 72 deaths resulting ; a mortality rate of y2 of 1 per cent, for the entire number, the mortality for each year having steadily decreased from 0.94 per cent, in 1886 to 0.25 per cent, in 1891, 0.22 per cent, in 1892, and 0.24 per cent, in 1893. During the four years from 1892 to 1895 inclusive, there were treated at the Pasteur Insti- tute in New York 424 bitten persons from all parts of the United States and Canada, among whom only 2 deaths occurred. The patient bitten by an animal supposed to be rabid should be sent at once for treatment to one of the Pasteur Institutes; and should be accompanied, if possible, by a piece of the medulla oblongata of the biter animal, in order to determine by experimental methods whether the animal was rabid or not. The specimen should be removed with an aseptic knife, and be placed in a mixture of equal parts of pure glycerin and water, previously sterilized by boiling. The period of treatment is usually 15 days, during which from 2 to 6 inoculations are administered daily with viruses of gradually increasing intensity ; the number depend- ing on the time which has elapsed between the infliction of the bite and the commencement of the treatment. The Hydrophobia Committee, appointed by the British Parliament in 1887 to investi- gate M. Pasteur’s treatment of rabies, consisted of Sir James Paget, chairman, Sir Joseph 480 TRAGACANTHA TRITICUM. Lister, Dr. Lauder Brunton, Sir Richard Quain, Dr. Geo. Fleming, Sir Henry Roscoe and Dr. Burdon Sanderson, with Professor Victor Horsley as secretary. Their report to parliament, made after an extended investigation in Paris, and much experimental research, states as follows: “ It may hence be deemed certain that M. Pasteur has dis- covered a method of protection from rabies comparable with that which vaccination affords against infection from small-pox. It would be difficult to overestimate the import- ance of the discovery, whether for its practical utility or for its application in general pathology. . . . From the evidence of all these facts we think it certain that the inoculations practiced by M. Pasteur on persons bitten by rabid animals have prevented the occurrence of hydrophobia in the large proportion of those who, if they had not been so inoculated would have died of that disease.” Professor Victor Horsley, the secre- tary of the committee, said three years afterwards in Fowler's Dictionary of Medicine, that “ its adoption has reduced the mortality among those bitten by indubitably rabid dogs from 15 per cent, to 1.3 per cent.” Tizzoni and Cantani have lately published reports of experiments on the cure of rabies after its actual outbreak. They found that an alcoholic precipitate from the serum of highly immunized animals not only caused protection against rabies but also cured it even after the first symptoms of the disease had made their appearance. It has also been announced that at the Pasteur Institute of Bologna a cure of rabies in the advanced stage was effected by a special mode of the Pasteur treatment. A man bitten by a rabid dog, who had subjected himself to the Pasteur inoculations, was seized with the phe- nomena of paralytic rabies. Paralysis having progressed from the lumbar region over the whole organism, bladder and rectum included, intravenous injections of the fixed virus were administered, whereupon the painful symptoms gradually diminished and finally a perfect cure was accomplished. Mallein is an extract in glycerin of the products of cultures of the bacillus mallei, the microbe associated with glanders. This toxin, when injected into animals affected with glanders, produces a strongly marked febrile reaction, similar to that caused by tuberculin in tuberculous sub- jects. It is now extensively employed in veterinary practice for the purpose of testing horses suspected of being infected with the disease. Recently, however, in London, a case occurred in which ten horses in one stable showed the typical reaction after the use of mallein, but sub- sequently developed none of the symptoms of glanders. TRAGACANTHA, Tragacanth, —is a gummy exudation from Astragalus gum- tnifer 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, 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. Mucilago Tragacanthae, Mucilage of Tragacanth,—Tragacanth 6, Glycerin 18, Water to ioo. Dose, §j or more. Tragacanth is demulcent, but in large quantities it may cause indigestion. It is chiefly employed to suspend resins and heavy powders in 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 12 of the 15 official troches, and is a better agent than acacia for making emulsions of cod-liver oil. TRITICUM, Couch-£rass,—is the rhizome, gathered in the spring and deprived of its roots, of Agropyrum repens, the Couch-grass, a perennial plant of the nat. ord. Gram- inese, abounding in meadows and cultivated grounds, where it ranks as a weed, though of the same genus as wheat. It contains much sugar and a gum-like principle, Triticin. Dose, in infusion or decoction. ULMUS UVA URSI VALERIANA. 481 Extractum Tritici Fluidum, Fluid Extract of Triticum.—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 Ulmus fulva, an indigenous tree of the nat. ord. Urticeae. It contains a large quantity of mucilage which it readily parts with to water. Mucilago Ulmi, Mucilage of Elm,—Elm 6, Water to ioo, digested for an hour and strained. Dose, ad libitum. Should be freshly made, when wanted. 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 application in cases of inflammation. It is also employed in the dilatation of fistulse, 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. They con- tain Tannic and Gallic Acids and 3 principles, viz., Arbutin, a bitter glu- coside, neutral, crystalline, soluble in warm water and resolvable into glucose and Hydroquinone; Ericolin, bitter and amorphous; Ursotie, 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. in infusion or decoction. Extractum Uvae Ursi, Extract of Uva Ursi.—Dose, gr. ij-x. Extractum Uvae Ursi Fluidum, Fluid Extract of Uva Ursi.—Dose, Infusum Uvae Ursi, Infusion of Uva Ursi (Unofficial),—g j to Oj. Dose, Arbutinum, Arbutin, C24H32014 (Unofficial).—Dose, gr. iij-v. 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. Bearberry was formerly used in all calculous affections and chronic dis- orders 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 strang- ury, and has proved serviceable even in uterine hemorrhages. Arbutin has been successfully employed in cardiac dropsy as a diuretic, also in urethritis. VALERIANA, Valerian,—is the rhizome and roots of Valeriana officinalis, a large, herbaceous plant of the nat. ord. Valerianege, having Preparations. 482 VALERIANA. small, white, or rose-colored flowers. The plant is a native of Europe, but is cultivated in Vermont and New York. It contains a complex Volatile Oil, from which are developed by oxidation Valerene, C10Hi6, which is a terpene, Valerol or Baldrian Camphor, C12H20O, and Vale- rianic 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 the oxidation of Amylic Alcohol, and from it are formed the various Valerianates. It is not identical with the natural acid. Dose of the powdered root, gr. x-xxx. Preparations of Valerian. Extractum Valerianae Fluidum, Fluid Extract of Valerian.—Dose, j. Tinctura Valerianae, Tincture of Valerian,—strength 20 per cent. Dose, gss-ij. Tinctura Valerianae Ammoniata, Ammoniated Tincture of Valerian,—has of Valerian 20, Aromatic Spirit of Ammonia to 100. Dose, gss-ij. Oleum Valerianae, Oil of Valerian (Unofficial),—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, TT\jj-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. Preparations of Valerianic Acid. Ammonii Valerianas, Ammonium Valerianate,—see under Ammonium. Dose, gr. ij-x. Ferri Valerianas, Ferric Valerianate,—described under Ferrum. Dose, gr. j-iij. Quininse Valerianas, Quinine Valerianate,—described under Cinchona. Dose, gr- j-iij- Zinci Valerianas, Zinc Valerianate,—is described under Zincum. Dose, gr. *4-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. 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, diaphoretic 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, probably from a resemblance between its odor and theirs when under venereal excitement. After a time it produces in them violent spasms and convulsions. In full doses it increases the action of the heart and raises the temperature, in most persons producing exhilaration (in some, slight mental disturbance), with formication of the hands and feet. Long used it induces a condition of low melancholy and hysterical de- pression. Large doses cause hiccough, diarrhoea, nausea and vomiting, frequent micturition with tenesmus of the bladder and lithates in the urine, mental disturbance even to delirium, reduced motility and sensi- bility, and lessened reflex excitability. The Oil in large doses is para- Physiological Action. VANILLA VERATRUM VIRIDE. 483 lyzant 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 supposed to combine therewith some of the sedative qualities of their acid con- stituent. Valerian was formerly much employed in epilepsy, but it was probably useful only in the hysterical form of that disease (hystero-epilepsy). It is a valuable remedy in all forms of hysteria, especially when occurring in 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. Ammonium Valerianate 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. Zinc Val- erianate 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, epi- lepsy and neuralgia, frequently with considerable success. The Ferric and Quinine Valerianates are used as are the other salts of their respective bases. Therapeutics. VANILLA, —is the fruit of Vanilla planifolia, a perennial climbing plant of the nat. ord. Orchidese, native of the West Indies and tropical America, but cultivated in Java, etc. Its characteristic odorous principle is Vanillin, the Methyl-ether of Proto- catechuic Aldehyd, which oxidizes slowly in damp air to Vanillic Acid, and may be resolved into Methyl Chloride and Protocatechuic Acid. Vanillin may be made synthetic- ally from Coniferin or from Eugenol. Dose, indefinite. Tinctura Vanillae, Tincture of Vanilla,—io per cent. Dose, a few drops, according to the strength of flavor desired. Trochisci Ferri, Troches of Iron,—contain about per cent, of Vanilla. 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 roots of Veratrum viride, the Indian Poke (Poke-root, or Swamp Hellebore), an indigenous plant of the nat. ord. Liliacese. Veratrum Viride contains several alkaloids, Jervine, C26H43N02, Pseudo-jervine, C29H43N07, Cevadine, C32H49N09, a very little Rubijervine, C26H43N02, and traces of Veratrine, C37H53NOn, and Veratralbine, C28H43N05. Vera- iroidine, formerly regarded as one of its alkaloids, is now thought to be a mixture of Rubijervine and a toxic Resin. The drug also contains gallic acid and sugar. 484 VERATRUM VIRIDE. Allied Plants. Veratrum Album, White Hellebore,—is a native of the mountainous regions of con- tinental 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 contains the alkaloids Jervine, Pseudo-jervine, Rubijervine, traces of Cevadine, and another powerful alkaloid Veratralbine, Veratrum Sabadilla, Cevadilla (Asagrcea officinalis'),—is a bulbous plant of the nat. ord. Liliacese, 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. Preparations. Extractum Veratri Viridis Fluidum, FI. Ext. of Veratrum Viride.—Dose, rr\j-iv. Tinctura Veratri Viridis, Tinct. of Veratrum Viride,—40 per cent. Dose, npij-x. Norwood’s Tincture of Veratrum Viride (Unofficial),—has a very high reputation for efficiency,—Dose, rt\v, increased by n\J every 3 hours, until pulse is down to 65, when the original dose will hold it there. Veratrina, Veratrine,—is a 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, in 6 of ether, 2 of chloroform, 96 of glycerin and in 56 of olive oil. Dose, gr. ■sV—rV- Unguentum Veratrinae, Veratrine Ointttient,—Veratrine 4, Olive Oil 6, Benzoinated Lard 90. For local use. Oleatum Veratrinae, Oleate of Veratrine,—Veratrine 2, Oleic Acid 98. Local use. Physiological Action. Veratrum Viride is in action closely allied to Aconite, being a power- ful 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. 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 symptoms very much, the pulse becoming very rapid and so small as to be almost imperceptible ; the skin is cold and clammy, and constant vomiting, extreme debility, giddiness, impaired vision, and partial un- consciousness 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- VERATRUM VIRIDE. 485 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 con- trary, always causes emeto-catharsis, and produces less violent convul- sions. It stimulates the vagus centre and paralyzes the vagus ends, de- presses 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, col- lapse, and death from cardiac and respiratory paralysis. Veratrine is an acrid, intensely irritant powder, consisting of a mixture of alkaloids. It causes violent sneezing, a burning sensation, and free salivation. It affects the heart and circulation similarly to the other Veratrise, and in addition seems to be a direct poison to muscular tissue, and to cause violent convulsions before the muscular paralysis sets in. The alkaloids Jervine and Rubijervine both depress the circulation, while the latter produces the emeto-catharsis. 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. Therapeutics. Veratrum Viride is inferior to Aconite in most of the fevers and imflammations, 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 486 VERBASCUM—VIBURNUM. 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 preparation may be given hypoder- mically, in doses of np ij-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 pres- ent 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),—is the leaves of Verbascum Thaspus, the Mullein-weed, a common plant of the nat. ord. Scrophulariacese, 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 iv of fresh leaves to the pint of milk is the form in which it has generally been given ; this quantity to be taken thrice daily. Mullein is emollient and demulcent, perhaps also slightly anodyne. It has long been a popular Irish remedy in pulmonary affections, as under its use the weight steadily in- creases in phthisis and other wasting disorders, 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 dysentery and as a poultice for hemorrhoids. The dried leaves may be smoked with benefit in aphonia from laryngeal irritation. VIBURNUM OPULUS, Cramp Bark,—is the bark of Viburnum Opulus, a shrub of the nat. ord. Caprifoliaceae. Extractum Viburni Opuli Fluidum, FI. Extr. of Viburnum Opulus. Dose, 3 ss-ij. Viburnum Opulus is highly valued by many practitioners as a remedy for uterine and abdominal pains. The so-called Viburnum Compound of Dr. Hayden is stated by its manufacturers to consist of ‘ ‘ the active principles of the Viburnum Opulus, Dioscorea Villosa, Scutellaria Lateriflora, and a combination of aromatics, prepared by a process peculiar to ourselves.” This they call publishing the formula of the preparation. VIBURNUM PRUNIFOLIUM, Black Haw,—is the bark of Viburnumpru- nifolium, an indigenous shrub of the nat. ord. Caprifoliaceae. 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. Extractum Viburni Prunifolii Fluidum, FI. Ext. of Viburnum Prun. Dose, 3 ss-ij • Viburnum Prunifolium is considered to possess nervine, antispasmodic, astringent, VIOLA VISCUM VITELLUS XANTHOXYLUM. 487 diuretic and tonic properties, and to be especially useful in preventing abortion, in the nervous diseases of pregnancy, and in spasmodic dysmenorrhoea. It may be administered with cannabis indica, morphine, nerve-sedatives or simple aromatics. No exact observa- tions have been made regarding its action, and its therapeutical claims are denied by many who have used it. It often excites nausea and vomiting. VIOLA TRICOLOR, Pansy, (Unofficial),—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 contains an active alkaloid, Violine, allied in many respects to Emetine, and poisonous. Dose, gr. x-gj, in decoction. Viola is mucilaginous, emollient, expectorant and slightly laxative. Its active princi- ple is emeto-cathartic, but exists in very small quantity. A decoction of the fresh herb in milk, with a poultice of the same, was formerly recommended highly 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 constitutional syphilis. Viola Cucullata, the common Violet, is used in Pennsylvania with success as an in- ternal antidote against rattlesnake venom. The leaves are eaten, and a poultice of salt and indigo is applied to the wound. VISCUM, Mistletoe (Unofficial),—occurs in two species, (1) Viscum album, the European Mistletoe, a small, parasitic, evergreen shrub, of the nat. ord. Loranthaceae, growing chiefly on deciduous-leaved trees, and (2) Viscum favescens, 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-gj in decoction, or rtpv-xxx of a ten per cent, tincture. The berries of the mistletoes have produced emeto-catharsis, with great thirst, tenes- mus, bloody stools, convulsions and even death in young children. 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 contractions. It has been used in cardiac affections, dropsies, uterine hem- orrhages and amenorrhoea, also as an abortifacient. VITELLUS, Yolk of Egg,—is the yolk of the egg of the domes- tic fowl, Gallus Bankiva, var. domestica. It is a viscid, reddish-yellow, opaque liquid, of bland taste, alkaline reaction, odorless, and may be regarded as a dense emulsion of oil suspended in water by means of albumen. It is coagulated by heat or by alcohol, and contains Vilellin, which is a proteid related to casein, also Cholesterin and Albutnin, besides fat, inorganic salts, sugar, etc. Glyceritum Vitelli, Glycerite of Yolk of Egg, Glyconin,—consists of Vitellus 45, Glycerin 55, rubbed together until thoroughly mixed. 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, and an excellent protective application for burns, erysipelas, fissure of the nipples and many cutaneous disorders. It is also used as a cosmetic, and may be employed as an aliment. XANTHOXYLUM, Prickly Ash,—is the bark of Xanthoxylum americanum, the northern species, and of Xanthoxylum Clava-Herculls, 488 zea mays. the southern species, of an indigenous shrub of the nat. ord. Rutacese. It contains a volatile oil, a fixed oil, resin, gum, coloring matter and an alkaloid, Xanthoxyline, which is identical with Berberine. Dose, of the powdered bark, gr. x-xxx. Preparations. Extractum Xanthoxyli Fluidum, Fluid Extract of Xanthoxylum.—Dose, 5 ss-j. Decoctum Xanthoxyli, Decoction of Xanthoxylum (Unofficial),— to the quart. Dose, a pint during 24 hours in divided doses. Xanthoxylum is a stimulant and aromatic bitter, a local and systemic sialagogue, also 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 the stomach, intestines, liver and pancreas. It also increases the cardiac action and raises the arterial tension, and is classed among the vegetable alteratives, with Mezereum, Guaiac, Stillingia, etc. 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 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. Physiological Action and Therapeutics ZEA MAYS, Maize (Indian Corn),—This well-known species of the nat. ord. Gramineae, though itself unofficial, is the source of the offi- cial Starch (see Amylum), and of two drugs, one official, viz. : — Zea, Corn-Silk (Stigmata Maydis),—the styles and stigmas of Zea Mays, which should be gathered when the tassels have shed their pollen. Its active principle is thought to be Maizenic Acid. There are no official preparations. Extractum Zese Fluidum, Fluid Extract of Zea (Unofficial),—is made by the general rule for fluid extracts. Dose, Ustilago, Corn Smut (Unofficial),—is Ustilago Maydis, nat. ord. Fungi, a smut grown upon the stems, the pistils and the male inflorescence (tassel) of Zea Mays. 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. Extractum Ustilaginis Fluidum, Fluid Extract of Ustilago (Unofficial),—may be prepared by the general rule for fluid extracts. Dose, npx- 3 j. ZINCUM. 489 Zea 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 urinary bladder. It has been used with success in incontinence of urine, uric and phos- phatic gravel, gout, rheumatism, urethritis, pyelitis, acute and chronic cystitis, cardiac dropsy and obstructive valvular disease of the heart. The properties of Ustilago, so far as examined, resemble those of Ergot and Nux Vomica combined. It is a spinal excitant and exalts sensibility and reflex action, producing tonic convulsions on the least irritation of the skin. It slows the heart by stimulation of the pneumo- gastric, dilates the pupils, causes muscular paresis, and death by tetanus of the respiratory muscles or by exhaustion. Experiments on its reputed oxytocic action have not substantiated the claims made for it in this re- spect, though it is said to have produced abortion in cows after they had eaten the diseased grain. As a therapeutic agent Ustilago has been very little used, but when employed it has been as a substitute for Ergot. Physiological Action and Therapeutics. 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 official, but is not employed as a medicine. Zinc Salts and their Preparations. Zinci Acetas, Zinc Acetate, Zn (C2H302)2 -|- 2H20,—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 36 of alcohol at 59° F., in 1 x/z of boiling water and in 3 of boiling alcohol. Used locally as an astringent in solution of gr. j or ij to the 3 , or internally in doses of gr. ij. Zinci Carbonas Praecipitatus, Precipitated Zinc Carbonate,—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, Zinc Chloride, ZnCl2,—a white, granular powder, or porcelain-like masses, or moulded into pencils, odorless, of such intensely caustic properties as to make tasting dangerous ; very soluble in water and in alcohol; very deliquescent. Is tonic and escharotic. For internal use a solution in Spirit of Ether is the most convenient form, strength gj to the 25, of which four to eight minims may be given twice daily in water. Strength of injections and collyria, gr. j-ij to the 3. Liquor Zinci Chloridi, Solution of Zinc Chloride,—is an aqueous solution, contain- ing 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 490 ZINCUM. also as an injection in gonorrhoea, leucorrhoea, etc., in dilute solution, y2 to I per cent. Burnett’s Disinfecting Fluid is similar to the above but slightly stronger. Zinci Iodidum, Zinc Iodide, Znl2,—a white, granular powder, very deliquescent, of sharp, saline and metallic taste and acid reaction ; very soluble in water and in alcohol. Dose, gr. ss-ij in syrup. Zinci Oxidum, Zinc Oxide, ZnO,—an amorphous, white powder, without odor or taste ; insoluble in water or alcohol; soluble, without effervescence, in dilute acids, also in ammonia water. Dose, gr. j-x, in pill. Unguentum Zinci Oxidi, Ointment of Zinc Oxide,—has of Zinc Oxide 20, Ben- zoinated Lard 80. Oleatum Zinci, Oleate of Zinc,—has of Zinc Oxide 5, in Oleic Acid 95. For ex- ternal use. Zinci Sulphas, Zinc Sulphate, ZnS04 -f- 7H20,—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 under Cuprum. Zinci Valerianas, Zinc Valerianate, Zn (C5H902)2 -j- 2H20—white, pearly scales, having the odor of valerianic acid, a sweetish and styptic taste and acid reaction ; soluble in about 100 of water and in 40 of alcohol. Dose, gr. y1^—ij, in pill. The Bromide is described under Bromum, and the Phosphide under Phosphorus. 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 painful 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 astring- ent, 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 Car- bonate resembles the Oxide in action. The Iodide locally is a power- ful escharotic 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 probability due to its base and not to the acid combined with it. The 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. ZINCUM. 491 The action of the Bromide and Phosphide are described respectively under Bromum and Phosphorus. Antidotes and Incompatibles. Lime-water, mucilaginous drinks, soap, TannicAcid, milk, Potassium and Sodium Carbonates, if given early, are the antidotes in poisoning by the salts of zinc. Incom- patibles are—Lime-water, Alkalies and their carbonates, Silver Nitrate and vegetable astringents. Lead Acetate produces double decomposition with zinc salts, but it is often used in solution with the Sulphate as an injection. 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 will not act through the epidermic tissue. It is a commonly used disinfec- tant and deodorant, and in weak solution (ttl iij—v of the Liquor to 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 com- bined with Opium and Ipecac. The Acetate is used for the same pur- poses 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 child- ren, and with Aromatic Powder and Morphine it is very efficient in gas- tralgia. 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 and 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 im- pure carbonate (calamine) with the oxide and an unguent basis, was until recently a favorite application as a soothing protective to abrasions and Therapeutics. 492 ZINGIBER. inflammations of the integument. The Valerianate has been used in chorea, epilepsy, neuralgia, and various anomalous nervous affections, such as the nervous headache of hysterical women, nervous coughs and aphonia due to uterine and ovarian irritation. The Bromide and Phosphide are used with reference to their respective non-metallic bases, under which titles their uses are described. ZINGIBER, Ginger ,—is the rhizome of Zingiber officinale, a plant of the nat. ord. Scitaminese, 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. It contains an aromatic volatile oil, and a resin. Preparations. Extractum Zingiberis Fluidum, FI. Ext. of Ginger,—alcoholic. Dose, 3 ss. Tinctura Zingiberis, Tincture of Ginger,—20 per cent. Dose, n^xx-gij. Syrupus Zingiberis, Syrup of Ginger,—has of the Fluid Extract 3 per cent, in sugar and water. Dose, 3 ss-ij. Trochisci Zingiberis, Troches of Ginger,—each troche contains of the Tincture 2 minims, with Tragacanth, Sugar and Syrup of Ginger. Oleoresina Zingiberis, Oleoresin of Ginger,—contains all the virtues of the root, and is extracted by ether. Dose, Tt\^~j, well diluted. Ginger is also a constituent of Pulvis Aromaticus and Pulvis Rhei Compositus. Ginger is sialagogue when chewed, sternutatory when inhaled, and ex- ternally 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. Ginger Beer is a favorite temperance beverage, but most of the preparations sold under its name are simply carbonated water flavored with ginger. The following recipe is furnished by Dr. William Hardman, of Blackpool, in whose family it has been used for over fifty years, and the excellence of which he guarantees. Take oz. of the best ginger well bruised, I oz. of cream of tartar, and I ]/2 lb. of cane loaf sugar. Put all the ingredients into an earthen vessel, and pour on a gallon of boiling water; when nearly cold add a gill of yeast, cover over with a blanket, and let it stand in a warm place until next morning. Then skim it, and run it through a filtering bag, bottle it, cork well with good corks, and tie dowm the corks with string. In three days it will be fit for use. The bottles must be clean and sweet. A little lemon juice is considered an improvement by some. (Lancet.) PART II. PHARMACY AND PRESCRIPTION WRITING. Pharmacy (Pharmakon, a medicament),—may be defined as the art of selecting and preserving medicines, and preparing them for adminis- tration. It may be divided into— Official or Galenical Pharmacy,—dealing with the processes and prepa- rations of the Pharmacopoeia ; and— Extemporaneous or Magistral Pharmacy,—which includes the opera- tions of compounding and dispensing remedies as directed by the extem- poraneous prescriptions of physicians. A Pharmacopoeia is an official list of the drugs and their prepara- tions recognized by the medical profession of a certain country. In foreign countries the Pharmacopoeias are published under government auspices and have the force of a legal standard ; in the United States its publication is left to the medical and pharmaceutical professions and it is revised every ten years by a convention called for that purpose. The official Pharmacopoeias in the English language, with the dates of their latest revision or additions, are as follows, viz.— The Pharmacopoeia of the United States of America, 7th Decennial Revision, 1890; official from January 1, 1894. The British Pharmacopoeia, 1885 ; Additions, 1890. Is now in pro- cess of revision. Pharmacopoeias and Dispensatories. Besides the above there are—The Pharmacopoea Germanica, 1882 ; the Pharamacopee Fran?aise (Codex Medicamentarius), 1884; the Austrian, Pharmacopoea Austriaca, 1889 ; Russian, Ph. Rossica, 1880; the Swedish, Ph. Suecica, 1869; the Norwegian, Ph. Nor- vegica, 1879 ; the Danish, Ph. Danica, 1868, 1874, 1876 ; the Belgian, Ph. Belgica, 1885 ; the Swiss, Ph. Helvetica, 1872, 1876 ; the Spanish, Farmacopea Espanola, 1884 ; the Portuguese, Ph. Portugueza, 1876 ; the Indian, Ph. of India, 1868 ; the Hungarian, Ph. Hungarica, 1888 ; The Netherlands’, Ph. Neerlandica, 1889; the Roumanian, Ph. RomAna, 1874 ; the Finnish, Ph. Finnica, 1885 ; the Chilian, Farmacopea Chilena, 493 494 WEIGHTS AND MEASURES. 1886; the Greek, Ph. Hellenica, 1868; the Japanese, Ph. Japonica, 1886; the Mexican, Nueva Farmacopea Mexicana, 1884; the Croatia-Slavonian, Ph. Croatico-Slavonica, 1888; and the Italian, Farmacopea Italiana, 1887. A Dispensatory is a commentary on one or more pharmacopoeias, giving in extenso the physical and medicinal history of the drugs and preparations, together with their doses, physiological action and thera- peutics, and includes similar information about many drugs which are not official in any pharmacopoeia, but are of occasional use or general interest. A dispensatory is a private publication, of authority according to the reputation of its author. The principal dispensatories are American pub- lications, and are veritable drug-encyclopaedias, so elaborately do they deal with every subject embraced therein. Those of acknowledged value are— The Dispensatory of the United States of America, by Dr. Geo. B. Wood and Dr. Franklin Bache. 17th edition, revised and largely rewritten, by Professors PI. C. Wood, J. P. Remington and S. P. Sadtler. Philadelphia, J. B. Lippincott & Co. 1894. The National Dispensatory. 5th edition, revised by Professors Stille, Maisch and Caspari. Philadelphia, Lea Bros. & Co. 1894. The American Dispensatory, by King & Lloyd, Cincinnati, is the recognized au- thority of the “eclectic” practitioners. A Companion to the U. S. Pharmacopoeia, by Drs. Oldberg and Wall; New York, Wm. Wood & Co.—is an excellent book, but not so exhaustive as the others in its method of treating the subjects embraced in it. A Companion to the British Pharmacopoeia, by Peter Squire; 16th edition, I.ondon, 1894; is the nearest English approach to the American dispensatories, and is the standard text-book on the general materia medica in Great Britain. Although a very good book it does not compare as a work of reference with either of the two great American Dispensatories first above named. WEIGHTS AND MEASURES. The working formulae of the U. S. Pharmacopoeia of 1880 were con- structed on the system of parts by weight for all articles, whether solids or fluids, except in the case of fluid extracts, for which the metric weights and measures were employed. On this system it really made no differ- ence what unit of weight was adopted in official pharmacy. The phar- macopoeia of 1890 has, however, in most cases employed definite weights for solids, and measures for liquids, in terms of the metric system. In certain cases, where weighing is decidedly more convenient, or where the product is adjusted to a percentage by weight which would be rendered uncertain if the ingredients were taken by measure, liquids are ordered to be weighed. And in some cases (Aqua Destillata, Aqua Aurantii Florum, etc.) the quantities are directed simply by volume. In most WEIGHTS AND MEASURES. 495 cases, therefore, solids are officially directed to be weighed by grammes, and liquids to be measured by cubic centimeters. At the same time, how- ever, the weights and measures generally used by physicians in prescrib- ing, and by pharmacists in dispensing medicines, are, and will doubtless continue to be, in the United States, those of the Apothecaries’ or Troy System of weights, (having 480 grains to the ounce and 5760 grains to the pound); and the Wine Measure. The drachm (60 grains) and the scruple (20 grains), are intermediate units of weight which are still used, but are becoming obsolete. The units of the Wine Measure are the minim which in water at its maximum density equals gr. 0.95 ; the fluidrachm (60 minims), and the fluidounce (8 fluidrachms or 480 minims). The.signs used to denote these units are minim, 9 scruple, 3 drachm, § ounce, and in the case of liquids an f to denote fluid is often placed before the sign, thus f3 for fluidrachm, f3 for fluidounce. The relations between these units of weight and measure are as follows:— "lj> One minim = 0.95 grains, One fluidrachm = 56.96 “ One fluidounce = 455.69 “ Measure. Weight. grain j = 1.05 minims. 2 i = 6t.20 “ '§) — 5°5-6o Weight. Measure. Table of Troy or Apothecaries’ Weight. Pound. Libra. Ounce. Uncia. Drachm. Drachma. Scruple. Scrupulum. Grain. Granum. .3 3 9 gr- I = 12 = 96 = 288 = 5760 i = 8 = 24 = 480 1 = 3 = 60 1 = 20 Table of Apothecaries’ or Wine Measure. Gallon. Congius. Pint. Octarius. Fluidounce. Fluiduncia. Fluidrachm. Fluidrachma. Minim. Minimum. C. O. fg f3 nt 1 = 8 = 128 = 1024 = 61440 1 = x6 == 128 — 7680 1 = 8 = 480 1 == 60 The British Pharmacopoeia recognizes only the Imperial Standard (avoirdupois) weights, having grains to the ounce, 16 ounces to the pound (instead of 12), and 7000 grains to the pound; and the Imperial Measure, having 20 ounces to the pint (instead of 16, as with us). Table of British Pharmacopceial Weight. Troy grain, Avoirdupois ounce and pound. Pound. Libra. Ounce. Uncia. Grain. Granum. lb oz. gr. I = 16 = 7000 i = 437^ 496 WEIGHTS AND MEASURES. The Troy ounce contains 42y2 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. Table of British Imperial or Pharmacopceial Measure. Gallon. Congius. Pint. Octarius. Fluidounce. Fluiduncia. Fluidrachm. Fluidrachma. Minim. Minimum. C. O. floz. fldr. min. I = 8 l6o = 1280 = 76800 1 = 20 = 160 = 9600 1 = 8 = 480 1 = 60 The Metric, or Decimal System of Weights and Measures, is now the official system in the United States, having been adopted throughout the last revision of the U. S. Pharmacopoeia. It is in general use on the continent of Europe, and is employed by French and German physicians in this country. Its three standard units are as follows, 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. 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 volume of one kilogramme of pure water at the temperature of its maximum density, in vacuo. Theoretically, the Liter is equal to one cubic decimeter, or 1000 cubic centimeters. Per contra one-thousandth of a Liter is the Milliliter (or Cubic Centimeter), which measure of pure water at its maxi- mum 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 original and French spelling is metre, litre, gramme; the Anglicized form is meter, liter, gram. The U. S. Ph. of 1890 sanctions a combination of both, thus— meter, liter, gramme. The metric terms used in pharmacy are few, and are generally confined to the Gramme, the Cubic Centimeter (or fluid-gramme) and the Milli- gramme ; but the system embraces many other terms of increase and de- crease, which are set forth in the following table, viz.— ioooo. Myrialiter. ioooo. Myriameter. 1000. Kiloliter. i OCX). Kilometer. ioo. Hectoliter, ioo. Hectometer. io. Dekaliter. ioooo. Myriagramme. io. Dekameter. 1. Liter. 1000. Kilogramme. 1. Meter. .1 Deciliter. ioo. Hectogramme. .1 Decimeter. ,oi Centiliter. io. Dekagramme. .oi Centimeter. .ooi Milliliter (Cubic 1. Gramme, .ooi Millimeter. Centimeter). .1 Decigramme. .oi Centigramme, .ooi Milligramme. The relations between the Metric Weights and Measures and the Apothecaries’ are as follows, viz. :— WEIGHTS AND MEASURES. 497 1 meter = 39.370432 inches. I liter = 2.113433 pints. I gramme = 15.43234874 grains. I grain = 0.06479895 gramme. 1 minim = 0.061613 cubic centimeter. 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. Pharmacopoeia will influence the medical profession in its behalf. With all the influence brought to bear in its favor it certainly has not yet been adopted by any considerable propor- tion of native-born and home-educated physicians and pharmaceutists. One of its greatest difficulties for the physician is the absence of any correspondence or relation between the unit of weight (gramme) and the unit of measure (liter), and the consequent want of fluid denominations below the cubic centimeter, corresponding with the decigramme, centi- gramme and milligramme of the weight scale. 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 constructed. 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 teaspoonfuls, and the tablespoonful to about 4 teaspoonfuls or fgss, while the wineglass is supposed to contain about The use of gradu- ated medicine glasses is strongly recommended instead of the above ap- proximate measures. They may be obtained at 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 mo- bile liquids produce very small ones. These differences are well illus- trated in the following table, which gives the number of drops in a flui- drachm of several liquids of certain classes. [See the Appendix for a fuller table.] 498 WEIGHTS AND MEASURES. Syrupus Acaciae, 44. Syrupus Scillae, 75. Aqua, 60. Liquor Potassse, 62. Liquor Hydrargyri Nitratis, 131. Acetum Opii, 90. Vinum Opii, 100. Tinctura Opii Deodorati, 110. Tinctura Opii Camph., no. Tinctura Opii, 130. Tinctura Iodi, 148. Tinctura Aconiti, 146. Alcohol Dilutum, 137. Alcohol, 146. Oleum Ricini, 77. Oleum Copaibse, 123. Oleum Juniperi, 148. Spiritus Camphorge, 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. ./Ether, 176. Bromum, 250. Chloroformum, 250. 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 percent- ages and specific gravities of Alcohol, Ammonia Water, Acetic, Hydro- bromic, Hydrochloric, Nitric, Sulphuric and Phosphoric Acids, and aque- ous solutions of Potassa and Soda. The specific gravity of any substance is expressed by the quotient obtained by dividing the weight of a given measure of the substance 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. 499 PRESCRIPTIONS. Extemporaneous Prescriptions are formulae written 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 ingredients to be used, which are also expressed in Latin; then the directions to the com- pounder, followed by the directions to the patient, the last being now usually expressed in English; and finally the signature and address of the prescriber. A prescription then has four component parts, viz.— Superscription,—consisting of the name of the party for whom it is designed, the date, and the sign R—signifying “ Take thou.” Inscription,—the body of the prescription, consisting of one or more of the following subdivisions, viz.—the 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 the prescription a suitable form. 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. A single in- gredient 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. Again, the basis may need no 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 that the prescriber has a clear idea of something to be accomplished by each one, and also provided that there is no chemical or medicinal 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. 500 PRESCRIPTIONS. In writing an extemporaneous prescription, the first step is to write the patient’s name and address, the date, and the sign R. Then the title of each ingredient should be written in Latin and in the genitive case, except that when a certain number only of an ingredient is ordered, the name of the ingredient should be in the accusative case, for example, “ Vitel- lum unum,—one yolk-of-egg.” Next, the quantity of each ingredient sufficient for one dose should be mentally determined and multiplied by the number of doses which the mixture is to contain, and the result set down in signs and Roman numerals. The directions to the pharmacist and patient being added, and the prescriber’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 accord- ing to the requirements of each case. Frequently the ingredients and quantities for but one pill, powder or suppository are named, with instruc- tions to make a certain number after the formula. When an unusually large dose of any poisonous drug is prescribed, it is customary to under- line 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. An Example will perhaps make the foregoing more comprehensible, and at the same time serve to indicate the style of writing usually em- ployed. The following formula is that ordered in the U. S. Pharma- copoeia for the preparation known as Black Draught, but officially styled the Compound Infusion of Senna; approximate weights and measures being substituted for the pharmacopoeial metric weights. Procedure in Writing a Prescription. For Mrs. Gray. Recipe, Take,— July yth, 1894. Superscription. (Basis.) Sennce, setniunciam, Of Senna, half an ounce, Magnesii Sulphatis, Of Magnesium Sulphate, Manner, ana unciant unatn, Of Manna, of each an ounce, (Adjuvant.) (Corrective.) P'ceniculi, drachmam unatn, Of Fennel, one drachm, Inscription. (Vehicle.) Aqua; Bullientis, fluiduncias octo, Of Boiling Water, eight fluid-ounces. Macera per horam in vase clauso, deinde cola. Macerate for an hour in a closed vessel, then strain. Signetur, Let it be entitled,—A wineglassful every four hours until it operates. /. F Wood, M. D. Subscription. Signature. Abbreviated in the style usual among physicians, the above prescription would read as follows, viz.— PRESCRIPTIONS. 501 For Mrs. Gray. July Jth, 1894. R. Senna, gss Mag7iesii Sulphat., Manna, . aa Fceniculi, Aqua Bull., f^viij. Mac. per hor. in vase clauso, deinde cola. Sig.—A wineglassful every four hours, till it operates. Wood. As the result of the above is nearly identical with the official prepara- tion, we might write the same prescription more simply, as follows,— . Infusi SenncE Compos., ijviij. with the proper superscription and signature ; this being the manner of prescribing the official preparations. It will be noticed that in the above analysis the term basis covers two ingredients; but it is obvious that either of them might be considered the principal agent, and the other one classed as an adjuvant. “These four parts of a formula are intended to accomplish the object of Asclepiades, curare cito, tute et jucunde; in other words, to enable the basis to cure quickly, safely and pleasantly.” (Pareira.) Another Example will illustrate the mental operations which should always be followed by a prescriber ; for no matter how good a memory he may have, he will surely make a grievous mistake some day if he fol- lows the practice of writing prescriptions from memory. Furthermore, the unscientific character of the latter habit will, when appreciated, pre- vent any educated physician from indulging in it. Every prescription should be written with a definite purpose in view, consequently the mind of the prescriber should weigh each step carefully, and should avoid all slavish subjection to ready-made formulae. Suppose, then, that we wish to order for Miss Graham an emulsion of Castor Oil, flavored and sweetened so as to make it less disagreeable to the taste than it naturally is. If the ingredients were simply mixed to- gether, as in the previous example, the result would be an unsightly preparation, consisting of sweetened and flavored water with the oil float- ing on top. So we require that the process of emulsification be first accomplished, by which the oil is minutely subdivided and suspended in the water, by the aid of the emulsifier, which may be any viscid excipient, as gum, soap, or yolk-of-egg. Taking the last-named for the emulsifying agent, we would begin by writing down in order the following terms, as stated in italics, viz. : — For Miss Graham. June 10th, 1894. R. (Take thou—) Olei Ricini, (of Oil of Castor), Vitellum, (Yolk-of-egg), Tere bene simut; dein adde—(Rub well together ; then add—) 502 PRESCRIPTIONS. Having gone so far, we begin to think of an agreeable vehicle, and choosing from the many Syrups at our disposal that of Ginger, and from the flavored Waters that of Cinnamon, we write further for these as the ingredients to be added, thus— Syrupi Zingiberis, (of Syrup of Ginger), Aqua Cinnamomi, (of Cinnamon Water). The ingredients are now all entered upon the prescription, but their respective quantities have not yet been decided on. We proceed, then, by first taking into consideration the total quantity of the medicament required,—which, in this case, as the preparation is intended to purge the patient, need not embrace more than one or two doses. As it is well to provide for a repetition of the dose, in case the medicine should not act sufficiently, we will decide upon two doses in all. Now, the average adult dose of Castor-oil is about a tablespoonful, or half-an-ounce, and as we want two such doses we insert the sign and numerals f§j, or simply §j, opposite the title of the oil, which is written in the genitive case. But to emulsify it properly we need about one-half as much of the emulsify- ing agent, and we may express this by writing for half-an-ounce of yolk- of-egg, or for the yolk of one egg, or for one yolk-of-egg, which weighs about half-an-ounce. This would be expressed in Latin by either of the following methods, viz. :— Vitelli semi-unciam, One half-ounce of Yolk-of-egg. Vitellum ovi unius, (j). The Yolk of one egg. Vitellum unum, (j). One Yolk-of-egg. As the word Vitellus means Yolk-of-egg, we may omit the word Ovi, and accepting the latter as the best style, insert the numeral j opposite the word Vitellum, which is properly in the accusative case. The whole quantity so far specified is one ounce and a half, and if we add two and a half ounces of diluent, we shall have a four-ounce mixture, or the full of a regular sized bottle, as found in the shops. There being consider- able viscidity already present in the emulsion we do not need much syrup, so we assign to the Syrup of Ginger the odd half-ounce, leaving two ounces of the Water to make up the total bulk of four fluid-ounces. The prescription now only requires for its completion that the subscrip- tion and signature be added. We proceed to admonish the dispenser by telling him to mix the ingredients together, and therefore write the word Misce, or the abbreviation Mcommonly used therefor; and to further point out the nature of the preparation we add, Let be made an emulsion, or in Latin, Fiat emulsum,—the passive verb taking as predicate-nomina- tive the thing into which the making is to be. The final words Label— or Write thus—are expressed by. the term Signetur, Let it be entitled,— followed by the directions for the patient or the person who is to admin- PRESCRIPTIONS. 503 ister the medicine, which should be in English, though they may also be written in Latin. Our completed prescription will stand thus,— For Miss Graham. June jotk, 1894. R. Olei Ricini, j. Vitettum, j. Tere bene simul, dein adde— Syrupi Zingiberis, ss. Aqua Cinnamomi, M. Fiat emulsum. Sig. —‘ ‘ One-half at once, to be repeated next day if re- quired." Potter. The last entry of the inscription might also be written thus—Aquce Cinnamomi, quantum sufficiat ad meaning “of Cinnamon-Water as much as may be necessary to [bring the whole quantity to] four ounces,” usually expressed in contracted style, thus— Aq. Cinnamomi, q. s. ad §iv. This style is preferred when any of the quantities are approximations, and the final item cannot be exactly stated to secure a certain total. In the foregoing case, the one yolk-of-egg might measure a little more than the half-ounce assigned to it; but by using the q. s. ad style at the end, we make sure of getting a total of exactly four fluid-ounces. The Use of Latin in Prescriptions. The use of the Latin language in writing prescriptions is a sore point with a certain class of patients who like to know what they are taking, or, in other words, like to exercise their critical judgment upon the pre- scription of a physician in whose learning, skill and judgment they pro- fessed to have confidence when they consulted him. This feeling crops out frequently in our State legislatures, where bills are periodically intro- duced making it a crime for a physician to write a prescription in any other than the vernacular language. It is well for the student to know the reasons for maintaining the use of a dead language in the ordinary affairs of life. These reasons are as follows :— The names of plants vary in every modern language, and even in the same language several different plants not infrequently receive the same common name. For example,—the name “ Starwort ” is given to Aletris farinosa and to Helonias dioica; “Colic-root” is one of the names of Aletris farinosa, also of Dioscorea villosa and of Liatris spicata; “ Man- drake ” is applied to Podophyllum and to Mandragora ; “ Winter-green ” to Chimaphila and to Gaultheria; and “Snake-root” to five different plants, viz.—Asarum, Cimicifuga, Eryngium, Senega and Serpentaria. There are many other instances of this diverse nomenclature in English ; and, as each plant has a different name in French, another in German, 504 PRESCRIPTIONS. and still another in Italian, Spanish, Dutch, etc., the confusion, in such a polyglot country as this, would cause innumerable errors if any but a generally understood language were used in prescriptions. Latin is such a language, it is the accepted language of science throughout the world, the Latin names of plants are definite and cannot be confounded, and a prescription written in Latin by a physician of any nationality, in any part of the civilized world, can be readily understood and correctly com- pounded by a pharmacist in any other civilized country. Another reason, formerly more potent than at present, is the protec- tion to the patient which the secresy of a Latin prescription affords. A prescription ordering mercury and potassium iodide in plain language would be an awkward thing to send by one’s child or servant to be put up, or to have ordered by telephone to be sent to Mrs. C. B. of a certain number and street. Again, there exists in many cases a strong prejudice against certain names of drugs, usually born of ignorance but none the less potent, and in such it becomes necessary for the patient’s good to conceal from him the name of the medicine he is taking. In this age of free education in all branches and the consequent smattering of every- thing possessed by almost everybody, the use of Latin does not afford the necessary secresy, and the physician who does not dispense his medicines is often compelled to resort to private formulae deposited by him with a certain druggist. In France, it is a criminal offense to make known or expose the contents or nature of a prescription to any person other than the party for whom it was written ; the law of that country recog- nizing the fact that prescriptions may betray secrets which should be care- fully guarded. Opium, Morphine, Cocaine, and other agents likely to cause drug- habits, should never be ordered on written prescriptions for neurotic or hys- terical subjects. The physician should keep such drugs in his own hands, and retain the absolute control of their administration in every case in which he finds it necessary to use them. He should protect his patient from such a result as drug-slavery by every means in his power. Many of the worst cases of the cocaine-habit, known to the author, were ac- quired by the use of cocaine in nasal sprays prescribed by physicians; and similar methods are responsible for many of the wrecks made by in- dulgence in opium and morphine. There is no royal road to prescription-writing ; practice, care and knowl- edge of the whole subject is necessary to enable one to turn out habitually those elegant prescriptions which are properly termed “ magistral,” 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 espe- cially 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 PRESCRIPTIONS. 505 teaching of Latin is not within the scope of this work, and hence this part of the subject will be concluded 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. A very full table of the Latin words, phrases and contractions used in prescription-writing, also a table of genitive case-endings, will be found in the Appendix; but for a com- plete treatment of the subject the reader should consult Dr. Pareira’s Selecta e Prcescriptis, in which every detail of prescription-writing is fully explained. Principles of Combination. 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 pre- scribe 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 neces- sary to give Arsenic so as to impress the system, at the same time that Iron is indicated; but the two remedies should be given separately, so that the dose of either can be increased or diminished independently of the other. The principles of combination formulated below were long ago enun- ciated 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 intestine is best reached by a union of the diverse substances. It may take an intense irritation of the mucous membrane to purge as actively as does a mild irritation of both the mucous membrane and the muscular coat. There are powerful medicines which act similarly upon some parts of the organism but dissimilarly upon other parts. By combining such remedies powerful effects can be obtained at the points where the two lines of action cross each other, without influencing to a great extent other portions of the system. Thus, Chloral produces sleep by its ac- tion upon the brain, and also has a distinct influence upon the heart, but none upon the intestinal tract. Morphine acts upon the brain, and does not influence the heart, but has a powerful effect upon the intestinal tract. By combining Chloral and Morphine we get an overwhelming conjoined influence upon the brain in producing sleep with the least possible disturbance of the heart and of the intestinal tract. Second. To obtain the joint action of two or more diverse remedies. Thus, in a cough mixture Morphine may be included to quiet the cough, whilst Ipecacuanha and Squill (in accordance with the first principle) are 506 PRESCRIPTIONS. added to affect the mucous membrane. The application of this principle requires caution, or the practitioner will be led into that chief abomina- tion—polypharmacy. It is worse than futile to attempt to prescribe for every symptom. The underlying cause of the disorder or the understratum of bodily condition must be sought out and prescribed for simply. Third. To obtain a special combination, which is really a new remedy, or which experience has shown acts almost as a new remedy. Thus, when to Iodide of Potassium in solution Corrosive Sublimate is added, a new chemical compound is formed, which experience has shown to be of great value in syphilitic diseases. Griffith’s antihectic mixture is another in- stance 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 ordi- nary action of Opium upon the skin is so enhanced that the combination may be looked upon almost as a new remedy. Foiirth. 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 incompati- ble, 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 while soft and sticky. Sugar-coated pills and “ compressed pills” are apt to get so hard and insoluble that their use requires caution. In regard to mixtures, flavoring oils should be freely used, and the power of Glycerin to conceal the disagreeable taste of many substances should be remembered. (Therapeutics, jth edition, page 108, et seq.) Metric prescriptions are written or compounded with sufficient accu- racy by considering a Milligramme as equal to the Jjth of a Troy grain, a Gramme as equivalent to 15 Troy grains, and a Cubic Centimeter (fluid gramme, milliliter) as equal to 15 minims, or fluidrachm. All other metric terms, units and prefixes may be wholly ignored by the physician and the pharmacist. In fact the terms centigramtne and decigramme are rarely used at all, the former being generally expressed by 10 milli- grammes and the latter by 100 milligrammes. The term Gramme when abbreviated is printed and written Gm., the term Milligramme, Mg., and the term Cubic Centimeter, Cc. In expressing quantities by metric weight or measure in writing the common or Arabic numerals are used, and are always placed before the term or abbreviation designating the unit, thus— Metric Prescriptions. PRESCRIPTIONS. 507 2.50 Gm.,30 Cc. When apothecaries’ weight is employed the numerals are placed after the sign or symbol designating the unit, and in Roman characters, thus: gr. x, 3ij, jjss, §vj. The decimal point after the figure representing the number of grammes or cubic centimeters should be replaced by a line, in order to avoid such errors as might arise from the misplacement of a point, the dropping of ink, or the intrusion of a fly- speck, which might cause serious results in many cases. The simplest rule for writing a prescription in metric terms by one who is not prac- ticed in the use of the system, is the following, viz.— Write as though prescribing but one dose of each ingredient in grains or minims and decimals thereof; then substitute the term 1 ‘ grammes ’ ’ or 11 cubic centimeters ’ ’ for grains or minims, and the prescription is correct for 15 doses in metric terms. Of course, when writing for a mixture or solution, the proper quantity of vehicle must be added to complete the one dose, and must also be expressed first in grains or minims. For example,— One dose. IS doses metric. R. Quininae Sulphatis, gr. j, I Strychninse Sulph., gr. -fa or 0.016, Ext. Glycyrrhizse FI., npiv, 4 Syrupi, 60 oi6 This gives a two-ounce mixture approximately, of which the dose would be a tea- spoonful. R . Quininse Sulphatis, gr. j, 1 Massse Ferri Carb., gr. ij, 2 Ext. Nucis Vomicse, Sr- X or °-25> • ■ • • One dose. 15 doses metric. Ft. pil. no. xv. Sig.—One pill thrice daily after meals. 25 The above rule will answer for all liquids except those which are very- heavy (as Syrups and Chloroform), or very lighf (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 Cc., the table- spoonful to 20 Cc., the Troy § to 30 grammes, the fluidounce to 30 Cc., and 8 fluidounces to 250 Cc. 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. i. = 29.52 28.00 38.00 43-70 22.14 = 59-04 56.00 76.00 84.40 44.28 giv. = 118.08 112.00 152.00 174.80 88.56 ■= 236.16 224.00 304.00 349-6o 177.12 Water. (Grammes.) Tinctures. (Grammes.) Syrup. (Grammes.) Chloroform. (Grammes.) Ether. (Grammes.) 508 prescriptions. A table of equivalents between Apothecaries’ and Metric Weights and Measures will be found in the Appendix. Abbreviations. Abbreviations, though very commonly used by physicians in prescrib- ing, are a source of much annoyance to the compounder, and frequently 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-endings. 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 elements of uncer- tainty. In the Appendix will be found a list of the Latin terms used in prescriptions, with the abbreviations in vogue, and the English meanings. 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. Aconitum. Hydrargyrum. Hydras. Hydriodas. Hydrochloras. Hydrocyanas. Ammon. . . . Ammonia. Ammoniacum. Hydr Aq. Chlor. . . . Aqua Chlori. Aqua Chloroformi. Sodium Sulphate. Sodium Sulphite. Sodium Sulphide. Aq. Fontis. . . Might easily be read Aqua Fortis. Chlorine. Chloral. Chloroform. Sod. Sulph. . . Sulphur. Sulphide. Sulphate. Sulphite. Chlor Sulph Hyd. Chlor. . . Calomel. CorrosAe Sublimate. Hydrate of Chloral. Zinci Phos. . . Zinc Phosphate. Zinc Phosphide. Renewals of Prescriptions. 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 doubt- less 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 advantage resulting to the drug-taker, who too frequently carries in his pocket-book a stock of receipts 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- PRESCRIPTIONS. 509 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 in- sinuations too frequently made over the drug-counter in reflection on physicians, and many other similar practices, have caused the non-com- batant profession to regard the average druggist with suspicion. If phy- sicians 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 deroga- tory 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 pro- fession as a matter of convenience to themselves, not as a right belonging to the pharmacist. The homoeopaths 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 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 danger- ous 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 dis- solved, 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 fraudu- lent method of dispensing drugs, which the innocent and ignorant patient, who believes in the power of the minimum 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 them- selves, 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 in medicine than homoeopathy ; and avoid pocket-cases, drachm-vials, and triturations, as badges of charlatan- ism. It is high time that we asserted our independence in all these mat- ters, and made use freely of those means which are recommended by our individual judgments as promotive of the best results to our patients and to ourselves. With a small stock of reliable fluid extracts, and an equally moderate supply of gelatin-coated pills and compressed tablet-triturates 510 PRESCRIPTIONS. from the best houses, physicians could check-mate the unscrupulous prac- tices of many druggists to a great extent, save their patients many dol- lars, 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 Vivus, 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 ” for a ease of croup. 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 careful 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 thank- ful. The blank used by the writer measures iff inches by joined by a perforated edge to a stub 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 words, “ Copy of Pre- scription No 189. . For ” These blanks are bound up in books of 100 each, with a flexible morocco cover, from which the book of stubs may be slipped and a fresh book inserted as required. The size is ample for all ordinary requirements, and permits of the book being carried in the breast-pocket. Prescription Blanks. INCOMPATIBILITY. 511 INCOMPATIBILITY. Incompatibility may be Chemical, Pharmaceutical or Therapeutical, according as 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 or Corrosive Sub- imate with Limewater, producing the Black and Yellow Oxides of Mercury respectively, and commonly known as “Black Wash” and “ Yellow Wash.” Such a 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 that— 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 precipitation, 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 maybe soluble in an excess of the alkali. 6. Tannic and 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 cannot be poured from the bottle ;—Vinegars or Syrups containing Acetic Acid (Syr. Allii, Syr. Scillae) added to a solution of alkaline carbonates, causing decom- position of the latter with evolution of C02;—the addition of Liquor Potassse to a solu- tion of Ammonia-alum, setting free gaseous ammonia;—the mixing of Strychnine Sul- phate and Potassium Bromide in solution, causing the decomposition of the alkaloid sul- phate 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. 512 INCOMPATIBILITY. Insoluble Salts.—The following more or less Insoluble Salts will be formed whenever the materials of which they are composed are brought together in solutions : the Hydrates, Carbonates, Phosphates, Borates, Arsenates and Tannates of most earthy and heavy metals and alkaloids, and the metallic Sulphides; the Sulphates of Calcium and of Lead, and the subsalts of Mercury ; the Chlorides, Iodides, and Bromides of Bis- muth, Silver, Lead, and subsalts of Mercury ; the Iodides of Quinine, of Morphine, and of 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 Bicarbonates with Limewater. Solutions of Magnesium Sulphate, Alum, Zinc Acetate or Sulphate, with solutions of salts of Iron, Manganese, Bismuth, Antimony, Lead, and 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 with solutions 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 or 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 Subnitrate, with Lead Ace- tate, with Subchloride of Mercury, or with neutral solutions of Quinine, Morphine, and Strychnine salts. Table of Precipitant Solutions. The following table shows the most important instances of solutions which mutually precipitate each other, the letter P meaning “ forms a precipitate with ”— Solutions of— Alkaloidal Solutions (generally). Metallic Solutions (generally). Solutions of Lead Salts. Solutions of Silver Salts. Solutions of Calcium Salts. Solutions of Magne- sium Salts. Solutions of Albumen. Solutions of Gelatin. Alkalies, P P P P P P Tannic Acid, P P P P P P Carbonic Acid and Carbonates, P P P P P P Sulphuric Acid and Sulphates, P P P Phosphoric Acid and Phosphates, P P P P P P Boric Acid and Borates, P P P P Hydrochloric Acid and Chlorides, P P Hydrobromic Acid and Bromides, P P Hydriodic Acid and Iodides, P P P Sulphides, P P P Arsenical Preparations, P P P Albumen, P P P 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 :— INCOMPATIBILITY. 513 Oxidizers. Oxidizable or Combustible. Chlorine and its Oxides. Free Hydrochloric Acid. Nitro-hydrochloric Acid. Chlorates. Hypochlorites. Chromates. Chromic Acid. Permanganates. Nitric Acid. Nitrates. Bromine. Bromates. Iodine. Iodates. Silver Oxide. Peroxides (Dioxides). Phosphorus. Hypophosphites. Sulphur. Sulphides. Glycerin. Sugar. Alcohols. Oils. Ethers. Tannin. Cork. Charcoal. Creosote. Dry Organic Substances. Powdered Iron and Zinc. Arsenous Acid. Cyanides. Oxalates. Ferrous, Mercurous and Stannous salts. Explosions have resulted from mixing Fluid Extract of Uva Ursi with certain sam- ples of Spirit of Nitre, Chromic Acid with Glycerin, Potassium Permanganate with Glycerin, Nitric Acid with Glycerin, Silver Nitrate with Creosote, Silver Oxide in pill with Extract of Gentian, Potassium Chlorate with Glycerin and Tincture of Ferric Chlo- ride. Calcium Chloride triturated with Sulphur in a mortar has exploded, so also has Calcium or Sodium Hypophosphite when triturated alone. Tincture of Iodine with Ammonia 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. Lozenges of Potassium Chlorate, carried in the pocket with a box of safety matches, have exploded by rubbing on the composition on the outside of the box, causing an extensive burn of the thigh. Hydrogen Peroxide (Dioxide) is peculiar in that it acts both as an oxidizer and as an oxidizable agent. It reduces oxidizing agents and is itself reduced at the same time, hence it is incompatible with all the substances mentioned above. Nitrites may act in the same way under favorable circumstances. 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 Potassium Iodate. Potassium Chlorate with Syrup of Ferrous Iodide, 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 separated constituents may be active and hence important, or inert and therefore unimportant. Instances of this are—the addition of an acid to a Quinine and Licorice mixture, resulting in precipitation of the Glycyrrhizin (relied on to cover the taste of the Quinine) by the acid ; or the use of Quinine, Tincture of Ferric Chloride and Liquorice together ; 514 INCOMPATIBILITY. —or the prescribing of solutions of Chloral and Potassium Bromide with an alcoholic preparation, the Chloral separating to the top as an alcoholate, and therefore dangerously in excess for the first few doses;—or the neglect to prescribe Acacia or some other emul- sifier in mixtures of an alcoholic fluid extract of a resinous body with an aqueous prepara- tion, which would result in the separation of the resin to the surface and an overdose with the first teaspoonful. When a fluid extract is diluted with a liquid 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 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 oils 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 Nitrous 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 1 drop to Fixed oils and Copaiba with aqueous liquids (except excipients). Tinctures made with Alcohol with those made with Diluted Alcohol. Alcoholic Tinctures and Fluid Extracts with aqueous preparations. Spirit of Nitrous Ether with strong mucilages. Infusions generally with metallic salts. Therapeutical Incompatibility arises when two agents are 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, and also in the Appendix, under the title The Treatment of Poisoning. They are summarized in the table on page 64, ante. The Dangers of Incompatibility may in great measure be avoided by the use of the utmost simplicity in prescribing. The subject can only be glanced at within these pages, but the following simple rules may help the burdened memory of the student and the practitioner. Never use more than one remedy at a time, if one will serve the purpose for which you are prescribing. INCOMPATIBILITY. 515 Never use Strong Mineral Acids with other agents, unless you know ex- actly what reaction will ensue. They decompose salts of the weaker acids, and form ethers when combined with alcohol. Never combine Tree Acids with hydrates or carbonates. Select the simplest solvent, diluent or excipient you know of, remem- bering that the solvent power of alcohol and of water for their respective substances decreases in proportion to the quantity of the other added. Generally do not combine two or more soluble salts; for such salts in solution, when brought together, usually exchange their radicles, thereby forming an insoluble compound. [See ante, page 512.] Never prescribe a drug with any of its Tests or Antidotes. Never prescribe a Glucoside (as Santonin, Colocynthin, etc.), in com- bination with free acids or with a substance containing Emulsin, as these agents will decompose it. Aconite should be ordered in water alone, Corrosive Mercuric Chloride by itself in water or in simple syrup. The latter drug is incompatible with almost everything, even the Compound Syrup of Sarsaparilla being said to decompose it. Potassium Iodide decomposes most of the metallic salts, and is one of the drugs which are best administered alone. The following-named substances are incompatible with so many others that it is best to always prescribe them alone; they are best given in sim- ple solution : — Alum. Dilute Hydrocyanic Acid. Dilute Nitro-hydrochloric Acid. Sulphuric Acid. Mercuric Chloride (Corr. Sub.) Iodine and Iodides. Syrup of Ferrous Iodide. Potassium Permanganate. Potassium Acetate. Potassium Bromide. Tartar Emetic. Tincture of Guaiac. Morphine Acetate. Morphine Hydrochlorate. Quinine Sulphate. Liquor Calcis. Liquor Potassae. Liquor Potassii Arsenitis. Liquor Ferri Nitratis. Tinct. Ferri Chloridi. Zinc Acetate. Iron and Quinine Citrate. Free Chlorine in Solution. Tannic and Gallic Acids. Silver Nitrate and Lead Acetate and Subacetate, though incompatible with almost everything, may be combined with Opium, the latter forming therewith a compound which though insoluble is therapeutically active as an astringent and anodyne lotion. Silver Nitrate with Creosote forms an explosive compound. Tannic and Gallic Acids, and substances containing them (as the 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. 516 EXTEMPORANEOUS PHARMACY. Iodine and the soluble Iodides are incompatible with the alkaloids and substances containing them, also with most metallic salts. Alkalies neutralize free acids, and precipitate the alkaloids and the 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. Resinous Tinctures or Fluid Extracts, (j-iij> diluted with 3 to 4 of water, gives great relief in chronic bron- chitis with dyspnoea. Lobelia, for paroxysmal dyspnoea (R). Ammonium Chloride, combined with stimulating expectorants, such as Serpentaria, Sangui- naria, or Eucalyptus (B); when secretion is thick and abundant, may be applied by an atomizer (R). Carbolic Acid, as inhalation of spray, 1 part to 100 of water; may be combined with tincture of Iodine (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 Ammonium Iodide, are very serviceable in combination with expectorants (B). Colchicum, in gouty subjects (R). Balsam of Peru, and of Tolu, when copious secretion of pus (R). Ammonia, as inhalation, to lessen expectoration (R). Oleum Anthemidis, in pulmonary catarrh with excessive secretion and difficult expectoration, a very useful remedy, n\jj-iv (P). Am- moniacum, the mistura, with Ammonium Chloride or Carbonate, efficient in the bronchitis of old people, with wheezing and abundant secretion (R). [See Bronchorrhcea, for formula.] Benzoin, of the compound tincture to boil- ing water, as inhalation ; eases cough and lessens expectoration (R); is some- times used by atomization (B). Phosphates, for the resulting cachexia (B); the Calcium Phosphate (R). Serpentaria, as stimulant. Alum, powdered, dusted over surface (B). Silver Nitrate, locally (gr. v-xx to the if) on sponge probang (B). Camphor, to allay cough and promote expectoration (B). Sumbul has decided efficacy (P). Opium, with expectorants, to allay cough (B) ; when cough frequent and violent, without any signs of obstructed oxidation ; also to check excessive secretion (R). Codeine, gr. 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, Rbv-xx thrice daily (B). Grindelia, an excel- lent expectorant, and especially when cough is troublesome (B). Strychnine, as a respiratory stimulant and to check the reflex vomiting (B); the Syrup of the Phosphates of Iron, Quinine, and Strychnine. Squill, in chronic forms with tenacious sputa, but not when fever or acute inflammation (R); the Pil. BRONCHORRHCEA. 595 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). Apomorphine, by the mouth, as an expectorant, alone or along with morphine (Br). Seepage 368. Chekan, a fluid extract of the leaves is highly efficient (M). Carbonic Acid, diluted, may be inhaled with benefit (P). Formalin, in dilute solution, as spray. [See page 287.] Nuclein, has been administered with benefit, as a gen- eral tonic. Gallic Acid, is 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 profuse bron- chial secretion (R). Myrtol, in fetid bronchitis, of great value (Gubler). Co- paiba, when purulent secretion (R); for profuse secretion, the best of all expec- torants, but nauseous (B). Cubeb, when profuse expectoration, has similar remedial influence (B). [See Bronchorrhcea, for formula.J Terpin Hydrate, gave immediate and curative results in cases of long-standing and obstinate bronchitis, which had resisted all other treatment; gr. xlviij, in Glycerin, q. s. ut. ft. solutio, Syr. Lactucarii, q. s. ad of which a teasp. every three hours (Boyland). Terebene, is proving very valuable; requires an equal weight of light magnesium carbonate to suspend it. Koomiss-cure, possesses great value (B). Cod-liver Oil, a teaspoonful ter die, after meals, of great service, if con- tinued (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, nutritious, and stimulants necessary when great prostration; Koomiss is an excellent article of diet. [Compare Cough, Emphysema.] R. Ext. Eucalypti FI., . . Ammonii Chloridi, . . Ext. Glycyrrhizse, . . . 3 ij. Syrupi Tolutani, . . . 3 iij. M. Sig.—A teasp. 4 to 6 times daily. Prescriptions. j R. Syrupi Scillae, . . . . ss. Tinct. OpiiCamph., . 3 ij. Ammoniaci, . . . 3 ss. Syrupi Tolutani, . . . 3 x. M. Sig.—A teasp. p. r. n. R. Ammonii Chloridi, . . Syrupi Picis Liquidse, . gvj. M. Sig.—A tablesp. 4 times daily. R. Tinct. Sanguinariae, . . S[j. Ammonii Chloridi, . . 3 j. Syrupi Tolutani, . . . 3 ij. Spt. Etheris Nitrosi, . . * ss. Aquse, 3 iijss. M. Sig.—Tablesp. p. r. n. I R. Ammonii Carbonat., . . gr. xl. Infusi Serpentarise, . . 3 iv. ! M. Sig.—A tablesp. every 3 hours. Bronchorrhcea. Ammonium Iodide, often improves the condition, especially if used with Arsenic (B). Eucalyptus, the oil of great utility (B); n\,ij ter die on sugar, or see formula above. Sulphurous Acid Gas, as inhalations, or in solution as spray, sometimes improves (B). Lead Acetate, as astringent to restrain secre- tion (B); gr. j-ij every 2 hours. Petroleum, crude, in capsules, has been ad- ministered 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- phates,-also Cod-liver Oil, as restoratives (Wa). Copaiba, the most serviceable expectorant, but nauseous (B); when copious secretion of pus (R). Cubeb, 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 (rc\,v) or by inhalation from ato- 596 BRUISES—BUBO—BUNION. mizer. Terpin Hydrate, seems to be even more efficient than turpentine, in doses of gr. x-xx daily. Carbolic Acid, internally (try), and by spray (gr. v ad 5j aquae), often of great utility (Da C). Benzoin, by inhalation, for its local influence. Myrtol, is largely eliminated by the lungs, and is a most valuable agent in bronchorrhoea and fetid bronchitis, acting as a stimulant and antisep- tic (Gubler); dose, rtyj in capsules (Br). [Compare Cough.] &. Copaibae, Syrupi Tolutani, . . aa ss. Spt. Etheris Nitrosi, . . 5j. Aquae Menth. Pip., . . £ ij. M. Sig.—A teasp. every 4 hours. Prescriptions. | U. Ammonii Chloridi, . . Emulsi Asafoetidae, . . .5 iv. Misce. Sig.—Tablesp. as required. . Potassi Iodidi, . . . . ,^j. Ac. Nitrici Dil., . . . 3 iij. Tinct. Belladonnae, . . %j. Ac. Salicylici, . . . . %]. Aquae Camphorae, q.s. ad 3 iv. M. Sig.—Dessertsp. in water 3 or 4 I times daily, for fetid bronchitis. I£. Copaibae, Bals. Tolutan., Pulv. Acaciae, . . . aa ss. Ac. Sulph. Aromat., . . 3 ss. Aquae Destillat., . . 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 ; tr\,v-x every 2 or 3 hours (P) ; in bruises, sprains, etc. (Wa). Aconite, the liniment locally to painful sprains and bruises (Wa). Capsicum, a strong tincture applied with gum, said to act like a charm on discolored bruises (R). Sulphurous Acid, a solution constantly applied (R). Oil of Bay, as stimulating liniment (P). Opium, the tincture with Linimentum Saponis (3j to Jj) 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); Calomel locally applied for indolent buboes refusing to heal after opening (H). Nitric Acid, indolent and broken bubo (R). Sulphides, are less useful in ma- turating buboes 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); in 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 poultices. Diet, should be generous, with cod-liver oil, in phagedenic bubo. Treatment of syphilitic bubo is that of general syphilis; local measures are useless, and no treatment is called for until the general eruption appears (Keyes). [Compare Chancroid, Syphilis.] Bunion. Iodine, as 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 BURSITIS—CACHEXIAS. 597 Burns and Scalds. Carbolic Acid, 1 part to 30 of Linim. Calcis, or I 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 applica- tion for burns of all degrees. Boracic Acid, a saturated watery solution, used with great success (Lister). Lead Carbonate, as white lead paint, an excellent application to burns of small extent (B). Salicylic Acid, 3j to viij 01. Olivse, is an efficient local application (B). Collodion, flexible, to burns of first degree (R). Phytolacca, relieves pain (B). Lime, as Lime-water and Oil, equal parts (R); or Lime-water with Linseed Oil (the celebrated Carron Oil) or better still with Olive Oil, a favorite and efficient application (P). Acetanilid, powdered and dusted over the surface, is an excellent application. Rhus Toxicodendron, the tincture externally, £>j to the pint of water, in superficial but extensive burns (P). Cantharis, the tincture diluted with 40 of water and applied on rags, is a most excellent application. Sodium Carbonate in solution as lotion, immediately relieves pain and promotes rapid healing. Turpentine, in dan- gerous 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); exclusion of air the main indication (H). Pinus Canadensis, the con- centrated extract, painted on freely, relieves the pain effectually. Prescriptions. Lime and IJnseed. B- Olei Lini, ,1VV)- Aquae Calcis, .3 viij. M. Sig.—Apply on sheet lint, and cover with oiled silk. B. Iodoformi, gj. Cetacei, l|j. Ext. Conii Alcohol., . . gr. xl. Acidi Carbolici, . . . gtt. x. M. Sig.—Spread on lint and cover the parts therewith. B- Sodii Carbonatis, . . . i|vj. Aquae, Oiij. M. Sig.—Apply freely for 3 days on old cloths or lint. B . Pulv. Carbonis Ligni, . 25 viij. Sig.—To be dusted thickly over the burned parts. Bursitis. Iodine, painted on outside, after removal of fluid from aspirator (D) ; after blistering (Wa). Blisters, in rheumatic enlargement of bursae, are almost in- dispensable 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. Calcium 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 is the best tonic in the cachexia of gastric ulcers, especially in chlorotic females (Wa). Arsenic, a prompt remedy in the malarial cachexia ; also of real value in the cancerous (Wa). Hydrastine, in paludal and splenic cachexiae, stands in high esteepi (B). Nitric Acid, is adapted to the cachexia following acute diseases or intem- perance ; also as alterative after a 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, 598 CALCULI. glands, and oculo-nasal mucous membrane affected. Phosphates, in bone diseases, wasting, bronchitic, leucorrhceic, etc. (B). Arnica, in very developed cachexiae, has excitant action on the nervous system (Wa). Eucalyptus, a serviceable tonic and stimulant in cachectic states generally (B). Manganese, the Syrup of Ferrous and Manganese Iodide, in anaemic, syphilitic, 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, mer- curial 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 cachexiae, anaemia, etc. (Wa). Massage, has been productive of remarkable results in many forms of cachexiae (B). Aliment, of prime importance (B.) [Compare the titles Anaemia, Scrofula, Syphilis, etc., and the Formulae for Tonics, on pages 572 and 577.] Calculi, Biliary. Chloroform, in 20- to 6o-drop doses every 3 or 4 hours, is by some supposed to act as a solvent of gall-stones; it cannot so act 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, 5j once daily for a year, is Durande’s solvent remedy ; is not solvent, and as an anodyne is inferior to morphine or chloral (B). Morphine, gr. % with Atropine, gr. hypodermic- ally, the best anodyne for the pain and vomiting during the paroxysm (Br). Chloral sometimes relieves the pain (R). Counter-irritants, as mustard poul- tices to relieve the pain during the paroxysm (Br). Olive Oil, at night, fol- lowed next morning by 3 or 4 seidlitz powders an hour apart, efficient in facili- tating the expulsion of accumulated gall-stones; this treatment is based on rational principles, as gall-stones placed in Olive Oil undergo solution, losing nearly 70 per cent, of their weight in 10 days (Brockbank) ; per diem between the attacks the best prophylactic (Id). Sapo Animalis, of the Br. Ph., is still more efficient for their solution and breaking up (Id). Nitro-muriatic Acid, as bath, found useful in India to relieve the pain and promote expulsion of the calculus, of the acid to a gallon of water (Scott). Sodium Phos- phate, in before each meal for several months, to prevent recurrence (B) ; should be given in plenty of water (B). 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). Succinate 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 important; withhold all starches, sugars, and fats, also malt liquors and spirits ; moderate exercise out of doors, lean meats, eggs, fish, fruits, and succulent vegetables to be used freely. Mineral Waters, the alkaline are useful, especi- ally Vichy, which is deemed of great benefit. [Compare Colic, Jaundice.] Prescriptions. R . Ferri Peroxidi Succinat. Hydrat., 2jss. Aquae, vjss. M. Sig.—Teasp. after each meal for several months. &. Spt. Etheris Comp., . . gij. Liq. Magendie, .... rrpxxx. Syr. Zingiberis, q. s. ad 5j. M. Sig.—Teasp. doses, an hour apart, until pain is relieved. Calculi, Renal and Vesical. Alkalies, especially Potassium salts, if long continued will effect solution of uric acid calculi (R); Sodium salts should not be used (B). Calcium Carbon- ate, an old and efficient remedy, also Limewater has been used with benefit, CANCER. 599 and may be injected into the bladder (P). Potassium Citrate, in large doses for bloody urine containing uric acid crystals (R); the Citrate and Carbonate are the most desirable solvents for uric acid gravel (Sir H. Thompson). Potas- sium Tartra-borate, if long used, is very efficient as a solvent for uric acid cal- culi (B). Potassium Salts, are much more efficient than those of Lithium as solvents for uric acid (Rogers). Alkaline Mineral Waters, those rich in Potas- sium 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. xv thrice daily in a glass of flaxseed tea. Magnesium Boro- citrate is a good solvent of uric acid calculi (Madsen). Lithium Citrate, to pro- mote oxidation (Da C). Piperazin, as a solvent for uric acid and urate concre- tions, is far superior to other agents. Olive Oil, internally, is of excellent ser- vice in renal as well as in hepatic calculi, controlling the crises of the disorder with undoubted effect (Aussilloux). Hydrangea, in ' decoction, used by the Cherokees in all calculous affections with uniform success (Butler). Lead Acetate, gr. % to the % of distilled water, injected into the bladder to prevent formation of phosphatic calculi, or a solution of Dilute HC1 Acid, "HL ij—iij to the £ (Sir H. Thompson). Nitric Acid, very dilute, as injection for phosphatic calculi (R); gtt. j to the , as injection into the bladder in chronic cystitis and phosphatic deposits (B). Cotton-root, in decoction, as a demulcent for strang- ury 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 the pain of the paroxysm (R). Anaesthetics, for the same purpose (B). Morphine, hypodermically, as an anodyne 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 vegetables may be used freely, also skimmed milk or buttermilk. Mineral waters, preferably Vichy, Fried- richshall, and Carlsbad. Frequent abstinence from animal food. Lemon-juice and soft water in large draughts, are useful. Surgical Measures. Lithotomy or Lithotrity for removal of a stone from bladder. Solvents are of no use except for a very small calculus, and even then a considerable time must be occupied in the process. No operation in surgery more certainly safe, rapid, and successful than lithotrity (Sir H. Thompson). [Compare Colic, Lithiasis, Oxaluria, etc.] Prescriptions Magnesium Boro-citrate. Potassium Tartra-borate. R. Magnesii Carbonat., . . £j. Sodii Biborat., Acidi Citrici, . . . . aa z ij. Aquae Bullientis, 3 viij. M. Sig.—Tablespoonful 3 or 4 times daily. (B.) R. Potassii Bitartratis, . . . partes iv. Ac. Borici, partem j. Aquae, partes x. By heating the above together, the salt is obtained as a powder, of which gr. xx in a large draught of water 3 or 4 times daily. Cancer. Opium, stands first in the list of palliatives, allaying pain and quieting irri- tation (Wa); as powder applied to cancerous sores; also Morphine, 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. to -fa), a good hyp- notic (P). Arsenic, in cancer of the stomach, diminishes pain and checks vomiting ; also in scirrhus of stomach and epithelioma. Arsenous Acid, pure or with starch, as a caustic ; enough should be used to set up active inflam- mation (R); may cause arsenical poisoning by absorption. Belladonna, locally and internally of great benefit as palliative in severe pains of cancer (P). Conium, as poultice, and internally to relieve pain (R); is par- ticularly applicable to pain of cancer (P) ; as palliative (Wa). Hydrastis, has 600 CANCRUM ORIS—CARBUNCLE. a renewed interest (Pf). Carbolic Acid, undiluted, to sore, and injected be- neath 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 C). Citric Acid, 3j to aquae, useful in allaying pain of cancerous ulcerations (Wa). Acetic Acid, 1 to 3 aquae ; n\pcxx injected into the tumor, has been used with varying success (Wa). Chloral, in 10-grain doses, 3 times a day, has relieved the most severe pain of cancer (R). Chloroform, as vapor to raw surface (R). Pyoctanin (Methyl Violet) in solution, by injection into the neoplasm, to bring about the shrivelling up and final disappearance of carcinoma (Mosetig). Hy- oscyamus, bruised leaves, locally (P). Bismuth, relieves pain and vomiting of gastric cancer (B). Aurum, the Arsenate was extensively employed internally by Massart with benefit (see page 176). Iodoform, applied to diseased surface, relieves pain and removes fetid odor (P). Resorcin, 15 parts to 20 of Vaselin as an ointment twice daily after washing with a solution of Pot. Permanganate, has successfully stopped epithelioma (Antonio). Potassium Chlorate, in im- palpable powder, dusted on epithelioma, said to be curative (B). Pepsin, in- jections into tumor (B). Salicylic Acid, pure, applied in powder (B). Zinc Chloride, the most efficient and safe escharotic; parts j-ij to v of flour, as “caustic arrows ” inserted at base of tumor (B). Potassa Fusa, as escharotic (B). Zinc Sulphate, dusted over, dry ; an excellent caustic; remove the eschar by poultice (B). Bromine, for destruction of uterine cancer, is preferred by some (B). Chromic Acid, a powerful escharotic (B). Calcium Carbonate, 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). Toxins, the erysipelas and prodigiosus toxins have proved more efficient in sarcoma than in carcinoma (see page 477). Ozone, locally applied as antiseptic and anodyne in cancer of the tongue and throat, is highly efficient; was used on Sir John Millais with great benefit during the last three months of his life, kept him comfortable without narcotics. Poultices, of starch, applied cold (R); or poultices of bread, sprinkled with charcoal or freshly ground coffee, as deodorizers to open can- cers. Water Enemata, to relieve pain and straining in intestinal cancer (R). Electrolysis, has been of great service in many cases, relieving the pain, and diminishing the tumor. In a case of sarcoma of the thigh, in which amputa- tion was the only possible resource, after one application of the needles by Mr. Annandale, the pain was relieved and the tumor diminished (Duncan). It seems proved that there is a less frequent return of cancerous growths removed by electrolysis than by the ordinary procedures; the evidence in its favor has recently accumulated (Tibbits). In any case in which operative interference is necessary, electrolysis is the preferable method, and in others is advisable (Butler). In 18 cases of epithelioma treated by electrolysis, 13 were cured, 2 improved, in 2 there were no results, and 1 ended fatally (Groh). [Compare Uterine Cancer.] Cancrum Oris. Arsenic, in medicinal doses (R). Nitric Acid, to surface (R) ; strong Nitric Acid the best caustic for worst forms of the disease (Wa). Potassium 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 Aphth/e, Stomatitis.] Boric Acid, administered internally and externally as for Boils (which see); equally efficacious in carbuncle, diminishing pain, redness and hardness ; nu- merous apertures rapidly form for the elimination of the core ; the fever falls, excitation and insomnia abate, and the carbuncle heals, in the majority of Carbuncle. CARIES. 601 cases, without surgical interference (Alison). Mercury, Corrosive Sublimate, injected into tumor at several points, in doses of 2 drachms of a y per cent, solution dividedly, has produced good results; these injections were often repeated, in broken doses likewise, on the following days (Casson). Bella- donna, with Glycerin, as local application to relieve pain (P). 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 aquas, locally, has most striking effect (Wa) ; may be used with benefit internally or hypodermically (Cezard). Calcium Sulphide, gr. y 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 is thought to create a 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- 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 inci- sion, followed by dressing with Carbolized Oil, is the course to pursue in malig- nant pustule. Caustic Potash, applied before an opening occurs, or small pieces inserted into openings made by scalpel, to cause the rapid separation of the slough. The resulting ulcer should be treated on general principles. [Com- pare Anthrax, Boils.] Prescriptions. 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. R. Tinct. Ferri Chloridi, . gj. Potass. Chlorat., . . . Knj- Liq. Ammonii Acetat., . 5 iij. Syrupi et Aquae, q. s. ad jfviij. 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, the best is Syrup of Calcium Lacto-phosphate, or Parrish’s phosphates (R). Villate’s Solution, injected through the sinuses to dissolve the carious bone, has cured many cases (B). [See formula below.] Sarsaparilla, a very useful medicine (P). Iodine, locally, with Iron or Cod- liver Oil internally (Wa). [See Bone.] Potassium Iodide, in syphilitic caries, holds the first place (Wa). Cod-liver Oil, to promote constructive metamor- phosis (R). Mechanical Contrivances, are 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.] Prescriptions. R. Cupri Sulphat., Zinci Sulphat., aa partes xv. Liq. Plumbi Subacetat., p. xxx. Aceti, p. cc. ( Vitiate’s Solution.') & . Syrupi Calcii Lacto-phos- phatis (U. S. P.), . . Sig.—A dessertsp. to a tablespoonful 3 or 4 times daily. 602 CATALEPSY CATARACT CATARRH. 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. to , 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). Catalepsy. 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 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 to malassimilation in gouty or rheumatic persons (C). Iridectomy, made early and effectually may postpone the progress of lenticular opacity, if due to increased intraocular ten- sion (C); in partial cataracts, which have become stationary, iridectomy for artificial pupil may be done to expose the clear portion of the lens (Roosa). Medicine, accomplishes nothing except to improve the general health and so delay the progress of the opacity. Removal may be performed by one of several operations (Roosa). Cataract. Catarrh, Acute Nasal. Menthol, I or 2 parts dissolved in 20 of chloroform, of which a few drops in the hollow of the hand, the hands then rubbed together and placed before the face, the remedy being inhaled alternately through the nose and the mouth, will arrest the progress of a cold in its initial stage (Wunsche). Chlo- roform, by inhalation in small quantities, is an excellent nasal antiseptic, and is of great value in acute nasal catarrh. Sodium Salicylate, to abort a cold (see page 428). 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 trevery % hour, very useful for a commencing cold in the head (Smith). Belladonna, in acute nasal catarrh with profuse watery secretion, v of tincture, then rr\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 aquae, syringed into the nasal passages in subacute coryza with muco- purulent secretion (P); acts similarly to Aconite, but is contraindicated if much gastric or intestinal irritation exists (B). Iodine, by inhalation in daily attacks with itching nose (R); 3(j of the tincture with 3j of Carbolic Acid inhaled from 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). Arsenic Iodide is very efficient as a remedy for an acute cold, coryza, and similar affections, especially when accompanied by a sore throat resembling that of diphtheria; gr. iij triturated with gr. xx of sugar of milk, one-halfof which CATARRH, ACUTE NASAL. 603 may be dissolved in £iv of water, and a teasp. given every hour or so. Ar- senic, when sneezing, itching of nostrils and frontal headache (R); as cigar- ettes (B). [See under Asthma, for formula.] Veratrum Viride, if Arsenic fails (R). Potassium Bichromate, in small doses, gr. trituration, is very efficient, especially when the nasal discharge is thick, stringy, and glutinous. Potassium Chlorate, in doses of eight or ten lozenges a day, will abort many a cold (R); a very good remedy in ordinary catarrh (P). Quinine, gr. x, with Morphine, gr. )/(,, at incipiency, will often abort an acute coryza (B). Opium, at night, if taken early in the case, 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). Am- monia, may be inhaled in the early stage (R). Camphor, as inhalation, the spirit in form of vapor (R); with Opium and Ammonium Carbonate as pow- der (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 accom- panied by vomiting and diarrhoea (R). Ipecacuanha, for acute nasal and bronchial catarrh, and ordinary colds in children (B). Cimicifuga, when head- ache, 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 rtpx to xxx, every half hour until profuse diaphoresis sets in, is one of the best modes of aborting a cold; or Pilocarpine Hydrochlorate, gr. )/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 Coca diluted with water is equally efficient if enough be used (Cohen). Resorcin, the best of all applications. (See Ca- tarrh, Chronic.) Chloral, 20 grains in §j of Castor Oil, applied with a soft mop, when the Schneiderian membrane is very irritable, checks the secre- tion of mucus and lulls the irritation and the head pains (Brodnax). Ammo- nium Chloride or Cubeb, 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 effi- cient (R). Oil Inunctions, daily to the whole body, in cases of undue suscep- tibility to taking cold, will prevent the frequency of the attack (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 sus- ceptibility, supplemented by occasional Turkish baths (R). [Compare Cough, Hay-Fever, Influenza.] R. Quininae Sulpliatis, . . gr. xviij. Liq. Arsenicalis (B. P.), trpxij. Liq. Atropinae (B. P.), . TT\j. Ext. Gentianae, . . . . gr. xx. Pulv. Acaciae, q. s. Ft. pil. no. xij. Sig.—One every 3, 4, or 6 hours, for acute colds. ( Whalen.) Prescriptions. R. Acidi Carbolici, . . . . gr. lxxx. * Alcoholis, 3; ss. Aq. Ammonise, .... rrplxxx. Aquae, g ijss. M. Sig.—A few drops as an inhalation from a cone of blotting paper. (Brand.) R. Morph. Acetatis, . . . gr. iv. Bism. Subnitrat., Pulv. Talci, . . . aa gj. Ft. Chartulas no. xxx. Sig.—Use as snuff in acute rhinitis. (Sajous.) R . Camphorae, gr. 1. ALtheris, 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.) &. Codeinse, gr. ij. Syrupi Tolutani, Syr. Scillse Comp., . aa gj. M. Sig.—Teaspoonful occasionally for a common cold. (B.) 604 CATARRH, CHRONIC NASAL. R. Tinct. Aconiti, .... npx. Tinct. Belladonnse, . . g ss. Syrupi Zingiberis, q. s., a? 3>j- M. Sig.—Half to one teasp. according to age, every hour. Perrier's Snuff. R . Morph. Hydrochlor., . gr. ij. Bismuthi Subnit., . . . £vj. Pulv. Acacise, . . . 3 ij- M. Sig.—Use as snuff, % to yi. 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). Glycozone, fre- quently applied, is of benefit (Edson). Hydrastis, is of value in chronic coryza, also in ulceration of the septum or any other part of the nasal fossae, gtt. v of the tincture thrice daily internally, and £>j to Sjviij of water locally by syringe (P). Pulsatilla, is excellent in subacute inflammation of nasal passages, with offensive muco-purulent discharge, 3j-ij to of water, as wash (P). Potas- sium Bichromate, is an excellent local application in a solution of gr. j-x to water (B); small doses, gr. in trituration, internally, a most efficient remedy, especially when the discharge is tough and stringy, and the nose tender. Cocaine, is much used, but is only of temporary benefit; many of the proprie- tary snuffs and powders for chronic catarrh contain this drug, their use fre- quently inducing the cocaine habit. Resorcin, the best of all applications, in acute and chronic catarrh ; after cleansing the nose with a Boracic Acid solu- tion, or Dobell’s, use a 2 to 10 per cent, ointment (in Vaselin), also a spray every other day, of a 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 the latter does. Eucalyptus, has been employed with benefit (Wa). Bismuth, in powder with Acacia, as in Ferrier’s snuff (see above), or with Tannin, Calomel, Iodoform, etc., used by insufflation daily (Robinson). Iodoform and Tannin, I 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-pharyngeal space, has been used with success (Mosler); Wei de Meyer’s Catarrh Cure is simple Sodium Bicar- bonate and a little pink coloring matter (Robinson). Potassium Permangan- ate, gr. j-x to the pint of warm water, as a deodorant solution when necessary. Ammonia, by inhalation, when painful inflammation of nasal mucous mem- brane 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). Salicylic 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). Cubeb, finely powdered and blown into the nares by an insufflator (B), has 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 (Rob- inson). Ammoniacum, in the same condition, very small doses, gr. j-iij, with Ipecac or Ammonium Carbonate, will greatly lessen the amount of secretion (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 pow- der, as alterative application, gr. x-xv to the § 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). Bromine, the vapor may greatly benefit, but must be used with caution (B). Senega has been found service- CEREBRAL ANAEMIA. 605 able (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 aban- doned. Sprays by hand-ball atomizers, or compressed air apparatus, of warm watery solutions, Vaselin, 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 Vaselin spray. [See formula below.] Sulphur Waters, internally, of great benefit in follicular dis- ease (Robinson). [Compare Oz. . Tqxij. Liq. Strychninae (I P- c.), . gj. Syr. Tolutani, .... |jjss. Infusi Rosae Acidi (B. P-)> .ad%vj. M. Sig.—A tablesp. in a winegl. of water every 4 to 6 hours. R . Tinct. Sanguinarioe, Tinct. Lobeliae, . . aa £jss. Vini Ipecac., . . . . giij. Tinct. Opii Camphorat., Syr. Scillse, . . . . aa ,^jss. Aquae Cinnamomi, . ad £ vj. M. Sig.— gj every three hours in the cough of bronchitis. (Potter.) Coxalgia Barium Chloride, in considerable doses (gr. j-ij) persevered in for a month, is thought to be most valuable in scrofulous diseases of the joints (Wa). Sul- phuric Acid, 3j ad §j 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). Ferrous 624 croup. Iodide, in scrofulous disease of the joints, with Cod-liver Oil and nutritious diet (Wa). Iodoform, very successfully used by many continental practition- ers in scrofulous diseases of the joints (Wa). Cod-liver Oil, the remedy on which most reliance is to be placed (R). [Compare Abscess, Caries, Suppu- ration, Synovitis.] Croup, Catarrhal. Aconite, valuable (R) ; has been employed with the best results (P); 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 occa- sional 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 hpv-x every 2 or 3 hours next day (M & P). [Com- pare Laryngismus Stridulus.] R. Potassii Citratis, . . . gj. Syr. Ipecac. 3 ij. Tr. Opii Deodorat., . . gtt. xij. Syr. Simplicis, . . . . 3 ij. Aquae, 3JSS- M. Sig.—Teaspoonful every two hours at 2 years of age. In severe form of spas- modic laryngitis. (M. dr* P.) Prescriptions. R. Tinct. Belladon., . . . gtt. iv. Tinct. Opii Caraph., . . gtt. 1. Pulv. Aluminis, . . . . gr. vj. Syr. Acacise, ? ss. Aquae, . 3jss. M. Sig.—Teaspoonful every 2 or 3 hours at 6 months old when cough fre- quent and harassing. (A/. dr3 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 (70°-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 ten or fifteen 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). Potassium Chlorate, as alkali, after emetics, the most reliable internal remedy, gr. ij-iij every 2 hours to a child of 4 years (M & P). Ferric Chloride, 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, are: Copper Sulphate, in small frequent doses (R); Ipecacuanha, inferior to Mercury (B); in severe cases vomiting should be caused 2 or 3 times a day, and should be commenced early (R); Apomorphine, effective, but highly dangerous (B). Senega, is con- sidered 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 at a time (R). Hydrogen Dioxide, the solution, I to 4 of water, copiously sprayed over the nose, throat, mouth, etc., to destroy the membranes and pre- vent their reproduction ; then Glycozone, a teasp. in a winegl. of water thrice daily internally, prevents any disturbance of the stomach and regulates the bowels (Edson). Lactic Acid, as solvent of membrane (B). Iodine, the tinc- ture, externally, affords great relief, and tends to prevent formation of false CYANOSIS CYSTITIS. 625 membranes (VVa). Water, warm bath, hot fomentations or compresses 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 afterward. 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, 21 ]/2 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.] Prescriptions. R . Pulv. Sanguinarise, . . gr. xx. Pulv. Ipecac., . . . . gr. v. Syr. Ipecac., .... ij. M. Sig.—A teasp. every % hour until emesis, then y2 teasp. every hour. (P.) R . Acidi Lactici, z iijss. Aq. Destillat., . . . . M. Sig.—To be used as a spray, or ap- plied by a mop. (London Throat Hospital.} Cyanosis. 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). Oxygen, by inhalation in the cyanosis of asphyxia from toxic gases or due to opium and chloroform narcosis. 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). [Compare Asphyxia, Asthma, Dyspnoea, Heart Affections.] Cystitis, Acute. 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, with 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 (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); in small doses, the best remedy for acute cystitis. Aconite, for febrile symp- toms (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 the kidneys are diseased (P). Alkalies, the Citrates and Bicar- bonates if urine is highly acid; stop when it becomes alkaline (R); Liquor Potassae in barley-water or in a decoction of Triticum repens, preferred to all other alkalies; urine must be maintained at a neutral or very slightly acid re- action (Thompson). Cannabis Indica, an excellent anodyne in all bladder cases, having specific effect on that organ. Rest in horizontal posture, muci- laginous drinks, hot fomentations and hip-baths, from ioo° to iio°, laxatives for the bowels, light food; Milk-diet often necessary, especially in children. [Compare Bladder Irritable, Calculus, Dysuria, Enuresis, Hema- turia.] Prescriptions. R. Pulv. Opii gr. xij. Camphorse, gr. xxx. Ext. Belladonnae, . . . gr. iij. Ol. Theobrom., . . . . q. s. M. et div. in supposit. no vj. Sig.—One to be used at bed-time. R . Atropinse Sulphatis. . . gr. j. Acidi Acetici, ... gtt. xx. Alcoholis, Aquae, aa ss. M. Sig.—Four drops in a winegl. of water before each meal. (G.) 626 CYSTITIS. 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 in the day, at least, in pills made with Glycerin (Thompson). Sodii Benzoas, 3j in Tinct. Gelsemii 3.ij-iij> and water to §vj, makes an excellent wash for painful cystitis of old men with enlarged prostate ; a fluidounce should be warmed and injected, and retained 20 to 30 minutes (Copeland). Alkalies, when urine is acid; the Liquor Potassae, with Hyoscya- mus as an anodyne, preferred notwithstanding its chemical incompatibility, to control painful and frequent micturition (Thompson); Bicarbonates or Citrates better, as the strong reaction of liq. potassae unfits it to be given in doses suffi- ciently large to affect in any great degree the reaction of the urine (R). Triticum, is very efficient as an internal remedy, 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 n\,x-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, to the pint, a wine- glassful every 3 or 4 hours, has been used internally with considerable success (Dessein). Pareira, considered superior to Uva Ursi (Brodie) ; often very suc- cessful (P). Chimaphila, is often very efficient, but is more actively diuretic than the above-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 stimu- lating effect (P). Turpentine, has been useful in many cases (R); when cys- titis is 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. Myrtol, has been used with excellent results in the Paris Hospital. 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). Salol, proves an efficient disinfectant, as its constituents are excreted with the urine; solu- tions of 5 to 10 per cent, in Retinol, gave gratifying results in subacute cases of obstinate character, where other agents were of no avail; this solution remains in the bladder, in diminishing quantity of course, after 6 or 8 urina- tions (Desnos). Camphoric Acid, in ]/2 to 3 per cent, solution in hot water, as injection, has cured several cases. Carbolic Acid, and Sulpho-carbolates to preserve the urine sweet (R). Sulphites will accomplish the same object (B). Silver Nitrate, by intra-vesical injection, gr. j in to begin with, increased gradually to gr. to the 3 at most (Thompson); stronger solutions are advo- cated by Professor Richardson of New Orleans, and Professor Gardiner of McGill College, Montreal; in the writer’s experience a solution of gr. v to the § 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 giv of warm water, once daily; Nitric Acid, dilute, r»\J —ij to the of water; Tannic Acid, gr. j to ; Borax, in §ij of Glycerin and §ij of water, of which to of warm water for one injection; Quinine, gr. j-ij to the Jj of water, with a drop of Acetic Acid. All injections must be used with great care, not more than 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, CYSTS DE A FN ESS. 627 hypodermically, increases the contractile power of the bladder, and enables it to empty itself more perfectly (Langenbeck). Pichi, the fluid extract, to xxx four times daily, gave excellent results in bad cases of long standing, urine being alkaline, ammoniacal, ropy and purulent (Delamere). [Compare Bladder Irritable, Calculus, Dysuria, Enuresis, Hematuria.] Prescriptions. R . Uvae Ursi Fob, Pareirse Radicis, . . aa Sig.—Boil in 3 pints of water until re- duced to a quart, then strain, and take I or 2 wineglassfuls 3 or 4 times daily. ( Thompson.) & . Quininoe Sulphatis, . . 3 ss. Acaciae, . . . . . 3 ij. Morphinse Sulphatis, . gr. jss. Aquae, ... q. s. ad §iij. M. Sig.—A tablesp. to ounces of warm water, which inject in 3 parts, daily. R. Ext. Tritici Repentis Fluidi, Syr. Amygdalae, . . aa ij. M. Sig.—A dessertsp. in water 5 or 6 times daily. (Pancoast.) Ijt. Sodii Boratis, . . . . 35 j. Glycerini, Aquse, aa % ij. M. Sig.—Tablesp. in four ounces of warm water as an injection. li . 01. Terebinth., .... ss. Camphorae, gr. xv. Extr. Hyoscyami, . . . gr. ss. Fiat massa. Sig.—Take a piece the size of a cherry-stone morning and evening. (Chauvel.) K. Argenti Nitratis, . . . gr. vij. Aquae Destillat., . . . M. Sig.—Injection every third or fourth day after washing the bladder out with warm water. (Ricord.) Iodine, by injection very effective in cysts of the neck, and sometimes in unilocular ovarian cysts (B); tfx after tapping (R). Silver Nitrate, gtt. v-x of a strong solution (gr. xx ad 3(j). as injection into cystic tumors (wens), after allowing the contents to escape, will cure by setting up adhesive inflammation (B). Galvano-puncture, will permanently occlude cysts of the neck (B). Aurum Chloride, may sometimes cure ovarian dropsy (B). Remedies, internally, have all proved worthless (E). [Compare Ovaritis.] Cysts. Quinine, cures some forms, and often causes deafness (Brown-S£quard). 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). Gelse- mium, the tincture, Rbxv-xx, repeated 2 or 3 times a day, is often useful in the treatment of nervous deafness, and seems to have an influence on the organ of hearing similar to that of Nux Vomica on the organ of sight. Colchicum, when from gout in ear (A). Cantharides, as ointment; gr. xxx ad Adipis, below and behind the ear bis die, with alterative mercurial treatment, in deaf- ness from thickened tympanum (Wa). Collodion, contractile, applied to the membrana tympani, in deafness from relaxation of the membrane, has exerted a permanently beneficial influence, even in cases of long standing (Wa). Turpentine, gtt. xl in Jss 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 blis- ter, has proved curative in chronic deafness, after all other remedies had failed (Wa). Gargles, in throat-deafness, are of great value; of Potassium Nitrate, Borax, etc., in sthenic cases ; tincture of Capsicum added in nervous forms; of Hydrargyrum Bichloride, when from secondary syphilis (Wa). Water, Deafness. 628 DELIRIUM DELIRIUM TREMENS. washing in warm water, in deafness from general debility (Toynbee). Faradi- zation, of the ear in nervous deafness, in which slight results only to be expected from the treatment (R); demands the utmost caution (Wa). Inflation, by the Politzer bag, or eustachian catheter, in throat deafness. Remove wax from external canal. Delirium. Belladonna, in delirium of typhus and other fevers (R); in severe forms of delirium (P). Hyoscyamus, in 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 hypodermically; Laudanum in low, muttering deli- rium (R); is regarded with suspicion (P). Cannabis Indica, the extract in doses of gr. x/i~x/z in nocturnal delirium occurring in softening of the brain (Wa). Potassium Bromide, in delirium resembling delirium tremens (R). Camphor Monobromide, useful in rambling delirium (Wa). Camphor, in 20- grain doses, every 2 or 3 hours, especially in low, muttering delirium (R). Chloral, in violent delirium of fevers (R). Antimony, in 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.] Chloral at outset (R); very successful, but dangerous to old drunkards or when heart disease exists (B); the experience of inebriate asylum physicians does not bear out the teaching that chloral is dangerous to old alcoholic cases, being by them commonly given in 30-grain doses every 3 or 4 hours until sleep is induced, without apparent danger. Belladonna, of proven effi- cacy when congestion of the brain (P); useful for the insomnia when coma vigil, cold surface, cyanosis (B). Stramonium can do all that Belladonna can do, and is more powerful (Tr). Hyoscyamus, in some forms admirable (P). Hyoscine, is a useful drug in delirium tremens, and in other affections in which tremor is a marked symptom (Weatherly). Duboisine, is even more sedative and hypnotic. Opium, cautiously, if at all (B); as rectal injection, hypodermi- cally, or with spirits ; if patient strong, delirium boisterous, and pulse full, add Tartar Emetic or Aconite (R). Bromides in the “ horrors ” preceding the delirium, 3j every 4 to 6 hours; are of less value in the delirium, and in sub- sequent attacks (R); Ammonium Bromide has been used with very good results (Wa). Chloroform, inhalations to procure sleep (R); anaesthetics are dangerous (B). Cannabis Indica, gr. ss-j of extract, one of the least dangerous and most useful 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 hypodermically almost to the commencement of tetanic action (Luton). Arnica, the tincture is exceptionally serviceable in cases where there is depres- sion (B). Coffee, often exceedingly useful (P). Digitalis, 3ss of tincture re- peated in 4 to 6 hours (R); a tablesp. of the infusion every 4 hours in pale subjects, where anaemia of brain, with effusion and oedema (B); has cured many cases promptly without producing any unfavorable symptoms; its safety and efficacy are alike questionable (Wa). Cimicifuga, an excellent tonic for the nervous system, is very successtul (P). Quinine, with a mineral acid to restore digestion, in the “horrors,” and in adynamic states (B); gr. j two or Delirium Tremens. DEMENTIA PARALYTICA DENGUE DENTITION. 629 three times daily as a tonic, the best agent 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 tinc- ture 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, is useful (P). Alcohol, of undoubted use where failure of stomach to appropriate food (B) ; is best omitted entirely from the treatment, the experience in inebriate asylums showing that cases recover more rapidly and surely without alcohol. Water, about 6o° with ice to head, to reduce temperature in the hyperpyrexia (R). Treatment, should tend to nour- ishment, 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 should be used 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 excitement; hot baths and wet pack to eliminate the poison ; a quiet, dark room, sleep a necessity, often induced by Belladonna. [Compare Alco- holism ; also page 115, for Treatment of Delirium Tremens.] Prescriptions. R. Tinct. Capsici, Ext. Lupulini FI., . aa 5 j. Mucil. Acaciae, . . . . 5 ss. Aquae Cinnamomi, . . Jjjss. M. Sig.—Dessertsp. as required for the wakefulness and excitement which pre- cedes an attack of delirium tremens. R. Chloralis Hydratis, , . £vj. Ext. Conii FI., .... 3 iij. Ext. Hyoscyami FI., . 3 iv. Mucil. Acaciae, . . . . Aquae Menth.Virid., . ad £ ij. M. Sig.— Teaspoonful in water after each meal, to prevent delirium tremens. 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 ; Calcium Lacto-phosphate, 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. Quinine, in five-grain doses every four or five hours for the fever (Da C); 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 Sali- cylates, 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, of the tincture may be given every hour for two or three doses (Fayrer). Aconite, with salines and Nitrous Ether, during the pyrexia, which may be so high that cold sponging or the cold bath may be re- quired. Bitter Tonics, as Gentian or Calumba, with Quinine and a mineral acid or Strychnine during convalescence. Treatment, is entirely symptom- atic. Belladonna, in convulsions of dentition, rarely fails to relieve (P). Hyoscy- amus, to alleviate pain and subdue irritation ; better than Opium for children (P). Chamomilla, n\j of the tincture every % hour, an excellent sedative for children (A. A. Smith). Potassium Bromide for irritability and convulsions in Dentition. 630 DIABETES. teething (R). Dulcamara, the infusion, in diarrhoea of dentition, quickly checks symptoms (P). Calumba, excellent for the accompanying vomiting and diarrhoea (P). Hypophosphites, of Calcium 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 to the (E. Smith). Castor Oil, for the diarrhoea of denti- tion to clear out the bowels, then a mixture of Chalk and Catechu, or Zinc Oxide.gr. j to the dose, with gtt. j of Laudanum if required to reduce peristalsis (Id). Lancing the Gums to relieve tension when gum is actually swollen; should not be indulged in indiscriminately. Prescriptions. R. Potassii Bromidi, . . . 5jj. Olei Anisi, TT^ij. Mucil. Acacise, Aq. Menth. Pip., . . aa M. Sig.—Teasp. every half-hour until the child is relieved. (B.) R. Sodii Broraidi, Sodii Bicarb., Chloralis, aa gr. xx. Aq. Menth. Viridis, . . 3jss. Syr. Zingiberis, . . . . 3 ss. M. Sig.—Half-teasp. to a dessertsp., according to age. 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 C); 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, is used successfully to reduce the quantity of urine (B). Valerian, large, increasing doses (R). Krameria lessens the quan- tity of urine (P). Diet, a dry diet beneficial (B). Diabetes Insipidus. Prescriptions. R. Extr. Ergotie FI., . . . Sig.-—Half-teasp. thrice daily, gradually increased to a dessertspoonful. R. Acidi Gallici, . . . . . Div. in chartulas xij. Sig.—One powder 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 is credited with several cures (see Aurum below): the Lithiated Arsenical Water was used in 70 cases, with cure of 96 per cent. (Martineau). [See infra for formula.] Morphine, is very efficient in reducing sugar when used by mouth, but is of no value when employed subcutaneously, even in the same case (Bruce). Opium in large doses (gr. vj-xij a day), ameliorative. Codeine, is especially serviceable (B); abates thirst and controls appetite (R); its value much disputed (P) ; is of great value in many cases (W) ; is one of the best remedies in doses of gr. (Da C). Jambul, has given favorable results after abandoning all the usual remedies (Lawrence); in 2 severe cases, in which 7 and 3 per cent, of glucose were excreted, the urine was brought back to normal by preparations of the bark, and kept so for two years (Vix); should be given after meals, in water or wine sweetened with Saccharin. Sodium DIABETES. 631 Salicylate has cured when all other drugs have failed (R); gr. x-xv in com- pound spirit of Lavender, and water, thrice daily, is my favorite remedy (Da C). 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 insix weeks (Begbie); useless (Da C). Krameria lessens the quantity of urine (P). Phosphates, to avert failure of nutrition (B). Aurum, the Chloride is one of the promising remedies (B); the Bromide of Gold and Arsenic caused so much im- provement in one case that he was accepted as a good risk by one of the fore- most life insurance companies (E. A. Wood). 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 amount of testi- mony for its value in this disease is quite considerable (B). Iodol, can be ad- vantageously substituted for Iodoform in all the diseases to which the latter is applicable (B). Uranium Nitrate, gr. i-iij, thrice daily has caused decided im- provement in several cases (Hughes). Aloin, for the accompanying constipa- tion (Da C). Nux Vomica, or Strychnine, is generally beneficial. Calcium Lactophosphate benefits the thin, nervous type of diabetic remarkably (B). Antipyrin, affects secretion, and has been used with benefit in this disease. Orchitic and Adrenal Extracts have been given with reported success. 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 C); alkaline mineral waters for diabetes of hepatic origin and in obese subjects, are extremely useful (B). Alkaline Waters, when of hepatic origin and in obese subjects; tepid drinks for the intense thirst (B). Salines, a warm solution of the Phosphate and Chloride of Sodium, by intravenous in- jection, in diabetic coma, produced astonishing results in one case (B). Oxy- gen as oxygenated water, instead of carbonated water, has been successfully used (Le Blond). Glycerin has produced good results (B); used in place of sugar (W). 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 underclothing. Peanuts, are an excellent article of food for diabetics, being rich in albumen, of which they contain 47 per cent., together with 19 per cent, of fat and non-nitrogenous extractive matters (Furbringer). Milk-cure, by skimmed milk, very successful, 6 to 10 pints daily; give 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). Saccharin, as a substitute for sugar, does well for sweetening purposes, but is not a nutrient, and has no influence on the disease. Dulcin, is 200 times sweeter than saccha- rin, and is harmless in reasonable doses, up to 24 grains in the day (Robert). Levulose, is a saccharine food which can be taken freely and without any in- jury by diabetic patients; it most nearly approaches the ideal carbohydrate food indicated in diabetes (Hebra); it is assimilated well and nearly all oxid- ized by diabetics, who are able to partake freely of it in comparatively large quantity (Ebstein): sugar and sugar-forming food constitute more than half the nourishment needed by a healthy person, and it is the imperative duty of the physician to furnish a diabetic with a moderate amount thereof, to prevent death from inanition, and to lessen the danger of diabetic coma which is in- duced by a diet of meat alone (Leyden); Levulose, formerly very high in price, is now sold at a reasonable rate under the name Diabetin. Prescriptions. R. Lithii Carbonatis, . . . gr. xl. Sodii Arsenatis, . . . . gr. j. Ext. Gentianse, . . . . gr. xx. Ft. pil. no. xxv. Sig.—One night and morning until sugar disappears. More convenient than Martineau’s liquid. ( Vigier.) R. Liq. Potassii Arsenitis, . gjss. Tinct. Opii Deodorati, . X't. Syrupi Zingiberis, . . . gj. Aquse Cinnamomi, q. s. ad iv. M. Sig.—Teasp. thrice daily. 632 DIARRHOEA. R. Sodii Arsenatis, . . . . 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.) R. Codeinae, gr. viij. Syrupi, et Aquae, . . . gij. M. Sig.—Half-teasp. thrice daily, grad- ually increased up to two teaspoonfuls. (.Pavy.) Diarrhoea. Mercury, in diarrhoea of children with bad digestion, flatulent distention and clay-colored, pasty, stinking motions, gr. j of the Bichloride to of water in doses of 3j every hour, or, still better, Hydrarg. cum Creta, gr. every hour or two, will restore the natural bilious color and limit the number of the stools(R) ; Calomel in minute doses, gr. toiV every half hour, is useful in the diarrhoea and dysentery (ileo-colitis) of children, when there is much irritability of the stomach (B); in the acute or chronic diarrhoea of children, characterized by slimy stools mixed with blood and accompanied by pain and straining, gr. j of the Bichloride to £x of water, in doses of 3j, is very efficient, curing with re- markable speed and certainty (R); in mucous diarrhoea, gr. j. of the Bichloride to a quart of water, in doses of 3j every hour (A. A. Smith). Antipyrin, in doses of gr. to i *4, has rendered signal service in the diarrhoea of infants and children. Aconite, in diarrhoea from chill, with high fever and cutting pains in the abdomen (P). Camphor, in summer diarrhoea and the preliminary diar- rhoea of Asiatic Cholera (B); when from effluvia of drains or exposure to cold (R) ; useful in many forms (P). Ipecacuanha, in summer diarrhoea and dysen- tery of children with greenish stools (B); hourly drop-doses of the wine, espe- cially if vomiting (R) ; when from nervous irritation, especially in young chil- dren (P). Dulcamara, in diarrhoea of children from damp, or with dentition (P). Pulsatilla, dyspeptic diarrhoea, mucous discharges, active piles (P). Qui- nine, 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 ytjj, with occasional doses of Aconite, for vomiting and diarrhoea of gastro-enteritis and prolapse of rectum (P). Chamomile, an infusion in sum- mer diarrhoea of adults, or in that of dentition (R); the Oil in diarrhoea of chil- dren, especially from worms (P). Arsenic, for evacuation of undigested food (B); gtt. j of Liq. Arsenicalis 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). Sul- phuric Acid, in summer and choleraic diarrhoea; small doses in the chronic form and in the straining diarrhoea of children (R). Peptenzyme, is excellent in cholera infantum and the summer diarrhoea of children. Balsam of Peru, is excellent in diarrhoea, with or without tenesmus (Tr). Kola, is useful in atonic diarrhoea. Zinc Salts, are very efficient in the summer diarrhoea of children (B). Haematoxylon, is devoid of irritating qualities and is well adapted to the diarrhoeas of young children. Calumba, in diarrhoea due to relaxation of the mucous membrane and not dependent on inflammation (B). Catechu, in atonic diarrhoea and in that following withdrawal of morphine or opium from habitues, also in the diarrhoea of children ; in the latter the tincture with Chalk- mixture is very serviceable. Kino, in atonic diarrhoea ; the tincture in doses of 3j for the diarrhoea resulting from the disuse of opium or morphine. Coto, the fluid extract, or Cotoin, is one of the new remedies for atonic diarrhoea. Tan- nic Acid, is very useful in profuse and chronic diarrhoea (B); with milk diet in chronic diarrhoea and dysentery (S). Opium, is commonly used, but is best when evacuations are very watery, combined with mineral Acids or with Lead Acetate (B); with Starch as an injection in severe cases (R). Codeine, gr. ss-j answers most satisfactorily in the milder forms of diarrhoea and leaves no un- pleasant after-effects (Braithwaite). Bismuth Subnitrate, is effective, requires large doses; gr. xxx-lx every 3 or DIARRHCEA. 633 4 hours; is especially indicated when desire for stool is felt immediately after eating (B); gr. j hourly with milk, sometimes with gr. of gray powder in vari- ous forms of infantile diarrhoea (R). Bismuth and Ammonium Citrate, in diar- rhoea without irritation, but rather relaxation of the intestinal mucous membrane. Bismuth Salicylate, is highly praised in the diarrhcea of phthisis and in that of typhoid. Salol, is very efficient in acute diarrhoea due to action of microbes. Resorcin, gives very marked satisfaction in the diarrhoea of children. 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 combined with Bismuth in cholera nostras and cholera infantum (B). Mineral Acids, in painless, watery stools, light color and alka- line (B). Alkalies, Mistura Cretae in sour-smelling stools (B) ; Sodium, Potas- sium or Magnesium Bicarbonates when acid canal (R). Calcium Carbonate, as Chalk-mixture, in the later stages, also in the diarrhoea of typhoid or phthisis (R); may be combined with Opium and with vegetable astringents. Lead Acetate, with Opium as an injection (R) ; is excellent in all forms (B). Rhu- barb, in early stages to get rid of irritant, afterward to check the diarrhoea (R); when torrefied it has no purgative power, but its astringency is retained. Ru- mex, in morning diarrhoea (R). Arnica, checks exhausting diarrhoea with great certainty (P). Silver Nitrate, in diarrhoea of children, with white, pasty, and offensive stools; combined with Opium the most effective remedy for that of phthisis and typhoid (B). Saline Purgatives, a teaspoonful of Epsom salts (Magnes. Sulph.)in awineglass of water every three hours when intestinal inflam- mation (B). Copper Sulphate, the most effective astringent in chronic diarrhoea and that of phthisis (B). Ergot, in persistent, chronic diarrhoea (B). Iodine, one or two drops of tincture in diarrhoea from atony of mucous membrane (B). Castor Oil, in diarrhoea from irritating matter in the intestinal canal, as un- digested aliment or irritant secretions, no remedy more useful (B). Diet, should be cool or cold, light, bland food; gruel, rice, arrowroot, 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. In most forms of diarrhcea in children it is wise to cut off milk and substitute some artificial food (R). [Compare Dysentery, Cholera.] Prescriptions, R. Bismuthi Subnit., . . . 3 j-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. R. Zinci Sulphatis, Pulv. Opii, Pulv. Ipecac., . . . aa gr. xij. M. Fiant pil. no. xij. Sig.—One 3 or 4 times daily in chronic diarrhoea of adults. R. Sodii Bromidi, . . . . 3 ss. Mucil. Acaciae, Aquae Purce, aa q. s. ad j|ij. M. Sig.—Teaspoonful every three hours in the diarrhoea of dentition, for child less than a year old. (A. A. Smith.) R. Tinct. Opii Camph., Tinct. Catechu, . . aa giij. Mist. Crete, 3 x. M. Sig.—A teaspoonful four or five times daily for children. R. Tinct. Opii Deodorati, . zj. Tinct. Calumbae, q. s. ad 3 ij. M. Sig.—Teasp. in a winegl. of water before meals. R. Tinct. Opii Deodorat., . nyx. Bismuthi Subcarb., . . 3jss. Syrupi Zingiberis, . . . 3 vj. Mist. Cretae, . q. s. ad 3 iv. M. et fiat emulsum. Sig.—A teaspoon- ful every 2 or 3 hours, for a child of one year old, when the stools are acid and green. (Goodhart.) R • Zinci Oxidi, gr. xvij. Sodii Bicarb., gr. viij. M. et div. in chartulas iv. Sig.—One every 6 hours. 634 DIPHTHERIA. R. Plumbi Acetat., . , . gr. xx. Pulv. Opii, . . . . gr. x. Fiat niassa, et, div. in pil. x. Sig.—One twice daily. R. Ac. Nitrici Diluti, . . . gij. Tinct. Camphorae, Tinct. Opii, . . . . aa Syr. Zingiberis, . . . . g iv. Aq. Mentha; Pip., q. s. ad £ vj. M. Sig.—Tablesp. doses to be used after a cathartic. (Hope's Mixture as modified by Thompson.) R . Spiritus Altheris Co., Tinct. Opii Camph., . aa Sj. Syr. Simplicis, . . . . 3 ij. M Sig.—A dessertspoonful after each movement. R. Tinct. Opii Camph., Syr. Rhei Aromat., . aa Sss. Aqua; Calcis, . q. s. ad M. Sig.—A teasp. for children. Diphtheria. Antitoxin, is eminently successful, particularly when the treatment is com- menced early in the case, (See page 149.) Mercury, the Corrosive Chloride internally, with Ichthyol rubbed into the glands of the neck, employed with marvellous success (Davison); doses for 24 hours are gr. in §'\v of water for young children, gr. )4 in 3jvj for children of 6 or 7 years, gr. Y in for adults, with Ichthyol fas above) and Antipyrin by enema if much fever (Dale) ; the Bichloride has given me most success, with a gargle of Thymol or Boric Acid (Da C); gr. jss in 3R of glycerin and water, of which £>j every )4 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 (Oatman). Hydrargyrum 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); gr. in Jiv of water, of which gj to iv as per age every hour (Schultz); used by homoeopaths in Berlin almost entirely, sometimes alternated with Apis, but most efficacious alone; table of 484 cases so treated, with 28 deaths. {Brit. Jour. Homaeop., 1884, p. 382.) Calomel is next in importance to Quinine and Iron, has proved successful in cases where other means failed, gr. every 3 hours, with a little Dover’s powder (Da C); checks plastic exudation, its use limited to children of good constitution, with sthenic symptoms ; gr. 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 3iv, 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 sali- vation is feared (Reiter) ; the safest and most efficient germicide with which we can saturate the system; nothing like it in diphtheria, gr. *4-yi every hour, even gr. j every 2 hours has no bad effects, no salivation (Fowler). 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). 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 injurious in ady- namic 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). Arsenic, in medicinal doses for malignant cases, or when sloughing of throat (R); the Iodide, in doses of gr. every hour or so, (see under Throat, Sorr), an ex- cellent remedy for the so-called diphtheritic sore throat. Calcium Chlorate, in solution locally as lotion for the mouth ; considered almost specific by some ; its chief utility is in removing fetor; may influence germs (R). .Potassium Chlorate, grain-doses every ]4 hour (Smith); is more largely used than any remedy, both internally and locally (B); in full doses with Liq. Cinchonse, DIPHTHERIA. 635 seems to be of service in some cases (Wa). Carbolic Acid, as spray, a 5 per cent, solution in the atomizer cup ; locally to the fauces, to remove fetor and destroy disease-germs (B); the strong acid in Glycerin as caustic on a mop or brush (W); with Iodine internally to prevent systemic infection (B). Sodium Sulpho-carbolate, internally, has been found useful in lieu of Carbolic Acid (Wa). Salicylic Acid, locally, and internally, gr. x, has produced good re- sults (B). Sulphurous Acid, the 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); in full and frequent doses, causes rapid disappearance of the exudation, and improvement in the general condition ; 3) 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, 3) to §j aquae, locally, an easily managed application (B); an injection for nares in nasal diphtheria (Da C). [See formula below.] Sodium Hyposulphite, in solution of 3j to of water, of which hourly doses of 3), to be retained in throat several minutes before being swallowed, 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). Lime-water, dissolves false membrane; the vapor of slaking 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 tincture, gtt. xx every 2 or 3 hours; or better the Per- chloride, gr. y to j every 2 hours in syrup and water, is easier to take and doesn’t hurt the throat (Da C); the solution is an ingredient of Loeffler s Solu- tion (see formula below) for local use. Thymol, 3) in Glycerin and Water 3'rij, is the best agent for use as a gargle (Da C). Toluene, with Menthol, Creolin, etc., as in Loeffler s Solution, which is applied on a swab of cotton every 3 hours for 4 or 5 days, after cleansing the surface; is highly efficient for destroying the bacilli and preventing absorption of toxin (Loeffler). Hydrogen Dioxide, the solution, as spray or gargle, is a very useful application, and may be diluted with 3 to 4 parts of water; is much more powerful against young bacilli of diphtheria than against those of two days old, and hence its therapeutic value is especially available at the very outset of the disease, and as a prophylactic during epidemics thereof (Traugott). Glycozone internally, a tablesp. in a winegl. of water every 3 hours, has an excellent effect (Edson). Tartaric Acid, locally converts membrane into a gelatinous mass, easily ex- pelled (Vidal). Chloral, a dilute solution in glycerin and water makes an excel- lent local application for the throat; internally may be used as a symptomatic remedy in the early stages, but not when the heart is weak. Papain, by atom- ized inhalation, is used to destroy the membrane. Pineapple Juice and Papaya Juice, used by sipping and swallowing the juice after chewing the pulp, highly efficient in India (Chambers); see page 377. Boracic Acid, in solution as gargle, ranks next best after Thymol (Da C). Sulphur and Alum, equal parts, pow- dered and blown into the throat at the moment of deep inspiration, as often as asphyxia is threatened, are efficient (Jones) ; Sulphur is a very old and efficient local remedy in diphtheria, the flowers (sublimed sulphur) rubbed up with water as a gargle, or blown upon the throat through a quill, was the method of Dr. Field, who had a great reputation in England a few years ago for curing this disease {Lancet). 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 (Fruitnight). Chinolin, a 5 per cent, solution painted over the affected parts with great advantage (Seifert); the tartrate in 10-grain doses in- ternally (B). Bromine, the vapor by inhalation, is useful (Wa) ; a TJ-W solution in distilled water, of which gtt. j-iij every hour in a teasp. of sweetened water, using a glass spoon ; and a saucer full of Bromine Water in the room, renewed every 12 hours, has seemed to be extremely efficient in a number of cases. Iodine as inhalation frequently ; with use the solution may be increased 636 DIPHTHERIA. to §ss at each inhalation (R). Potassium Permanganate, gr. in distilled water, internally, and also used locally, is of undoubted benefit (B); is credited with brilliant results even in malignant cases. Sanguinaria, the best emetic, and by many is considered specific in this disease (P). Lactic Acid, 3iijss to 3x of distilled water, as gargle, on mop or by spray, to dissolve membrane (B). Tannin, a 5 per cent, solution as spray (R). Cubeb, very efficient in the catar- rhal forms of diphtheria (Robinson) ; the freshly ground berries in large doses in early stages of the disease, a very successful treatment (Trideau). Turpen- tine, 3j of the oil thrice daily, with rt\,iv of Spiritus yEtheris as a corrective, at the same time using ice-bags, and a gargle of Potassium Chlorate solution, and internally doses every 2 hours of a 2 per cent, solution of Sodium Salicylate (Roesse, Baruch). Tar and Turpentine vapor, made by burning in the room Coal-tar7 parts to Oleum Terebinthinas 3 (Delthil). Methylene Blue, was used with success after losing cases by other treatment; even in simple non-diphtheritic ulceration of the throat, patients would, after one or two appli- cations of the solution express themselves with delight as being cured (Rose). Chlorine-water, tablesp. doses internally and as a gargle, highly efficient; a mixture of Chlorine-water 2 parts and Distilled Water 1, of which 3j internally every 2 or 3 hours, is by far the best treatment of this disease; no water should be given after the mixture (Schubert); as a prophylactic the same may be given 2 or 3 times daily (Id). Nuclein, has been used with benefit (see page 134). Strychnine, hypodermically, for the subsequent paralyses (R). Alcohol, is probably as good a local antiseptic as any ; diluted with equal parts of water, by hand-ball atomizer every y2 hour; is the prince of antiseptics, and the most perfect and reliable medicine in diphtheria of which we have any knowledge (Hills). Stimulation, freely, the essential part of the treatment; infants are not injuriously affected by every teasp. doses of whiskey every y2 hour; stimu- late for effect and not by dose ; those cases do best which are stimulated freely and early (Da C); there is more danger from giving too little alcohol than from too much ; a three-year-old child can comfortably take of Cognac, or gr. xv of Musk or Camphor, or gr. xv-3j of Ammonium Carbonate in 24 hours ; in the septic form especially, the intoxicating action of Alcohol is not experi- enced, and young children with general sepsis began to improve when their of brandy were increased to jfxvj daily (Jacobi). Water, as ice in the mouth, and the wet pack to the throat are extremely serviceable (B); Ice sucked, especially at commencement, and continued until the disease declines (R); Ice packed in bladders or thin india-rubber bags, to the throat (W). Ali- ment, good foods, wines or brandy, necessary from the start to maintain the patient’s strength (R); a teasp. of glycerin every 3 or 4 hours, plenty of good soup and wine, nutritive enemata, are necessary to sustain the system. Moist inhalations. Temp, of room 68° Fah. Removal from the house wherein attacked is advisable. Tracheotomy, only in extremis (R) ; is not successful in diphtheria, though very much so in membranous croup (Da C). Intubation of the Larynx, as an alternative to tracheotomy, is enthusiastically advocated by many operators. Prescriptions. R. Hydrarg. Chlor. Corros., . gr. jss. Glycerini, 5j. Aquae Destillatae, .... iij. M. Sig.—A teasp. every hour for 6 doses, then every hour night and day to a child of four years. Also,— R. Ung. Iodoformi (1 in 10), rubbed in over swollen glands every 3 hours. (Grant-Bey.) R. Potassii Chloratis, . . . . gr. xl. Syrupi Simplicis, (calid.) . Jijss. Solve, et adde— Ac. Sulphurici Aromat., Tinct. Ferri Chloridi, . aa 3j. M. Sig.—Teasp. doses for adults, every 2 to 4 hours, reduced as improvement ad- vances, but kept up throughout disease. R. Sodii .Sulphitis, 3 iij. Glycerini, sj ij. Aquse, q. s. ad 3 iv. M. Sig.—Nasal injection. [Da Costa.) R. Ac. Tartarici 5 j. Glycerini Aquse Menth. Pip., q.s. ad 3 iv. M. Sig.—Gargle frequently. ( Vida/.) DROPSY. 637 R. Tinct. Ferri Chloridi, . . Ijj. Syrupi Tolutani, Liq. Potassi Citratis, . aa 5 ijss. M. Sig.—Teasp. to dessertsp. accord- ing to age, every 3 hours, 3j=rrpx of the tincture. {Anderson.) R. Hydrarg. Chlor. Corros., gr. j, may be added to the above formula, which should then be given in teasp. doses. Alcoholis, . . . . q. s. ad Cc. 100. Sig.—To be applied by cotton swab every 3 hours for 4 or 5 days. {Lceffler's Solution.') R. Tinct. Ferri Chloridi, . . Sjj. Potassii Chloratis, . . . . Misce et adde— Aquae, q s. ad viij. Sig. —Gargle. (Jacobi.) For the chemistry of this combination see under Chlorijm, ante, page 233. Gly- cerin should not be added, as in Dr. Ja- cobi’s original R, which makes a mixture which may explode. R. Mentholi, Gm. 10. Toluene, . . . . q. s. ad Cc. 36. Dein adde— Creolin Cc. 2. Liq. Ferri Chloridi, . . . Cc. 4. Dropsy. Arsenic, in dropsy from feebleness of heart, and in old age (B) ; swelled feet from debility (R). Aurum, has an ancient reputation in several forms of dropsy (see page 175). Digitalis, one of the best remedies, especially in renal dropsy from acute desquamative nephritis; the infusion in doses of 35s (B); the fresh infusion best for that of heart disease, especially when tricuspid regurgitation (R); induces striking effects in cardiac dropsy, when scanty urine and venous engorgement; has high rank as a diuretic (P). Apocynum Cannabinum, actively diuretic (P). Diuretin has been employed with marked benefit in both cardiac and renal dropsy, in hepatic cirrhosis, and in various diseases of the heart and kidneys accompanied by oedema: gr. xv several times daily, in aqueous solution, avoiding acids or acid vegetable juices. Caffeine, the Citrate in 5-grain doses is eminently diuretic; for objections to its use see page 198. Cactus, has long had a high reputation in dropsy among the natives of its habitat; is probably of service in cardiac dropsy. Hydrar- gyrum, a classical pill in dropsy with dyspnoea from cardiac disease is the combination of Dr. Baillie, containing Mercury, Digitalis, and Squill (see formula below); Calomel in doses of gr. ss-ij is eminently diuretic, especially in cardiac dropsy, but by many it is thought to act by aiding the action of other diuretics. Bryonia, as a drastic purgative and diuretic ; care necessary as it depresses the heart; the infusion best (P). Hellebore, the tincture, in doses of gtt. v-xv, every 2 or 3 hours, very successful in dropsical effusions, especially in general anasarca after scarlatina (P). Senega, as a diuretic when dropsy is dependent on kidney disease; has been praised (P). Chima- phila, is useful as a diuretic in renal dropsy especially when loss of appetite and debility (P); may be substituted for Scoparius (B). Juniper, largely used as a diuretic in cardiac and renal dropsy (B) ; esteemed in post-scarlatinal dropsy (R). Iron, purgative chalybeate waters (B): the Liquor Ferri et Am- monii Acetatis (Basham’s Mixture), in anaemic dropsy (Da C). Pilocarpus, very valuable in renal dropsy when secretion of urine is much reduced or sup- pressed (B). Jalap, the compound Jalap powder, gr. xv-xx, with 3>i'j of Potas. Bitart, and a little Ginger, early in the morning, 2 or 3 times a week ; no hy- dragogue superior in dropsy from Bright’s disease (Wa). Turpentine, controls dropsy with albuminous urine, from non-desquamative renal disease; gtt. ss. every 2 to 4 hours (P). Colchicum, as a hydragogue in hepatic and cardiac dropsy when patient is vigorous, also in post-scarlatinal dropsy (B). Scopar- ius, esteemed by English physicians (B); is most useful in cardiac dropsy; Cullen found it the most certain diuretic: diluents should be freely used with it (P). Squill, in cardiac dropsy; cautiously if fiom kidney disease ; if anaemic add Iron (R). Taraxacum, is occasionally used as a diuretic, with limited utility (B). Copaiba, gives good results, especially in ascites, which see for formula (B). Potassium Bitartrate and Acetate, are very certain as diuretics 638 DUODENAL CATARRH. when largely diluted with water, as Cream of-tartar lemonade; indicated in desquamative nephritis, and in general dropsy from valvular disease of the heart (R). Elaterium, of unquestionable value as a derivative in many pas- sive forms of dropsy, though many fear it (P). Acupuncture, or better still, incisions from y to an inch long, one over each external malleolus generally sufficient; a hot sponge, moistened with weak Carbolic Acid solution kept to incisions (R). Aliment, dry diet is of advantage in dropsy of serous cavities (B); should be light in acute dropsies; nourishing in chronic. Water not in- jurious but beneficial as drink. Warm baths, Holland gin in small doses, tapping for alleviation in incurable cases. A moderately warm, dry atmos- phere. Skim-milk diet said to be of great value in renal dropsy. [Compare Ascites, Hydrocele, Hydrocephalus, Hydrothorax, etc.] Prescriptions li . Vini Colchici Seminis, . . % ss. Liq. Ammonii Acetat., . . Infusi Petroselini, . . . . gx. M. Sig.—Teasp. every 4 hours. An excellent diuretic, especially adapted to the dropsy of scarlatina. (B.) R. Elaterini, gr. j. Spt. Etheris Nitrosi, . . . giy Tinct. Scillae, Tinct. Colchici, . . . aa % ss. Syr. Symplicis, . .... gj. M. Sig.—A teaspoon ful 3 or 4 times daily, for hepatic and cardiac dropsy in sthenic subjects. $. Tinct. Digitalis, 3j-ij. Tinct. Scillae, g ij. Spt. Juniperi Comp., . . g iv-vj. Potassii Acetatis, . . . . g iv. Vini Albi, . . . . q. s. adg vj. M. Sig.—A tablesp. 3 or 4 times daily. 1$ . Potassii Acetatis, .... Spt. Etheris Nitrosi, . . . g ij. Aquae, . . . . . q. s. ad g viij. M. Sig.—Tablesp. every 3 or 4 hours. li. Potassii Bitartrat., . . . . j. Ext. Taraxaci, g ss. Decocti Taraxaci, . £ viij. M. Sig.—]/2 wineglassful twice or thrice daily. li • Pulv. Digitalis, gr. j-jss. Pulv. Scillae, 'gr. j. Hydrarg. c. Creta vel Pil. Hydrargyri, .... gr. j—iij. Ft. pil. no. j. Sig.—One thrice daily. R . Aceti Scillse 1$ ss. Infusi Digitalis, . q. s. ad j|iv. M. Sig.—A tablesp. 2 or 3 times daily. Ii. Pulv. Scillae, Pulv. Digitalis, . . . . aa g ss. Potassii Nitratis, . . . . gj. M. Fiat massa, et div. in pil. xxx. Sig.—One pill thrice daily. H • Liq. Ferri et Ammonii Ace- tatis (U. S. P.), . . . . 3yj. Sig.—Dessertsp. or two three or four times daily. (Basham's Mixture.) Duodenal Catarrh. Salol, is the most efficient remedy. Sodium Phosphate, oj four times daily, extremely efficient in catarrhal conditions of the duodenum and bile-ducts, resulting in jaundice, hepatic colic, etc. (B). Vichy Water, in similar condi- tions, probably owes its efficacy to the Sodium Phosphate contained in it (B). Potassium Bichromate, in doses of gr. r5~5> two or three times a day, is an excellent remedy in so-called duodenal dyspepsia, manifested by a bitter taste, coated tongue, pale stools, vomiting of glairy fluid and dull pain in right hypo- chondrium. Arsenic, has been used with success in jaundice from catarrh of bile-ducts after duodenal catarrh (B). Aurum salts will often remove duodenal catarrh, and that of the bile-ducts, also the jaundice therefrom (B). Podophyl- lum, in catarrhal and malarial duodenitis. Nitro-muriatic Acid, internally in mucous duodenitis ; also as bath to right hypochondrium (3 iij to gall, j), temp, of bath 96° (B). Aliment, no starches or fats ; milk, eggs, oysters, beef-broth, broiled or raw beefsteak, white-fish (B); the diet should be exclusively animal, in order to let the stomach deal with it. [Compare Jaundice, Biliousness.] DYSENTERY. 639 Dysentery, Mercury, in minute doses for the ileo-colitis of children; gr. to of Calomel or Hydrargyrum cum Creta every half hour (B); gr. of the Bi- chloride hourly or every 2 hours, in acute or chronic dysentery if stools are slimy or bloody (R). Ipecacuanha, is par excellence the remedy for acute dysentery of the ordinary type ; large doses ; gr. xxv-xxx (P); gr. xv in milk (B); valuable in acute or epidemic forms, also in summer dysentery of children, with greenish stools, mucus and blood, gr. ij-v every 2 hours, in milk (B); in dysenteric diarrhoea of children, especially with vomiting, which will often yield to hourly drop doses of Ipecac wine (R). Hamamelis, when the discharges contain much blood (R). Aconite, when fever and cutting pains (P). Nux Vomica, in epidemic dysentery (P) ; prune-juice stools, much gas, vital depression (B). Arsenic, Fowler’s solution gtt. ij with gtt. v of Opium often benefits (B). Quinine, when periodic (B) ; in malarial subjects is as suc- cessful as Ipecacuanha in dysentery of the ordinary type (P). Gamboge, gr. % in 24 hours, exceedingly valuable, especially in young persons (P). Castor Oil, as a mild cathartic, is very valuable in appropriate cases (Wa); gtt. v every hour, in water with sugar and gum, is excellent for dysenteric diarrhoea of children (Smith). Bismuth Subnitrate, in doses of 15 to 20 grains every hour or so, is highly efficient; may also be used in suspension with Starch or Chalk- mixture, as a rectal injection. Arnica, is highly extolled for cases where the vital powers are depressed (Wa). Salol, is highly efficient. Saline Purgatives, Epsom salts the best treatment for acute dysentery, especially when fever, pain, tenesmus and stools of mucus and blood (B). Potassium Bitartrate, in acute dysentery with scorbutic symptoms, as seen in miners, sailors, etc.; a full cathartic dose, or more, has acted most beneficially as a preliminary to other treatment, and in many cases has proven to be the only remedy required. Silver Nitrate, in pill. gr. %-), with Opium, in acute dysentery after subsidence of acute symptoms ; also as enema beyond the sigmoid flexure (gr. x-xx ad Oj aquae) ; also as escharotic through speculum to ulcer of rectum (B) ; a solution of 1 in 1000, as antiseptic wash daily, up to 60 washes in series, entirely successful in many cases of the recurrent form of tropical dysentery, having lasted from 1 to 5 years (Gallay, Surgeon-Major for French Colonies). Balsam of Peru, 3 grains, with alcohol 3j> syrup of lemons and water excellent for dysentery (Tr.) Opium, as enema, with starch and milk, after canal is emptied by salines; indispensable in chronic dysentery (B); for the purging (R); a remedy of great value, and applicable to every stage and every form of the disease, allaying pain and vascular excitement, moderating peri- stalsis, promoting the cutaneous secretion ; is inferior to Ipecac in acute dysen- tery, and is most valuable in the chronic form (Wa). Glycerin, with infusion of Linseed (1 to 4), to allay tenesmus (B). Lead Acetate, as enemata, in acute and chronic dysentery, to allay tenesmus (B); with Ipecac and Opium in pill, for acute form (Da C). Sulphuric Acid, with saline purgatives (B). Copper Sulphate, useful in acute dysentery; in chronic the most valuable astringent (B) ; gr. x-xx ad Oj aquae (R). Ergot, in chronic, after acute ; and also in the acute form (R). Grape-cure, is used successfully in the chronic form (P). Iron Pernitrate, sometimes in chronic (army) dysentery (B). Calumba, is of great value in chronic dysentery with ulceration of colon (P). Chekan, is used with benefit. Injections of mucilaginous enemata (as Linseed) are of great value (R). Diet is of prime importance (B). Avoid animal food and stimulants; liquid foods best; all cold (R). [Compare Diarrhoea, Enteritis.] Prescriptions & . Magnesii Sulphatis, . . . viij. Ac. Sulphurici Dil., . . . ,^ss. Aqute, M. Sig.—Tablesp. in a winegl. of water every hour or two until it operates. (B.) \ &. Ergotini, gr. xx. Ext. Nucis Vom., . . . . gr. v. Ext. Opii, gr. x. Fiant pil. no. xx. Sig.—One pill every ! 6 hours. [King.) 640 DYSMENORRHCEA. R. Plumbi Acetatis, . . . . gr. xxiv. Ipecacuanhae, gr. iij. Pulv., Opii, gr. iij. Fiant pil. no. xij. Sig.—One every 2 hours until blood ceases, then at longer in- tervals. (Da Costa.) R. Plumbi Acetatis, . . . . gr. iv. Morph. Acetatis, . . . . gr. ss. Aquae Fervid., M. Sig.—Enema to allay tenesmus. R . Bismuthi Subnit., . . . . 3 ij. Spt. Ammon. Aromat., . Tinct. Opii, gtt. xvj. Syrupi Simplicis, . . . . |jss. Misturse Cretae, M. Sig.—Dessertsp. to child over one year ; tablesp. or more to an adult, every 2 or 3 hours, after emptying bowels by a laxative. R. Morphinae Sulph., . . . . gr. ij. Strychninae Sulph., . . . gr. Ac. Sulphurici Dil., . . . § ss. Aquae Camphorae, . . . . % iijss. M. Sig.—Teasp. well diluted, every hour or two. In epidemic dysentery with prune-juice stools and marked depression. R. Ext. Ergotae FI., . % iijss. Tinct. Opii Deodorati, . . ss. M. Sig.—Teasp. thrice daily. {Andrew.) R . Liq. Ferri Nitratis, Ac. Nitrici Dil., . . . aa 3 ss. Syr. Zingiberis, l|j. Aquae, q. s. ad 5 iij. M. Sig.—Teasp. thrice daily for a child of 2 years. Tonics to follow palliative treatment. (Starr.) R . Ferri Sulphatis, gr. xl. Pulv. Opii, gr. xx. Fiant pil. no. xx. Sig.—One pill thrice daily, in chronic dysentery. Dysmenorrhcea. Ammonia, the Aromatic Spirit in doses of Sj every 4 hours or oftener, a thoroughly trustworthy remedy, and should be used in place of the alcoholic stimulants generally prescribed (Illingworth). Ammonium Acetate, has re- markable power over many forms of dysmenorrhoea; the Liq. Ammonii Acetatis, in doses, with gr. X of Ipecac, every 2 or 3 hours, to keep up the action of the skin until the flow is well established (E). Antipyrin, as an anal- gesic, is efficient. Acetanilid, is equally efficient for the pain. Cimicifuga, relieves the pain in the congestive variety, and is decidedly useful (P); is said to be very efficient (R); is valuable (Wa). Opium, necessary when pain is very severe; one hypodermic of Morphine at each period is often sufficient (Wa). Codeine, when Morphine is not well borne, has given very complete satisfaction in several cases; gr. X to X morning and evening (Oliver). Gelsemium, relieves pain in the neuralgic form, x of the fluid extract every 2 hours (B). Chloroform, as the liniment on a flannel wrung out of hot water, or by inhalation as anaesthetic when pains very severe; sometimes exerts a permanent influence (Wa). Ergot, given when the molimen begins, is useful in the congestive form (B). Amyl Nitrite, may be inhaled with bene- fit in the neuralgic variety, especially in chlorotic girls (Wa). Sodium Borate, in the membranous form, has been used with great benefit combined with Ext. Belladonnas (Wa). Camphor, is my favorite remedy, gr. x in mucilage and Cinnamon-water; repeat the dose in an hour or two if necessary (Dewees). Guaiacum, is very useful (P); drachm doses of the ammoniated tincture in the neuralgic or rheumatic forms (B). Caulophyllum, is by many considered the best curative remedy for spasmodic dysmenorrhoea, if given in the intervals. Viburnum Opulus, the fluid extract, in half-drachm doses, has considerable reputation in some sections for uterine pains of various kinds, and is useful in the spasmodic variety of this affection ; may be used in combination with Canna- bis Indica (Thomas). Arsenic, gtt. iij-x of Fowler’s sol. with gtt. x of Tinct. Digitalis, ter die between the periods, gives excellent results (Athill); indicated when copious membranous discharge from bowels and uterus (R). Cannabis Indica, is very useful as a palliative in painful menstruation (B); gr. ss-j thrice daily to relieve the pain (R). Nux Vomica, in neuralgic form ; Syrup or Elixir of Iron, Quinine, and Strychnine (B). Apiol, neuralgic form (B) ; as emmena- 641 DYSPEPSIA. gogue, night and morning, for several days near the period (Wa). Pulsatilla, in the functional form ; is of much benefit when discharge is scanty or profuse, black and clotted; should be persevered in for 2 months or more (P) ; gtt. ij every hour is most effective when the affection is not of membranous, obstruc- tive, or neuralgic character (Smith). Hydrastinine, has been used with benefit. [See under Menorrhagia.] Chloralamid, in one dose of gr. xxx, to prevent an impending attack, has been of service. Belladonna, in neuralgic or spas- modic forms, dark and fetid discharge, crampy pains, and cold chills ; a sup- pository or mild injection, together with internal administration, will relieve (P); in neuralgic dysmenorrheea it will permanently relieve (B). Aconite, a valuable remedy when commenced early (P) ; for the congestive form in ple- thoric subjects (B). Aletris, is advertised as a highly efficient agent. Carbonic Acid, injected into the vagina (See page 82). Electricity: in neuralgic, a gal- vanic current; in congestive, the inverse current (B). Croton-chloral, in neu- ralgic form (R). Iron, if depending on anaemia (B). [See Amenorrhcea for formula.] Cajuput Oil, said to relieve the pains (R). Rue and Sumbul, are reported useful (P). Emetic of Ipecac, with warm covering in bed, feet in hot water, hot ginger tea, Liquor Ammonii Acetatis ; if pain very severe, a sup- pository of Morphine and Belladonna per rectum ; best to avoid anodynes (E). Accessories, spinal ice-bag, when scanty discharge; when menorrhagic, hot water spinal-bag; sitz-baths, either hot or cold, or cold alone, during intervals. R. Ext. Cimicifugre FI., . . . giv. Ext. Pulsatillse FI., . . . gjss. Ext. Eriodyctii FI., . . . £j. Syr. Aurantii, . . q. s. ad £ iv. M. Sig.—One or two teasp. every two hours, for six doses. Prescriptions. R. Ext. Ergotse Fluidi, . . . £ vij. Tinct. Gelsemii, . . . . g). Tinct. Aconiti, TTLxvj. M. Sig.—Teasp. every 2, 3, or 4 hours. In congestive dysmenorrheea. R. Ext. Belladonnte, . . . . gr. iv. Ext. Stramonii, Ext. Hyoscyami, . . . aa gr. v. Quininse Sulphatis, . . . gr. xl. Fiant pil. no. xx. Sig.—One pill thrice daily, in neuralgic dysmenorrheea. R. Ext. Opii, gr. v. Ext. Cannabis Ind., Ext. Hyoscyarai, . . . aa gr. x. Camphorse, . . . gr. xxv. M. Fiant. pil. no. x. Sig.—One pill two or three times daily. {MeLane.) R. Ext. Viburni Prunifol. FI., Ext. Senec. Aurei, . . . z\). Tinct. Guaiaci Volat., . . tifxij. Sig.—A teasp. in new milk, thrice daily, between attacks, 3 j every hour during at- tack, and a hot sitz-bath. R. Ext. Cannabis Ind. FI., . gjss. Ext. Viburni Op. FI., . . Mucil. Acacise, i^iij. Aq. Cinnamomi, . q. s. ad J iv. M. Sig.—Dessertsp. every 4 to 6 hours. Dyspepsia Pepsin, is very beneficial; Scheffer’s or Beale’s saccharated pepsin with diluted HC1 acid (B) : is especially adapted to gastric indigestion. Pancreatin, for intestinal indigestion; Liquor Pancreaticus to peptonize milk, gruel, soups, etc., before administration, in cases of great digestive debility. Peptenzyme, is said to be very efficient. Papain (Papoid), acts equally well in gastric and intestinal indigestion, and hence is particularly indicated in cases of difficult diagnosis as to the location of the trouble ; is used in the various forms of dys- pepsia and indigestion with most excellent results : has marked proteolytic action in acid, alkaline and neutral solutions, and in the presence of many chemicals, antiseptics and therapeutic agents (Chittenden). Ingluvin, also promotes digestion (B). Pineapple Juice has the power of digesting proteids (Marcano) ; the fresh juice is a very constant and powerful digestant of albu- minous matters, its ferment being decidedly active in the presence of either 642 DYSPEPSIA. acids or alkaline carbonates, but most energetic in neutral solution, and be- tween 122° and 140° F. (Chittenden). Mineral Acids, Hydrochloric or Lactic with Pepsin after meals in atonic dyspepsia ; Hydrochloric after meals for acid pyrosis; Nitro-muriatic for dyspepsia with mental despondency, oxalates in urine, offensive gas, sallow complexion (R) ; Phosphoric, dilute, very efficient before meals (Da C). Sulphurous Acid, tt\,v-3j, well diluted, for acid pyrosis (B). Alkaline Mineral Waters, before meals in atonic dyspepsia, and highly useful in the dyspepsia of obese subjects (B). Alkalies, shortly before a meal increase the gastric juice, and are usually better than acids in atonic dyspepsia; Sodium Bicarbonate is the best (R) ; a full dose (gr. xl-lx) in dyspeptic attacks, with flatulence, etc., usually affords speedy relief (Wa); Limewater is often efficient. Chloroform, gtt. xv-xx in sweetened water, when rapid fermentation of food and evolution of gas soon after eating ; is promptly efficient in giving relief (Willis) ; a highly efficient remedy in acute dyspepsia. Chloral, is a very good remedy in doses of 5 to 10 grains in of cinnamon water; acts as a gastric antiseptic and sedative, and is efficient in the nervous dyspepsia of neurotic subjects, with severe gastric pain. Arsenic, drop doses of Fowler’s solution before meals in irritative dyspepsia (B); also when diarrhoea is excited by food (R). Bryonia, in dyspepsia of liver origin, and bilious headache with vomiting (P). Charcoal, when flatulence ; Nux Vomica in 5 tt\, doses before meals, better (R). Mercury, Gray powder, gr. j, 3 or 4 times a day, when dyspepsia during chronic disease or convalescence; if constipated, Calomel, gr. ss, with Ext. Hyoscyami, gr. iij, in pill for 3 nights (R); the Yellow Oxide, in doses of gr. for dyspepsia septica and kindred disorders of the ali- mentary canal; remarkably efficient in Austrian navy (Schaffer). Ipecacuanha, tt\,v-x of the wine most valuable in atonic and chronic catarrhal dyspepsia (P); constipation, depression, food like a heavy weight (R). Hydrastis, gtt. v— xv of the tincture before meals, a good stomachic tonic (B); in chronic dys- pepsia, sluggish liver (P). Pulsatilla, a good remedy when depression with fear of death, white-coated tongue, little or greasy taste, nausea, flatulency, heartburn ; gtt. v in water every 4 hours (P). Cannabis Indica, often renders good service in indigestion. Nux Vomica, gtt. v-x ter in die before meals as stomachic tonic (B); when flatulence, weight on head, and heartburn (R); often of the highest possible value in simple atonic form, or in the dyspepsia of drunkards (P). Cinchona, with mineral acids in atonic dyspepsia (P). Quinine, especially for town- dwellers and elderly people ; checks excessive fermentation in alimentary canal (R). Chamomile, nQj of oil, very useful in atonic dyspepsia (P). Igna- tia, useful in nervous dyspepsia (P). Taraxacum, certainly does good in sim- ple atonic dyspepsia (P). Belladonna, gr. l/e to % of the extract, once a day when there is constipation (R). Bismuth, mixed with vegetable Charcoal in flatulent dyspepsia (R); gr. x with same quantity of Calcined Magnesia, in chronic gastric catarrh, where diet cannot be regulated (Rose) ; the Subgallate (Dermatol) is said to be an efficient remedy. Aurum, the Chloride is useful in nervous dyspepsia (see page 176). Manganese, gr. x-xv of the Black Oxide in gastrodynia and pyrosis (B). Sanguinaria, gtt. ij-v of tincture or gr. of alkaloid, in atonic dyspepsia promotes secretion and increases the appetite (B). Silver Oxide, -grain doses with same quantity of Ext. Hyoscyami be- fore meals in nervous dyspepsia (B). Xanthoxylum, as stomachic tonic, 3j of the fl. ext. in atonic dyspepsia (B). Simple Bitters, Calumba is the best; Quassia or Gentian or infusions of them as vehicles for acids and alkalies (B) ; Calumba is easily tolerated when the stomach is weak (R); Gentian as stom- achic and tonic, very useful in atonic dyspepsia and that of gouty subjects ; the tinct. in some aromatic water, or in combination with alkalies and sedatives (Wa): Chirata is particularly serviceable in the dyspepsia of gouty subjects. Rhamnus Purshiana, in all cases of dyspepsia associated with a torpid liver and constipation ; small doses at first, gradually increased (Wa). Salophen, is used with decided benefit in intestinal dyspepsia with flatulence. Strontium Bromide, is excellent in dyspepsia, also in acetic and lactic fermentations. Glycozone, is an excellent remedy for atonic and acid dyspepsias, in which it 643 DYSPEPSIA. gives very gratifying results (Edson). Aloes, combined with other agents, where habitual constipation accompanies dyspepsia (R); especially indicated in duodenal dyspepsia, gr. ij-iv with Ipecac gr. j-ij, two or three times a week (Wa). Water, a dry diet will entirely relieve the ice-water dyspepsia, or that due to excessive beer-drinking (B); half a tumbler of cold water J2 hour be- fore breakfast acts to some people as a purgative and removes many dyspeptic symptoms, but flatulent dyspepsia is often traceable to excessive water drink- ing at meals, especially that of iced beverages (R). Hot Water, a pint to a pint at iio°-i5o° F. an hour before each meal and yi an hour before going to bed, each draught sipped slowly during 15-30 minutes; as a cure for dyspep- sia this is an old and efficient practice (Wa). Milk-cure, has succeeded ad- mirably (B); fresh Buttermilk a most excellent article for dyspeptics, as also is Kumyss. Alcohol, in any form, especially good wines, is useful in the atonic dyspepsia of sedentary livers (B); when loss of appetite and of digestive power from fatigue, a glass of wine or brandy-and-water before eating is very appro- priate ; useful also in indigestion of town dwellers, or during convalescence from acute disease (R). Diet, avoid tea and hot beverages, over-cooked food, over-feeding and iced-water; masticate all food well, eat slowly, small quan- tities and frequently. Active out-of-door habits should be cultivated, and all articles of food known to disagree should be strictly, avoided. [Compare Acidity, Biliousness, Flatulence, Gastralgia, Pyrosis.] R. Acidi Hydrochlor. Diluti, . 3 jss. Glycerini, ij. Syr. Rubi Idaei, .... )$jss. Liq. Pepsini (Fairchild), . 3jiij. Spt. Chloroformi, . . . . 3 ss. Vini Albi vel Xerici, q. s. ad$ xij. Sig.— ss thrice daily after meals. Prescriptions. R. Pepsini (Jensen) sjiijss. Ac. Tartarici, gr. v. Glycerini, Sjjss. Vini Xerici, . . q. s. ad 5jviij. M. Sig.—Teasp. or two after meals. R. Tinct. Nucis Vom., . . . giij. Ac. Hydrochlorici Dil., . . v. Glycerini, 3 ij. Aquae Lauro-cerasi, . . . §j. M. Sig.—Dessertsp. before meals, to improve appetite and digestion. R. Ac. Hydrochlorici Dil., . 3j. Tinct. Capsici, 3 ss. Tinct. Calumbae, .... Sjss. Vini Pepsini, . . . q. s. ad 3 iv. M. Sig.—Dessertsp. after meals. In atonic dyspepsia. (Pancoast.) R. Tinct. Capsici, IT\xvj. Tinct. Nucis Vom., ... 3 ij. Tinct. Gentianae Co., q. s. ad3 ij. M. Sig. —A teasp. in water thrice daily, with gr. A Aloin at bedtime, avoiding a starchy diet. For aggravated dyspepsia with constipation. (Pa Costa.) R. Bismuthi Subnitratis, . . £jss. Pepsini, x)). Strych. Sulphatis, . . . . gr. j. Tinct. Cardam. Co., q.s. ad M. Sig.—Teasp., thrice daily in water. For bilious dyspepsia. R . Sodii Bicarb., 5 ij. Spt. Ammon. Aromat., . . X ij. Tinct. Zingib. §j. Infusi Gentianse Co., . . ad 3 viij. M. Sig.—Teasp. or two thrice daily. For acid dyspepsia. R . Chloralis Flydratis, ... 3 ss-j. Sodii Flyposulphitis, . . . %). Aquae Menthae Pip., . . ad£ iij. M. Sig.—A teaspoonful in water after meals in nervous dyspepsia with severe gastric pain. R. Rhei, Gentianae, et Carda- momi,contus., . . . . aaxij. Spt. Vini Gallici, . . . . 3ij. Aquae, 5 vj. Macera per horas 48, cola, et adde— Tinct. Nucis Vomicae, . . gj. Potassii Carbonatis, . . . gj. M. Sig. —Tablesp. in water thrice daily, before meals. R . Creosoti, rr^viy. Bismuthi Subcarb., . . . gij. Glycerini, Aq. Menth. Pip., . . . aa !|j. M. Sig.—To be well shaken. A teasp. every 3, 4 or 6 hours, for pain in stomach and wind. (B.) 644 DYSPHAGIA—DYSPNCEA DYSURIA. Dysphagia. Cocaine, the Hydrochlorate in solution, 20 per cent., as spray or by swab, re- lieves the dysphagia of phthisical laryngitis (P). Cajuput Oil, in nervous dys- phagia, used in India with considerable success (P). Potassium Bromide, for congenital dysphagia of liquids in children, when no diphtheria or malforma- tion (R); in hysterical dysphagia (Wa); benefits a curious affection sometimes seen in children, who from their birth can swallow solids with ease but choke at liquids (R). Sprays of Ammonium Bromide, Chlorine-water, or other sedative agents in warm solution, for the dysphagia depending on specific disease of the larynx (Muirhead). Galvanism, in the vicinity of the oesophagus will speedily remove hysterical dysphagia (Muirhead). Tonics, as Strychnine, Iron and Quinine, for post-diphtheritic dysphagia. Iced Fluids, slowly swallowed, will often remove spasmodic dysphagia (Wa). Dyspnoea. Morphine, hypodermically, the most efficient agent in relieving dyspnoea from cardiac disease, or any other form ; but if albumen in the urine it must be withheld (Allbutt); controls dyspnoea from any cause, more energetically than any other agent, giving the very power to breathe (Huchard). Grindelia, of great service in dyspnoea with cough, occurring in emphysema (W). Cimicifuga, has often relieved most distressing cases from cardiac disease (P). Spigelia Anthelmia, produces and often relieves it when with palpitations (P). Valerian has proved useful when nervous (P). Prunus Virginiana, has proved very efficacious in cardiac dyspnoea (P). Amyl Nitrite, serviceable in cardiac dyspnoea and other forms (Wa). Asafcetida, in combination with other anti- spasmodics, often very beneficial in dyspnoea of chronic bronchitis (Wa). Chloroform, a few whiffs give great relief in the cough and dyspnoea of phthisis and bronchitis (Wa). Ethyl Iodide, by inhalation, is very serviceable in many forms (See). Terpin Hydrate, of especial value in asthmatic dyspnoea, gr. ij every % hour until gr. x are taken (Boyland). Terebene, for the dyspnoea of chronic emphysema of the lungs; efficient in combating this symptom of various pulmonary affections. Arsenic, for the dyspnoea of weak heart. Oxygen inhalations, relieve the dyspnoea of advanced phthisis and also the cardiac dyspnoea connected with mitral disease (P). Dyspnoea is a symptom, and may be due to cardiac, pulmonary, pharyngeal, laryngeal or tracheal disease (T). [Compare Angina Pectoris, Asthma, Bronchitis, Croup, Emphysema, Phthisis, etc.] Prescriptions. R. Potassii Iodidi, 3j. Tinct. Lobelise, iv. Syr. Sanguinaria, . . . . sj. M. Sig.—Teasp. every hour. R. Liq. Morph. (Magendie), . 5jj. Spt. Etheris Compos., . . Syr. et Aquas, . aa q. s. ad £ ij. M. Sig.— 3 ss-j thrice daily. Cantharis, gtt. j (sometimes v) of tincture ter die, for frequent micturition with pain (R) ; for irritable bladder, vesical tenesmus (B). Cannabis Indica, relieves dysuria (R); when bloody urine (P); an excellent anodyne in painful affections of the bladder, having specific action on that organ. Belladonna and Hyos- cyamus, have similar sedative effects in vesical and urethral irritation (P). Linseed, as infusion, is often a valuable adjunct (P). Opium, in suppository, gr. ij combined with Hyoscyamus, gr. x, an excellent palliative (P); an enema of Laudanum or Morphine hypodermically to relieve the strangury caused by blisters (B). Camphor, is said to relieve strangury (R). Chimaphila, has undoubted power (P). Squill, often produces the best effects, especially a com- bination of the Acetum with Spt. Aiitheris Nitrosi equal parts, of which 3ss in Dysuria. EAR ECTHYMA—ECTROPION. 645 3ij of Anise-water, every hour or oftener (Wa). Gelsemium, a useful remedy (B). Ergot, in paralytic dysuria, with sensation of bladder being imperfectly emptied (P). Alkalies, the Citrates, when dysuria from uric acid crystals in young male children (R). Nitrous Ether, Spt. Athens Nitrosi, 3j~jss in any convenient vehicle, a popular and efficacious remedy (Wa). Diluent Drinks, freely, especially a decoction of Uva Ursi, or of Cotton-root (P). [Compare Vesical Sedatives, Bladder Irritable, and Cystitis.] Boric Acid, dry by insufflation, to destroy aspergillus in the external meatus ; used after weak astringent injections, leeches, fomentations, etc., in general inflammatory conditions of the external ear (Whitla). Sodium Bromide, in large doses, gr. xxx ter die, gives some slight benefit in tinnitus aurium (Id). Cocaine, by instillation, sometimes gives considerable relief in tinnitus aurium, from its influence on arterial pressure (Id). Water, warm, by syringe, to re- move wax and foreign bodies. Olive Oil, poured into the canal, to drive out insects or their larvae. Iodol, renders good service in eczema of the ear; in moist, confluent eczema of the pinna, extending within the auditory canal, the sur- faces should be thoroughly cleansed, and the powder insufflated into the canal; in dry, external eczema it is best applied in the form of a Lanolin ointment. The inflam’n disappears completely under this treatment in about 2 weeks, but irrigation should be kept up for a short time afterwards to complete the cure (Chatellier). [Compare Boils, Deafness, Otalgia, Otitis, Otorrhcea, Vertigo.] Ear Affections. Ecchymosis. Arnica, rapidly disperses, if administered shortly after injury, npv-x in water every two or three hours (P). Alcohol, diluted more or less, according to the amount of irritation present, is a good lotion (P). Hamamelis, the tincture diluted with 5 to 8 parts of water, as lotion, when much discoloration. Ammo- nium Chloride, in solution, as lotion on lint, or with bread or Linseed to form a poultice, in ecchymosis of the eyelids (Wa). Capsicum, the tincture or a strong infusion mixed with an equal bulk of mucilage or gum arabic and a few drops of glycerin added, painted on over the bruised surface, a second or third coat- ing being applied as soon as the first is dry ; there is nothing to compare with this treatment for a black eye. [Compare Bruises, Purpura.] Quinine, cures, though in many subjects will cause it (B) ; when due to mal- nutrition (R). Lead, the Liquor Plumbi Subacet., 3j ad Oj aquae, a soothing application (Wa). Zinc Oxide, the Glycerite with a little Camphor, an excellent application (Wa). Cod-liver Oil, internally and locally (B). Grape-cure, often happily modifies (P). Borax, a solution in rose or elder flower water (Wa). Chlorinated Lime, a solution as a lotion (Wilson). Chrysarobin, internally, half-grain doses, in water or pill, given with good results (Stocquart). Ecthyma. Silver Nitrate, freely to the exposed surface, in ectropion of lower lid due to hypertrophy of conjunctiva after inflammation (C). Collodion, successfully used in entropion to restore position of the lid by its contraction. Should be concentrated (Wa). Faradization, in paralytic ectropion (C). Operative Measures, of great variety, are in use, Arlt’s being the best for bad cases in the upper lid (Roosa). Epilation of lashes gives temporary relief in entropion. Ectropion and Entropion. 646 ECZEMA. Eczema. Aristol, is an excellent application. Mercury, as black and yellow wash in early vesicular and pustular conditions ; mercurial ointments are the most efficient of the local applications, especially those of White Precipitate, Nitrate, mild Chloride, and Black Oxide ; ointments of the Biniodide or Bichloride as irritating application in chronic indolent form (Pf) ; Brown Citrine Ointment nightly in eczema of the margin of the eyelids after detaching scales (B); very useful when eczema on hairy parts of face ; often is best mixed with a tar oint- ment (R). Arsenic, TTpv of Fowler’s solution thrice daily on a full stomach, gradually diminishing the dose, in the chronic type (B); especially in eczema of vulva, anus and scrotum (R); small doses for acute, full doses for chronic form ; the urine to be closely watched and the drug discontinued on the least sign of renal irritation (Pf). Sodium Arsenate, hypodermically into an eczematous patch, to change the indolent form into an active one (Pf). Rhus Tox., exter- nally and internally, when burning and itching, quickly subdues in some cases (P) ; in chronic form with rheumatism, worse at night-time; also in acute cases if given at the very'beginning, of a good tincture is dose enough to begin with (Pf). Phosphorus, of undoubted service in eczema of long standing, prob- ably acts as a hepatic stimulant, gr. in oil, or reliable pill (Pf). Viola Tricolor, an infusion the best form, with purgative doses of Senna for a few days, then alone, in eczema of the head and face; gives prompt results (good or bad); often aggravates, which, though good in chronic forms, must be avoided in acute types (Pf). Calcium Sulphide, gr. to -fa in acute and chronic cases of pustular character, the impetigo of old writers ; small doses in acute form, larger ones in chronic cases (Pf). Sulphur, internally and Sulphides as baths, but not in the acute stage (R); solution of Potassium Sulphide in water locally (B). Liquor Potassae, or a stronger solution of Potash, to infiltrated patch of chronic eczema, before attempting to heal it (Pf). Croton Tiglium, the seeds bruised in alcohol, as liniment (Wa) ; the Oil as basis of stimulating applica- tions in the chronic form (Pf). Glyceriteof Tannin, locally (R). Potassium Iodide, is often efficient where a syphilitic history or inheritance can be traced. Salicylic Acid, locally, in eczema of hands and feet has been very successful (B) ; in plaster is of very great value, and becoming more recognized (Unna, Pick) ; the best form is a salicylated soap-plaster (see formula below). Salol, as an antiseptic powder, has done good service. Belladonna, gr. X °f extract with gr. iij of Quinine Sulphate thrice daily in eczema of the hand, with Bismuth Subcarbonate as a dusting powder (B). Zinc Salts, the Oxide and Carbonate as dusting powder, or the Sulphate, etc., in astringent ointments (Bulkley). Buckwheat Flour, one of the best dressings ; a limb may be enveloped in a bag filled with the flour (Bulkley). Tar, internally, the Pix Liquida in doses of gr. ij-v thrice daily, when Arsenic fails to relieve or is contraindicated ; locally in third stage when redness, drying and scaling; Oleum Cadini, when genuine, is the best form of tar, mixed with simple ointment (3ss-j ad : 01. Rusci or Pix Liquida may be used (Pf): Tar should never be used in the moist stage, but only after the acute inflammatory symptoms have subsided, and then cautiously ; a useful combination, and one less likely than tar ointments to cause irritation, is 01. Cadini, 3j-iij, 01. Amygd. Dulc., q. s. ad §j, brushed lightly over the diseased surface. Conium, the tincture may be added to one of the ointments for the pruritus, which is usually very obstinate; so also Stramonium or crude Petroleum (Pf). Hamamelis, locally as antipruritic, and in chronic eczema marked by decided venous retardation (Pf). Benzoin, to allay itching, the compound tincture painted on the skin (R). Lead, soluble salts as lotions when much inflamma- tion and discharge (R); also in early vesicular and pustular conditions; Diachylon ointment comes next in efficiency to mercurial ointments (Pf). Zinc, the Oxide and Carbonate as dusting powders (R); the Sulphate with Alum, Glycerin, and Rose-water, an excellent lotion (B); the Oxide is not curative, but as a protective is the best ointment, when freshly and well made, for use over a large surface (Pf). Lime-water, as sedative application and to ECZEMA. 647 check discharge ; after inflammation is subdued, Lime-water and Glycerin (R) ; mixed with oil (Carron Oil) a very good application in acute eczema. Carbolic Acid, externally and internally in chronic forms (B) ; is analogous to Tar, and suitable to the same types of the affection as the latter is (Pf). Phytolacca has cured obstinate cases (B). Graphite, in ointment, i to io, or with some inert powder, as Lycopodium or precipitated Calcium Phosphate, in fissured eczema, especially that of the hands and behind ears (Pf). Bismuth, the Subnitrate or Subcarbonate locally (R); the Subgallate (Dermatol), has proven very useful in the treatment of moist eczema. Ichthyol, a promptly efficient remedy. Thiol, may well replace Ichthyol; the dry form as a dusting powder has been used with remarkable benefit. Anacardium Orientale (Oil of Cashew), as oint- ment in patches of indolent chronic eczema (Pf). Iris Versicolor, in chronic eczema of gouty patients invaluable as a hepatic stimulant, tt\,v-x of tincture from the fresh root twice daily (P). Glycerin, locally at night when caustic lotions have been used (R). Electricity has cured obstinate cases (B). Milk- cure, when acid indigestion present (B). Thyroid Extract, has been used with benefit (see page 132). Water, locally is injurious, unless its sp. gr. approaches that of the blood serum ; Rose-water with a little Glycerin and Sodium Chlor- ide when ablution necessary in second stage, that of exudation and crusting (Pf). Soaps, Petroleum, Cade or Carbolic (R); Sapo Viridis, to soften up in- filtrated patches of chronic form, instead of the potash solutions mentioned above (Pf). Diet should be largely vegetable, especially vegetables which are eaten raw ; Cod-liver oil as a supplemental article of diet. Chaulmoogra Oil, in old cases is often of great benefit, as an ointment; the Oil 1 part to 2 or more of Vaselin (Wa). Oil of Cajuput, put up by mistake of druggist for Oil of Cade, made a remarkable cure in a case which had resisted treatment for some time (Claiborne). Prescriptions. R. Violae Tricolor, £j. Sennae, ijss. M. Fiant chartulae no. iv. Sig.—Make an infusion with hot water from each paper, and take every night. (Piffard.) R. Acidi Salicylici, gj. Zinci Oxidi, g iij. Pulveris Amyli, ziv. Adipis Lanae Hydrosi, . . gj. M. Fiat unguentum. Sig.—Apply daily as a paste for eczema. (Practitioner.) R. Vini Ferri Amari, .... Syrupi Tolutani, . . . . iij. Liq. Potass. Arsenit., . . gj. Aquae Anethi, g ij. M. Sig.—A teasp. to a dessertsp. thrice daily. (Wilson.) R . Hydrarg. Ammoniat., . . gr. xv. Glyceriti Amyli §j. M. Fiat unguentum. (Muller.) R . Olei Cadini, Zinci Oxidi, aagss-j. Ung. Aquae Rosae, . . ■ % ')■ M. Sig.—Ointment, antipruritic and mildly astringent. (Bulkley.) R. Ferri et Ammon. Citrat., . g j. Potassii Citratis, . . . . g ij. Liq. Potassii Arsenit., . . Tinct. NucisVom., . . . g ij. Tinct. Cinchon. Comp.,ad j|iv. M. Sig.—A teasp. in water, after meals, as tonic and alterative. (Bulkley.) &. Aluminis, gr. xx. Zinci Sulphat., ..... gr. x. Glycerini, 7,). Aquae Rosee, M. Sig.—Lotion. (B.) R. Emplas. Diachyli Simplicis, Emplas. Saponat., . . aa p. xl. Petrolati, p. xv. Acidi Salicylici, p. v. Sig.—Emplas. Salicyl. Compos. (Pick.) R . Liq. Plumbi Subacet., . . Glycerini, .^ss. Aq. Laurocerasi, . % ijss. M. Sig.—Lotion, when there is much weeping. (B.) R. Picis Liquidae, Pulv. Sem. Anisi, . . . aa g ijss. Magnesiae Calcin., . . . . q. s. M. Ft. pil. no. c. Sig.—Two to ten pills daily. • (Miguet.) R. Ol. Cadini, % ss. Glycerini, gj. Ung. Diachyli, 3 ijss. M. Ft. unguentum. In squamous ec- zema with thickened skin. (Fox.) 648 EMACIATION EMISSIONS EMPHYSEMA. Calcium Phosphate, is especially useful in chronic wasting disease (R). Arsenic, is used by cattle-breeders to fatten oxen, etc., quickly (Tr). Iodine, improves the appetite and digestion, and gives strength and plumpness to the body (Wa). Cinchona, in small doses improves the appetite, and the general tone (Wa). Iron Salts, cause marked gain in flesh and color (Wa) ; remark- ably promote the appetite and digestion (B). Cod-liver Oil, internally and externally with friction, often very effective in the mal-nutrition and marasmus of children (P). Olive Oil, by friction daily; inunctions are of value in many wasting diseases (P). Pepsin, to promote digestion of food (P). [Compare Atrophy, Phthisis, Tabes Mesenterica.] Emaciation. Hyoscine, the Hydrobromate in pill, gr. T|j in £vj injected into the nostrils is often effectual (Wa). Tannin, finely powdered, blown into the nostrils through a quill (Wa); a strong solution, gij ad giv, by nasal syringe (B). Turpentine, may be given internally with advantage (Wa) ; especially in debilitated conditions (B). Lead Acetate, gr. ij-iv with Opium gr. ss-j, proves signally useful (Wa). Vinegar, on lint introduced into the nostrils, sometimes highly efficient (Wa). Digitalis, is of undoubted benefit (B); the infusion best (R). Transfusion, when death from exhaustion is apparently imminent (B). Facial Artery, compression of (R). Keep head elevated and cool; warm the feet and hands by plunging into hot water; apply ice over the nose ; resort at once to the tampon, if bleeding becomes alarming. Cauterize with electric cautery any ulcers in anterior nares. [Compare Hemorrhage for formulae.] 655 ERUPTIONS ERYSIPELAS. Eruptions Produced by Drugs, etc. Aconite, vesicular exanthemata. Antimony (locally), papules, vesicles, pus- tules, similar to the eruption of small-pox. Antipyrin, erythema and urticaria, chiefly on thighs and abdomen, with much itching. Antitoxin (Diphtheritic), erythema, with pain in the joints. Arsenic, erythema, eczema, papules, vesi- cles, pustules. Atropine, erythema, like the rash of scarlet fever. Belladonna, as Atropine. Borax, papules, scarlatiniform. Bromides, acne, chiefly on the face and back ; pustules, deep tubercles with ecchymoses, ulcers, pemphigus. Castor Oil, urticaria. Cinchona, as Quinine. Carbolic Acid, erythema. Chloral Hydrate, erythema on face and neck, itching, desquamation, eczema, petechiae, purpura. Codeine, as Opium. Copaiba, also Cubeb, urticaria, erythema, eczema, pemphigus; the Copaiba rash has a preference for the ankles and wrists. Cod-liver Oil, acne. Croton Oil (locally), papules, pus- tules. Digitalis, erythema, after long usage. Iodides, acne, papules, vesicles, pustules, eczema, ecthyma, ecchymoses and purpura ; the Iodide rash prefers the face and back of neck and shoulders. Mercury, erythema, eczema. Opium and Morphine, erythema, papular eruption with marked desquamation and itching. Phosphorus, purpura. Quinine, erythema, scarlatina, papular erythema, hemorrhagic purpura, pemphigus, and prurigo ; the prevailing type of the Quinine eruption is erythema, or eczema or purpura, and is essentially ephemeral; it is of a bright vivid hue, disappearing on pressure, and resembles scarlatinal rash, first appearing on face and neck, and thence spreads over the body : in some instances it comes in distinct spots and re- sembles measles ; in others it is an urticaria, with some oedema, and distress- ing burning, tingling, and itching; five cases of purpura are authentically re- ported. Rhus Toxicodendron (and other varieties of Sumac), vesicles, perhaps pustules, with redness, swelling, and intolerable itching. Salicylic Acid, urti- caria, purpura, pemphigus, vesicular angina. Santonin, pemphigus, vesicles. Stramonium, as Atropine. Strychnine, as Quinine. Sulphur (locally), ery- thema, eczema. Tar, acne. Tartar Emetic (locally), as Antimony; in some cases of poisoning by tartar emetic a rash of the above description appeared all over the body. Turpentine, as Copaiba. Articles of Food producing eruptions are : Acid Fruits, may cause acute ec- zema. Strawberries, urticaria. Apples, acneform efflorescence about the mouth. Walnuts, inflammation of buccal mucous membrane. Shell-fish, urticaria. Roast Turkey, in one case caused great urticaria. Lager Beer, acne in some. Alcohol, aggravates cutaneous inflammations. Butter, Oat- meal, Buckwheat, Fish, are popularly credited with causing eruptions, but there is no evidence therefor. Erysipelas. Antitoxin (Streptococcus), see page 154. Pilocarpine, to abort the disease, very efficient if used early, gr. l/e hypodermically, or fluid extract of Jaborandi internally; when free diaphoresis occurs, the temperature and pulse fall to normal, and the disease is checked ; not suitable to debilitated cases, or those with a weak heart (Da C). Aconite, a favorite remedy with Liston, if used at beginning, when fever high (Wa); no more useful agent in idiopathic erysipe- las, especially facial, and cases of sthenic type (B); at onset, often cuts the attack short; is very useful in the erysipelas following vaccination (R) ; very valuable in sthenic cases (P); especially so in traumatic erysipelas (Tr). Belladonna, of tincture in water every hour for five or six doses, also locally; has astonishing power in superficial and non-vesicular forms, also when erysipelas attacks the brain, and in the phlegmonous type (P); for simi- lar indications as noted under Aconite, also when adynamia ; if much fever, combine it with Digitalis or Aconite; when much depression, give it with Quinine; gr. °f the extract with gr. ij of Quininse Sulph. every 3 or 4 hours 656 ERYSIPELAS. (B); the extract with Glycerin, equal parts, spread thickly over the surface (Quain); should be used both internally and externally, and may be combined with Aconite (R). Iron, Tincture of the Chloride, the nearest to a specific yet discovered; the remedy of most service, any man being decidedly to blame who neglects its use ; requires decided doses, gtt. xl every 4 hours (Da C); treatment by it very general, but questionable (B); should be given with shorter intervals than 4 hours (R); is very successful in this disease (P); ten- drop doses every hour, or every 4 hours (Quain); is also used locally with much success, being painted over the surface in full strength. Quinine, may be given with the Iron; also alone if thoracic complications, wherein Iron might be contra-indicated (Da C); if pulse soft and tremulous, or very rapid with low muttering delirium (D); a combination of Quinine and Tincture of the Chloride of Iron offers special advantages (Wa) ; in the more severe cases to sustain the vital powers, and prevent cerebral embolism; but large doses, gr. xv-xx every 4 hours, are alone of any use (B). Ammonium Carbonate, when feeble circulation, cyanosis and delirium ; also when any signs of embol- ism appear (B); highly useful in debilitated subjects (Wa); after free purgation the continued use of this salt is all that is needed in most cases (Watson). Potassium Iodide, with agents to secure free action of the bowels, skin and kidneys, the most efficient treatment in erysipelas ambulans, in which Iron and Quinine are useless (Da C). Antipyrin, is particularly efficient when hy- perpyrexia (Ernst). Rhus Tox, a very useful remedy in the vesicular form (P). Tartar Emetic, in doses of gr. frequently repeated, renders incontest- able service (B). Calomel and Jalap, as purgative at onset, followed in 4 or 5 hours by Magnesium Sulphate, (fss (Da C). Chloral, is an admirable adjunct to give sleep at night (Id). Turpentine, as a stimulant erysipelas, more generally serviceable than Alcohol (B). Local Applications. Silver Nitrate, by Higginbotham’s method in traumatic form ; gr. lxxx of the brittle stick dissolved in giv of water and painted 2 or 3 times over inflamed surface and beyond, after careful washing and drying (R); no agent more useful in subduing external inflammation. Iodine, painted over affected and neighboring surface, to prevent spreading (R). Ichthyol, is very efficient as a 10 to 25 per cent, collodion : Ichthyol and Ether, of each 5, Collodion 10 parts, with or without the addition of Castor Oil; has almost specific properties in this disease (Radclifife). Thiol, dry, as a dusting powder, has given excellent results. Iodized Collodion, is very successful as a local application. [See formula below.] Collodion, a thick coating relieves (B). Digitalis, an infusion is of much service, applied as a lotion (R). Sulph- urous Acid, and Glycerin, equal parts, or a solution of Sodium Bisulphite (Dewar). Zinc, Benzoated, as ointment, or the Unguentum Zinci Oxidi, any- thing to exclude the air, and whichever one is most agreeable to the patient (Da C). Bismuth, the Ointment of the Oleate, a very certain application to allay itching and burning, lessen pain, etc. (Shoemaker). Oil, by inunction, is very grateful in simple erysipelas (B). Oil of Turpentine, painted over surface is said to be remarkably efficient. Vaselin, Lard or Mercurial Ointment diluted, 3j to §j of Vaselin; the simplest applications are the best (B). Car- bolic Acid, one part, with 8 to 14 parts of Oleic Acid, locally by inunction for 3 or 4 minutes every % hour, all around the edge of the diseased part until it ceases to spread (Jacobi). Cotton Wool, sprinkled with flour or a mixture of Starch and Zinc Oxide, is a good application (B). Earth, clean yellow clay, free from grit or sand, and powdered, applied directly to the skin in the form of a smooth paste, made by mixing it with water, the best of all applications, having properties of antiseptic, antiphlogistic, antipyretic, and antimorbific nature (Hewson). Tracheotomy, promptly if oedema of glottis occurs, the operation giving time for inflammation to subside (Da C). Incisions, may be necessary in traumatic erysipelas when limb is greatly swollen and inflamed ; also in the phlegmonous variety (Id). Diet, a milk-diet is generally suitable ; should be light but nutri- tious (R); feed the patients well (Da C). [Compare Phlegmon.] ERYTHEMA—EXHAUSTION. 657 R. Quininae Sulphatis, . . . Ext. Belladonnae, . . . . gr. ijss. Ft. pil. no. xx. Sig.—Two pills every 4 hours, where much depression. (B.) Prescriptions. R. /Etheris, Alcoholis aa gv. Pyroxylini, ....... gj. Solve, et adde— Ammonii Iod., gr. xl. Cadmii Iod., Cadmii Brom., , . . . aa gr. xx. M. Sig.—For local use with a camel’s hair pencil. If the cadmium salts are not to be had use sjj Ammon. Iod., and gr. xx of Pot. or Amm. Bromide. (.Humphreys.) R. Quininae Sulphads, . . . %j. Ac. Sulphurici Dil., . . . q. s. Aquae, 3 ij. Tincturae Ferri Cblor., . . Spt. Chloroformi, . . . . Glycerini, . . . . q. s. ad 3 iv. M. Sig.—A teasp. in water every two hours. [Loomis.) R. Plumbi Acetatis, Ammonii Carb., . . . . aa %). Aquae Rosae, ..... Ft. lotio. Sig.—Apply on lint, to allay irritation. (Peart.) R. Tinct. Ferri Chloridi, . . .3). Syrupi Tolutani, 5j. Liq. Potassii Citratis, . . M. Sig.—Teasp. to tablesp. according to age, every 3 hours, q j has ij has gss has lT^xl. [Anderson.) R. Acid Carbolici, Alcoholis, aa gij. 01. Terebinth., giv. Tinct. Iodi., . . . . Glycerini, g x. M. Sig.—Brush over surface every 2 hours, and cover with a thin layer of wad- ding. R. Tinct. Ferri Chlor., . . . zij-iij. Glycerini, Aquae, . . . aa M. Sig.—Teasp. every 2 hours for children. (Gibney.) Erythema. Antipyrin, internally, for the itching, is efficient. Belladonna, useful in cases resisting ordinary treatment (B). Quinine, the most valued remedy in erythema nodosum (B). Rhus Toxicodendron, a valuable remedy (P). Zinc Sulphate, as lotion, with Alum and Glycerin [see Eczema, for formula] ; or the Acetate, in ointment (see below). Bismuth, dusted over erythema about genitals of infants soothes pain and promotes healing (B). Mineral Acids, Nitric and Nitro-hydrochloric, have been advantageously used when from imperfect digestion (B). Dusting Powders, of Starch, Lycopodium or Buckwheat flour are very useful. Thiol, the dry form, as a dusting powder. Prescriptions. R . Plumbi Carbonatis, Bismuthi Subnit., . . . aa gj. Sodii Bicarbonat., . . . . Zss. Ung. Zinci Oxidi Benz., . gij. Ft. unguentum. Sig.—Local use. R. Zinci Acetatis, gr. ij. Aquae Rosae, zj. Ung. Aquae Rosae, . . . %). M. Sig.—Ointment. Acetanilid, for the “ tired feeling,” a pinch put into the mouth, mixed with saliva and swallowed, rests one up in a few minutes and makes one as fresh as before (Brodnax). Arnica, a few drops internally for aching of the muscles (R); in nerve prostration with general aching from over-fatigue (P). Phos- phorus, for physical or mental exhaustion ; also in depression from overwork (R). Calcium Phosphate, combined with Calcium Carbonate and Ferric Phos- phate, gr. j of each for a dose (R). Potassium Bromide, when insomnia, bad dreams and irritability (R). Opium, gtt. j of Laudanum with 2 or 3 of the Tinctura Nucis Vomicae, 3 or 4 times a day, for symptoms of exhaustion with Exhaustion. 658 EXOPHTHALMOS EXOSTOSIS EYE DISEASES. headaches, flushing and dyspepsia (R). Ammonia, internally ; its influence is but brief (R). Coffee or Tea, in hot or cold climates (R). Castor, is service- able, but seldom used (P). Musk, benefits all forms of nerve-exhaustion (P). Cimicifuga, for headache from over-study or excessive fatigue (R). Alcohol, of value in all conditions of fatigue (P). Coca, lessens the sense of fatigue under exertion, relieves thirst, and obviates the effects of a too rarefied atmo- sphere; is suitable for weakly subjects easily fatigued, and convalescents (P). Cocaine, has been used successfully in exhaustion from sunstroke, loss of blood, and diarrhoea (P). Wet Sheet, dripping, cold, as a restorative, and to prevent aching of muscles (R). Sea Bathing, is also valuable (R). Habits, change of occupation better than absolute rest. [Compare Adynamia, Convalescence, Insomnia, Myalgia, Neurasthenia.] Exophthalmos. Exalgin, has been used with some success in the treatment of exophthalmic goitre (Churton). Belladonna, of tincture hourly, of great service (R); results recorded from its use are very remarkable, but Digitalis will usually answer better (P). Duboisine, gr. of the sulphate 2 or 3 times daily, has produced remarkable results in one case (Hunt). Opium, may be of use in some cases (P). Iron, with Digitalis, seems to do more good than any other medicines (Da C). Chalybeate Waters, are beneficial (B). Aurum Bromide, in daily doses of gr. y% to l/e, continued until its characteristic headache is produced (Goubert). Thyroid Extract, is used with benefit (see page 132). Thymus Extract (see page 133). Bromides, with Iron, of very great value in the milder forms associated with anaemia in young women (Y). Digitalis, to raise arterial tension and slow the heart, is decidedly ameliorative in young subjects (B); in some cases beneficial, but in others it increases the cardiac excitement and makes matters worse, while its tendency to cause gastric irri- tation is more manifest in this disease than in any other (Y). Strophanthus, quiets the cardiac action and is of real service in this malady ; 5 minims may be given thrice daily (Y). Convallaria, ameliorates the painful palpitation (Wa). Arsenic, gr. twice daily, increased with intermissions up to gr. daily, is my favorite remedy (Jaccoud). Zinc Valerianate, gr. j thrice daily, is valuable to allay the nervous symptoms and the insomnia (Y). Galvanism, of the cervical sympathetic and pneumogastric, also of the eyes and thyroid gland, is decidedly curativejin uncomplicated cases (B). Exostosis. Potassium Iodide, may promote absorption when recent-; also use friction with an ointment of Mercury or Iodine (D). Aconite, was used by Storck (P). Mercury, a moderate course of mercurials may be effectual, when exostoses are due to a blow or from syphilis (D). Excision, if required (MacCormac). Ex- ostoses of the clavicles in children almost always disappear of themselves (D). Eye Diseases. Belladonna, locally and internally in iritis, conjunctivitis and other inflam- mations. Atropine, in iritis, locally ; hypodermically in glaucoma (R) ; the best application generally in inflammatory conditions of the eye; the indis- criminate instillation of Atropine in persons over 35 or 40 years of age by general practitioners is to be condemned, being liable to light up an incipient or latent glaucoma. Pilocarpus, is used with great benefit in many eye- affections, particularly amblyopia from alcohol and tobacco, detachment of the retina, chronic iritis, keratitis, hemorrhage into the vitreous, glaucoma, muscae, EYELIDS—FACE. 659 atrophic choroiditis, hemorrhages of the retina, white atrophy of the optic nerve, and inflammatory affections with effusion and exudation, to promote resolution and absorption (Wecker). Strychnine, hypodermically in muscular asthenopia, amblyopia, amaurosis, and in progressive nerve-atrophy not de- pendent on intercranial diseases (R); increases the sensibility of the eye, the field of vision becoming extended, and the vision more acute (Br). Ergot, is useful in many eye affections, especially disturbances of accommodation, acute and chronic inflammations, and the blepharitis and pustular conjunctivitis of children (Wa): is a myotic. Acetanilid, is exceedingly effective in optic neuritis with pain, not only to remove the latter but also to arrest the inflammatory process (Dujardin-Beaumetz). Cocaine, as a local anaesthetic in ophthalmic surgery, a 4 per cent, solution, by instillation, sometimes injection required, as into the muscles for squint operation ; is mydriatic, and in some cases panoph- thalmitis has resulted after operations under it (R). Chloroform vapor, close to a photophobic eye, relieves (R). Oleate of Mercury and Morphine, outside the eye in palpebral conjunctivitis, and stye; also in syphilitic iritis (R). Silver Nitrate, Copper and Zinc Salts, are much used in weak solutions for conjunc- tivitis, etc. Euphrasia, had an extended reputation in Germany, is a mild astringent, and of service in catarrhal conjunctivitis (P). Pulsatilla, as lotion in inflammations and ophthalmic cases (P); Santonin, gives good results in inflammatory and atrophic conditions of the retina and optic nerve, and in the stage of effusion of many otherinflammations (Wa). Ruta, minim doses, night and morning, in dimness of vision depending on functional amaurotic condi- tion, produces good results (P). Physostigmine, topically, to contract pupils; to reduce excessive atropinization ; stimulates the third nerve (P). [Compare Amaurosis and Amblyopia, Asthenopia, Cataract, Conjunctivitis, Cor- neal Opacities, Glaucoma, Iritis, Keratitis, Myopia, Ophthalmia, Photophobia, Retina, Strabismus, etc., also the Lists of Mydriatics, Myotics and other Agents acting on the Eye, on pages 37 and 38.] Eyelids. Calomel, locally, or Brown Citrine Ointment, as an application in many dis- eases of the lids (B). Mercury and Morphine, the 20 per cent, ointment with Lard, applied outside the lid, for stye (R). Pulsatilla, internally, and exter- nally as wash, in ophthalmic cases and inflammations ; the so-called stye may often be aborted by this treatment (P). Cadmium, much esteemed as colly- rium, gr. ij of sulphate to jfj aquae rosae (R). Zinc and Copper Sulphates, are esteemed applications (B). [See Conjunctivitis for formulae.] Ergot, an aqueous infusion, as a collyrium, in ptosis and paralysis of the eyelids (Wa). Tannin, a strong solution (1 to 3 aquae), locally; or a weaker solution (1 to 20, 30 or 50 aquae), is much employed; also used in pomade, or as fine powder (Wa). Veratrine, in solution, brushed over lids once daily in painful spasmodic contraction of the orbicularis (Wa). Ammonium Chloride, in solution as lotion, for ecchymosis of eyelids, vulgarly known as black eye. Capsicum, the tincture or infusion for a black eye (see under Ecchymosis). [Compare Blepharitis, Conjunctivitis, Ecchymosis, Ectropion, Ptosis, etc.] Face. Amyl Nitrite, to *4, in 30 times its volume of spirits, for flushing of face, or sensation of flushing, with cold feet and hands, and great prostration, chiefly in women at change of life (R). Curare, effective in facial spasm, when other remedies failed (P). Blisters, behind the ear, in facial palsy, followed by warm covering to the part (H). Strychnine, has improved some cases of facial palsy (P). [Compare Acne, Freckles, Neuralgia, Odontalgia, Parotitis, T1C-DOULOUREUX.] 660 FALSE PAINS FEET FEVER. Tartar Emetic, with small doses of Opium, and external fomentations, where evidence of congestion (L). Opiates, to allay uterine irritation, after rectifying any derangement of bowels (L). Opium, is valuable, having specific action on uterine muscular fibres, relaxing some, stimulating others (Wa). Acetanilid may be given with benefit. False Pains. Feet. Arsenic, swelled feet of old or weak persons (R); oedema of feet and ankles in the old, from feebleness of the heart (B). Lead, as ointment, equal parts of Emplastrum Plumbi and Linseed Oil spread on linen, and wrapped round sweating feet; to be renewed every third day for nine days (R). Potassium Permanganate, solution gr. j to the as wash, will remove fetor of feet (B); temporarily discolors the skin. Boracic Acid, in strong solution, is used with good results. Chloral, 1 in 50 of water, as bath, efficient. Sodium Bicarbon- ate, a solution freely applied will remove fetor (B). Belladonna, will check fetid secretions (R). Salicylic Acid, in solution with Borax, the most agreeable and efficient deodorant for fetid perspirations (B); 3jss-iij with 3iij of dried Alum, in powder, applied freely to feet after washing and drying ; Acid. Sali- cyl. 3, Magnesium Silicate 87, is the composition of the powder used in the German army for sweating of the feet. Iron, the Chloride, mixed with y its weight of glycerin, as paint to the soles and interdigital spaces, in severe cases of sweating feet; should be exposed to the air while drying; repeat after 48 hours at first, subsequently at longer intervals, during which the feet should be washed in vinegar and water night and morning and powdered with salicylated talc or starch and tannin (Vignol). Alum, powdered, locally, the most satisfac- tory application for bromidrosis (Baylor). Sodium Chloride, 3 tablespoonsful to Yz a pint of water, as antiseptic lotion for tender feet, answers perfectly in most cases. Ice, to the spine, or heat and cold alternately, to equalize the circula- tion, has been strongly advocated (Wa). Stockings, should be changed every day, and dipped in a strong solution of Boracic Acid and dried, to effectually check fetid perspirations. Cold Footbath, and drying with friction, for cold feet (R). [Compare Chilblains.] Prescriptions. R . Ac. Salicylici,1 gr. xv. Amyli, . . . . . . . . gr. cl. Talci, . 3iij- M. et trit. Sig.—Locally for sweating feet. (Kohnhorn.) R. Ac. Borici (pulv.), . . . £jss. Vaselini, §j. M. Sig.—Ointment for bromidrosis. (Championniire.) Fever. [See also the titles of the Fevers, in their alphabetical order.\ Guaiacol, applied to the surface, as antipyretic (see page 259). Aconite, has the highest value in the eruptive fevers, also in all hyperpyrexiae (B); always indicated in early stage of simple inflammatory fevers, pneumonia, and in most acute congestions (P); has marvellous power over sthenic fevers; ther- mometer should go hand in hand with Aconite (R). Veratrum Viride, pos- sesses considerable power as an antipyretic; useful in rheumatism, pneumonia (P); in delirium ferox of fevers it is of value (B); strongly recommended in both sthenic and asthenic fevers (R). Belladonna, in the eruptive fevers, espe- cially scarlatina (B); in typhus, with delirium, insomnia, painful sensitiveness to light and sound, and in all hypenemic states of brain and spinal cord (P); is prophylactic often against scarlet fever (Pf); in delirium of fevers, also excellent in typhus (R). Gelsemium, in remittent and typho-malarial, of real benefit; is FEVER 661 antipyretic (B) ; in bilious remittent, of value (Pf). Arsenic, in prostrating acute fevers to strengthen pulse and invigorate patient; except quinine no drug subdues intermittents so well (R) ; in malarial, especially typho-malarial, it is of great value (B). Quinine, in the eruptive fevers and all malarial, remittent, and intermittent; as apyretic, less effective and more dangerous than cold baths; useless in typhus and typhoid, except for hyperpyrexia (B); it is anti- miasmatic, antiseptic, and antiphlogistic; and of great value in intermittent, septicsemic, and hectic fevers (P): large doses at night to reduce temperature in typhoid and other fevers, are strongly urged in Germany. Cinchonine is better than quinine as prophylactic against ague (R). Antipyrin, the type, also the best, of the new series of synthetical antipyretics, which includes Acetanilid, Kairin, Phenacetin, Chinolin, Thallin, etc.; is antipyretic and diaphoretic, moderates the intensity of the febrile movement, and is especi- ally indicated in self-limited diseases with persistent hyperpyrexia, especially pneumonia, typhoid, etc. Phenacetin, the favorite antipyretic among the new synthetical compounds; is efficient and safe. Kairin, is an efficient antipyre- tic, but profusely diaphoretic, also a cardiac and nerve depressant of great power, and highly dangerous in pneumonia and other fevers where the heart is weak; it often produces nausea and vomiting with headache and tinnitus aurium (P). Resorcin, has been given in acute rheumatism, typhoid, typhus, pneumonia, erysipelas, etc., as an antipyretic ; like Kairin, however, its action in lowering temperature is transient as compared with Quinine or Salicylic Acid (P); may be used hypodermically as it is not irritant (B). Salicylic Acid, or Sodium Salicylate, nearly equal to Quinine as an antipyretic ; very useful in all forms with high temperature and in intermittents, especially in septicaemia, pyaemia, erysipelas, and surgical fevers (R). Digitalis, the German antipy- retic ; very useful in scarlet fever, rheumatic, and pneumonia (B); especially in typhoid (R). Cimicifuga, as substitute for Digitalis, but less effective ; good in hectic fever (B). Hydrastine, intermittents, typhoid with copious sweats (P). Arnica, is antipyretic, full doses in sthenic cases, small (tt\,v of tincture) in asthenic ; large and small doses produce different results (B); in rheumatic fever and typhoid it is highly extolled (P). Camphor, subdues reflex excitabil- ity ; is praised as stimulant in adynamic fevers (P); in adynamic fevers and where there is delirium (R). Mercury, large doses of Calomel, the German specific treatment of typhoid (B); small doses in typhoid at commencement; has marked effect on tonsils in scarlatina (R). Rhus Tox., in rheumatic fever after Aconite, and in scarlatina with typhoid symptoms, is invaluable (P). Opium, much less used than formerly ; useful in delirium, and with Quinine in remittents and intermittents (B) ; fevers characterized by prostration, insomnia and delirium, noisy or muttering, with picking of bed-clothes and twitching of the muscles,—in such cases Opium, judiciously given, may save an almost hope- less case (R): Morphine, hypodermically, the best form in febrile diseases, being less disturbing to the stomach and digestive power (P). Turpentine, in typhoid, puerperal, and yellow (npc-xxx) as a stimulant to vaso-motor nervous system (B); as enema (3ss-j in starch mucilage with of Tinct. Opii if pain) invaluable when in typhoid hemorrhage occurs with tympanites (R). Tartar Emetic, minute doses (gr. frequently repeated, and with Opium, are of great value in many acute febrile diseases (B); as a diaphoretic ; in ague ; in large doses to abort specific fevers (R). Muriatic Acid, very useful in all forms, especially in typhoid and the exanthemata; relieving dryness of the mouth and fauces, increases digestion, and restrains the diarrhoea (B). Acid Drinks, such as raspberry vinegar, citric acid, etc., very grateful and useful (R, B); two sliced limes or lemons, with of sugar, in Oj of boiling water, cooled and strained, makes an agreeable refrigerant beverage (Wa). Baptisia, useful in common continued fever, or in the first stage of typhoid; drop doses of a fresh tincture every hour. Eucalyptus, has given varied results in malarial fevers, some observers praising it very highly (P). Valerian, has done much good in fevers of a nervous character (P). Sumbul, is used in Russia for low fevers of typhoid type (P). Cocculus,for tympanites of typhoid (P). Ammo- nium Acetate, as a diaphoretic, and in simple forms, as catarrhal; the Carbon- 662 FEVER—FISTULA. ate, in scarlet fever and measles (R). Purgation, by Castor Oil, Magnesium Sulphate, etc., before exhaustion (R). Mustard Bath, on recession of rash in eruptive fevers (R). Aliment, milk and beef-tea alternately, every 3 hours; milk only, in fevers and inflammations of the digestive tract (B). Alcohol, in low conditions is useful when it causes improvement in symptoms, which may become worse (R); Coffee better than alcohol (P). Water, especially car- bonated water as a drink, is a valuable adjunct to remedies in the treatment of fevers; warm baths, the wet pack, hot and cold compresses, fomentations, moist inhalations, etc., have great value (see the various fever titles) : a most important agent: cold baths or cold wet pack to reduce temperature (B); cold affusion, baths, packing, ice, and ice-bag; hot affusion and sponging, all of great value in every form (R). Prescriptions. R . Tinct. Aconiti, 5 ss-j. Spt. Etheris Nitrosi, . . Z ij. Glycerini, . . . . q. s. ad %ij. Sig.—A teasp. hourly to an adult. R . Antipyrini ss-j. Aquae Cinnamomi, . . . 25 ij. M. Sig.—A teasp. every 2 hours for children, to control pyrexia. Fever, Simple. Aconite, in small repeated doses, the best remedy for febricula, etc. (B); in ordinary febrile conditions, if given early, will abate fever and induce free per- spiration ; may be administered in conjunction with any other remedy indi- cated (R). Veratrum Viride, in small doses, as antipyretic (P). Hyoscyamus or Belladonna, very useful in febricula, especially for head symptoms and con- stipation (P). Gelsemium, when remittent or bilious symptoms (P). Arsenic, if typho-malarial symptoms (B). Phenacetin, in hourly doses of gr. iv or less, in the simple continued fever of children, as antipyretic. Hydrochloric Acid, in the continued fever of childhood, has a beneficial influence (West). Valer- ian, when nervous excitability (P). Lemon-juice, as lemonade or with Potas- sium Bicarbonate, as a mild diaphoretic and diuretic (P). Pomegranate-juice is very grateful if mixed with sugar or honey (P). Bromides, gr. ss-j every quarter-hour are excellent for the febrile disturbances of children (Smith). Baths, warm, in simple fevers of children (R). Aliment, milk and beef-tea alternately every 3 hours, the most useful (B). Prescriptions. R. Ac. Hydrochlor. Dil., . . Spt. .ditheris Co., .... Syr. Rosae, 5 ss. Aquae Camph., . q. s. ad £iv. M. Sig.—Teasp. to tablesp., according to age, every 6 hours. (.Modified frotn West.) R. Potassii Acetatis, . % ij. Spt. AStheris Nitrosi, . . 3 iv. Syr. Simplicis, Sj. Liq. Ammonii Acetatis, . ? ij. Aquae Camphorae, . q. s. ad $ viij. M. Sig.—Teasp. to tablesp. doses, ac- cording to age. Piper Nigrum, the confection, as a gentle stimulant in anal fistula (P). Iodine, by injection, sometimes curative, but generally fails (Wa). Sangui- naria, as injection, has cured (P). Capsicum, the weak infusion, a useful stimulant in fistulous ulcerations (P). Glycozone, Sj in Sj of lukewarm water, as enema once or twice daily, soon produces good effects in cases of fistula in ano (Edson). Bismuth Subiodide, after operation, dusted over the surface of the wound after washing, to stimulate granulations when the healing process is indolent, is remarkably efficient. Surgical, division of sphincter in anal fistula, by knife or ligature, the best treatment (D); in fistula lachrymalis, dila- tation of passage by probing the canaliculus, or slitting the canaliculus up (D); in vesico-vaginal, or recto-vaginal, surgical methods best. Diet should be nourishing and digestible; fresh air and general hygienic conditions are necessary (R). Fistula. FLATULENCE FLUSHING FOREIGN BODIES. 663 Nux Vomica, will remove flatulence and intestinal indigestion (B) ; when constipation, heartburn, weight on head (R). Charcoal, gr. v or x, soon after or just before meals (R) ; mixed with Bismuth (R). Chloroform, pure, in drop doses, benefits (R) ; by far the best agent in flatulent dyspepsia to prevent flatulence, always given well diluted (Huchard). Carbolic Acid, when no acidity present (R). Turpentine, gtt. iij-v on sugar, will quickly relieve (B). Strontium Bromide, is excellent in flatulence from decomposition. Asafcetida or Valerian, quickly relieves the flatulence of hypochondriasis (P). Asaf. 3j of tinct. to O'/z water, dose 3j ; useful for children (R). Sodium Sulpho-carbolate, gr. xxx after eating, will be found very serviceable (R). Phosphoric Acid, dilute, is often promptly alleviative. Anise, the Oil, also Ether, or any other member of the carminative group (see page 46), will promote the expulsion of gas from the stomach and intestines. Mercury, in flatulence with clayey stools (R). Calumba, an effective remedy for flatulent disposition is an infusion of each of Calumba and Ginger, gj of Senna, hot water Oj, a wineglassful ter die (P). Potassium Permanganate, in flatulence attendant on obesity (B). Physostigma, flatulence of women at climacteric (B). Sulphurous Acid, in 5 to 10 minim doses, when flatulence due to fer- mentation (R). Diet, abstain from sugar, starchy food and tea—especially sugar ; eat little, slowly and regularly ; as a general rule abstain from alcoholic drinks and from vegetables, especially cabbage. Pepsin or Ingluvin after meals, to promote digestion (R). [Compare Colic, Dyspepsia.] Flatulence. Prescriptions. R . Tinct. Nucis Vomicae, Tinct. Physostigmatis, Tinct. Belladonnae, . . aa M. Sig.—Fifteen drops twice daily in a little water. R. Gummi Camphorce, Pulv. Zingiberis, Pulv. Capsici, . . . . aa gr. j. Ft. pil. no vj. Sig.—One pill as re- quired for gastric and intestinal flatulence. R. Bismuthi Salicylatis, . . . g iv. Magnes. Calcinat., . . . g iv. Pulv. Carb. Ligni, . . . . Olei Anisi, 3 ij. Ft. pulv. Sig.—A teaspoonful before each meal. (Huchard.) R . Tinct. Illicii Anisati, Tinct. Gentianae, Tinct. Nucis Vomicae, . aagj. Chloroformi, nqxv-xxx. M. Sig.—8 to 10 drops in a winegl. of water, before meals. Flushing-heats. Nux Vomica, TT\jj of the tinct. with tr\j of Laudanum in hysterical flushings of the middle-aged, with flatulence, weight on head and perspirations (R). Amyl Nitrite, to *4 in thirty times its volume of rectified spirits, is effect- ive for flushing of face, or sensation of flushing, followed by coldness, with cold feet and hands and great prostration occurring at climacteric chiefly (R). Potassium Bromide, at climacteric, with mental depression (R). Zinc Vale- rianate, or Valerian, flushings at the climacteric (R). Eucalyptol, for.the flushings, palpitations and flatulence incident to the change of life (R). [Com- pare Climacteric Disorders.] Foreign Bodies. In the Eye, remove by bathing, or wiping towards the lower inner corner with a soft, moistened handkerchief, or a bent bristle, the two ends being held in the fingers: use tepid solution of Vinegar (3ss to for removing lime, tepid water for powder; then apply a weak Zinc or Alum collyrium, or instil a solution of Atropine (gr. ij to the or Cocaine, 4 per cent. In the Ear, 664 FRACTURES FRECKLES GANGRENE. examine carefully with speculum before removal; first syringe with warm water, or a drop of sweet oil to drive out insects, before using the forceps; apply equal parts of Laudanum and Olive Oil, a few drops on cotton, if much pain. In the Nose, a current of tepid salt water, forced up one nostril, may force down the body through the other, if the mouth be held open. In the Larynx or Pharynx, if water can be swallowed, the obstruction is in the trachea. Never push a body down; remove by curved forceps or blunt hook. If passed into the stomach use solid diet to imbed the article. If all fail and the case be urgent, resort to catheterism or tracheotomy. In the Flesh, remove at once by forceps, or sponge and water. [Compare Asphyxia and Apncea.] Fractures and Dislocations. Arnica, internally is excellent to neutralize the ill effects of mechanical inju- ries, in a wineglassful of water every 2 or 4 hours; when used after amputations, it certainly has the power of promoting the rapid union of the surfaces: the infusion is better than an alcoholic preparation for external use (P). Aconite, quickly and repeatedly, if feverish symptoms ensue (P). Iodine, internally and by friction, occasionally useful in ununited fractures (Wa). Calcium Phosphate, promotes formation of callus (Wa). Opium, useless in surgical fever, and may do harm (Cl); for nervousness or muscular spasms after dressing, gr. of Morphine hypodermically as anodyne (Ag). Benzoin, the tincture on lint, as a dressing for compound fractures and other severe injuries, leads to rapid and satisfactory healing (Bryant). Carbolic Acid, 1 to 20 or 1 to 40 solutions, for irrigation and dressings in compound fractures, obviates pyaemia and most of the other preventable causes of death (P). Lead-water and Laudanum, on lint, or a Calendula lotion to the part, after re- duction of the injury, with Morphine hypodermically and perfect quiescence. Diet, should be very simple for a week or ten days. [Compare Wounds.] Freckles. Resorcin, as paste with Zinc Oxide, applied to the face, to promote peeling of the skin and removal of freckles and other superficial spots (Unna). [See under Acne.] Iodine, the tincture or glycerite, locally (B). Liquor Potassae, 3j to aquae rosae, as a lotion (Todd). Benzoin, the compound tincture with water, as cosmetic to remove freckles (P). Sodium Borate, a saturated solution of Borax is a safe and often efficient lotion to remove freckles (B). Lime- water, and Olive Oil, equal parts, with a little Liq. Ammoniae, as liniment (Wa). Potassium Carbonate, makes a good lotion for freckles, sunburn and tan (B). Mercury, the Bichloride, with Alcohol and Glycerin, as a lotion, has been found effective: Donovan’s solution, rr\,lxxx to 3viij of water, of which j every three hours, has been highly successful (Wa). Prescriptions. li • Potassii Carbonatis, . . . 3 iij. Sodii Chloridi, 3 ij. . Aquae Aurantii Flor., . . % ij. Aquae Rosae, gviij. M. Sig.—Face-wash. (B.) R. Hydrarg. Chlor. Corr., . . gr. vj. Ac. Hydrochlor. Dil., . . 3j. Alcoholis, Aq. Rosse, . aa 3 ij. Glycerini, 3j, Aquae, ad iij. Apply at night, wash off in morning. Gangrene. Salicylic Acid, pure, in powder locally, to destroy fetor and change the character of the morbid action (B). Carbolic Acid, acts in the same way (B); a i per cent, solution as lotion in gangrenous ulcers (Wa). Sodium Sulphate, in solution, I to 5 or 10 of water, as lotion or applied on compresses, to destroy odor, soothe pain and restore healthy action (Wa). Ammonium GASTRALGIA, GASTRODYNIA. 665 Chloride, in solution as baths and fomentations, very successful in one case of senile gangrene (Wa). Cinchona, or better, Quinine, has often proved of value (P) ; generally decoction of Cinchona is best (Wa). Turpentine, locally, after removal of gangrenous part, a most efficient application (B); by stomach and inhalation from hot water in gangrene of lungs; the oil locally in dry and chronic gangrene (P). Sanguinaria, has been recommended (P). Oxygen, as gaseous bath in senile gangrene (R). Charcoal, as poultice, value doubtful (R). Citric Acid, Lemon-juice dropped into wound, which is then covered with lint steeped in a solution of Chlorine; very effective for hospital gangrene, in Parisian hospitals {Lancet, October, 1879). Ferric Chloride, locally, is consid- ered superior to the mineral acids (Wa). Nitric Acid, strong, applied carefully until the ulcer is converted into a firm, dry mass (Wa); is probably the best escharotic, next to Bromine, for gangrenous destruction (B). Bromine, is the best escharotic for hospital gangrene (B). Chromic Acid, is a very efficient caustic, penetrating deeply with but little pain (B). Opium, to soothe the pain, and diminish restlessness and irritability (Wa). Myrtol, 1 or 2 drops, in cap- sules, internally, for gangrene of the lungs. Gastralgia, Gastrodynia. Resorcin, internally, acts exceedingly well. Opium, in some form necessary to relieve the pain in severe cases (Da C). Morphine, is of great value (P); subcutaneously in epigastrium very efficient, or in small doses with Bismuth and milk before meals (R). Belladonna, is useful in painful affections of the stomach (R). Atropine, often relieves promptly, and is excellent in neuralgic pain of the abdominal viscera (P). Nux Vomica, an excellent stomachic, gtt. v-x of tincture before meals (B); gtt. j—ij every 2 hours in many forms of gastric de- rangement (R). Strychnine, hypodermically for gastralgia and gastrodynia (R); in very small doses, gr. two or three times daily, a very successful remedy (P). Arsenic, sometimes dissipates the pain surprisingly (B); a drop of Liquor Arsenicalis before food in irritative dyspepsia and gastralgia with heartburn (R). Bismuth, when gastralgia due to irritation of mucous mem- brane, acts well alone, but is most efficient when given with aromatic powder and a little Morphine (R) ; or a combination of Bismuth and Arsenic in more chronic cases (B); the Subcarbonate is especially adapted to gastralgia with laborious digestion and putrid or acid eructations (Wa). Manganese, the Black Oxide in gastrodynia and pyrosis (R). Zinc Oxide, an excellent remedy when gastralgia occurs after food, gr. v-x with aromatic powder and Morphine, before meals (B). Silver Nitrate, in solution to check the pain of many stomachal disorders (R) ; a pill of gr. ss, with Extr. Hyoscyami gr. ij—iv (Wa). Hydrocy- anic Acid, often cures rapidly when gastralgia from nervous derangement (B); may check vomiting as well as relieve pain (R); Cherry-laurel water a useful form (P). Nitro-hydrochloric Acid, gtt. ij-iij of the dilute acid, is serviceable (Da C). Ether, a few drops or the compound spirit often relieves quickly (B). Chloroform, npij-v on sugar, often relieves (B). Chloral, some- times relieves pain in gastralgia (R). Pulsatilla, is efficient in many cases of painful dyspepsia, with coated tongue, headache and nervous depression (P). Pepsin, when gastrodynia from indigestion (P). Creosote, checks pain after food (R). Alum, often affords relief (B). Ergot, of value in visceral neuralgias (P). Alkalies, for pain in stomach, Liquor Potassse generally employed (R). Quinine, in cases showing periodicity, and those of neuralgic type (P). Sodium Salicylate, for gastralgia with fermentation (R). Nitroglycerin allays the pain speedily (B). Carbonic Acid Water, in painful and irritable conditions; may be mixed with milk (R). Milk-cure, very efficacious in obstinate cases (B). Galvanism of the pneumogastric, and locally to the organ itself (B). Aqua- puncture has given extraordinary relief (B). Diet is of the greatest importance; food should be easily digestible, varied and plainly cooked ; sedentary livers should refrain from much animal food; meals should be regular and frequent, eating little at a time, and that very slowly. Alcoholic beverages do harm as 666 GASTRIC DILATATION GASTRITIS. a rule, but may benefit particular cases. Eating should be done in as agree- able a frame of mind as possible, and the patient should rest for a time after a meal. [Compare Acidity, Dyspepsia, Neuralgia.] Prescriptions. R. Morphinae Sulph., . . . . gr. j. Ac. Carbolici, 3SS- Aq. Menth. Pip., . q. s. ad^'w. M. Sig.—Teasp. thrice daily. {Da Costa.) R . Bismuthi Subnit., Magnesii Carb., . . . aa gr. xvj. Ac. Hydrocy. Dil., . . . n^x. Aquae, iv. M. Sig.—Dessertsp. for a child of 3 years in flatulent gastrodynia and gastralgia. R. Bismuthi Subnit., . . . . Ac. Hydrocy. Dil., . . . £ss. Mucil. Acaciae, Aq. Menth. Pip., . . . M. Sig.—Tablesp. thrice daily. R. Ac. Hydrocy. Dil., . . . zij. Aq. Laurocerasi, . q. s. ad 3D. M. Sig.—Teasp. every 4 hours. R . Pepsini, gj. Ac. Hydrochlor. Dil., . . gss. Glycerini, Sjss. Aq. Cinnaraomi, . . . . 5 ijss. M. et filtra. Sig.—Tablespoonful doses for slow and feeble digestion. R. Atropinae Sulph., . . . . gr. j. Zinci Sulph., ...... zss. Aquae Destill., 3j. M. Sig.—3 to 5 drops two or three times daily. (B.) Gastric Dilatation. Carbolic Acid, internally to allay fermentation, with an occasional washing by the stomach-pump (Da C). Strychnine, hypodermically or by the mouth, or Nux Vomica, the best remedy, conjointly with washing of the stomach and strict diet (Da C). Bismuth Subnitrate, with Magnesia or Soda, or Lime- water frequently, for the acidity, which is one of the most distressing symptoms (Fenwick). Bismuth Salicylate, as an internal antiseptic, is highly praised. Salophen, relieves the fermentive disturbances. Diet, should be free from all starch and sugar, and from vegetables of any kind (Fenwick); milk not advis- able, as much fluid will further dilate the organ ; solids better, as small quan- tities of dry, stale bread, or gluten bread, and underdone meat (Da C). Gastritis, Acute. Mercury, Calomel in broken doses, with ice, frequently swallowed, for the idiopathic form, which is occasionally seen and cannot be distinguished from that due to irritant poisons (Da C). Bismuth, the Subnitrate or Subcarbonate in full doses after the acute symptoms have abated (Da C). Morphine, hypo- dermically for pain (B). Ice, internally and externally gives great relief (R). Aliment should be given per rectum; no food, except milk and Lime-water, being admitted to the stomach for some time (Da C). Antidotes, in cases of irritant poisoning, as Alkalies to neutralize acids, Dialyzed Iron or the Hy- drated Sesquioxide for arsenic, Turpentine for phosphorus, etc. (see Ap- pendix) : then Oil, Albumen or milk, to protect the mucous membrane; stimu- lants, Opium, Ammonia, etc., to antagonize the depression of the vital powers. Gastritis, Chronic. Arsenic, sometimes surprisingly curative ; for the vomiting gtt. j-ij of Fow- ler’s solution before meals (B). Pulsatilla, in subacute gastritis of phlegmatic temperaments, white tongue, heartburn, nausea, flatulency, little or no taste (P). Hydrastis, gtt. v-xv of tincture or fluid extract, daily before meals, espe- cially for gastric catarrh of acute alcoholism (B). Nux Vomica, gtt. j of tinc- GASTRITIS. 667 ture every 5 to 10 minutes for 8 or 10 doses, in acute gastric catarrh, with head- ache or sick-headache; also drop or 2-drop doses every 2 hours or oftener, when chronic gastric catarrh occurs in the course of chronic disease (R). Cin- chona, to promote healthy state of mucous membrane, the infusion best with mineral acids, or Quinine; the Red Bark in gastric catarrh of drunkards (B). Alkalies, either shortly before meals, to stimulate production of gastric juice; or some hours after, to neutralize the acids of decomposition (Da C). Pepsin, gr. v immediately after a meal, to assist digestion (Da C). Podophyllum, in small doses at night, to act on upper bowel; purgation as a method of treat- ment stands at the head (Da C). Ipecac, in small doses may prove highly useful, ttbv-x of the wine (P); for the nausea and vomiting (R). Tannic Acid, in 4-grain doses with a drop of Glycerin to make a pill (B). Bismuth Subni- trate, is very useful in chronic gastritis, especially that of drunkards, and the chronic gastric catarrh of children with vomiting (R); invaluable for its seda- tive, alterative and astringent action; 10-15 grain doses several hours after meals (Da C); the Subgallate (Dermatol) is being advertized as a remedy for chronic gastritis. Bismuth Salicylate, as an internal antiseptic, is highly praised in chronic gastric affections. Strontium Bromide, gave successful re- sults in 32 cases of gastric catarrh (See). Resorcin, acts exceedingly well. Glycozone, is one of the best remedies for the chronic gastric catarrh of alco- holism, and that from other causes (Edson). Hydrocyanic Acid, is much used (R); in subacute gastritis it often proves useful given in an ordinary efferves- cing draught (Wa). Silver Nitrate, in % or )4-grain doses with Opium if pain, or preferably Belladonna, is extremely useful (Da C); to check pain and vom- iting (R). Silver Oxide, is nearly as good as the nitrate, and not liable to pro- duce staining (Da C). Opium, or Morphine, to quell pain in chronic gastritis from alcoholic excess (R). Eucalyptus, a most useful stomachic, not to be used in inflammatory states (B); is used with benefit (R). Mercury, the Yel- low Oxide, in doses of gr. in chronic form (see under Dyspepsia). Calumba, and other bitters are useful (B). Ammonium Chloride, in high repute in Germany (B). Caffeine, especially when associated with migraine (B). Lead Acetate, in chronic gastritis with gastralgia and pyrosis, may be combined with Morphine beneficially (B). Alum, when vomiting of glairy mucus (B). Aliment, such as will be digested in the small intestines; requires careful attention ; 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 efficient; the farinace- ous vegetables, rice, tapioca, arrowroot, aerated bread. [Compare Dyspepsia, Gastralgia.] Prescriptions. R. Sodii Bicarbonat., .... %jss. Tinct. Aurantii Cort., . . Infusi Calumbse, . q. s. ad viij. M. Sig.—Two tablesp. before each meal. In chronic gastric catarrh. 1 R. Magnesii Sulphatis, . . . Sodii et Potassii Tart., . . gss-). Ac. Tartarici, .... gr. xx. Sig.—Dissolve in a glass of water, and j drink, an hour before breakfast. R. Aluminis, Ext. Gentianse, 3 ss. M. Ft. pil. no. xxx. Sig.—Two twice daily. R. Sodii Bicarbonat., . . . . gr. lxxx. Spt. Chloroformi, .... gjss. Tinct. Gentianse, . . . . ,3 ss. Infusi Rhei, % iv. Aq. Menth. Pip., q. s. ad viij. M. Sig.—A tablesp. or two before each meal. In chronic gastric catarrh, with flat- ulence. R. Argenti Oxidi, gr. xij. Ext. Belladonnse, . . . . gr. iij. Olei Caryophylli, .... gtt. xx. M. Ft. pil. no. xxiv. Sig.—One pill twice daily. {Da Costa.) 668 GASTRIC ULCER—GLANDERS AND FARCY. 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 (DaC). Bismuth Subnitrate, relieves pain and vomiting and contributes to the cure(B): See under Gastralgia for formulae. Chloroform I, with Bismuth Subnitrate 3, and Water 150, of which <5j->j hourly, or without the bismuth, which is not necessary, gives marked improvement in recent ulcer as well as in long-standing cases (Stepp). Silver Nitrate, in solution, to check pain and relieve the vomiting (R); is next in value to Bismuth, promoting cicatrization 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, 1 part to 10 of water, 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 hemostatic; 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). Resorcin, acts very well; its analgesic property herein is so marked that the stomach is enabled to tolerate food (Pope). Glycozone, is the best of all known agents for the treatment of gastric ulcer (Edson); should be given on an empty stomach, one or two teasp. in a wineglassful of water. Charcoal is said to ease the pain by preventing formation of acid products (R). Mercury, Corrosive Sublimate an effective remedy; gr. thrice daily before meals (B). Pepsin, by facilitating diges- tion, is useful (B). Iron, for the anaemia; the Lactate or Aminonio-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 formu- la); Brandy may be added, also Laudanum, gtt. x-xx, if the rectum is irritable (B). Milk-cure, has succeeded 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, farinaceous vegetables, rice, arrowroot, 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 3iij—vj (A. H. Smith). [Compare Hematemesis.J Gastric Ulcer. R. Argenti Oxidi, Ext. Hyoscyami, . . . aa gr. x. Ft. pil. no. xx. Sig.—One pill thrice daily before meals. Prescriptions. R. Argenti Nitratis, . . . . gr. v. Ext. Opii, gr. iij. Ft. pil. no. xx. Sig.—One pill thrice daily. R. Bismuthi Subcarb., . . . iij. Morphinse Sulph., .... gr. j-ij. Pulv. Aromat. gj. Ft. pulv. no. xij. Sig.—One powder in milk before each meal. R . Argenti Oxidi gr. v. vel Zinci Oxidi, g ss. Morphinse Sulph., . . . . gr. j-ij. Ft. pil. no. x. Sig.—One pill thrice daily, before meals. 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 GLANDS GLAUCOMA—GLEET. 669 (Wa). Carbolic Acid, and the Sulphites, as Sodium Sulphite, are most worthy of trial. Creosote, 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 Ferric Chloride, may be useful. Potassium Iodide, grs. 150 daily, with baths in Hot Springs of Arkansas, con- quered the disease in me, probably the only man who ever survived it. (Dr. Paul Paquin, Univ. Mo.) No drug yet tried has any marked specific effect on the disease (Durham). Mallein, for diagnostic purposes (see page 480). Glandular Affections. 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 Ferrous Iodide occupies an important place (B); Potassium Iodide for mammae and testicles, but especially for thyroid (R). Iodoform is equal, if not superior to Iodine, in enlarged scrofulous glands, and othjer glandular swellings (Wa). Lead Iodide, 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. every two hours (B); the Oleate of Mercury and Morphine in obstinate and painful tonsillitis, and inflammation of lymphatic glands (R). Aurum Salts, have cured enlarged and indurated cervical glands. Aurum and Arsenic Bromide, the solution is highly efficient in cervical adenitis (Barclay); rendered good service in a case of adenitis with enormous enlargement of the left side of the neck (E. A. Wood). Belladonna, especially in tonsillitis (P). Valerian, with Guaiacum, in strumous enlargement (P). Hydrastis, frequently controls (P). Carbolic Acid, a 2 per cent, solution injected into substance of gland (B). Electrolysis, used by me to remove a number of swollen and pain- ful lymphatic glands in the neck (Remak); by the use of strong and often interrupted faradic currents multiple indurated lymphatic tumors have been removed or diminished (Meyer) ; enlarged glands have been repeatedly cured by electrolysis (B). [Compare Bubo, Wen, Goitre, Tabes Mesenterica, Parotitis, Tonsillitis, etc.] Glaucoma. Atropine, hypodermically is beneficial (Anstie); imprudently used has caused the disease (Graefe, Wells): should not be indiscriminately instilled into the eyes of persons over 35 or 40 years of age, in whom it may light up a latent or incipient glaucoma. Physostigmine, lowers intra-ocular tension, and, with Quinine, is indicated in all cases of threatened glaucoma, to preserve the eye from the risk of consecutive glaucoma, and after iridectomy or sclerotomy (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 and often curative. Drainage of Eye, by gold wire or catgut, has proved successful (Wecker). Gleet. Cantharis, in drop doses, when frequent desire and pain in region of pros- tate (R) ; of benefit in subjects of relaxed fibre and feeble circulation (B). Blisters, to the perinaeum, of undoubted benefit (R). Piper Methysticum, has 670 GLOSSITIS GLOTTIS. cured obstinate gleet (Switzer). Bismuth, 1, Glycerin 1, 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, £ss in Oss of water with 3j of Laudanum, makes a good injection for gleet (R); internally for anaemic subjects (St). Mercury, grain of Corrosive Sublimate in 3 vj of water, is a good injection in gleet, used every 2, 3 or 4 hours (R); Donovan’s Solution in doses of 10 minims thrice daily, so uniformly successful in controlling chronic urethral discharge as to be almost a specific for gleet. 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 con- dition (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). Sandalwood Oil, TT\,xv ter die (R). Glycerite of Tannin, with equal quantity of Olive Oil or mucilage, as injection, 3'j enough ; persevere 8 or 10 days after discharge ceases, 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). Gleet is 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 ; frequent ablutions, fresh air, good nour- ishment. [Compare Gonorrhoea.] Prescriptions, R. Tinct. Ferri Chlor., . . . 3 vj. Tinct. Cantharidis, . . . 3jij. M. Sig.—15 drops in water three times daily. R. Pulv. Cantharidis, . . . . gr. iij. 01. Terebinth, £j. M. Ft. pil. no. xij. Sig.—One thrice daily in obstinate gleet. If strangury occur, stop for a day or two. R. Zinci Sulpliatis, gr. iij. Ac. Carbolici, rtyj. Ext. Hydrastis, Ext. Belladonnae, . . . aa gr. vj. Gelatini, q. s. M. Ft. bougia no. vj. Sig.—One in urethra at bedtime. R . Ac. Tannici, gr. x. Bismuthi Subnit., . . . . gij- Aq. Rosse 3 vj. M. Sig.—Shake and use as an injection thrice daily. [Maury.) Glossitis. Bismuth, gr. xx of Subnitrate 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 ddute 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 appa- rently imminent (A). * 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 §j of water; or Alum, gr. x to the 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.] Glottis, CEdema of. GOITRE GONORRHOEA. 671 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 5 strong enough for the worst cases (Wa). Potassium Iodide, internally, also exter- nally as ointment, in simple hypertrophy of the gland (R). Strychnine, gr. thrice daily, has been successful in several cases (Holmes). Ferric Chloride, 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 hypodermically with good results (Wa). Ammoni- ium Chloride, as an internal remedy has proved curative (Stevens). Thyroid Gland, 3j to ij, once a week, cured 4 children completely, and cured or relieved 9 out of 12 cases so treated (Bruns) ; Thyroid Extract is used with benefit (see page 132). Electrolysis, has sometimes cured in cases of simple hypertrophy and cystic gland (B); 6 out of 14 test cases of goitre were absolutely cured by electrolysis (Duncan). Spongia Usta, was formerly considered a sovereign remedy (Wa). Seton, has cured. Fluoric Acid, in doses of hbxv to 3j 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, Lane, Hedenus, Billroth and Greene. [Compare Exophthalmos.] Goitre. Prescriptions. R. Ammonii Chloridi, . . . z vss. Syrupi Simplicis, . . . . Sss. Aq. Cinnamomi, . . . . M. Sig.—Teasp. thrice daily. R • Unguenti Hydrargyri Iodidi Rubri, Vaselini, gvij. M. Sig.—Use as directed. (Gross.) Aconite, a drop of tinct. each hour in the acute stage (R); when inflamma- tion (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). Colchicum, 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). Ferric Chloride, when acute stage has passed and the discharge is degenerating into gleet, few remedies are more useful than this tincture, in doses of thrice daily (Wa). [See Erysipelas for formula.] Alkalies, Citrates or Bicar- bonates 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) freely (Otis). Turpentine, in chronic stage, when parts are relaxed, moderate doses are of great benefit (B). Cantharis, 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 half a winegl. of water to which add some bitter tincture (Chap- man) ; 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). Sandalwood Oil, valuable in sub- Gonorrhcea. 672 GONORRHOEA. acute (P); a good quality difficult to obtain (Pf); the best internal remedy, Copaiba next (St). Cubeb, unlike Copaiba, is given with good effect in acute stage; best results from a mixture of both as in electuary (see formula below); is not irritating to the stomach, and agrees with some patients better than Copaiba (Wa). Balsams of Peru and Tolu, also Buchu, Uva Ursi, Chima- phila, Pareira, etc., are among the numerous remedies used for gonorrhoea (R). 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). Silver Nitrate, a weak solution (gr.j-v to the §) as injection; in vaginal gon- orrhoea a strong solution (3j to the §) through speculum to every part of the canal (B); as abortive injection is useless and dangerous (St). Zinc Salts, a weak injection of the Chloride, gr.j to 3yj or viij of Rose-water; or the Sul- phate gr. j to the §, frequently repeated, is probably the best treatment (B); the best injections are those of the Sulphate or Acetate, gr. vj-xij to 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 gonorrhoea (Hill). Lead Acetate, the dilute solution of the Subacetate, as injection, may be employed at any stage (B). Chloral, a weak solution, gr. j-iv to the 3, a very good injection (Hill). Resorcin, a 1 per cent, solution makes a useful injection (Wa). Antipyrin, 100 parts, Corrosive Sub- limate 1, Distilled Water 10,000, used as injection four times daily and retained as long as possible (Vatier). Boric Acid, 3iss, Tinct. Iodine 3ij. Glycerin Ijij, Distilled Water q. s. ad 3iv, as injection morning and night, has given ex- cellent results in both acute and in chronic cases when other treatment proved inefficient (James). Potassium Permanganate, a solution, X to 1000, one or two quarts at each sitting, washing out the bladder as well as the urethra several times daily, is highly efficient. Alumnol, a 1 to 3 per cent, solution as injection, is reported to be efficient. Mercury, excellent results from Corrosive Sublimate (Pf); gr. to 3viij aquas destill, in subacute and chronic stages, as injection thrice daily ; may have gr. ss-j of Zinc Chloride added with bene- fit ; is often effectual (Wa). Hydrastis, the infusion best for injection, 3j °f root to 3 viij aquae (Pf); the fluid extract is one of the best injections, properly diluted; or the Muriate of Berberine (Hydrastin) 3j to j|iv mucil. acaciae (B). Soluble Bougies made of Iodoform, Eucalyptus and Cacao-butter, are highly recommended to cut the disease short (Wa) ; a series of similar preparations, having a basis of Gelatin and Glycerin, medicated with the usual astringent 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 the shirt for covering (St). Rest, in bed is an absolute desidera- tum, 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 Triticum with Potassium Bicarbonate. Sexual thoughts to be entirely avoided (Otis). Alcohol, as a beverage, or any other stimulant, must be avoided entirely (R). [Compare Chordee, Gleet, Orchitis, Rheumatism Gonorrhceal, Urethritis, Urethral Stricture, Vaginitis.] Prescriptions. For Internal Use. $. Potassii Citratis, .... jfss-j. Spt. Limonis, gss. Syr. Simplicis, iij. Aquae, gj. M Sig.—Dessertsp. largely diluted, 3 or 4 times daily. As alkali for the increas- ing stage. (Otis.) For Local Use. U. Zinci Sulphatis, gr. vj. Plumbi Acetatis, . . . . gr. viij. Ammon ii Chloridi, . . . gr. iv. Aluminis, gr. v. Aquae Rosae, Jj. M. Sig.—Injection to be used after acute symptoms subside. 673 GOUT, The Black Paste. R. Pulv. Cubebae, 5iij. Copaibse, ....... Jjss. Aluminis, g ij. Sacchari Albi, 3j. Magnesise, 3jss. Olei Cubebse, gj. Olei Gaultherise, . . . . £j. M. fiat electuarium. Sig.—A piece the size of a walnut after each meal. (Otis.) For hiternal Use. R. Resorcini, gj. Ac. Borici, gr. xx. Zinci Acetatis, gr-/{-/4- Aquae Destil., £ iv. M. Sig.—Dessertsp. as injection. For Local Use. R. Pulv. Iodoformi, . . . . % ss. Ac. Carbolici, 3 ij. Glycerini, i|ij. Aquae Destil., . . q. s. ad 3 viij. M. Sig.—Teasp. as injection. R. Oleoresinse Cubebse, . . . 3 iv. Potassii Bromidi, . . . . 3j. Olei Sassafras, rf^x. Syr. Acacia;, ij. Aquae, q. s. ad £vj. M. Sig.—Dessertsp. 3 or 4 times daily. (/. Wm. White.) R. Zinci Sulphatis, gr. viij. Liq. Plumbi Subacet. Dil., 3 iv. M. Sig.—Use as an injection. R. Zinci Chloridi, gr. j. Aquae Rosse, B vj-viij. M. Sig.—Use as injection. [For Alkaline Emulsion of Cqpaiba see ante, page 534.] [For Injection Brou and others, see ante, page 540.] Piperazin, the best solvent for uric acid ; promptly reduces the redness and swelling of the joints in acute gout; remarkably relieves the paroxysm, and promotes elimination of uric acid and urates; should be given in doses of 15 grains daily, dissolved in a pint or more of carbonated water. Lysidin, is still more powerfully solvent on uric acid (see page 391); tried in cases of chronic gout with exacerbations with excellent results (Grawitz). Phenocoll, when much pain and fever; combined with Piperazin, gr. xv of each daily in a pint or more of carbonated water, is very efficient treatment. Morphine, hypodermically, as close to the affected joint as possible outside of the red areola, is miraculous in giving immediate relief. Antipyrin, remarkably efficient for relieving the pain as well as prophylactic against future attacks (Marshall). Aconite, may cer- tainly relieve pain (P). Belladonna, the best remedy to effectually and speedily soothe pain, also in gout of the stomach ; 5-rq, doses efficacious (P). Potassium Iodide, especially when pain is worse at night (R). Colchicum is merely pallia- tive ; a large dose (3j) of the wine often removes the severest pain in an hour or two, and soon after the swelling 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 (P) ; is useful in the bronchitis, asthma, dyspepsia, urticaria, etc., of gouty sub- jects (R) ; Colchicine Salicylate, is highly efficient in chronic gout (see page 249). Strontium Salicylate, in chronic gouty conditions, appears to be the most valuable drug that we have (W). Sodium Salicylate, 10 grains every 2 hours internally, also £ij to §vij of warm water as lotion on lint covered with oiled silk, in acute gout, is very efficient treatment. Cascara Sagrada, is said to pro- mote the elimination of uric acid to a remarkable extent. Coffee, a tincture of green coffee promotes elimination of the poison of gout from the system. Vera- trine, as ointment to painful joints (R). Sulphides, as baths in chronic gout, or fumigation with Sulphurous Acid, and bed-clothes exposed to its strong fumes (R); Sulphur waters certainly benefit (B). Iodine, painted around joints in chronic gout (R). Strychnine, hypodermically for later stage of gout paralysis (R). Lithium, the Bromide internally and a strong solution of Lithia to the joints (B); the Bromide is the most efficient agent in combating the disease Gout. 674 GUMS. (Aulde); the Carbonate (gr. v to the 3) on lint around gouty enlargements, joints, etc. (R). Chirata, for the dyspepsia of gouty subjects. 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 (tt\^x— for the cachectic state (B). Alkalies, to relieve indigestion, especially Lithium Salts; alkaline mineral w.iters 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 administration (Wa). Alkaline Poultice, Linseed meal 9 parts to one of Sodium Bicarb, is a useful application (R). Turkish Baths, are useful in chronic gout (R). Carbonated Water freely, has an exceedingly beneficial influence. Oxygen, is used with benefit in cases of deficient oxidation (Br). Aliment, farinaceous vegetables and acid fruits ; avoid animal or saccharine food ; Milk- cure has improved cases, and apparently removed the diathesis (B); Cod-liver oil in chronic gout(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 by hot, moist flannels; wrap the hands in flannel dripping with water, and cover with water-proof bag, to dissolve gouty deposits. [Compare Arthritis, Lith^mia.] Prescriptions Scudamore1 s Mixture {Modified). R. Vini Colchici Radicis, . . 5j. Magnesii Sulphatis, . . . gj. Magnesise (Jptimse, . . gij. Aqua Menth. Pip., . . . 3X. M. Sig.—Tablesp. every hour until it ■operates on the bowels. R. Vini Colchici Seminis, . . 3 ss- Tinct. Digitalis, . . . . xij. Liq. Potassii Citratis, . . 3 'jss- M. Sig.—A teasp. in water every six hours. Lallemand's Specific. K • Ext. Colchici Acet. (B. P.), Ext. Opii Aquosi, . . aa gr. xv. Potass. Iodidi, 3 iv. Potass. Acetatis, . . . . zij. Aqute Destill., . . . • • liijss. Vini Albi, 3 ss. M. Sig.—20 drops thrice daily. R. Colchicinse, gr. j. Ext. Colocynthidis Co., . gss. Quininse Sulphat., . . . . giij. Ft. pil. no. lx. Sig.—One pill every four hours. (B.) R. Lithii Citratis, Magnesii Carbonat., . aa ijj. M. et div. in pulv. no. 1. (50). Sig.—One powder in water thrice daily. In chronic gout. R . Lithii Bromidi, 3 j. Liq. Potas. Citrat., . . . 3 iv. Syr. Tolutan., i|ij. M. Sig.—A teasp. in plenty of water after each meal. (Aulde.) Myrrh, the tincture for spongy and ulcerated gums (P); o'j-iv in 3*v of 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 3j aquae, applied by a camel’s-hair brush, after each meal, for retraction of gums with loosening of the teeth (Stille). Tannin, the Gums. HAIR—HAY-FEVER. 675 glycerite, for spongy and bleeding gums (B). Carbolate of Iodine, when fetor, (B). Benzoin, the tincture a good application (B). [Compare Scurvy, Teeth. J R. Aluminis, g ss. Tinct. Myrrhae, 2[j. Tinct. Cinchonae g iv. Mel. Rosae, Vini Albi, M. Sig.—Mouth-wash. Prescriptions. R . Tinct. Orris, Spt. Rosae, Alcoholis, aa^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 Dioxide, 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, §ss, Starch, 3'j: a very effective one is Barium Sulphide and Zinc Oxide (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.] Prescriptions. R . Sodii Boratis, z iv. Aq. Ammoniae, %). Spt. Myrcise, 5ij. Aq. Rosae, gxiij. M. Sig.—Shampoo Hair Wash. 1£. Ol. Ricini, Ol. Bergamottae, .... 01. Cinnamomi, Ol. Caryophylli, . . . aa TT^vij. Ol. Lavandulae, rr^xl. Tinct. Cantharidis, . . . gj. Aq Ammoniae, gij. Alcoholis, . . . . q. s. adOj. M. Sig.—Hair Tonic. $ . Ac. Salicylici gr. xl. Tinct. Benzoini, Z ss- Alcoholis, Glycerini, . . M. Sig.—Hair Wash. Hay-Fever. 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.] Belladonna, when nasal secretion is 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 nQj-iij every 2 hours for three doses, then tr\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 676 HEADACHE. 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 C). 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., . . g.j. Aquae Cinnam., M. Sig.—Teasp. every 4 hours. For Local Use. R. Tinct. Iodi, gj. Ac. Carbol., gtt. x. Aq. Destill., §iv. M. Sig.—For local use with atomizer or post-nasal syringe. R. Ext. Hyoscyami, .... gr. xij. Potassii Iodidi, sjj. Potassii Bicarb., . . . . ij. Ext. Glycyrrhizae Pur., . . sjiv. Aq. Anisi, ....... givss. M. Sig.—Dessertsp. every 4 hours until relieved. (Weber.) R. Mentholi, Ac. Carbol., 3SS- Zinci Oxidi, zj. Ol. Amygd. Dulcis, . . . tjss. Cerati Simplicis, . . . . 3 ij- M. Sig.—Apply thoroughly to the nos- trils every few hours. R. Liq. Potassii Arsenit., . . Tinct. Belladonnae, . . . gij. M. Sig.—5 to 10 drops after meals, as a prophylactic. U . Quininse Bisulph., .... ziij. Aquae, M. Sig.—Irrigate the nares, after cleansing with a weak alkaline solution. R. Cocainse Hydrochlor., . . gr. vj. Aquae Destill., M. Sig.—5 per cent, solution. A few drops to be instilled into nares while head is lowered. (Da Costa.) R. Tinct. Euphrasise, .... zjss. Aq. Camphorse, . q.s. ad 3 ij. M. Sig.—Teasp. four times daily, for the catarrh. Antipyrin, 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. Acetanilid, in 4-grain dose, equally effective. 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 maiked relief in sick-headache not of neurotic origin (Smith); drop doses every 10 min- utes for an hour cure sick-headache, especially when accompanied by bilious- ness (M). Strychnine, with Aloin and Belladonna, in minute granules, for bilious headache 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, with nausea and vomiting, usually the result of hepatic derangement; rt\j every half- hour for three doses, usually relieves promptly (Pf). Bryonia, ordinary bilious Headache, Bilious-sick. 677 HEADACHE. sick-headache with vomiting (P). Picrotoxin, gr. by stomach, in periodical form (B). Chamomile, a popular remedy (R). Salol, is one of the most effi- cient remedies. Podophyllum, in sick headache, with dark bilious diarrhoea, or when constipation with dark evacuations (R). Sanguinaria, when due to stomach derangement, a few doses relieve (P). Hydrastis, from constipated bowels (P). Mercury, as Blue Pill, to prevent or mitigate ; or small doses (gr. °f the Bichloride when headache with light-colored diarrhoea (R). Ammo- nium Chloride is an efficient remedy in most forms (Wa). Sodium Phosphate, a useful laxative in so-called bilious sick headache (B). Potassium 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 constipation (Br). Nitro-muri- atic Acid, 10 drops of the dilute acid in a winegl. of water, before each meal, often an effectual remedy (Br). Charcoal, two teaspoonfuls stirred in half- glass of water, as a draught, is an efficient remedy for sick-headache with sour stomach and flatulence, etc. [Compare Hemicrania.] Prescriptions. R. Ammonii Chloridi, . . . 3 iij. Morphinse Acetatis, . . . gr. j. Caffeinse Citratis, . . . . 3 ss. Spt. Ammonii Aromat., . %). Elix. Guaranae, iv. Aquae Rosae, 3 iv. M. Sig.—Dessertsp. every quarter-hour until relieved. [Carpenter.) R. Podophylli Resinae, . . . gr. ij. Tinct. Zingiberis Alcoholis, . . . q. s. ad §}. M Sig.—Teasp. in a winegl. of water every night at bed-time, or every second, third or fourth night as required. (Dobell.) Antipyrin or Acetanilid (see preceding article). Aconite, to reduce the cir- culation (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 ; tr\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. fa, 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 constipated bowels (P). Amyl Nitrite, for head- aches with severe flushing heats at menstruation or climacteric, a sufficient dose (R). Mustard, in hot foot-bath, or as poultice to nape of neck in various forms of headache (R). Water, cold water poured gently over forehead, some- times warm water better (R); a very hot foot-bath often effectually relieves (Wa). Purgatives are often beneficial, especially when congestive headache arises from suppression of hemorrhoidal discharge, or in persons of phlegmatic habit; Aloes best (Wa) ; or Colocynth, as derivative, when cerebral hypersemia (Da C). Headache, Congestive. 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 Bro- mide nightly, at bedtime. (Da Costa.) R. Spt. Ammoniae, 5j. 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. 678 HEADACHE. Headache, Nervous. Antipyrin, is efficient [see under Headache, Bilious-Sick]. Acetanilid, is very efficient in headache from fatigue (Brodnax); as routine remedies for the relief of headache these agents are much more valuable than bromides and caffeine (Whitla). Phenacetin, is used with success (M). Cannabis Indica, ten-minim doses of the tincture thrice daily in the intervals, often curative in bad cases of neuralgic headache; or to doses of the extract (P). [See under Hemickania.] Belladonna, of tinct. every 3 hours, when pain over brows and in eyeballs, especially when at menstrual periods; also when from over-study or fatigue (R). NuxVomica, 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, are useful when the nervous system has been irritated, but harmful when it is exhausted (Hammond). Silver Nitrate, half-grain doses with minute doses of Pil. Coloc. Comp., in- valuable in headaches of hysterical women and especially stomach headaches of delicate and literary men (Wa). Ignatia, removes clavus hystericus (Pf). Ammonia, the Aromatic Spirit (3ss-3ij) or the Carbonate (gr. v-x) in nervous headache (B); the Hydrochlorate (gr. x-xx) in bilious and hysterical head- aches, especially in hard worked and delicate young women (Wa). Amyl Nitrite, inhaled, when extreme pallor of face (B). Arsenic, throbbing supra- orbital headache (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 and menstrual headaches (P). Coffee and Tea, when from nervousness or exhaustion (R) ; Coffee especially uselul (P). Caffeine Citrate, one.to 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. Guarana, a very effective palliative, gr. xx every half-hour for three doses (P); Tt\,xv of the fluid extract every quarter-hour increased to will often relieve periodical headaches not of malarial origin (Smith). Sodium Salicylate, in small doses, gr. ij-iij every quarter hour, is very efficient in neuralgic headache (Br). Phosphorus, as dilute Phosphoric Acid, in doses of tibxxx well diluted, thrice daily; or Zinc Phosphide.gr. 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 headache (Wa). Potassium Cyanide, locally in reflex headaches, as gastric, cardiac, pulmonary, menstrual (B). Valerian is of great value in excitable persons (P). Camphor, a satu- rated solution in Eau-de-Cologne rubbed on head, when headache 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 Subcarbonate, 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, hbxv-xxx of the spirit internally, often effective (Wa). Galvanism, sometimes valuable ; the constant current always, avoiding too great intensity lest amaurosis ensue (Hammond). [Compare Hemicrania, Neuralgia.] R. Potassii Cyanidi, . . . . gr. x-xx. Aquae Laurocerasi, . . . iv. M. Sig.—Apply locally on a compress for to )/,, an hour. (B.) Prescriptions. R. Extracti 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. Rosae, q. s. M. et div. in pil. no. xxx. Sig.—One pill after each meal. (Fordyce Barker.) R. Ext. Cannabis Ind. FI., . ss. Pulv. Acacias, g v. Syr. Aurantii Cort., . . s ij. Aquae, q s. ad £ vj. M. Sig.—Teasp. every 3 hours. HEART AFFECTIONS. 679 Heart Affections. Potassium Iodide, the true remedy for the heart; especially applicable in non-compensatory mitral or myocardial diseases, and where there is cardiac debility; restoring energy and vascular tension at first; then by dilating, later on, all the arterioles.it frees the heart from resistance, and enables it to re- cover its contractile power; also dilating the coronary arteries it furnishes nutrition to the heart itself (See). Strychnine, in medicinal doses, is said to strengthen the heart-beats (R). Nux Vomica, gave speedy relief in several cases of heart-failure in which death was imminent; small doses every hour for four successive doses, then every hour (Bowie); in a case of cardiac hyper- trophy and mitral insufficiency, in which death was imminent from heart- failure, one drop of the tincture in a teasp. of water every 5 minutes for 10 doses, then every 10 minutes for 3 doses, continuing at longer intervals, com- pletely restored the cardiac force, and dispelled the accompanying cardiac asthma (Macfarlan). Digitalis, acts as a stimulant tonic (P); small doses for sedative action ; tonic or physiological doses to create hypertrophy in dilata- tion (Tr); irregularity of pulse is best indication (R); irritable heart (Da C) ; the tincture, given without water, is the best preparation; especially indicated in weak heart acting rapidly because of its weakness, and in valvular disease (Wa). Helleborein, as a substitute for Digitalis (see page 300). Chloral, is generally contraindicated in heart affections, but may be used with benefit in neurotic palpitation and in p5eudo-angina pectoris. 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). 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 dyspnoea (Striimpell); hypodermically, is employed in many cardiac disorders with marked advantage, especially in dyspnoea and angina with diseased coronary arteries, mitral regurgitation with its dyspnoea and insomnia, aortic disease, etc. Cimicifuga, safer than Digitalis in fatty heart (B); its action is strongly stimulating and tonic; it relieves exces- sive dyspnoea when weak heart (P). Cactus, is highly esteemed in functional cardiac affections. 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). Aconite, in the highest degree serviceable to diminish excitement or irritabilitv ; it is more a remedv for functional de- rangement than for organic disease (Wa); in pericarditis (R); in nervous pal- pitations and hypertrophy (P); 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 Digi- talis is contraindicated (W). Iron, useful in various forms, especially anaemic disorders and palpitation ; also in dilatation and fatty heart, and mitral regur- gitation (B). Hyoscyamus, in functional derangement from emotion, is speci- ally indicated; requires large doses (n\,xl-lx), or gr. fa of Hyoscyamine Sulphate hypodermically (Wa). Amyl Nitrite relieves heart pains resisting all other treatment (W). Blisters, flying blisters over the praecordial region, to stimulate action in extreme weakness (R). Alcohol, as Brandy when heart suddenly enfeebled by fright, loss of blood, etc. (R). Ether, hypodermic- ally, repeated soon, is a very promptly-acting stimulant in sudden heart- failure ; the compound spirit in Sj doses for less urgent cases. Schott Cure, as practised at Neuheim, is a combination of saline baths, containing C02 in so- lution, and a series of graduated gentle exercises ; the best results therefrom are obtained in cases of cardiac dilatation due to overwork or worry, but it is also useful in fatty infiltration of the heart (not fatty degeneration) accompany- ing general obesitv (M). [Compare Angina Pectoris, Dropsy, Endocar- ditis, Pericarditis, Syncope, and the five following articles.] 680 HEART AFFECTIONS. Prescriptions. R. Ext. Ergotse FI., .... £ iijss. Tinct. Digitalis, . . . . M. Sig.—Teasp. thrice daily'in enlarged heart without valvular lesion. R. Spt. Comp., Liq. Morphinse Sulphatis, (U. S. P., 1870), aagj. Teasp. as required for dyspnoea. Heart, Dilated. Digitalis, where much dilatation, and hypertrophy of left ventricle without valvular disease ; is not contraindicated when aortic disease (R); use in physio- logical doses (Tr) ; in simple dilatation gives most favorable results (W); very useful in mitral disease, when 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 C). Scoparius, the infusion (Broom-tea), to maintain the kidney action if Digitalis is not sufficient (Da C). Purgation, brisk, free, watery stools, next to Digitalis is the best treatment (Da C). Morphine, hy- podermically, gr. yi-yi two or three times a week in dilated heart with dyspnoea (B). Amyl Nitrite, dyspnoea from dilatation (R) ; is useful when great dysp- noea, the cardiac asthma (P). Ether, the Compound Spirit an excellent remedy for the dyspnoea (Da C). 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 (Foster). Schott Cure, in dilatation due to overwork or worry (see preceding page). Heart, Fatty. 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, in occasional doses has been given with apparent benefit (Wa). Iron, the tincture of the Chloride in small doses for a longtime, 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 C). Chloral, must be entirely debarred (Id). Ether, the compound spirit for sudden attacks of pain or dyspnoea (Id). Amyl Nitrite, for the same indications (Id). Stimulants, freely used, in an acute attack of any kind, afford the only chance (Id). Schott Cure, useful in fatty infiltration (not fatty degeneration) accompanying general obesity (M). Heart, Hypertrophied. Aconite, often better than Digitalis (R); dangerous in hypertrophy of left side, with diseased valves, but useful in simple hypertrophy (P); for over- action, 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 C). Digitalis, very useful in pure hypertrophy due to valvular 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, inadmissible when valvular lesions exist (B); gives the best results, next after Aconite (Da C). Lead Acetate, for violent palpitations, in some instances effi- cient (Wa). Amyl Nitrite, for dyspnoea, syncope (R). Ergot, in enlarged heart without valvular lesion ; may be combined with Digitalis (B). Potassium Iodide, small doses long continued benefit some cases (Wa). Camphor, in HEART AFFECTIONS. 681 doses of gr. iij-xij daily for tumultuous palpitations and dyspnoea of hyper- trophy 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). Aconite, for the fluttering heart of nervous persons, and nervous palpitations (R) ; for over-action, with hypertrophy (B) ; for palpitation with simple hyper- trophy (P). Hydrocyanic Acid, when from dyspepsia (P). Iron, when palpitation due to anaemia, a very frequent cause ; other causes are tobacco, coffee, tea, etc., to excess, dyspepsia, venery, excessive exercise (Da C). Spigelia Anthelmia, when due to mitral and aortic disease, with much dyspnoea (P). Digitalis, in small doses as sedative (Tr) ; combined with Iron in palpitation with valvular disease, or given alone in very severe cases (Wa); suits a large number of cases, especially for temporary purposes (Da C); the only remedy of 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 flut- tering heart (B); are useful when tolerated by the stomach (Da C). Hyos- cyamus, in nervous, and violent palpitations from excited state of the brain (P); in large doses, for functional disturbance arising from emotion (Wa). Bella- donna, in small doses, when irregularity of rhythm ; may also be applied exter- nally (Da C). Valerian, nervous palpitation, with dyspnoea (P). Eucalyptus, palpitation and weak heart (B). Galvanization, of cervical sympathetic and pneumogastric (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 some- times becomes necessary (Da C). Heart, Palpitation of. R . Pulv. Digitalis, gr. xx. Pulv. Colchici Sem., . . gr. xl. Sodii Bicarb., gr. lx. M. et div. in chart, no. xl. Sig.—One powder at first 3 or 4 times daily, gradually reduced to one at bedtime. For irregular cardiac action. [Bowditck.) Prescriptions. R. Tinct. Digitalis, . . . . % ij. Spt. Etheris Nitrosi, . . . 3j. Liq. Ammonii Acet., q.s. ad3 iv. M. Sig.—A dessertsp. every 4 hours. If prolonged insomnia with palpitation add of Morph. Sulph. gr. Jg to each dose. (jRichardson.) Heart, Valvular Disease. Nux Vomica, the tincture in one-drop doses every 5 minutes, remarkably efficient in heart-failure, even with death impending (Bowie); also for the asthma (Macfarlan). [See under Heart Affections.] 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); Tt\j of tinct. every yi hour or hour, often gives more relief than larger doses (Smith) ; when heart is weak and struggling (Da C). Cactus, is especially recommended in complicated aortic regurgitation, as it does not prolong the diastole like l5igitalis, but stimulates the cardiac action. Morphine, hypodermically for the dyspnoea, is 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 dyspnoea; is to aortic regur- gitation what Digitalis is to mitral (Dujardin-Beaumetz). 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 682 HECTIC FEVER—HEMATEMESIS. blood-pressure in the arterial system, and gives great relief (Da C). Veratrum Viride, has similar applicability, but is more apt to nauseate ; an admirable sedative, and one which does not sicken is a mixture of Tinct. Aconiti, tr\j, Tinct. Verat. Vir., riD'j. Tinct. Zingib., (Da C). Strophanthus, 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 overcome (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 (Id). Adonidine, in doses of gr. to£ thrice daily, acts excellently as a cardiac regulator (Id). Barium Chloride, 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 (Id). Purging, with Jalap, etc., in engorgement of right side of heart (R); occasionally uselul (DaC). Treatment is directed chiefly to the dilatation or hypertrophy resulting from the valvular disease; the simplest rule is to use judgment as to when the heart needs strengthening by Digitalis or reducing by Aconite or Veratrum Viride (Da C). [Compare Endocarditis.] Hectic Fever. Quinine, in large doses, gr. xv-xx daily, if stomach and intestines do not rebel (P); given before the paroxysm, to limit it (Roberts). Antipyrin, is better than Quinine, but must be used in much smaller dosage than ordinarily em- ployed, 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 the hectic of phthisis (Pibram). Phenacetin, is safer and equally efficient. Phenocoll, as an antipyretic, is used with marked success. 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, espe- cially 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 temperature and diminishes the sweats (B). Iron, the Mistura Ferri Composita has obtained great celebrity, especially when much debility and anaemia (Wa); the Sulohate and Tincture of the Chloride are 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 Perspira- tion, Phthisis.] Prescriptio ns. R. Tinct. Digitalis, iij. Tinct. Ferri Chloridi, . . M. Sig.—15 drops 3 or 4 times a day. (B.) R. Quininae Sulph., .... gjss. Elix. Taraxaci, ..... 3 iv. M. Sig.—Teaspoonful every hour for six hours. Hematemesis. Ipecacuanha, is decidedly effective in small doses, also when hematemesis is vicarious of menstruation (P, Wa). Hamamelis, of tinct. every 2 or 3 hours (R) ; effective from its Tannin (B). Alum, serviceable in passive hemor- rhage ; Iron better (B). Turpentine, especially in passive hemorrhage with debility (R) ; and in hemorrhagic transudations on the free mucous surfaces, hematemesis, etc. (B). Ergot, has often cured when other means failed (P) ; most valuable; in urgent cases Ergotin in 2 to 5 gr. doses hypodermically (R). Iron, the Subsulphate (Monsel’s solution) or Pernitrate, the best remedies ; gtt. j-ij frequently, diluted with ice-water (B). Lead Acetate, especially in gastric ulcer, gr. ss-v (B). Tannic Acid, gr. x-xx, when from gastric ulcer or HEMATOCELE—HEMATURIA. 683 obstructive disease of liver (B). Gallic Acid, an extremelv useful agent; is best used in combination with dilute Sulphuric Acid (Wa). Ice, in small pieces swallowed, a most useful agent, with perfect rest for stomach ; when hematemesis from that organ, nutrient enemata must be employed; iced champagne to arrest faintness, if persistent; when moderate the bleeding need not give cause for alarm. Prescriptions. R. Olei Terebinth., .... 3iij. Ext. Digitalis Fluid., . . i^j. Mucil. Acacise, % ss. Aq. Menth. Pip., . . . . £). M. Sig.—Teasp. every 3 hours. R. Ac. Gallici, Ext. Ergotse Aquosi, Digitalis, aa gr. xx. M. et div. in pil. no. xx. Sig.—One every 4 hours. Hematocele, Pelvic. 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 be still 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. 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. -fo 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 Ferrous Iodide 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. R . Iodi 5 j. Potassii Iodidi, sij. Glycerini, gviij. Prescription. Mix and saturate 8 oz. of cotton with the mixture ; then carefully dry; and label “ Iodized Cotton.” Turpentine, when with constitutional debility (B); in very small doses (R) ; often is very efficacious (P). [See under 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 C). 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, suc- ceeded in arresting it (Ghent). Quinine, large doses necessary ; cures when intermittent or from malarial infection (B) ; useful in some cases of intermittent hematuria (R). Myrtol, has been used with success in hematuria not due to acute congestion (B). Iron, the tincture of the Chloride, several times daily; in this affection the best form of Iron for internal use (Wa). Ipecacu- anha, exercises a powerful influence (Wa). [See under Hematemesis.] Ergot, by stomach or subcutaneously; may be combined with Ipecac, Krameria, or other astringents (B). Ergotin, hypodermically, is far superior for efficacy and rapidity of operation (Wa). Matico, the infusion, in doses of J;ij every 2 or 3 Hematuria. 684 HEMERALOPIA—HEMICRANIA. hours, is fully equal to Gallic Acid, Lead, etc. (Thompson). Ammonium Ben- zoate, 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 hypersemia 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., . . . 3_j. Tinct. Opii Deodor., . . £j. Infusi Digitalis, 3 iv. M. Sig.—Tablesp. every 4 hours or oftener. In hematuria, menorrhagia, pur- pura hemorrhagica, and the hemorrhagic diathesis. (D.) R • Ext. Ergotse Fluidi, Tinct. Kramerise, . . . aa^j. M. Sig.—A teasp. every hour or two. R. Ext. Ergotse (Squibb), . . 3j. Aquae, J;j. M. Sig.—For hypodermic use ; TT^x contain gr. j. Hemeralopia and Nyctalopia. Strychnine, night-blindness; small doses, gradually increased, of service (Wa). Mercury, Hydrarg. Chlor. Corr. gr. ij, ad aquae, dropped into the eye twice daily, with blister on each temple, and mild aperients, has cured hemera- lopia (Smith). Quinine, in as large doses as can be borne, after cathartic and emetic, for night- and day-blindness (Howard). Blisters, small, inches in diameter, close to external canthus of the eye (Bampfield). Electricity, occa- sionally useful (Wa). Rest, protection of eyes from bright light, constitutional remedies, as indicated by state of general health, change of climate, speedily cure hemeralopia. It is sometimes merely a symptom of pigmentary degenera- tion of the retina, or a feature of scurvy. Antipyrin, the most valuable single remedy for headache, especially in migraine and those cases 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, yi 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.). Acetanilid, the mysterious and striking powers of these two agents are best demonstrated in severe migraine (Whitla). Phenacetin, has been given with great benefit, in doses of 2 grains with grain of Caffeine Citrate, for migraine. 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 ; try 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 com- bined in pill with either Iron or Aloes (K); of especial value in the con- gestive form, the tincture in repeated doses until physiological action is induced (H); gr. of the extract before each meal, increased gradu- ally to Yi or grain, in the intervals, kept up for 3 months (Seguin); gr. yi 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 Magnesium Carbonate, is very useful, especially in hysterical females Hemicrania. HEMIOPIA. 685 (P). Croton-chloral, in milder forms without severe vomiting, 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 (PI); Guarana, is useful (B), a very effective palliative ; gr. xx every ]/2 hour, for three hours (P); its efficacy diminishes by degrees, attacks usually becoming longer (Tr); 3hj of fluid extract in course of an hour or two, to anticipate the attack when expected (Seguin). Caffeine, in typical migraine ; gr. j hypodermically (P) ; is espe- cially adapted when chronic gastric catarrh, gr. j every half-hour (B); the Citrate in grain doses every hour for some time before a paroxysm (Wa); gr. j every half-hour often gives marked relief (Smith). Valerian, of especial value when hemicrania in excitable temperaments, and after profuse or painful menstruation (P). Ammonium Chloride, is exceptionally serviceable ; seldom fails to cut short an attack (Austin); x-xv gr. doses (R) ; as a diffusible stimulant is very efficient, gr. xx up to 3j every hour during the attack (H). Sodium Chloride, in small doses, proved very efficient in six positive cases attended by gastric distress (Rabon). Podophyllin or Mercury, when of bilious origin (R). Bromides, for true migraine; Raspail’s Eau Sedative locally, gives great relief (B); when due to uterine disorder (R). Potassium Bromide, very serviceable in the paroxysm, also in continuous form (R). Eucalyptus, in cerebral anaemia (B). Digitalin, gr. bis die in granules 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 for- mula below.] Piscidia, is highly recommended (Wa); efficient in doses of £ij of the fluid extract (Ford). Arsenic, for cerebral congestion and hemicrania (B) ; for throbbing pain in one brow (R); often has the best effect: Watson believed that gtt. iv-vj of Liq. Arsenicalis, 3 or 4 times a day, with due attention to the bowels, would cure 9 out of every 10 cases (Wa). Aconitine or Vera- trine, ointment over brow (R); Aconitine internally is of great service (Seguin). Phosphorus, is strongly recommended (R). Amyl Nitrite, by inhalation, in migraine with pallor of face (R). Sanguinaria, a few doses very successful, when migraine is due to gastric derangement (P). Ignatia, 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 bandage wetted after being put on (Weir Mitchell). Acupuncture, the needle run down to the cra- nium will give relief in clavus hystericus, when nothing else will do so (Pan- coast). [Compare Headache, Bilious Sick, and Nervous.] Prescriptions. R. Quininae Sulphatis, . . . 3 ss. Pulv. Belladonnae, . . . . gr. x. Ext. Digitalis, gr. xv. Ext. Valerianae, 55 ss. Mellis, q. s. Ft. pil. no. xl. Sig.—2 to IO pills daily, gradually increased, during three or four days before the expected attack. R. Ammonii Chloridi, . . . sjvj. Ammonii Bromidi, . . . iv. Spt. Etheris Nitrosi, , • ?,)■ Syr. Pruni Virgin., . . . 5 iij. Aquae, q. s .ad M. Sig.—Dessertsp. 3 or 4 times daily, conjoined with the use of Raspail's Eau Sedative (see page 122)', locally. &. Mentholi, gj. Alcoholis, gj. 01. Caryophylli, Ol. Cinnamomi, . . . aa Tt^xx. M. Sig.—Apply with finger over seat of pain. R. Aconitine (Duquesnel), . gr. XV Alcoholis, Glycerini, aa %j. Aq. Menth. Pip., . q. s. ad 3 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 686 HEMIPLEGIA HEMOPTYSIS. daily, or a 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 (De Wecker). 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 hennplegics; gr. of 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. Atropine, gr. hypodermically, is remarkably efficient in stopping the bleeding in phthisical hemoptysis (Squibb). Gallic Acid, exceedingly effective (P); may be combined with Ergotin and Digitalis. [See Hematemesis and Hematuria for formulae.] Lead Acetate, 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). Chloral, is used with benefit, its vaso-dilator power probably acting as a derivative, and its sedative influence allaying excitement. Ipecac- uanha, has been highly praised (R); in emetic doses arrests hemoptysis (Tr), though in poisonous doses produces it (P); a well-founded case is recorded where Ergot and Gallic Acid utterly failed, and Ipecac was effectual; but it must be pushed to the nauseating point, in order to effect the control (Squibb). Turpentine, in 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 hemorrhages (Wa); in 10 grain doses every 2 hours (B). Oil of Erigeron, is very efficient when no fever or other signs of constitutional irrita- tion (Wa). Hamamelis, tipj-ij of tincture, every 2 or 3 hours (R); tt\jj-x of fresh tincture several times a day (Pf). 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 common salt, taken dry, repeated till nausea (R). Sulphuric Acid, the dilute acid a useful adjunct to other treatment (Wa). Spinal Hot-water Bag, to cer- vical or upper dorsal vertebrae (R). Auxiliaries, Cold externally, acidulated drinks, perfect rest, and antiphlogistic diet (Wa). . Ext. Ergotse FI., .... Ext. Ipecac. FI., Tinct. Opii Deod., . . aa M. Sig.—Teasp. every y2 hour. Prescriptions. R. Aluminis, 5jj. Sacch. Alb 3 ss. Pulv. Ipecac. Comp., . . gr. xx. M. ft. pulv. no. vj. Sig.—One powder every 2 hours. (Skoda.} . I’lumbi Acetat. gr. xx. Pulv. Digitalis, ..... gr. x. Pulv. Opii, gr. v. M. ft. pil. no. x. Sig.—One every 4 hours. (B.) I& . Liq. Ferri Subsulph., . . rr^xx. Aquae, t^ij. M. Sig.—Use as spray by inhalation for 5 minutes every hour. HEMORRHAGE. 687 Sulphuric Acid, sometimes very effective in uterine hemorrhage (B). Dilute Vinegar to leech-bites, piles, cuts, etc. (R). Apple-vinegar as injection tor vesical hemorrhage. [See under Hematuria.] Iron, when hemorrhagic diathesis due to anaemia ; the tincture of the Chloride preterred (B) ; this tincture as a 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 hemorrhage, Ergot or Ergotin of great value (P); not to be relied on alone (B). Antipyrin, is a most efficient hemostatic ; a 4 per cent, solution checks general oozing from a bleeding surface; as a styptic it constricts the small vessels without causing an external clot to break down (Park). Alum, is sanctioned by high authoiity (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). Ipecacuanha, produces hemorrhage in poisonous doses, yet has great energy in arresting it (P); exercises a powerful influence on internal hemorrhage generally, 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 hemorr- hage of typhoid (P). Belladonna, hemorrhage from rectal ulcers (P). Digitalis, in uterine, and many other forms, of great value (P) ; with restoratives has undoubted power in the hemorrhagic diathesis (B). [See Hemoptysis.] Bone- marrow, in hemophilia due to anaemia (see page 133). 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 Phosphates; no prescription more generalh 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). Arnica, in ecchymoses from mechanical violence (P). Rhatany, the extract, one of the most powerful hemostatics (Tr). Haematoxylon, is devoid of irritant qualities and is therefore well adapted to check the diarrhoeas and hemorrhages of young children. Grape-cure, as tonic for convalescents (P). Alcohol, in hemorrhagic diathesis, to elevate the arterial 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, is 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 is often indispensable, especially in hematemesis, in which nutrient enemata may be required. [Compare Dysentery, Ecchymosis, Epistaxis, Hematemesis, Hemoptysis, Hemorrhoids, Hematuria, Hemorrhage Post-partum, Intestinal, Menorrhagia, Metrorrhagia, Purpura, Wounds, etc.] Hemorrhage, Hemorrhagic Diathesis. Pancoast's Styptic. R. Potassii Carbonat., . . . gij. Saponis, j—ij- Alcoholis, giij. Mix and use as a styptic especially for operations about the face. {Jos. Pancoast.) Prescriptions. R. Ext. Ipecac. FI., . . , . 3'J- Ext. Ergotse FI., .... 3 iv. Ext. Digitalis FI., . . . . gij. M. Sig.— Half teasp. to a teasp. at a dose, repeated as required. An excellent anti-hemorrhagic combination. (B.) 688 HEMORRHAGE. Pagliari's Styptic. and put up in stoppered bottles. R. Tinct. Benzoini, .... viij. Aluminis, ft), 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, R . Infusi Digitalis, Ext. Ergotse Fluidi, Tinct. Kramerise, . . . aa^j. M. Sig.—A tablesp. as required in hemorrhagic conditions generally. (B.) Hemorrhage, Intestinal. Turpentine, should be used (B); especially in that of typhoid (P). [See Hema- temesis, for formula.] Belladonna, for irritable and bleeding rectal ulcers (P). Iodine, in passive form, gtt. j-ij of tinct. frequently repeated, of great service (B). Sulphuric Acid, is serviceable (B). Lead Acetate, often of great service, especially when used as an enema (Jenner). Tannin, one of the most ser- viceable remedies for the intestinal hemorrhage of typhoid fever (B). Ham- amelis, very effective in intestinal hemorrhage, owing to its large proportion of Tannin (B). Ergot is most valuable; may be given hypodermically in urgent cases (R). Gallic Acid, gr. xv with gtt. iij-iv 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); most useful (Da C). [Compare Hemorrhoids, Dysentery, Typhoid.] Hemorrhage, Post-partum. Atropine, hypodermically, is remarkably efficient. [See under Abortion.] Hamamelis, for persistent oozing (R). Ipecacuanha, in flooding after delivery (R). Iron, Monsel’s solution, j to iij of water, strong enough and safe as injection (B); the Perchloride diluted (R). Amyl Nitrite, rr\,v by inhalation, 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 (Play- fair); hypodermically in urgent cases, gr. ij of Bonjean’s Ergotin deeply into the tissues of the arm (Wa); 3ss doses of the fluid extract every 2 to 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. Ergotse FI. gtt. xxx ; each hour for 2 or 3 doses (B). Opium, the tincture 3j with Brandy, in profuse flooding (R). Vinegar, a handkerchief soaked in vinegar and carried into the uterus, w’ill often check a severe hemorrhage (Landis); is antiseptic, astringent and sufficiently irrita- ting 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, iio° 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 immersed in the ice. Transfusion of milk into veins may be necessary in cases of col- lapse (Thomas). HEMORRHOIDS. 689 Hemorrhoids. Galls, as ointment, very useful; the official Unguentum Gallae, or Galls com- bined with Lead and Opium (R). [See formula below.] Iron, a solution of the subsulphate as wash to bleeding piles, which should then be well oiled (B); or an ointment of the same (Basic Ferric Sulphate) gr. xv to the locally night and morning, with gr. j of the salt thrice daily by mouth ; gives excellent results. Hamamelis, by mouth, also as lotion or injection in bleeding piles (R); is employed with satisfaction; rr\jj-x of tincture several times a day; also as enema or suppository (Pf ). Nux Vomica, emphatically beneficial (P). Sulphur, gr. v-x, with 3j Confec. Sennae, as laxative (R); exercises a most soothing influence (Wa). Sulphides, especially Blue Lick water (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 delivery (B); to greatly relieve bowels (R) ; cures by removing constipation (P). Hydrastis, as lotion or ointment to external piles, of great value ; n\,v 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.] Stillingia, will remove permanently when due to constipation, and temporarily when from hepatic obstruction (B). Senna, to procure soft and easy evacuations 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); ad Oss of water as lotion for bleeding piles (R). Hyoscyamus or Stramonium, leaves bruised, or ointment, locally, for pain (P). Linseed Oil, boiled, in doses of j|ij 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 suc- cessful treatment by itinerants (Andrews); uncertain in all cases and in many fraught with danger (Gross): a good procedure: use 4 drops each of pure Car- bolic Acid and Glycerin, and inject one tumor at a time (Hunt). Grape-cure, is used with success (B). Saline Purgatives, notably Epsom salts, combined with Sulphuric Acid, will often stop the hemorrhage (B). [See Dysentery 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 of cold or tepid water, are very useful. Stool should be at night. Surgical Methods are : the ligature for internal hemor- rhoids, excision for external ones. Ligation, is the proper treatment for the former, all other methods of operating radically being now discarded as unsur- gical and dangerous to life (Gross). Thermo-Cautery is used by Smith of Lon- don 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, tending to drive the blood into the interior of that cavity (Holden). Prescriptions. R. Iodoformi, g). Balsam. Peruv., gij. Magnes. Calcin., . . . . gj. Cetacei, gss. Ol. Theobromae, . . . . q.s. M. et fiant suppositoria xij. Sig.—One twice daily. (Potter.) &. Ext. Colocynth. Co., . . . gr. xxx. 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.) 690 HEPATALGIA HEPATIC CONGESTION. R. Pulv. Gallse, gr. xx. Pulv. Opii, gr. x. Ung. Plumbi Subacet., . . gr. xl. Ung. Simplicis, M. et. ft. unguentum. Sig.—Ointment for piles. (CEsterlen.) R. Ext. Opii, gr. x. Pulv. Stramonii, . . . . gj. Pulv. Tabaci, sjss. Ung. Simplicis, 3SS. M. Sig.—Ointment for piles. {Shoemaker.') R. Pulv. Gallse, Pulv. Opii, Plumbi Acetat., . . . . aagr. xx. Ung. Picis Liquidse, Cerati Simplicis, . . . aa j$ ss. M. et. ft. unguentum. Sig.—Apply night and morning after bathing parts with cold water. R. Ac. Carbolici, 3 ij. Ac. Tannici, Alcoholis, ziv. Glycerini, M. Sig.—Hypodermic injection for piles. (Girard.) Hepatalgia. Ammonium Chloride, 20 to 30 grains 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^2 twice or three times a day (P). Quinine, would naturally be thought of in malarial subjects, but does not afford any relief (Anstie). Hepatic Cirrhosis. Diuretin, for the dropsy. [See under Dropsy.] Nitric Acid, in long-stand- ing 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). Aurum, the Bromide of Gold and Arsenic has been used with benefit (Barclay) ; the Chloride of Gold and Sodium, in doses of gr. -fa, as an hepatic alterative, maybe used conjointly with Sodium Phosphate (B). Sodium Phosphate is said to produce good results (Da C) ; has power to retard the sclerosis, and may possibly arrest the changes and restore a state of comparatively normal func- tion (B). Iodides, are the best remedies for the first stage (B); Potassium Iodide is highly recommended by some authorities (Da C) ; 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 ab- stinence from alcoholic beverages (Legg). Mercury, Corrosive Sublimate in small doses, gr. fa thrice daily, for a long time, does benefit the condition, and has possibly cured a few cases (Da C). Tapping becomes necessary for the dropsy, though purgation and diuresis may help to lessen it (Id). Diet, should be easily digested, especially milk, avoiding starches and fats, and quitting al- cohol (Id). [Compare Ascites.] 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 528 for formula.] Sulphur, as Sulphates in purgative natural waters, small doses often repeated; Potassium Sulphate is occasionally poisonous (R). Chelidonium, as deob- struent (P); energetically affects the liver (Pf). Iodine, tincture and ointment Hepatic Congestion. HEPATIC CONGESTION. 691 locally for hepatic engorgement after malarial attack ; also Ammonium Iodide 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 tor- pidity, is well worthy of attention ; gr. xx every 4 hours (Wa); an excellent remedy (Da C). Turpentine, epithems, hot, often found very beneficial (Wa). Quinine, gr. xv-xx with Morphine.gr. in 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 congestion 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 48.] 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 (Id). Aliment, no starches or fats; give 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.] R. Elaterii, gr. j. Spt. ditheris Nitrosi, . . 25 ij. Tinct. Scillse, Tinct. Colchici, . . . . aa 3 ss. Syrupi Simplicis, . . . . §)■ M. Sig.—Teaspoonful thrice daily. Prescriptions, R. Pil. Hydrargyri, Pulv. Aloes Socot., . . aagr. iv. Pulv. Rhei, Ext. Plyoscyami, . . . aagr. vj. M. et div. in pil. no. vj. Sig.—2 pills every other night. 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 j|vj. M. Sig.—Dessertspoonful before meals, and a milk diet. R. Cinchonidinse Sulph., Euonymini, Leptandrini, Juglandini, Irisini, aa^j. Podophyllini, Ext. Belladonnse, Ext. Hyoscyami, . . . aagr. x. M. et div. in pil. no. lx. Sig.—One pill thrice daily. In obstinate hepatic torpor. (Blackwood.) R. Ext. Taraxaci, gr. lxxij. Ext. Aloes, gr. xxiv. Ext. Colchici Rad., Pulv. Ipecac., . . . .aagr. xij. M. et div. in pil. no. xxiv. Sig.—2 nightly in chronic enlargement and torpidity. (Martin.) 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. 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.) R. Potass. Bicarb., Potass. Citratis, . . . . Syrupi Simplicis, . . . . % vj. M. Sig.—A teaspoonful to a tablesp. with a similar quantity of lemon-juice, in glass of water ; the whole to be drank while effervescing. (Wood.) 692 HEPATIC DISEASES HEPATITIS. Ammonium Chloride is highly serviceable in all cases of liver disease, whether due to organic changes or to functional derangement; especially indi- cated after the more acute symptoms have abated (Wa). Nitro-hydrochloric 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 bene- ficially 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 gen- erally are of doubtful propriety in liver affections (B); in hepatic congestion a full Calomel purge is of great benefit (Wa). Red Mercuric Iodide, as oint- ment, gr.jto £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 par- enchymatous than to serous inflammations (Da C). Ipecacuanha promotes the flow of bile (B); may be used in small doses with great advantage in func- tional 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 (Thudi- cum). 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). Sulphur, the sulphurous mineral waters, pro- longed, give excellent results in liver disorders (B). Alkaline Waters are very serviceable (B); especially the sulphur waters; Glauber’s salt in their place (Da C). Chlorine Water has been employed with benefit in chronic hepatic affections, in doses of 3ss—ij in or iv of water (W). Iron preparations, long continued, in amyloid degeneration (Da C). Gentian, and other bitter tonics, in functional disorder; also Nux Vomica occasionally, but use Mer- curials and Podophyllum sparingly (Da C). Iodine and Iodides in waxy en- largement, simple hypertrophy and chronic congestion, of great value (Wa) ; Potassium Iodide alternately with Ferrous Iodide in waxy liver (Frerichs); a few drops injected into hydatids (B). Sanguinaria is of great value in hysteria from chronic hepatitis, and in hepatic engorgement without organic disease (P). Stillingia for torpid liver and jaundice following ague, in the first stage of cir- rhosis, and in ascites from hepatic changes (B). Malt Liquors are harmful in all chronic affections, especially in fatty liver (B). Galvano-puncture for hy- datids, the negative needle into the hydatid (B). [Compare Lists of Agents acting on the Liver, page 48 ; also, the articles in this section entitled Bilious- ness, Calculi, Cancer, Hepatalgia, Hepatic Congestion, Hepatic Cir- rhosis, Hepatitis, Jaundice ] Hepatic Diseases. 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 C); in medium doses persistently for a long time has done excellent ser- vice in chronic suppurative hepatitis without abscess but with frequent exac- erbations. Tartar Emetic, gr. every two or three hours, with Opium or Calomel as indicated by symptoms ; of especial value early in the acute attack HERNIA HERPES. 693 (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 C). Sinapisms and Linseed poultices over the hepatic region in acute hepatitis (Wa). Saline Purgatives, as the Sulphate 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 the chronic form tending to abscess (Da C). Aspiration, when pus forms; early operation the rule of practice; has induced many recoveries (Id). [Compare Jaundice.] Hernia. Opium, or Morphine hypodermically to narcotism, often obviates the neces- sity of an operation in strangulated hernia (Wa). Chloroform, of evident bene- fit (Wa); inhaled to assist reduction (R); has superseded the use of Tobacco and Lobelia in strangulated hernia (P). Coffee, large doses, has certainly a remarkable influence in aiding or causing reduction of strangulated hernia (Wa). Thyroid Extract, causes herniae to vanish in a few weeks or months when due to accumulation of myxcedematous or fatty material in the abdominal cavity, and should be tried in hernial protrusions from any part of the abdomen before resorting to surgical means (Parker). 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 Dr. Gage in 1840, the Oil of Cloves being the injection used; Professor Pancoast injected tincture of Iodine for the same purpose. Operations for radical cure all unsatisfactory ; a properly adjusted truss 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 ; in this position the action of gravity, aided by the sudden action of the diaphragm, tends to draw inwards the posterior portion of the escaped gut, which is the part most difficult to manage by taxis. Cold Douche, with taxis properly performed and the position above described, will reduce 90 per cent, of the cases of strangulated hernia within a few minutes; the cold water should be poured from a height on the tumor while taxis is being performed (Raiford). Ferrum Arsenate, 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). Myrtol, is curative of herpes (B). 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 affections (Shoemaker). Alum, in herpes praeputialis, a solution of gj to j|j aquae, applied on lint to the glans penis, is generally effectual (Wa). Collodion, the flexible form, is applicable to various kinds of herpes (Wa). Magnesium Citrate, as a cooling laxative, with soothing and protective lotions and ointments, and the Liquor Picis Alkalinus, diluted 10 to 20 times for the itching (Bulkley). Astringent Lotions, of Tannin or Zinc Sulphate, in herpes praeputialis, to render the parts less sensitive (Da C). [For Herpes Circinatus see Tinea Circinata.] Herpes. 694 HERPES ZOSTER HICCOUGH. Prescriptiotis. 1£ . Tragacanthae, 3 ij-iv. Liq. Calcis, sjiv. Glycerini, gj. Aquae Rosae, 5 iij. M. Sig.—A soft jelly for local use as ointment. I£. Acidi Carbolici, gtt. v-xv. Pulv. Calaminae Praep., Zinci Oxidi, . •. . . . aa %ss-j. Ung. Aq. Rosae, .... gj. 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, the oleate ex- ternally without friction (R) ; hypodermically to mitigate the pain (Anstie). Celandine has been recommended (P). Dulcamara, has an old reputation (P). Silver Nitrate, painted on the warning patch of erythema, before or as soon as vesicles begin to form (R); as a local application is reported on favorably (Wa). Veratrine, as ointment (gr. xx-xl to the 3), in neuralgia following shingles (R). Zinc Phosphide, gr. ]/z every 3 hours, is said to control the pain and abort the eruption (Hughes). Grindelia, is reputed to relieve the pain (Stille). Mer- cury, the Ung. Hydrarg. Ammoniat. is said to relieve the pain and irritation re- markably (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). Gal- vanization of the affected intercostal nerves, the positive pole over their points of emergence, the negative brushed over the terminal filaments of the skin (B). Starch, dusted over the eruption, and on a muslin band sewed tightly around the body to protect it from the friction of the clothes, gives the greatest relief (Bulkley). Rest, absolute, when eruption is extensive (Fournier). R. Zinci Phosphidi, Ext. Nucis Vomicae, . . aa gr. x. M. et div. in pil. no. xxx. Sig.—One pill every 2 to 4 hours, as a nerve tonic. (Bulkley.) Prescriptions. R . Bismuthi Subnitratis, . . g iv. Hydr. Chlor. Mitis, Zinci Oxidi, aa M. ft. pul vis. 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., . j|iv. Aquas, ijij. M. Sig.—Wash for ulcerated vesicles. Morphine, hypodermically, often arrests hiccough (R) ; an injection of Mor- phine and Atropine together has stopped a most violent hiccough in which morphine alone and other agents had proved unavailing. Nux Vomica, in 5 or 10 minim doses of the tincture, with rrpxv 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). Cam- phor, has been recommended (R). Mustard, 3j infused in §iv of hot water 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 epi- gastrium for ten minutes, then to the site of the phrenic in the neck (Regoni) ; or the spirit, TTxx-xxx in some aromatic water, given internally, will often ar- rest the spasm immediately (Wa). Zinc Valerianate, gr. with a small por- tion ofExtr. Belladonnas, cured a severe case of fifteen days’ duration (Danet). Nitro-glycerin, sometimes arrests (R). In mild cases deep inspirations, hold- ing breath as long as possible, or a firm belt around epigastrium (T). Hiccough. HYDROCELE HYDROPHOBIA HYDROTHORAX. 695 Hydrocele. Iodine, injection of the 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 precautions (Volkman); the same end may be obtained by the simpler methods of injection noted above (Gross). [Com- pare Dropsy, Orchitis.] • Mercury, holds a high place in the opinion of many ; Calomel gr. )4-)4 twice daily, with mercurial inunction to the shaved head, or the latter alone; child to wear a woolen cap ; this treatment for 30 or 40 days (Wa). Ferrous Iodide, with Cod-liver Oil, always gives good results among the poor (Wa). Iodine, as lotions. [See Meningitis Tubercular.] Potassium Iodide, may arrest progress (Wa); is of value certainly ; appears to have power of promot- ing absorption (Wa). Cod-liver Oil, sometimes improves the condition, espe- cially in scrofulous children (Wa). [Compare Dropsy.] Hydrocephalus, Chronic. Hydrophobia. Belladonna, in all hyperaemic 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 tried (B). Hydrastinine, is used with benefit, in grain doses of the Hydro- chlorate, hypodermically. Curare, is encouraging, gr. ]/$ injected, 7 doses in 5)4 hours, dispelled the symptoms, but replaced them by paralysis of the limbs continuing for over 2 months (Ros); has seemed to antagonize the convulsive phenomena (B). Morphine, chiefly palliative ; for deep injection into the teta- nized 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); 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). Rabies Toxin, the Pasteur inoculation with a “ modified virus,” protects the bitten person from the disease. (See page 479.) [For the Statistics of this treatment see ante, page 479.] Diuretin, has been employed with benefit. [See under Dropsy.] Digitalis, in the purely dropsical form, also in passive pleuritic effusions ; used as a diuretic (3j-ij of infusion bis die, or oftener) of great value (R). Elaterium, unques- tionably of value as a derivative, though many fear it (P). Jaborandi, pro- duces good results (B). Iodine, Zj of tincture injected in returning hydro- thorax (B). Sanguinaria, has been used with the best effects (Wa). Blisters, Hydrothorax. 696 HYPOCHONDRIASIS HYSTERIA. when effusion has taken place, certainly seem to stimulate the absorbents to action (Wa). Dry Cupping, over the chest, gives relief (Da C). Thoracentesis, if much distress. [Compare Dropsy.] Hypochondriasis. Arsenic, in the aged, gives great comfort, especially when combined with Opium (B). Ignatia, is useful, the tincture is best (P). Cimicifuga, of singular value in puerperal hypochondriasis, and that accompanying spermatorrhoea, etc. (P). Aurum, the Chloride, gr. to ter die gives excellent results, when depression, vertigo, cerebral anaemia (B); Gold is an efficient remedy in hypo- chondriasis accompanying hepatic or testicular disease. Valerian, quickly re- lieves the flatulence of hypochondriacs (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; re- lieves 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 or stimulant effects in these cases (W). Cocaine, especially useful in cases marked by debility and nervousness, and in mental affections accom- panied 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. Antipyrin, for the painful affections of hysteria. Aurum, the Bromide is of decided benefit, in doses of gr. X to X (Rosenbach). Arsenic, lessens mobility of the nervous system and improves nutrition (B). Opium, gtt. j of Laudanum with gtt. ij of the tincture of Nux Vomica, 3 or 4 times a day, for the flushes, weight on the head, depression, etc. (R) ; Opium is a useful agent if its identity be concealed from the patient, otherwise the opium habit is sure to follow. Ignatia, useful in many forms of hysteria, with feeling of suffocation, sensation as of a ball rising to the throat, convulsive crying, flatulence, etc. (P). Cam- phor, in hysterical excitement (P). Musk, for many anomalous and distressing 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, when flatulence, weight on head, flushings and perspirations (R). 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 spirit for the acidity and eructations (B); the fetid spirit for flatulent colic, etc., may be given with great advantage in doses of £>ss-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). Orchitic Extract, is used with benefit. Cerebrinin, is employed with good results (Paul). Ovarian Compression, has in many cases relieved recent hysterical contractions, and many other similar phenomena ICHTHYOSIS—IMPETIGO IMPOTENCE. 697 (Bourneville). Electricity, for aphonia, paralysis and anaesthesia, and to educate the nervous control; is the sworn enemy of hysteria. Accessory Measures, occupation of mind and body; removal from influence of friends; complete abandonment of the 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. R . Ext. Ergotae, g]. Ferri Sulphatis, £ss. Ext. Nucis Vomicae, . . . gr. viij. Hydr. Chlor. Corros., . . gr. ss. Fiant pil. no. xxx. Sig.—One pill thrice daily. For the indigestion and anae- mia. (B.) Prescriptions. R. Tinct. Asafcetidae, Tinct. Valerianae Ammon., Tinct. Castorei, . . . aa Aquae Camph., 3VU- 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 §j, found very efficient (Wilson). Sodium Bicarbonate, as ointment, gr. xv-xxx to the or lotion, 3ij-iij to the pint (Devergie). Copper Sulphate, gr. x ad of 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 generally 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). Thyroid Extract, has been given with benefit. Ichthyosis. Impetigo. Salol, locally, as an antiseptic and deodorant powder. Arsenic, is very use- ful (see under 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 the day, with poultices at night to remove scabs (R). Quinine, and Mineral Acids, when from imperfect digestion (R). Zinc, the ointment of the Oxide, after subsidence of inflammation (R). Sulphur, internally, serviceable (R). Calcium Chloride, gr. xv-xxx, daily in some vegetable infusion, is well spoken of (Wa). Mercury, Citrine Ointment dilute, locally, is an excellent application (Wa) ; a very weak White Precipitate Ointment answers best in im- petigo 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 C). Laurel-water, relieves the itching (P). Grape- cure, has proved excellent (P). Flexible Collodium, or Liquor Guttse-perchae, to cover the pustules, if located where they are liable to irritation (Da C). [Compare Eczema.] 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). Aurum Chloride, prevents decline of sexual power (B); Gold Impotence. 698 INFLAMMATION. salts are highly praised by several authorities for decline of sexual power in men. Kola, as a general tonic. Cantharis, with Iron is beneficial (B); in large doses (gtt. xx-xxx), with Iron and Phosphoric Acid or Nux Vomica (R); of doubtful efficacy (Wa). Cubeb, removes functional trouble (B). Nux Vomica, drop doses of tincture in atonic impotence (B); in large doses when spermatorrhoea (R). Sanguinaria, has decided aphrodisiac properties, but is useful only in the functional form (B). Serpentaria, in relaxation and feeble erections, will often restore power; 3ss doses of tincture twice daily (B). Er- gotin, hypodermically about the dorsal vein of penis, when its enlargement and too rapid emptying is the cause of impotence (B). Cannabis Indica, is a useful remedy; the best combination for functional impotence would be one of Can- nabis, Nux Vomica and Ergot (B). Polygonum Hydropiperoides, is a useful remedy in the functional form, erections feeble, semen watery and testes soft (B). Ferrum Arsenate, acts as a tonic to the organs, and in full doses often benefits cases of the 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, Sper- matorrhoea, also the List of Aphrodisiacs, ante, page 55.] Prescriptions. R . Ferri Arsenatis, gr. v. Ext. Ergotae, gr. xxx. Ft. pil. no. xxx. Sig.—One twice daily. R . Sanguinariae, gr. ij. Ext. Ergotse, gr. xx. M. Ft. pil. no. xx. Sig.—One pill thrice daily. R . Ext. Cannabis Indicae, . . gr. x. Ext. Ergotae, gr. xl. Ext. Nucis Vom., . . . . gr. x. Ft. pil. no. xx. Sig.—One pill night and morning. R. Tinct. Sanguinarise, . . . 3 iij. Ext. Stillingiae FI., . . . M. Sig.—15 to 20 drops in water, thrice daily. R. Quininae 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. Gentianse, gr. xxx. M. Ft. pil. no. xxv. Sig.—One pill 2 or 3 times daily. Aconite, is especially indicated in inflammation of the respiratory organs, in the eruptive fevers, and all inflammatory states of high temperature and sthenic reaction ; not in adynamic states, or continued fevers, except for hyperpyrexia; may be advantageously combined with Opium (B); gives most brilliant results in many forms (R): always indicated in early stages of simple inflammatory fevers, in all inflammation of serous membranes, pneumonia, tonsillitis, acute rheumatism, erysipelas, 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 (tipx) 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; for inflam- mation of eyes, boils, carbuncles, etc., 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). Gelsemium, especially for inflammation of lungs and pleurae, and in pneumonia of fl. ext. every two hours) (B); in acute stage of gonorrhoea is valuable (P). Bryonia, exceedingly valuable in pleurisy and other serous inflamma- Inflammation. INFLAMMATION. 699 tions, 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. renders incontestable service (B); in pneumonia, tonsillitis, pleurisy, bronchitis, and other inflammatory affections (R) ; gr. l/e, frequently repeated, has the power of completely dissipating early local inflammations (Spender) ; quite as useful in arresting local inflammations as Quinine is in malarial fever (Lawrie). Pul- satilla, in acute and subacute inflammations with muco-purulent discharges, especially of eyes, ears, and nasal passages (P) ; also with Aconite in epididy- mitis (Pf). Mercury, in acute glandular inflammation of throat and neck, in ileo-colitis, iritis, syphilitic inflammations of serous membranes, laryngitis (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 solution in Nitrous Ether is a most efficient application to check in- flammation in superficial parts, as boils, felons, orchitis, synovitis, erysipelas, erythema, eczema, etc. (B). Iodine, as liniment in vicinity of local inflamma- tion to produce vesication (R). Sulphides, especially that of Calcium (gr. $\j) appear often to arrest suppuration ; after formation of pus they hasten matura- tion and circumscribe inflammation; in boils, abscesses, and deep-seated sup- puration, they improve the condition and promote healing (R). Antipyrin, Kairin, and other antipyretics (see under the title Fever). Alkalies, especi- ally 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 application to inflamed and erysipelatous surfaces (Wa); to eczema and other inflammatory diseases of the skin (Pf). Digitalis, the German antipyretic, is especially useful in pneumonia, bronchitis, rheumatic fever and scarlet fever (B); Aconite safer and better (R); locally and internally Digitalis 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 (Fairbank). Quinine, in peritonitis (Tr) ; is indicated in most acute forms, unless objections occur (P) ; has power to arrest inflamma- tion in formative stage; with Morphine and in full doses (gr. xv-xx) may sup- press 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. (R). Saline Purgatives, valuable as part of the denutrition treatment, and to diminish arterial tension (B). Salicylic Acid is antipyretic, especially in septicaemic inflammation, and acute rheumatism, erysipelas, pneumonia (B); Sodium Salicylate 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 inflamma- tions of mucous surfaces, to constrict the blood-vessels of the part (R). Pilo- carpus, 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 in many forms where sthenic reaction and ple- thora ; value of bloodletting probably due to derivative and counter-irritant 700 INFLUENZA. effects (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 the digestive tract use milk and beef-tea alternately every 3 hours; no starches or fats; in intestinal inflammation milk, eggs, animal broths, oysters, fish, but all food must be used with great caution ; skim-milk treatment (B); Cod-liver oil in many chronic inflammations, as of heart, lungs, kidneys, etc. (R). [Compare the various titles, as Bronchitis, Pleuritis, etc., also the list of Antiphlogistics on page 51.] Prescriptions. R. Tinct. Aconiti, %). Tinct. Belladon., . . . . 5 ij. M. Sig.—Three or four drops in water every hour. (B.) [See pages 541 and 542 for Liniment and Lotion formulae.] R . Antim. et Pot. Tart., . . gr. ijss. Magnesii Sulph., . . . . gij. Morphinae Sulph., . . . . gr. Ac. Sulph. Aromat., . . . Tinct. Verat. Virid., . . . 5>jss. Syr. Zingiberis, %ij. Aquae Destill., § x. M. Sig.—Tablesp. every 2, 4, or 6 hours. Antimonial and Saline Mixture. (Gross.) R. Ammonii Chloridi, . . . 3 v. Acidi Acetici, Alcoholis, aa 3 x. Aquae, q. s. ad£ x. M. et fiat lotio. Evaporating and dis- cutient lotion. Influenza. Menthol, dissolved in Chloroform, as inhalation, to abort an attack of influ- enza (see under Catarrh, Acute Nasal), is highly efficient as a prophylactic (Wunsche); Menthol in 5 to 10 per cent, spray, is highly praised. Cocaine, a 4 per cent, solution snuffed up the nostrils or sprayed into them, is very efficient in the early stage (R). Eucalyptus, the Oil, sprinkled on blotting-paper placed around a large room, was considered an efficient prophylactic during the Lon- don epidemic of 1891, and was much used in offices, shops, etc. Salol, and Salipyrin, as internal remedies, were highly extolled during the epidemic of 1891. Phenacetin, is used with great benefit, both as a prophylactic and a remedy. Phenocoll, the Hydrochloride has been used with marked success, in epidemic influenza, and for the neuralgic pains thereof. Acetanilid, 2, with Salicylic Acid and Ammonium Bromide, each 1 part, forming the mixture called Anti- nervin, was used with much success during the recent epidemic in Scotland. Quinine, the Hydrochlorate, gr. viij daily as prophylactic, has specific action, as shown by experience with hussars at Bonn during the epidemic of 1889-90 (Graeser); the Hydrobromate in 8 to 16 grain doses, if the fever is high (Huch- ard); Quinine is used with benefit throughout the disease, and especially for the neuralgic pains following the acute stage (Wa). Potassium Bicarbonate, is more nearly specific than any other remedy ; gr. xxx with of Glycerin and Liquor Ammonii Acetatis sjss, every three hours ; it prevents complications when given in time and also prevents sequelae (Calvert). Sodium Salicylate in doses of gr. v every half hour for six or eight doses, then every hour until all pain has vanished, then every two hours for a day or two, is very efficient (Parker). Ammonium Salicylate, is even better than the sodium salt; add Liquor Ammoniae Fort, 3j to Ac. Salicylic, gr. lxxx, to make an 8 ounce mix- ture for tablespoon doses (Id). Strychnine, for the underlying weakness and depression, the real enemy to fight against in the grippe, Strychnine is the best remedy we have (Huchard). Digitalin, crystallized, in dose of gr. in grip- pal pneumonia, in which, though the disease is in the lungs, the danger is to the heart (Id). Sodium Benzoate, with Quinine and Caffeine (see formula be- low) in the simple form of the grippe (Id). Ammonium, the Liquor Ammonii Acetatis, combined with Nitric or Chloric Ether, is often of great service (Wa). Sanguinaria, is used with much benefit (Wa). Cimicifuga has been given with INSANITY AND DEMENTIA. 701 much success (R). Camphor, in solution, hypodermically (see formula below), 2 to 4 injections daily, with 3 to 6 of Caffeine and 2 to 3 of Ether, for grippal pneumonia (Huchard). Camphoric Acid, in one dose of gr. xx-xxx, dry on the tongue, not over 2 hours before the expected time for sweating, is remarkably efficient to prevent it. Agaricic Acid, gr. by mouth, is efficient against the sweating of influenza. Bismuth Salicylate, or Naphtol, Betol, Salol, or Benzo-naphtol, as intestinal antiseptics, when such are required (Huchard). Sulphurous Acid, by fumigation or inhalation, a few drops on boiling water ; or as a spray, often controls influenza (R). Benzol vapor, is a reliable pulmonary antiseptic, and has been employed with very favorable results (Robertson). Benzoin, the compound tincture, 3ss-j, inhaled from a pint of hot water fre- quently (Da C). Tartar Emetic has been recommended strongly, but is too depressant (Wa); has extraordinary power of aborting local inflammations, especially those of the respiratory apparatus. [See under Inflammation.] Spiritus Etheris Nitrosi, in doses of 3j-jss, in any convenient vehicle, is a popu- lar and efficacious remedy (Wa). Cubeb, £>ss or 3j doses of the tincture in glass 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, largely diluted as lemonade, 3j-ij in the course of the day, proves highly useful (Wa). Boric Acid, as gargle, also borated ointment or vaselin to the nasal cavities, and great care taken of the cleanli- ness of the mouth ; antisepsis of the nose, mouth and pharynx is very important and does much to prevent complications and perhaps broncho-pneumonia (Plicque). Coca and Kola, the tinctures, a mixture of equal parts of each, for the nervous depression (Id). Hot Fomentations, for the headache (R). Turk- ish Baths, have been used with marked advantage (Wa). Prescriptions. U . Quininse Hydrobromat., Sodii Benzoat., Caffeinse, aagr. xxx. M. et ft. pil. no. xxx. Sig.—One pill thrice daily. (Huchard.) U . Ext. Cimicifugse FI., . . 25ss. Tinct. Opii Deodorati, . . gj. Syr. Tolutani, gxj. M. Sig.—Teasp. every four hours. &. Ammonii Chloridi, . . . gjss. Morphinse Sulph., . . . . gr. ij. Tinct. Sanguinarise, Syr. Ipecac., aa 5 iv. Mist. Glycyrrh. Co., Aquae, aa^jss. M. Sig.—Teasp. as required for the cough. Each dose has of Morphine Sul- phate gr. TV L£. Camphorse, g ijss. 01. Olivas (steriliz.), . . . ,^iij. M. Sig.— 3 ss hypodermically twice or thrice daily. (Huchard.) R. Ext. Ipecac. FI., . . . . 55 ij. Tinct. Opii Deodorati, . . 3 iv. Tinct. Aconiti, gj. M. Sig.—Five to ten drops every two hours, for the bronchitis. Insanity and Dementia. Hyoscine, has strong power as a mental alterative ; is particularly useful in that form of mental disturbance which renders the patient violent and abusive, restless and domineering, a nuisance to every one who has anything to do with him (Weatherly). Duboisine, gr. to YL hypodermically twice daily, is highly efficient in the treatment of the mental excitability of the insane, induc- ing quiet and refreshing sleep, and is not dangerous (Massant). Opium, especi- ally Morphine, is injurious in mania, but is useful in melancholia and for cli- macteric and senile cases. Chloral, does as much harm as good, is best suited to wildly maniacal and erotic patients. Potassium Bromide, is almost dis- carded, except for epileptic cases. Conium, is useful, sparingly, for noisy patients. 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 ; 702 INSOMNIA. the wet pack in the mania of hystero-epilepsy. Stimulants rank high, next to quiet and absence from home. Thyroid Extract, has been used with apparent benefit. Tonics and Hypnotics, should be employed in cases requiring them. Food of good quality is essential to the treatment. Kumyss, is an excellent food in hysterical dyspepsia and anorexia simulating that of insanity. Moral Treatment, is now successfully carried out in many asylums, but is expensive, requiring a large staff of trained attendants. 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 administered 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 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 requir- ing them to attend school daily, with remarkably good results. [Compare De- lirium, Hypochondriasis, Mania, Melancholia.] Insomnia. Chloral, is quite unrivaled, being the most direct and generally useful hypnotic (B); acts best in cases of purely nervous type (Wa); in doses of 20 to 30 grains is by far the best hypnotic for many forms of insomnia (R); is dangerous in old drunkards, in whom the heart and vascular system have undergone fatty and calcareous degeneration (B); in combination with Opium or Morphine it acts splendidly in small dose, each ingredient intensifying the hypnotic action of the other (Brodnax) ; children bear it well, especially when given with Pare- goric. Chloralamid, 30 grains in Sj of whiskey or brandy, in simple or idio- pathic insomnia, or that from nervousness, hysteria, chronic alcoholism, but not when due to excitement or severe pain. Croton-chloral, is feebler than Chloral and less toxic ; as a hypnotic 3) may be given (R). Somnal, is a com- bination of Chloral, Alcohol and Urethan, and strikingly efficient in the insomnia of convalescence from acute disease (Myers). Paraldehyde, in doses of 3)-3'h one of the most efficient and safe hypnotics, being free from depressant action on the heart and other unpleasant by-effects. Sulphonal, 15 to 30 grains in milk, 2 hours before effect is desired ; an admirable hypnotic in many cases, but its efficacy decreases with use, and it is of no value in insomnia due to pain. Trional, is markedly hypnotic and sedative, acts surely and promptly in the insomnia of neurasthenia and organic brain affections ; is better than Sulphonal or Chloral in many respects (Schultze). Tetronal, is somewhat less hypnotic than Trional, but more of a sedative ; the sleep from either lasts 6 to 8 hours, and is generally dreamless ; neither are of any use when insomnia is due to pain. Potassium Bromide, when from cerebral over-action, gr. xv before each meal, and gr. xxx on retiring; has cumulative effect (B); it in- creases hypnotic effect of Hyoscyamus, Belladonna, Cannabis Indica, Ether and Chloroform (R). Opium, 15 to 20 minims of the tincture, or *4 to grain of Morphine, the most effective hypnotic when insomnia is due to pain ; in combination with Chloral (see above) smaller doses of each are efficient. Opiates should be given so as to act at the natural time for sleeping (R). Codeine and Narceine are also hypnotic in proper doses. Hyoscyamus, an effective substitute for Opium in children, 3lj~E) °f tinct. necessary, and with- out danger (B); when Opium disagrees (R). Hyoscine, produces sleep after a brief period of excitement; gr. of the hydrobromate hypodermically is ex- cellent for the insomnia of the insane. Duboisine, is even more calmative and hypnotic than Hyoscine, and is especially useful when high mental excitement exists ; gr. to or hypodermically, may be combined with gr. % to % of Morphine. Belladonna or Atropine, is hypnotic in some conditions, especi- ally when prostration, low arterial tension and contracted pupils. Ignatia, for sleeplessness from nervous erethism, better than Morphine (Pf). Gelsemium, INTERMITTENT FEVER. 703 in simple wakefulness (B); and in that of drunkards, mania and over-excite- ment (R). Coffee, insomnia from lowering of nervous power, and chronic alcoholism (P). Sumbul, 30 to 40 minims of the tincture, with a little Chloric Ether, is very efficient in the insomnia of chronic alcoholism (P). Tartar Emetic, with Opium, is effective when insomnia is due to cerebral congestion and when Opium stimulates (B). Hypnal(see page 221) is credited with simul- taneous hypnotic and analgesic action. Methylal (see page 222) is an efficient hypnotic. Hypnone (see page 221), is of moderate hypnotic power, but is said to be especially useful in the insomnia of acute alcoholism. Urethan, a pure but mild and safe hypnotic, especially useful for children. Resorcin, produces quiet sleep in general nervous excitability, and in the insomnia of typhus fever and pulmonary tuberculosis. Ether or Chloroform, in full dose (R); may be used by inhalation when other means of producing sleep have proved unsuc- cessful. Phosphorus, when nutrition is inactive, and in the insomnia of the aged (B). Humulus, a hop pillow is said to be effective in many cases (P) ; the tincture of Lupulin, as a cerebral sedative. Cocaine has been used with some success (Wa). Chamomilla, h\j of the tinct. every quarter- hour, an excellent sedative for children (Smith). Cannabin Tannate, in 8-grain doses, a good hypnotic (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 apply cold to it, and a tepid bath to the body (B). [Compare Nervousness; also the title Hypnotics, on page 34, and the sub-title Analogues of Chloral on page 221.] Prescriptions R. Paraldehydi, X ijss. Alcoholis (99 per cent.), . 3jss. Tinct. Vanillae, gss. Aquae, sj. Syr. Simplicis, . .q.s. ad 3iv. M. Sig.—A teasp. or two every hour until sleep is obtained. ( Yoon's Hypnotic Elixir.) R. Potassii Bromidi, . . . . giv. Chloralis Hydratis, . . 3 iij. Tinct. Asafcetidae, . . . . giv. Syrupi, Xvj. Aquae, q. s. ad 3 vj. M. Sig.—Tablesp. every 2 hours until sleep is induced. In the insomnia of hys- teria. R. Potassii Bromidi, Chloralis Hydratis, . . aa 3 ss. Syr. Pruni Virgin., . . . %). Aquae, .... q.s. ad 3 iv. M. Sig.—Teasp. in a winegl. of water. Repeat in one hour if necessary. R • Chloralis Hydratis, . . . 3 ij. Potassii Bromidi, . . . . 3 iij. Tinct. Opii, gj. Syr. Aurantii Cort., . . . ziij. Aquae, q. s. ad M. Sig.—Teasp. at a dose. May be repeated if necessary. Quinine, as prophylactic, gr. v-x each morning in black coffee ; begin with gr. v, add gr. j each week (R); in ordinary intermittentsgive6or io 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 C); 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 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 administra- tion of Arsenic during intermissions; may be given in solution by rectum, or hypodermically (R); is almost specific in intermittents 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 Commission, 1866); average dose of each, gr. x (Wa). Cinchonidine Salicylate, promises well as an antiperiodic (B). Intermittent Fever. 704 INTERMITTENT FEVER. Arsenic, the best remedy next to Quinine, especially useful in long-standing agues of quartan type (R); useful as adjunct to Quinine daily to prevent relapse ; most important in chronic ague, with Iron ; also as prophylactic small doses of Fowler’s solution (B). Hydrastine, stands next after Arsenic ; indica- tions same as for Quinine (B); in doses of gr. ij-ix is strongly recommended (P). Pilocarpine, gr. x/% of the Muriate, in the cold stage, is strongly recom- mended by high authority, to excite profuse perspiration and thus lessen the attack (Da C). 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 substi- tute for Quinine, but inferior (B) ; grs. x-xl, in mild cases (P). Opium, as Mor- phine, gr. hypodermically, not only lessens the chill, but aids the action of the antiperiodic ; is to be strongly urged (Da C); is useful in the pernicious variety, in combination with Quinine (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 is now used as adjunct to Quinine (B); good in convalescence (P); has antiperiodic value not inferior to that of Quinine ; gr. of Strychnine equals gr. j of Quinine Sulphate (Wa). Strych- nine Arsenite, is highly efficient (see page 357). Methylene Blue is effi- cient, and has many advantages over Quinine, especially for very young chil- dren (Ferreira). Chloroform, to prevent an impending paroxysm; 3j-3ij of the spirit before the chill, or by inhalation (B). Narcotine, gr. ij-v ter die, is eminently antiperiodic; no other 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, Sfviij—xij, may occasion- ally prove efficacious (Wa). Eucalyptus, during convalescence (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 ; rrcss—ij in mint-water or gr. in n\,xx 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 ordinary cases; but Hydrarg. cum Creta Qui- nine 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, are used (R). Gentian, is valued chiefly as a vehicle (P). Ammonium Picrate, proved wonderfully effective in India, where 10,000 cases were treated therewith (Clark). Lemon, in decoc- tion, exceedingly efficient in preventing recurrence 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 commencement, inadmissible if gastric irritation (Wa). Antimony, at the onset and continuously in mild, uncompli- cated cases ; Tartar Emetic, gr. yi-'/e every 2 hours, has been followed by complete cures (Moore). Guaiacol, locally to skin, as an antipyretic (see page 257). Antipyrin, 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 adynamic subjects (Maclean). Purgatives, in the intermission, before using the antiperiodic, is good practice; Podophyllum, Colocynth or Jalap (Da C). Iron, is valuable in chronic cases ; the system should be thor- oughly saturated with it (Da C). Ergot, for the enlarged spleen (Da C). [Compare Malaria ; also the List of Antiperiodics on page 51.] Prescriptions. R. Acidi Carbolici, Tinct. Iodi Comp., . . . Jjiij. M. Sig.—4 drops every 4 hours in suf- ficient water. (B.) R. Massas Ferri Carb., . . • . gj. Acidi Arsenosi, gr. j. M. Ft. pil. no. xx. Sig.—One pill thrice daily in chronic ague. (B.) INTERTRIGO INTUSSUSCEPTION, 705 R. Quininse Sulphatis, . . . gr. xxxij. Mucil. Acacise Syr. Eriodyctii Aromat. (Parke, Davis & Co.), vel Mist. Glycyrrhizse Co., vel Velatine, . . . . q. s. ad !§ij. M. Fiat emulsum. Sig.—A teasp. contains 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. Quininse Sulphatis, . . . gj. Ac. Hydrobrom. Dil., . . gij. Aquae, 3 xiv. M. Sig.—A teasp. contains gr. of Quin. Sulph. The acid directed prevents the unpleasant cerebral action. (B.) R. Quininae Sulphatis, Pulv. Acaciae, . . . . aa sjss. Syr. Zingiberis, iv. M. Sig.—A teasp. contains one grain of Quin. Sulph. A good formula for children, the quinine being suspended, not dissolved. R. Quininse Sulphatis, . . . gr. xl. Ferri Sulph. Exsiccat., . . gr. xx. Acidi Arsenosi, gr. j. M. Ft. pil. no. xx. Sig.—One pill thrice daily. (B.) R. Quininse Sulphatis, . . . gr. xxx. Capsici, gr. xv. Opii Pulveris, gr. iij. M. Ft. pil. no. xx. Sig.—One pill to five pills as required. (Piffard.) R. Quininae Sulphatis, . . . gr. Ixxx. Ac. Sulphurici Diluti, . . q. s. Spt. Etheris Nitrosi, . . . giv. Syr. Tolu, Aquae, . q.s. ad gij. M. Sig.—A teasp. contains gr. v of Quin. Sulph. [Da Costa.) Acetanilid and Boric Acid, equal parts, dusted thickly over the surface, in the intertrigo of infants or adults, separating the surfaces which rub with ab- sorbent cotton (Brodnax). Bismuth, the Nitrate or Carbonate, as dusting pow- der (R). Tannin, the glycerite is excellent (P). Camphor, added to dusting powders, to allay heat and itching (R). Lime-water, to obviate results of irri- tating urine (R). Soap, with free ablution when intertrigo caused by acid se- cretions ; use greasy applications afterwards (R). Boracic Acid, as ointment, 3jss to §j of vaselin, a very useful application (Wa). Glycerin, with Traga- canth, etc. [See under Herpes for formula.] Calomel, as ointment, 3j to §j, is especially useful (Wa). Zinc Carbonate, as Calamine, a good dusting pow- der; so also is the Oxide, or Fuller’s Earth. Intertrigo Intestinal Obstruction. Opium, even doses every 4 hours, for 2 to 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, af- fords relief (Wa). Caffeine acts upon the muscular tissue and often proves of the utmost value (Wa). Senna, the infusion, in doses of is an efficient purgative (Wa). Purgation to be refrained from (Brinton). Enemata, insuffla- tion and surgical measures are often necessary. [Compare Constipation, Intussusception, Hernia.] Intussusception. Belladonna, gr. iv of the extract in 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- come, and has proved exceedingly effective, but is dangerous ; produces most 706 IRRITABILITY IRITIS JAUNDICE. depressing nausea ; not safe to use more than ifiv of an infusion of 3j to Oj (B). Inflation, of intestines with air (Hippocrates), seems a most reasonable mechanical 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 inflation. [Compare Hernia, Typhlitis.] Irritability. Ignatia, in small doses diminishes, in large doses excites irritability of cere- bro-spinal axis; the remedy par excellence (Pf). 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 n\j of the tincture every hour (Smith). Opium, gives calm to the nervous system if used in medium doses. Strychnine, in functional irritability of the nervous system. [Compare Insom- nia, Nervousness.] Iritis. Belladonna, locally and internally (R) ; every 3 hours, also as lotion (3j of extract to aquae), is of great value (P). Atropine, solution (gr. iv to the 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). Aurum, the Bromide of Gold, Arsenic and Mercury has been admin- istered with evident advantage (E. A. Wood). 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, or Morphine hypodermically (C). Copaiba, £ij 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, paracentesis when increased ten- sion, corelysis when only one or two adjacent adhesions ; iridectomy ; com- plete functional rest to the eyes, by Atropine and a bandage with compression pad, an absolute necessity during the whole period of treatment (C). [Com- pare Syphilis.] Prescriptions. R. Hydrarg. Chlor. Corr., . gr. j. Potassii Iodidi, zj. Tinct. Calumbae, . . . . 3 ij. Aquae Destil., . . q. s. ad §vj. M. Sig.—A dessertspoonful, in a wine- glass of water, 2 or 3 times daily. [Lawson.) R. Ol. Terebinth., sjiij. Syr. Acacise, 5jss. Aquae Cinnamomi, . . . 3 ss. M. Sig.—Teasp. 4 times daily. R. Extracti Belladon., . . . gj. Ung. Hydrargyri, . . . . l|vj. M. Sig.—For inunction to brow. Jaundice. Salol, is one of the most efficient remedies in catarrhal jaundice. Mercury, in attacks with depression, sickness and coated tongue, gr. of Gray Pow- der 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, JOINT AFFECTIONS. 707 is well adapted to the jaundice of infancy and childhood (Wa) ; Mercurials and Podophyllum are better avoided, especially in obstructive jaundice, unless very marked indications for them exist (Da C). Celandine, was formerly employed as a 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°, giij to gall, j (B) ; when jaundice depends on torpor of the liver, or is catarrhal in origin (W); during convalescence, of the dilute acid in gj of a compound elixir of Taraxacum before each meal (Da C). Quinine, when due to malarial miasm, or when periodic (B). Euonymin, an hepatic stimulant of especial power (B). Podophyllum, in catarrhal and mala- rial jaundice (B); when stools exhibit no trace of bile, one dose has cured (Wa) ; is best avoided, unless markedly indicated (Da C). Sodium Phosphate, no remedy superior in jaundice from catarrh of gall-ducts ; 3j doses every four hours for adults: gr. x-xx 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 the above mala- dies in children, white or clay-colored pasty stools, skin jaundiced (B). Saline Purgatives, as Rochelle salt, to depurate the upper bowel; 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); 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 Min- eral Waters, especially in catarrh of duodenum or bile-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; use 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 season- ing in food, and all liquors. [Compare Hepatic Cirrhosis, Hepatic Dis- eases, Calculi.] Joint Affections. Phenacetin, for the pyrexia of polyarthritis ; is efficiently antipyretic and safe. Aconite, for pains in inflamed joints (R) ; the liniment locally in chronic arthri- tic swellings (Wa). Mercury, the oleate in chronic inflammation of the knee (R): Ung. Hydrarg. Ammoniat., diluted, I to 4 at first, then 1 to 8, 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, 3iij-vj ad Glycerini §iij, Aq. destil. jfiv, in numerous obstinate cases of joint affections consequent on rheumatism (Wa). Ferrous 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 3iv of Lanolin, and 01. Olivae, 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 nodosities of joints; large doses continued are necessary (R). Alcohol, and water, equal parts, an excel- lent 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 708 KERATITIS—LABOR. (Wa). Cold Douche, Galvanism,Turkish Baths, for stiff joints (R). Digitalis, as fomentation, 3) of tincture to 0)4 boiling water, applied on flannel, has proved very efficient in acute inflammations of joints (Fairbank). Turpentine, the liniment a serviceable application in chronic enlargement of the joints (Wa). Sulphuric Acid, as irritant ointment, 3j of acid to §j of lard, very bene- ficial in chronic diseases of joints (Wa). [Compare Arthritis, Bursitis, Coxalgia, Gout, Rheumatism, Synovitis.] Keratitis. Atropine, renders great service by contracting the vessels (B) ; by instillation, with enforced disuse, and a protective bandage, should be regarded as meas- ures of course (C). Mercuric and Ferric Chlorides, with Cod-liver Oil, will accomplish all that medicine can do for interstitial keratitis in syphilitic sub- jects (C). Calcium Sulphide, proves most useful in doses of gr. to %, thrice daily, in sugar-of-milk trituration (Snell). Arsenic, Potassium Iodide or Bro- mide, Iron or Quinine, for constitutional effects in vascular keratitis ; also counter-irritation by Iodine painted on the temples until soreness (C). Ferric Chloride, successfully employed in panniform keratitis; a large drop of the solution dropped from a quill every second or third day (Wa). Physostigmine, lowers intra-ocular tension (B). Astringents or Irritants, as Alcohol in any form, Zinc Sulphate, Silver Nitrate, etc., are entirely inadmissible (C). Iridec- tomy, is often beneficial in severe vascular keratitis (C). Pressure-Bandage, in severe suppurative forms, limits extent. Water, cold when inflammatory symptoms marked ; hot (90-100° F.) in non-inflammatory form, to excite inflam- matory reaction ; should be discontinued when marked injection. [Compare Corneal Opacities.] Prescription. R. Hydrarg. Chlor. Corr., . . gr. j. Ammonii Chloridi, . . . gr. vj. Tinct. Belladonna, . . . gij. 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, only when uterine inertia, and after the first stage has passed; is dangerous if any obstacle in front; dangerous to child by paralysis of fcetal heart (B); is best given when head has passed the brim of pelvis (Wa). Anaesthetics, in protracted and painful labor ; cautiously with primiparae (B); increase the risk of post-partum hemorrhage (W). Chloroform, not to com- plete anaesthesia, lest uterine action be interrupted; usually begin its inhalation 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 -hour till effect produced (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, pro- motes expulsive power of uterus, lessens hemorrhage, stimulates longitudinal and oblique fibres of the os (Wa); 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 ; for relief of pains and after-pains, or painful com- plications (Wa); hypodermically in rigid os and cervix (R). 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 nervous excitement after LACTATION. 709 labor, and to check post-partum hemorrhage (P). 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 physio- logical doses (B) ; relaxes spasm in rigidity of the os (Wa). Acetanilid, eases pain and brings on profuse sweat which helps to relax muscular rigidity (Brod- nax). Quinine, to strengthen uterine contractions; used by many in place of Ergot (R). Cannabis Indica, the tincture gtt. xxx, as stimulant to uterine con- tractions, more prompt, less lasting, than Ergot (Wa). Ipecacuanha, after de- livery ; to promote natural functions (R). Cotton-root, as excitant of uterine contractions, may be more energetic than Ergot (P). Althaea, the decoction, as vaginal injection in difficult labor (P). Sodium Borate, excites activity of the uterus, and is well employed in tedious labor, where there is deficiency of uterine action (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 solution ; probably the worst of all antiseptics for this purpose; is too danger- ous for obstetrical use (Fleischman). [Compare Abortion, After Pains, False Pains, Hemorrhage Post-partum, Lactation, Puerperal Con- vulsions,—Mania,—Fever,—Disorders.] Pilocarpine, as a galactagogue, gr. % in brandy on retiring, the patient to be covered well in bed ; is efficient in direct proportion to its diaphoretic and sia- logogue effects, these being evanescent, but its galactagogue power remains for weeks, an occasional dose only being required to spur up the secretion when flagging (Minges): is a galactagogue, and probably the only example of this class we possess (M). Antipyrin, as an anti-galactagogue, 4-grain doses every 2 hours have proven highly efficient. Belladonna, internally or externally or both, in excessive lactation (R) ; Atropine gr. iv to §j 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 solution 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 Hypo- phosphite, in debility from over-lactation (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, Nipples, also the List of Galactagogues on page 57.] 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 Potas- sium 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 narcotize the child, and Mercurials in the same manner may sali- vate it (Br). Atropine, Hyoscyamine, the Salicylates, and Potassium Sulphide, have also been found in the milk after their ingestion by the woman. Lactation. Prescription for Milk Fever. K • Tinct. Aconiti, rr^xx. Antim. et Potass. Tart., . gr. ij. Spt. Etheris Nitrosi, Syr. Simplicis, . . . . aa 5 j. Aquae Aurantii Flor., . . Jij. Misce. Sig.—A teaspoonful in a wine- glassful of sweetened water, every two hours. [Fordyce Barker.) 710 LARYNGISMUS STRIDULUS—LARYNGITIS. Laryngismus Stridulus. Aconite, checks the spasm and relieves the croupous breathing (R). Anti- pyrin, has proven very serviceable. Belladonna, promises to be of value (Wa); Atropine, gr. in a goblet of water (60 doses), of which a teasp. every hour or will give prompt relief (Smith). Bromides, when uncomplicated except with convulsions (R); full doses will suspend an attack, and moderate doses steadily continued will prevent recurrence (B). Ipecacuanha, an emetic dose to cut short an attack (B). Lobelia, has been employed (R). Chloroform, quickly cures the paroxysm, a few drops on a handkerchief suffi- cient (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, in small, repeated doses (P). Emetics, Tartar Emetic ; Mercuric Sulphate (gr. iij—v) safer and better (R). 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.] Laryngitis, Acute Catarrhal. 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 oedematous laryngitis, gr. with gr. iij of Dover’s powder every 2 or 3 hours (Da C). Iodine, inhaled; also as counter-irritant painted over neck (B). Morphine, small doses to allay cough (A). Sulphurous Acid as spray is vaunted (Wa). Leeches to throat are valu- able 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 421). Zinc or Copper Sulphates, as emetics, in large quantities of warm water, where oedema slight (A); a solution of Zinc Sulphate, gr. xx to the § 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 oedematous 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 suc- ceed (Wa). Inhalations of hot steam, with Benzoin, the comp, tinct. gtt. x-xv to the , with gtt. x Tinct. Opii, or Hops, or Conium, of great service (Da C). Tracheotomy ought not to be delayed, if inhalations, leeches, and fomenta- tions fail (Wa); is especially indicated in sudden attacks of oedematous 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 CEdematous Laryngitis, see Glottis cedema of. Compare also Laryngis- mus stridulus, Pharyngitis.] Laryngitis, Chronic. Iodine, painted over neck as a counter-irritant, and inhalation of its vapor (B). Sulphur, as Sulphurous Acid by spray in syphilitic laryngitis, or a solution of Sodium Sulphite, 5j to the § of water (B); by inhalation, spray, or fumigation (R). Carbolic Acid, where long-standing hyperaemia with diminished secretion, 3j-ij to the § of glycerin is a most successful application (Mackenzie). Silver Nitrate, powdered or in solution to chronically inflamed larynx (R); a solution of gr. x or xx to the 5, applied with a brush by the LARYNGITIS LARYNGOTOMY. 711 aid of the laryngoscopic mirror (W) ; formerly 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 Chloride, a solution of £>j- ij in the of glycerin, as a local application (A). Zinc Chloride, gr. xx-xxx to the § of glycerin; alternation of topical remedies is of great value (A). Copper Sulphate, gr. xx to the § of water, locally twice a week (Da C). Bis- muth Subnitrate, by insufflation, is highly recommended in the worst forms of laryngitis (Tr). Guaiacum, as lozenges, is useful in mucous laryngitis (A). Althaea, as pectoral lozenges to relieve laryngeal irritation (P). Cubeb, the berries chewed are very efficient in relaxation of the larynx following a cold or long speaking (Wa). Cocaine, a 20 per cent, solution by spray, mop, or brush, is very efficient in many laryngeal affections (James). Benzoin, in strumous laryngitis (Wa) ; in chronic, Benzoin on hot coals, or inhaled from boiling water, is of great service (Tr). Tannin, in chronic catarrh and ulcerations, a solution, gr. x-xx to §iv, applied by hand-ball or steam atomizer (A). Inhala- tions, 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). Insuffla- tion, substances to be in small quantity, mixed with some bland powder (B). Functional Rest of the voice often requisite, especially in phthisical and syphilitic laryngeal ulceration (A). Chronic Laryngitis, includes many disorders of the larynx, which of late years have been differentiated 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 C). [Compare Cough, Dysphagia, Syphilis.] Laryngitis, Tubercular. Cocaine, as pastilles or by insufflation, to relieve pain and dysphagia, espe- cially when much ulceration or perichrondritis present; in the later stages its use prolongs life. Resorcin, a strong solution locally, is very beneficial in tuberculous and other ulcerations of the larynx (Tymowski). Zinc Sulphate, in solution mixed with a i or 2 per cent, solution of Cocaine, in the early catarrhal stage (Neumann). Silver Nitrate, in powder or solution locally (R). Bismuth Subnitrate, by insufflation is highly efficient (Tr). Iodoform, in large insuffla- tions has surprising anodyne effect when extensive tubercular ulceration exists (Neumann). Iodol, and Boric Acid, equal parts, by insufflation, in less severe cases (Id). Antitoxin, Paquin’s serum has produced good results (Loeb). Menthol, is of great value, relieves pain and is claimed to destroy the local de- posits ; a solution of i in io of pure olive oil brushed freely over the part daily, a solution of I in 5 being used after the first week. Lactic Acid, is reported by many authorities as highly successful, even curative ; a solution of 30 per cent., gradually increased to 75 per cent., brushed over the affected surface after swabbing with Cocaine, or a few drops injected into the larynx by a laryngeal syringe; is excellent, lasting good results having been obtained thereby (Whitla). Scraping the ulcerated spots before applying lactic acid, done by me in 200 cases with 28 cures (Ehring). Tracheotomy, where deep and extensive ul- cerations exist beyond the reach of local treatment. Diet, thick liquids are more easily swallowed than thin ones, and if the patient lies on a couch or bed with his head hanging down over the side while swallowing, this is rendered easier (Wolfenden); feeding should be done by the soft rubber tube when much dys- phagia exists which does not yield to cocaine. Dysphagia, as a constant symp- tom of chronic laryngitis is indicative of the tubercular form (Da C). Laryngotomy. Laryngotomy is more quickly and easily performed on the adult than trache- otomy, being further from the lungs and less dangerous. It is usually directed 712 LEPROSY LEUCOCYTHiEM I A. 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, Professor 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 carried 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 is valu- able (P). Gurjun Balsam (Wood Oil), as ointment and emulsion, has been used with success in alleviating the disease, by Dr. Dougall, Port Blair, Anda- man Islands; the ulcers of 24 lepers healed thereby. Ferri Arsenas, 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 of unguentum, gives very good results (Wa). Europhen, 5 per cent, in oil, cured a case five years ago on the island of Madeira (Goldschmidt). , Chaulmoogra Oil [see page 218], is credited with a few cures and many cases improved ; the oil is mixed with Psoralea corylifolia as a liniment, and is 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). Ichthyol, used internally and externally, has given good results. The Goto Treatment, consists in bathing daily in hot water in which are placed bags containing hichiyon bark, taifunshi, sulphur and yoku yaku ; internally he gives seiketsuren pills, tincture of the chloride of iron, quinine, strychnine, potassium iodide, gentian, columbo, carbonate of soda and potash, and Epsom salts (Alvarez); but proof is lacking that cure has been obtained in any case (Emerson). Toxins and Antitoxins, are being tried in various parts of the world, but are not trustworthy, as the bacillus has never been cultivated and animals are quite refractory thereto (Goldschmidt). Diet, nutri- tious food, with frequent baths and great cleanliness, will do much to prevent the manifestations of the disease (R). Leucocythaemia. Alkaline Hypophosphites, have been used with more or less benefit (Wa). Digitalis, in young subjects (B). Nitro-muriatic Baths, should not be neglected, with tonics and nutrients (A). Iron, is of little value (B); large doses may do good in the early stage, with careful diet, and Ergot to contract the spleen (Da C). Phosphorus, gr. increased to gr. , has proved successful in several cases (Wa). Arsenic, in as full doses as can be borne, may be of service, though hitherto ineffectual (Gowers); produced rapid improvement in a severe case, conjoined with Oxygen inhalations, 5 minims of Liquor Arsenicalis being given thrice daily, increased by 2 minims every 4 or 5 days until the dose reached 45 minims (Fred’k Taylor). Oxygen, 30 litres daily by inhalation, with the con- joined use of Arsenic (Id). Thymus Extract, has been used with benefit. Gal- vanization of the spleen causes improvement of the blood, increasing the num- ber of its red corpuscles (Gowers); is curative in uncomplicated cases (B). LEUCORRHOEA LICHEN. 713 Hydrastis, the fluid extract undiluted, applied topically, quickly improves in uterine and vaginal leucorrhcea (B). Pulsatilla, 5-drop doses ter die for a few weeks ; also a teasp. of the tinct. in a pint of cold or tepid water, as vaginal en- ema daily, when pain in the loins, depression of spirits, loss of appetite, etc. (P). Silver Nitrate, in solution locally, also tampon saturated with 3j each of Alum and Bismuth, when leucorrhoea due to granular vaginitis (Parvin). Balsams of Peru and Tolu, internally (P). Glycerin, is largely employed for vaginal leucorrhcea, and for erosions and ulcerations of the cervix uteri (B); the best vehicle for other agents (E). Glycozone, applied on small rolls of lint or absorbent cotton, after thorough washing of the vagina with solution of Hy- drogen Dioxide, 1 to 4 of water, and repeated twice daily (Edson). Borax, 3j to Oj of 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 leucorrhcea (R). Bismuth, with mucilage, as injection ; or with Cacao-butter as suppository (B). Copper Sulphate, in solution, as injection (R). Tannic Acid, in chronic cases ser- viceable as injection, 3ss in viij of claret wine (B); if os ulcerated, a sup- pository of Tannin and Cacao-butter to mouth of uterus (R). Iodo-Tannin, an excellent application, 3j of Iodine to 3) of Tannic Acid, a sufficient quantity to be packed dry around the cervix (B). Alum and Borax, make a useful injection in vaginal leucorrhoea (R). Belladonna, with Tannin as bolus when neuralgia or ulceration of the os; when disease due to over-secretion of mucous glands about the os and much pain present inject Sodii Bicarbonat., 3j ; Tincturae Belladonnae, ; Aquae Oj (R). Potassium or Sodium Bicar- bonate, 3j to Oj aquae as injection, especially when discharge alkaline and copious (R). Pareira, Uva Ursi, are successfully used (P). Sumbul, recom- mended 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 to the § (B). Potassium Chlorate, 3j 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 (R). Phosphates, for the cachexia (B): Calcium 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 are the best tonic for the pelvic vessels to relieve venous congestion ; use with elevated hips (E). [Compare Endo-metritis, Uterine Ulceration, Vaginitis.] Leucorrhcea. R. Aluminis, £j. Zinci Sulph. g ss. Sodii Boratis, gr. iv. Aq. Rosse, Sjviij. M. Sig.—Injection. (B.) Prescriptions. R. Liq. Plumbi Subacet., . . j^jss. Ac. Carbolici, . . . . M. Sig.—One-fourth to be added to a pint of water and used as an injection. Lichen. Antipyrin, internally for the itching, is efficient. Aconite, sometimes useful (R). Mercury, Calomel and Mercuric Nitrate Oint. mixed (also Tar Oint. added), in patches of obstinate lichen (R). Silver Nitrate, the Nitrous Ether solution painted every day or two over the patch (R). Baths, warm or of Sul- phides (R); sponging with alkaline lotions, diluted Lead-water, fluid extract of Grindelia well diluted, or solution of Copper Sulphate, gr. x to the in miliaria, or prickly heat (lichen tropicus); with dusting powders of Lycopodium, Zinc 714 LITHAEMIA LOCOMOTOR ATAXIA. Oxide or Starch, singly or combined (Hughes). Potassium Citrate, or some other refrigerant diuretic, and light, unstimulating food (Da C). [Compare Eczema, Strophulus.] Lithaemia Piperazin, by far the best agent to promote the elimination of uric acid and urates, with which it forms the most soluble of all known uric acid compounds : relieves the pruritus of the uric diathesis. Lithium Salts, especially the Citrate, gr. xx thrice daily, is very efficient (Da C); the Carbonate invaluable (Wa); the Bromide, in solution of Potassium Citrate given after stomach digestion is completed, one of the very best agents (Aulde). Strontium Salicylate, in chronic gouty conditions and in lithaemia with intestinal indigestion, the most valuable drug that we have (W). Salicylic Acid, or its salts, are most powerful solvents and excretents of uric acid (Haig). Lysidin, is still more solvent of uric acid than is Piperazin (see page 391). Cascara Sagrada, is believed to promote the excretion of uric acid. Colchicum, 15 minim doses of the wine twice or thrice daily, are very useful (Wa); the combination of Colchicine with Methyl Salicylate (Oil of Wintergreen) in capsules (see page 249) is a useful remedy. Coffee, a tincture of green coffee is anti-lithic. 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 laxative doses, 3j thrice daily, gives good results. Alkalies, in biliousness ; also the continued use of alkaline waters rich in potas- sium salts, for solution of calculi (B). Acids, Hydrochloric often of great ser- vice ; also Lactic, 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). Chimaphila is believed to check the secretion of lithic acid (P). Aliment, farinaceous vege- tables and acid fruits are suitable (B); Alcohol in any form is poison to a lithaemic (Da C); succulent 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 are recommended; removal to a locality where pure soft water can be procured, is often curative. [Compare Calculi, Dyspepsia, Gout.] Prescriptions. R. Lithii Bromidi, 5ss-j. Liq. Potassii Citrat., . . . t±iv. Syrupi Simplicis, . . . . £ ij. M. Sig.—A teasp. in a wineglassful or more of water, 2 hours after each meal. Reduce the dose after a week. R. Potassii Nitratis, . . . . Z j. Ext. Pichi FI., 5 j. Elixir Simpl., Jjiij. M. Sig.—A teasp. every 2 hours. R. Vini Colchici Rad., . . . gij. Ext. Phytolaccse FI., . . gj. Potassii Acetatis, . . . . giij. Aquae, . . , . . q. s. ad g vj. M. Sig.—A tablesp. four times daily. R. Tinct. Belladonnae, . . . rtpxviij. Vini Colchici Rad., . . . gij. Liq. Potas. Citrat., q. s. ad £ iv. M. Sig.—A dessertsp. well diluted, every 3 hours. Locomotor Ataxia. Antipyrin or Phenacetin for the lancinating pains ; the former relieves them remarkably: the use of Morphine for the pains should be avoided as long as possible (Osier). Acetanilid, is admirable for relief of the pains (B). Bella- donna and Ergot are highly efficient (Brown-Sequard). Silver Nitrate, when motor disturbances are very marked; improved I in 20 cases (R); gives the LUMBAGO. 715 best results in doses of gr. to gr. thrice daily, withholding it after a few weeks to prevent argyria (Da C); the only remedy which has done good in progressive locomotor ataxia ; gr. two or three times daily, with Sodium Hypophosphite, both to be discontinued when blue line appears on gums (Althaus). Silver Oxide, may be used instead of the nitrate, in half-grain doses (Da C). Aurum, is specially curative in all forms of sclerosis; the Bromide of Gold and Arsenic has been of special service in this form (E. A. Wood). Potassium Iodide, Corrosive Sublimate, or Gold and Sodium Chloride, all in full doses, often retard the progress of the disease (Da C). Physostigma has proved beneficial (R). Phosphorus, useful, but may not cure (B). Hyos- cyamine, ameliorative, gr. fa gradually increased to gr. (B). Electricity, the galvanic current relieves pain; faradic stops wasting of muscles (B); in the 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 70-75° gradually lowered to 60°, then shower-bath and 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 gj of water, of which twice daily (B). Strychnine, gr. in 3j 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: is now abandoned. Morphine, sooner or later becomes necessary for the lancinating pains; in one case, personally known to the author, which had been treated ineffectually by every known method, including suspension by Charcot himself, and was rapidly progres- sive, the abandonment of the hypodermic syringe for Morphine by mouth, gr. xv daily in divided doses, has seemed to result in complete cessation of pro- gress, which has now lasted over four years; the patient is free from pain, eats and sleeps well, and attends to business, getting around by aid of a stick and some slight assistance from friends when crossing a crowded street. Orchitic Extract, also Spermine, have been used with some success. Cere- brinin, is reported beneficial (see page 137). Lumbago. Cimicifuga, is said to be more effectual than any other remedy (R); has some- times wonderful success; no indications can be given for it; 3>ss-ij of fluid extract (B) ; is curative (P). Rhus Toxicodendron, in subacute muscular or ten- dinous rheumatism, worse at night; completely relieves some cases (Pf). Veratrum Viride, the tincture useful (R). Aconite, in % tt\, doses of tincture every two hours, with Linim. Aconiti locally (Wa). Iodides, if referable to syphilis, mercury, 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). Antipyrin, gr. vij, hypo- dermically, completely banished it in a very bad case at the Hotel Dieu, Paris. Morphine, hypodermically to relieve pain (R); gr. l/e with Atropine gr. hypodermically, 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 applica- tion. Potassium 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 (carefully, lest strangury and nephritis), of greatest value when the bowels regular and urine clear and abundant (Wa). Ether Spray, externally as freezing mixture (R). Guarana, in 20 to 40 grain doses, removed severe chronic lumbago (Rawson). Chloroform Liniment, affords relief (Wa). Canada 716 LUNG DISEASES. 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 cur- rent (B); is highly useful; faradization almost as successful as acupuncture (R). Strapping from the thigh upwards with layers of adhesive plaster which overlap each other; nothing is so instantaneously beneficial. Diet, should be gener- ous and nutritive ; Lemon-juice as a beverage. Absolute rest is of great im- portance. [Compare Myalgia, Rheumatism.] Prescriptions. R. Collodii, Tinct. Iodi., Spt. Ammoniae, . . . aa part. seq. Sig.—Paint over the part with a camel’s- hairbrush. (Burggraeve.) R. Ammonii Chloridi, . . . Ext. Cimicifugse FL, Syr. Simplicis, . . . . aa Sj. Aq. Laurocerasi, q. s. ad M. Sig.—A dessertsp. every four hours Aconite, is indicated in most acute congestions (P); is especially indicated in inflammatory states of the respiratory organs (R); Belladonna, in doses of b\j of the tincture frequently, is of great benefit in pulmonary oedema, to retard exudation of serum and to counteract the failure of the heart (Smith). Tere- bene, is very valuable in many conditions. Terpin Hydrate, is still more effi- cient and more easily administered. [See under Bronchitis.] Ammonium Acetate, serviceable not only in bronchitis, but in the whole range of acute pulmonary complaints as occurring in children (Dessau). [See under Bron- chitis, for formula.] Veratrum Viride renders important service in acute parenchymatous congestions (B) ; gr. l/e of resin in pill when temperature and pulse are high ; it tends to induce prostration, collapse, etc. (A). Blisters, fly- ing blisters to chest, and perhaps along the pneumogastric in hypostatic con- gestion (R). Copaiba, exercises a powerful influence over the pulmonary mucous membrane, and is beneficial in lung diseases generally, whenattended 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 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 counter-irritant in many chronic lung diseases, and even in the bronchitis of infancy (Park). Cubeb, in small and oft-repeated doses, is efficient in chronic bronchitis and other lung affections of old persons, checking the excessive secretion and gently stimulating the system (Wa). [Compare Bronchitis, Emphysema, Hemoptysis, Phthisis, Pleuritis, Pleurodynia, Pneumonia.] Lung Diseases. Lungs, Gangrene of. Creosote, 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 decoction of Cinchona (Wa). Eucalyptus, the Oil with Alcohol, equal parts of each, of which 3j as inhalation by steam atomization, is useful (Wa). Turpen- LUPUS 717 tine, the spirit on boiling water inhaled for fifteen minutes every two hours, successfully employed (Skoda). [Compare Pneumonia, Phthisis.] Lupus. Arsenic, in chronic cases not of syphilitic origin. Fowler’s solution long continued exerts a curative influence, and Arsenous Acid locally (B); the best remedy in lupus of the head and face (Wa); the Oleate in ulcerating forms, constantly applied, will destroy cell infiltration in a mild and comparatively painless manner; it is also well employed in the tubercular variety (Id). Phosphorus, as an internal remedy, maybe used as a substitute for arsenic (B). Aurum Arsenate, internally, is said to be serviceable. Aurum salts, locally and internally, have proved curative; the Chloride has been used as a caustic (P). Iodine is useful in lupus, whether syphilitic or scrofulous, the tincture or a glycerin solution locally (Hebra); the tincture or liniment applied to the edges and around them (R); it may also be employed internally. Aristol, is an Iodine preparation which has given excellent results locally as a dressing (Eichofif). Strontium Iodide, has been used in lupus vulgaris with varied re- sults. Calcium Chloride internally, has proved curative, but must be taken for a long time. Mercury, in small doses, is one of the constitutional remedies which should receive a fair trial (Whitla); as ointment in lupus erythemato- sus, and in form of Calomel ointment in scrofulous and tubercular lupus of children (R); internally Calomel in doses of I to 2 grains increased to 4 grains, will quickly check it (Wa); the Emplastrum Hydrargyri is very efficient in lupus erythematosus and allied affections (Kohn). Salicylic Acid, is the most typical member of the group of agents which have selective action on the new growth and destroy it with the least amount of injury to healthy tissue (Whitla); used as a paste, made by rubbing it with an equal part of Creosote, applied daily after using a strong (10 to 20 per cent.) solution of Cocaine over the part; or Unna’s plaster mulls, containing these two ingredients, may be used (Id); as dressing, Salicylic Acid 5, Creosote 5, Glycerinum Saponatum 90, after de- struction of the growth, has given good results where no scraping or other op- eration was performed (Hebra). Lactic Acid, seeks out the diseased tissue, as a dog does game, surely finds it and effectually destroys it (Hortmann); the concentrated acid should be used, either alone or as a paste made with Kaolin. Lead, the Liquor Plumbi, with 1 or 2 of glycerin, in the milder forms, applied warm after the removal of the crusts (R). Jequirity, is a good application to destroy the diseased tissue by setting up the jequirity inflammation (Shoemaker). Sodium Ethylate, on absorbent cotton, is the best of all the caustics, followed by Bismuth Oleo-palmitate as a soothing and astringent application (Id). Car- bolic Acid, the crystals melted by heat, as a mild escharotic (B); its action is very superficial. Zinc Sulphate, dried, freely dusted over the surface as a caustic, followed by a poultice to remove the slough (B). Silver Nitrate, a weak solution gradually strengthened, may be used in superficial forms (R). Chromic Acid, in solution, 100 grains to the § of distilled water, is an efficient escharotic (B). Thyroid Extract, has been used as a stimulant of the cutane- ous functional activity with most satisfactory results. Tuberculin, in this dis- ease has excited great interest, but the best authorities deny that its use has produced a single absolute cure ; yet combined with surgical methods it will give good results (Whitla). Scraping off the diseased tissue with Volkmann’s spoon under anaesthesia, is the most radical and satisfactory of the mechanical pro- cedures (Id): the Paquelin cautery is better than the spoon for removing the morbid tissue (Unna). Electrolysis, has given good results in Jackson’s hands, who reports that the electrolytic action of the current seems to expend itself only on the diseased tissue. Cauterization, with the actual cautery at white heat, after scraping out as much as possible of the diseased parts, so as to de- stroy 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 are only useful for the general health, and have no specific action on the disease. 718 LYMPHANGEITIS MALARIA. Prescriptions. R. Iodi, Potassii Iodidi, . . . . aa % ss. Glycerini, g). M. Sig.—Locally in lupus. (McCall Anderson.) R. Hydrargyri Bromidi, . . . Adipis, g\. M. ft. unguentum. Sig.—To cover the part affected, using Cod-liver Oil freely, and the following solution internally. In tubercular lupus of the face. (Hardy.) R . Ung. Arseni Oleat g ij. Ung. Simplicis, gj. M.ft. unguentum. Sig.—Use constantly over the affected surface. If pain sets in Opium maybe added. (Shoemaker.) R. Potassii Iodidi, ..... gr. Ixxv. Sodii Chloridi, Aq. Destil., 5 viijss. M. Sig.—Tablesp. before meals, night and morning. (Hardy.) Belladonna, the extract softened with glycerin and 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. Dilutus, as an external ap- plication, constantly applied, to soothe and restrain the inflammation (Wa). Iodine, in strong tincture, applied around the glands, to prevent suppuration (Roberts). Quinine, or Salicin, with alcoholic stimulants freely, in septic cases (Id). [Compare Bubo.] Lymphangeitis. Malaria, Chronic. Arsenic plays an important role in chronic malarial disease (B); diminishes splenic engorgement, and combined with Iron is rapidly curative of many af- fections due to the paludal miasm (Boudin); is a powerful prophylactic against malaria, and in chronic malarial poisoning, with frequent return of fever and neuralgia, its continued use is of great benefit (Fayrer). Quinine, is less cura- tive 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). 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). Iron and Manganese Iodide, the syrup in doses of rtbxx-xxx, is a successful remedy for chronic malarial infection (B). Manganese Sulphate, gives excellent results 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 combined, are of great value in chronic malarial infection ; both are highly antiperiodic, 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). Nuclein, has been used with benefit (Vaughn). 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 perspiration (Da C). [Compare Intermittent Fever, Remittent Fever.] Prescriptions. R. Cinchonidinse Salicylat., . g ij. Acidi Arsenosi, gr. j. Ferri Sulph. Exsiccat., . . gr. xx. M. ft. pulv. no. xx. Sig.—One powder in wafer thrice daily. R. Quininse Sulph., . . . . gr. xl. Ferri Sulph. Exsic., . . . gr. xx. Acidi Arsenosi, gr. j. M. ft. pil. no. xx. Sig.—One pill thrice daily. MANIA. 719 R. Cornus, Calumbse, Liriodendri, Pruni Virginianse, . . . 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, gij. Acidi Carbolici, gj. M. Sig.—Two or three drops three or four times a day, in water. R. Acidi Arsenosi, . . . . gr. j. Mass. Ferri Carbonatis, . gj. M. ft. pil. no. xx. Sig.—One pill thrice daily. Mania. Stramonium, is of value; allays irritation and induces tranquil sleep; in wild and furious delirium, but intermittent, also in nymphomania (P) ; many facts seem to confirm its reported value (Tr). Daturine, gr. xhinhr hypodermically in acute mania, but is less useful than Atropine or Hyoscyamme (Wa). Duboi- sine, gr. -fa hypodermically in acute mania (Gubler); is more sedative and hypnotic than the other alkaloids of the group and acts well in doses of gr. at first, gradually increased to gr. 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 hypersemic conditions of the brain (P). Hyoscyamus, in violent intermittent forms, to procure sleep and calm violent delirium (R); delirium with hallucinations but not congestion ; in milder and less inflammatory forms also hypochondriacal monomania (P). Hyoscine, finds its greatest and most useful application in the treatment of maniacal violence and noisiness, and is a drug for emergencies of this kind (Weatherly). [See under Insanity.] Veratrum Viride, successfully combats the excitement in acute mania (B). Camphor, has been used successfully ; its action is uncertain (P). Opium, and Tartar Emetic are satisfactory for many cases ; also Morphine hypodermically to induce sleep (R); its narcotic effect is of doubtful utility, better in insanity with depression (P); will not produce nar- cotism in many such cases, even in 2-grain doses. Cannabis Indica, 3j of tinct. with 3j of Potassium 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, equal parts, Z] of each thrice daily for weeks and months, has proved very efficient in acute and periodical mania, senile mania, and other forms (Clouston). Chloral, as calmative and hypnotic, has induced mental improvement (B). Paraldehyde, as a hypnotic, in doses of 3ss-j, is often decidedly useful (R) : larger doses are necessary, an average one is 3iss. Coniine, most suitable to acute mania, quiets muscular action ; doses of rr^ss—iij, or hypodermically, beginning with gr. : with Morphine conjointly injected, is very successful (R). Digitalis, 3ss-3j of tinct. valuable in acute and chronic mania, espe- cially when complicated with general paresis and epilepsy (Maudsley); caution ! 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 restorative, is fre- quently used in chronic mania with benefit, the Tincture of the Chloride in 5- 10 minim doses (B). Gelsemium, is more useful than Conium in mania with great motor excitement and wakefulness ; large doses required, rrpxv-xx of tincture. Croton Oil, as a purgative, riX~//3 every hour, as revulsive in mania from cerebral congestion (R). Cimicifuga, is often efficiently used in cases of mania occurring during the puerperal or pregnant condition (R). Chloroform, may be necessary to temporarily control very violent cases ; its inhalation need not be carried to complete anaesthesia. Galvanism, of the head and cervical sympathetic, has produced distinct improvement (B). Cold Douche, in mania- 720 MASTITIS—MASTODYNIA MEASLES. cal delirium, the patient being in a warm bath during the application of the douche to the head (R). Removal from home, from sympathetic friends, and from surroundings connected with the origin of the malady, is a prime necessity to a cure. [Compare Delirium, Insanity, Puerperal Mania.] Mastitis. Belladonna, Atropine locally (see Lactation), or combined with Morphine and Chloral, when much pain (B); especially as liniment to check secretion of milk when inflammation is imminent (R); or when breasts are 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 ; also fomentations in addition, but skin must be dried well before the Bella- donna is rubbed in (R); b\,v-x of tinct. internally as well (P). Camphor, a saturated solution in Glycerin locally, in mammary congestion threatening ab- scess (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 mammary 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 inflammation (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, 3j in Spt. Rosmarini Oj, 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 inflamma- tion of breasts, from circumference toward the nipple (L). Rest, by supporting mammas with strips of plaster, and bandaging the arm to the side, to prevent motion (T). Alcohol, over proof, applied by sponging until part is cold ; re- new if high heat returns. Heat, applied by a basin lined with flannel satu- rated with hot water, to relieve pain and prevent suppuration. [Compare Ab- scess, Lactation.] Mastodynia. 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 i of Tinctura Opii, may be used by gentle friction to painful breasts after parturition (Parvin). Non-interference in simple cases of enlarge- ment and tenderness, which will spontaneously subside if let alone; in severe cases support by strips or bandage, if breast pendulous ; Belladonna ointment or liniments ; amputation of the breast has been necessary (T). Measles. 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, doses of the tincture every 2 hours (Da C). 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 §iv 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 3ss~5j Liq. MELANCHOLIA. 721 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 water 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 (gr. j- iij) for the adynamia, or large (gr. xv)for hyperpyrexia and catarrhal pneumo- nia (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 or other complications (A). Water, cold affusion at commencement; packing, 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, Cacao-butter is very grateful and reduces temperature; also in the 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 the whole course (A). Hygiene, dark room, complete disuse of eyes, strict cleanliness (A). [For Sequelae see Bronchitis, Cough, Ophthalmia, Otorrhcea, Pneumonia, etc.] R. Acidi Carbolici, Acidi Acetici, . . . . aa Tinct. Opii Deodorati, . . Spt. Chloroformi, . . . . Z). Aquae, q. s. ad viij. M. Sig.—A .tablespoonful every 4 hours, until fever abates. (Keith.) Prescriptions. R. Tinct. Tolutanse, . . . . gij. Syr. Senegse, 5 ss. Acidi Acetici, gjss. Syr. Pruni Virg., . q. s. ad g iv. M. Sig.—A teaspoonful as required for cough after convalescence. Melancholia. Aurum, giv.es excellent results, gr. to of the Chloride thrice daily, especially when cerebral anaemia coexists (B); the Bromide of Gold and Arsenic has rendered good service in many cases, hypodermically thrice daily: Gold is highly recommended in suicidal melancholia. Bromides, sometimes afford relief which no other agent will; no indications (B); Potas- sium Bromide for townspeople, especially women with unendurable despon- dency (R). Arsenic, gives great comfort in the melancholia of aged persons, is best when combined with small doses of opium, thus—Liq. Potas. Arsenit. Tinct. Opii npiij-v ter die (B). Opium, in stimulant doses of tincture, gives good effects (B) ; especially when paroxysms of acute anguish and des- pair, or when suicidal impulse (Wa): Morphine hypodermically is of great benefit in some persons who have a peculiar idiosyncrasy therefor (R). Cam- phor has been highly recommended (R). Musk and Castoreum are employed in melancholia with benefit (R). Cannabis Indica, sometimes relieves (B). Phosphorus, depression from overwork (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, the tincture of the Chloride (B). Cocaine, a useful tonic and especially beneficial in nervous affections accompanied by depression (Br). Cimicifuga, in puerperal or uterine despondency, of singular value (P). Ignatia, has soothing effect in great mental depression (P). Orchitic Extract, has been used with benefit. Water-cure, shower-bath for 15-20 seconds, or warm-bath, 950 F. for 30 minutes; the shower or cold douche may be usefully employed in cases where reaction takes place after it (W). [Compare Hypochondriasis, Hysteria, Insanity.] 722 MENINGITIS. 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 the 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 subacute form (P) ; for nervous irritability during convalescence (A). Gelsemium, extremely useful; tt\,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 purgative effects (Wa) ; the Unguentum Hydrargyri rubbed in for 30 minutes into the skin on the front of the abdomen, groins and arm-pits, repeated after 12 hours if no evidences of improvement or salivation ; such unmistakable benefits follow the free use of mercury that to withhold this remedy in desperate or ap- parently hopeless cases is unjustifiable (Whitla). Potassium Iodide in large doses where vomiting and gastric derangement are absent, and in the later stages of syphilitic meningitis may be very valuable (Id); has cured (Nie- meyer). Ergot, the fluid extract in £>ss doses with an equal quantity of Potas- sium Bromide, every four 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 remedy, especially for acute stage before exudation, or during the stage of excitation (B) : when collapse, it may sustain the vital powers; with Tartar Emetic has proved most beneficial, but should be used with 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 searching (A); Croton Oil as a derivative and revulsive, also locally to the shaven scalp is productive of the best results (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 sub- dued (A): useless, and cause needless suffering (O). Water, cold water for hyperpyrexia (C); pounded ice in bag or bladder, as a cap to the head (R). There are no remedies which in any way control the course of acute meningitis (O). [Compare Meningitis, tubercular.] Meningitis, Cerebro-Spinal. Opium, in small doses is the most effective remedy ; its utility ends when effusion occurs and 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 C). Antipyrin, has rendered good ser- vice. Aconite, is 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, of fluid extract every 2 hours, to maintain constant physiological effect (B); is efficient for the delirium. Bel- ladonna, in all hyperaemic conditions of brain and spinal cord, especially dur- ing stage of excitement (P). Iron, the tincture of the Chloride, in 20-30 minim doses, every two hours, suggested by the similarity of the disease to erysipelas, has made many successful cures without leaving any sequelae (Klapp). Bro- mides, to guard the Opium and enable the latter to be pushed, 20-grain doses every 4 hours (Da C). Hydrocyanic Acid, dilute, rr\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 dis- ease 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 (Radcliffe) ; to head and upper spine for 5 MENINGITIS. 723 minutes only at a time, for the headache and tetanic symptoms (Da C). Vene- section, 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 hyper- pyrexia (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). Prescriptions. . Morphinse Sulph. ss. Ac.'Sulphurici Aromat., . zj. Tinct. Cinchonse Co., . ad gvj. M. Sig.—Tablesp. every 2 hours, for a boy of 12 years old. (Meigs Pepper.') & . Potass. Iodidi 3 iv. Tinct. Gentian. Comp., Syr. Sarsse Co., . . . . aa M. Sig.—Teasp. thrice daily, to pro- mote absorption during convalescence. Meningitis, Spinal. Aconite, is very useful (B); with an Ergot and Opium impression to reduce the amount of blood in the vessels of the cord (Da C). Potassium Iodide, 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 Ext. Belladonnae, or 20-30-grain doses of Potassium Iodide, and flying blisters along the spine (Da C). 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). Meningitis, Tubercular. Potassium Iodide, is the routine remedy to be administered in ordinary typi- cal cases, full and frequently repeated doses are necessary, gr. j every 2 hours for a child of 2 years (Whitla). Iodine, lotions to scalp, or inunction of Iodine ointment together with Ferrous Iodide and Cod-liver Oil internally, offer the best chance of success, although most remedies often fail (Wa). Potassium Bromide, combined with the Iodide in double the dose of the latter, is advan- tageous (Whitla). Tartar Emetic, the oint. as counter-irritant to scalp in tuber- cular 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): as a derivative and revulsive, also locally to the shaven scalp, is productive of the best results (Wa). Mercury, Hydrarg. Chlor. Corr., in doses of gr. to y has proved successful (Wa); Mercury by inunction should be used heroically as long as there is any reason to doubt the diagnosis, in the hope that the case may be one of simple meningitis (Whitla). Magnesium Carbonate, 3j-ij satu- rated with Lemon-juice, every 2 or 3 hours, a useful purgative in hydrocephalus (Wa). Turpentine, in doses of rr\^v—x with of Castor Oil, or terebin- thinate enemas, in incipient hydrocephalus (Wa). Purgatives, in small doses, 724 MENORRHAGIA. 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). Cases of recovery have been reported by reliable authorities, but they are extremely rare, and there is always a reasonable doubt as to the correctness of the diagnosis. I have never seen a case recover which I regarded as tuberculous (O). Menorrhagia. Opium, has specific action in reducing the uterine circulation and 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 menorrhagia due to want of tone in uterus (R). Ergot, large spongy uterus; BroriUdes bet- ter (B); Ergotin gr. j or ij in glycerin and water, undoubtedly efficacious as hypodermic injection (P) ; in all forms (R); minim doses of the fluid extract are very beneficial (Smith). Hydrastinine, a powerful uterine vaso-constrictor ; very successfully used in grain doses of the Hydrochlorate in 10 per cent, solu- tion hypodermically, for a few days before the expected term. Hamamelis, has decided influence on venous system ; of high repute (Pf). Arsenic and Iron, when from anaemia (B). Cannabis Indica, often successful (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). Erigeron, the Oil, in 10- drop doses, is efficient (Wa). Gossypium, a favorite uterine hemostatic in many hospitals, 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 closes every 3 hours (Parvin). Digitalis, very useful, especially when from heart disease, in plethoric subjects (R) ; of infusion as dose will arrest menorrhagia when unconnected with any disease (P, R). Aloes, with Iron in debilitated and relaxed subjects (B). Cimicifuga, passive, 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, com- bined 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 the Bromide a week before and discontinue when discharge ceases till a week before the next term ; if loss occurs every two or three weeks give Bromides continuously in 10-grain doses, but more when organic changes in womb (R, Wa). Am- monium 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). Cinnamon, the Oil, in drachm doses (R). Mammary Extract, gave signal satisfaction as an internal remedy in two cases of menorrhagia with dysmenorrhoea and enlarged uterus (Bell). Water, hot water bag to lower dorsal and lumbar ver- tebrae (R)'; cold sitz-bath, feet in warm water, especially valuable ; 6o°-65° F., for 5-15 minutes, patient then quickly dried and put to bed. [Compare Metror- rhagia.] Prescriptions. R. Ext. Ipecac. FI , .... gij. Ext. Ergotse FI., . . . . sjiv. Ext. Digitalis FI., . . . . M. Sig.—A half teasp. to a teasp. as required until emesis occurs. (B.) R. Ext. Ergotae (Squibb’s), . gr. xij. Ext. Opii, gr. vj. M. et div. in pil. no. xij. Sig.—One pill every hour, in profuse menstruation of atonic type. MENSTRUAL DISORDERS—METRORRHAGIA. 725 Menstrual Disorders. Aconite, gtt. j of tinct. every half-hour to hour promptly restores the discharge when suddenly suppressed from chill (P, B, R, Wa); as emmenagogue (Tr). Pulsatilla, often of the greatest value when menses scanty or delayed, or sup- pressed 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); n\,ij-iij of a saturated tincture thrice daily. Opium, in suppression from violent mental emotions, a valuable remedy (Wa) ; in many menstrual disorders it 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 of water, applied as lotion after each epilation (R); Citrine oint. extensively employed (Wa). Sulphu- rous Acid, with an equal part of glycerin, an efficient application (Jenner). Arsenic, has powerful influence, used internally in doses of n\,v of Liquor Arsenicalis thrice daily (Wa); the Oleate of Arsenic is an efficient local application. Sulphur Iodide, as ointment, 3j to ifjss, is efficient with Donovan’s solution internally (Sir E. Wilson). Copper Sulphate, as lotion, 3j to ifxvj of water, with of Zinc Sulphate, and of Aqua Laurocerasi (B). Opium, by suppositories or enema is more effectual than if administered internally (Wa). Aconite, is invaluable in early stage of simple inflammatory 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; 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 Poul- tices, produce great relief to pain and favorably affect the course of the disease (Duncan). Leeches, to the hypogastric region, may be required in patients of full habit. [Compare Puerperal Fever, Puerperal Metritis.] Metritis, Acute. Opium, has specific action on the uterine circulation (see page 367), and should be given freely in intractable cases of metrorrhagia from uterine fibroids or cancer, in which the establishment of the opium-habit is often advisable (Lutaud). Hydrastinine, a powerful uterine vaso-constrictor; successfully em- ployed in grain doses of the Hydrochlorate in 10 per cent, solution hypodermi- cally. Atropine, gr. to hypodermically, in profuse metrorrhagia after abortion or of obscure origin ; may require as many as four injections to cause cessation of the flow (Squibb). Salipyrin, in doses of gr. xv thrice daily, em- ployed in fifty cases of metrorrhagia from various causes, with best results in cases following labor or abortion (Orthmann). Ipecacuanha, possesses con- siderable energy in arresting flooding (P) ; in full emetic doses, gr. xx in even- ing, followed by an acidulated draught in the morning (Wa). Hamamelis, when persistent oozing (R). Ergot, the most valuable remedy in full doses Metrorrhagia. 726 MILIARY FEVER—MUSCLE MYALGIA. 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 Hemorrhage, post-partum.] Cannabis Indica, often arrests metrorrhagia 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. Sulphurici Dil., gtt. v-xx, well diluted (B); long and extensively prescribed (Wa). Cinnamon, is used with good effect (P); has specific action on the uterus (T). Digitalis, in plethoric subjects; the infusion best, a tablesp. bis die (P); the effect is prompt and decided (Wa). Magnesium Sulphate, often succeeds (B). Senegin, in 2-grain doses, is suc- cessfully employed (P). [Compare Amenorrhcea.] Ice, to abdomen, or within the uterus (B); Ice in every way the first thing to try (Wa). Rest, abso- lutely necessary. Dry Cupping, over sacrum, is found useful (R). [Compare Menorrhagia, Uterine Tumors.] Prescription. R. Ext. Ergofce FI., . . . . gss. Ext. Senec. Aur. FI., Ext. Viburn. Prunif. FI., aa^j. 01. Myristicae, rr^xx. Syr. Simplicis, . q. s. . j. M. Sig.—A dessertsp. every % hour until relieved, then reduce the dose. Keep the head low, and apply cold over the 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). Muscae Volitantes. Potassium Iodide, very effectual in curing muscse depending upon hepatic derangement (Wa). Valerian, often found curative (Wa). Muscse 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. Neutral-tint glasses may be worn to render the muscae less visible, if troublesome. Arnica, the best agent for contused muscular fibre ; also for shake, concus- sion, shock ; every 2 or 3 hours in water (P); a few drops of tincture in- ternally, removes stiffness, after packing with cold, wet sheet (R). Cimicifuga, 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, 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). Xanthoxylum, externally and inter- nally, 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, acu- puncture (B). Electricity, the constant current (B). Baths, Turkish, in aching Myalgia. MYELITIS MYOPIA MYXCEDEMA NiEVUS. 727 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 is important until 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, and generally better after repose, but increased with fatigue. [Compare Pleurodynia, Lumbago.] Belladonna, is decidedly effective, especially when disease is brought on by external violence (P). Ergot, most successful: large doses are necessary (B). Electricity, in chronic, not in recent form (B). Silver Nitrate, in chronic inflam- mations of the cord, one of the few remedies which are ever of service; gr. (W). Silver Phosphate, of special value in myelitis with disturbance of bladder and rectum (Wa). Sodium Phosphate, hypodermically, was employed with great benefit in a case of syringo-myelitis (see page 383). 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). [Compare Meningitis spinal, Paralysis.] Myelitis. Atropine, by daily instillation, systemically, 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. Extraction of the Lens, produces the happiest results in extreme myopia, especially when progressive, since by removal of the crystalline lens the refrac- tion of a very myopic eye is brought back nearly to emmetropia (Valude). Myopia. Thyroid Extract, or the thyroid gland itself, fed to the patient daily, is now the recognized treatment, and produces the best results (see page 131). Myxcedema. Nsevus. Ferrum Chloride, injected, is effectual ; but dangerous when applied thus to nsevi about the head (Wa). Creosote, pencilled over twice a day, may remove naevi (Wa). Chromic Acid, as escharotic, or local application, gr. c ad Jj aquae destil. (B). Electrolysis, or galvano-cautery, to remove naevi (B) ; 40 cases so treated; the process is certain and safe, leaving a faint cicatrix and no after- pain (Knott) ; in my hands has answered well during ten years’ use in these cases (Marshall). Nitric Acid, strong, as escharotic for small superficial naevi, followed by Oleum 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. Sodium Ethylate, prepared by adding the metal Sodium, piece by piece, to absolute 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 remov- ing moles from the face (Thomas). 728 NAILS NASAL AFFECTIONS NAUSEA. Liquor Potassae, a solution, 3U to 3j» on cotton-wool applied to margin of nail at ulcerated surface, to soften the nail in ingrowing toenail (B). Glycerin, or Silver Nitrate, on a fold of lint, to the ulcerated surface (C). Lead Car- bonate, 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 ingrow- ing 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). Glycerite 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). Zinfc Chloride, gr. ij to the §, or the Sulpho-carbolate, gr. v to the as solutions locally by cotton-wrapped probe to diminish sensi- bility of the nasal mucous membrane (Sajous). Cocaine, has many applica- tions in treatment of nasal affections ; a 4 per cent, solution by mop or spray will empty the engorged venous sinuses, and is very useful in acute catarrh, hay fever, etc., also for posterior and anterior rhinoscopy (R). [Compare Acne, Catarrh, Epistaxis, Hay Fever, Influenza, Polypus, Sneezing.] Nausea. Carbolic Acid, or Creosote, is very useful in reflex nausea. Hydrocyanic Acid, rr\j-iv of the dilute acid in of water, is useful (Beale). Ammonia, rtbiij-iv of Liq. Ammonias in a winegl. of water when the feeling of nausea is most troublesome, may cure the ailment (Id). Hydrargyrum, a small dose of Blue Pill or Calomel will sometimes cure very obstinate nausea, although many other remedies have failed (Id). Cocaine, a 2 per cent, solution sprayed high into the nasal passages, so as to reach the terminal filaments of the olfactory branches, is specific against nausea, its influence lasting several hours (In- graham). Chloroform, on sugar, will remove some kinds of nausea (B). Ipecacuanha, has no rival in sickness of pregnancy, scarcely less useful in that of chronic alcoholism ; very small doses, gr. of powder or rt\j of wine (P). Pulsatilla, in dyspeptic nausea, with coated tongue, flatulence, sick-head- ache (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, re- lieve nausea (P). Tartaric Acid, as effervescing draught, with a few drops of Tinct. Opii, Tinct. Calumbae, or Dilute Hydrocyanic Acid added, when from morbid gastric irritation (Wa). Bismuth Subnitrate, or the Liquor Bismuthi, when the salt in substance disagrees, is a remedy of established value in nausea and vomiting arising from gastric disorders ; may be combined with Hydrocyanic Acid (Wa), Counter-irritation, by a mustard poultice applied over the region of the stomach and liver for 20 minutes every 3 or 4 days (Beale). Heat, hot water on spongio-piline, worn for an hour or two, will fre- NECROSIS NERVOUS AFFECTIONS. 729 quently be found efficacious (Id). Cold, by a compress or ice-bag, over the stomach, is often very useful. [Compare Dyspepsia, Headache bilious- sick, Sea-sickness, Vomiting, Vomiting of Pregnancy.] Necrosis. Sarsaparilla, a very useful medicine in diseases of the bones (P). Rest, in a Salter’s swing, with poultices, water-dressings or stimulating lotions, to aid the 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 remove 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 fistulae, to convert them into large openings, permitting the removal of diseased bone (Kirk- patrick). [Compare Caries, Bone Diseases, Syphilis, Scrofulosis.] Nervous Affections. Nux Vomica, in one-drop doses of the tincture every 5 minutes, is promptly efficient in relieving many affections of reflex neurotic origin, as cough, dyspnoea, syncope, palpitation, flatulent dyspepsia, eructations, etc., especially when occurring in hysterical subjects (Macfarlan). Arsenic, of especial value in nervous affections resulting from malaria, in which large doses are required ; Hhx Liq- Arsenicalis, increased to rr\,xxx thrice daily (Wa). Asafcetida, is a remedy of much value in nervous affections connected with uterine derange- ment, also in dyspeptic hypochondriasis and other nervous affections ; may be combined with bitter tonics and mild aperients (Wa). Potassium Bromide, takes precedence in epilepsy, epileptiform 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, hypo- gastrium or epigastrium ; feelings similar to rigors, with anxiety, palpitation or fluttering of the heart,—all due to interference with the local circulation (Rey- nolds). Valerian and Valerianates, are thought to exercise some special influence over nervous affections, especially Zinc Valerianate, 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 (W). Sumbul, acts as a nervous stimulant, and is especially effi- cacious in neurotic migraine, also in hvsteria and the obscure paralytic affec- tions associated therewith (Wa). Caffeine, is of signal value in neuralgia, hemicrania and other nervous affections (Shaffer) ; grain-doses in solution hypodermically afford great relief in dorso-intercostal neuralgia attending shingles, insomnia, etc. (Anstie). Cocaine is a powerful nerve stimulant, destroying the sense of fatigue, and often evincing marked analgesic power in neuralgiae ; 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, melan- cholia, mania, and all nervous affections accompanied by pain (W); gives general repose to both body and mind, is of decided value in diabetes, and pro- duces marked improvement in melancholia and despondency (R). Lupulin, is peculiarly useful in nervous affections 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 (EberJe). Santonin, in convulsions, epileptiform seizures, and affections 730 NERVOUSNESS. regarded as choreic, etc., the result of reflex irritation from worms (Wa). Phosphorus, of occasional utility in affections of the nervous system induced by mental exertion or over-excitement; the danger from its use is its liability to produce fatty degeneration of the internal organs (Wa). Sodium Phos- phate, hypodermically, employed with great benefit in a case of syringo- myelitis, also in one of unilateral astasia-abasia; is considered by Luton to be possessed of reconstructive power equal to that of the animal extracts. Orchitic Extract, has been used with benefit in several affections of the nervous system (see page 136). Physostigma, given for six months or longer, in small doses, gr. of the extract every 3 hours, is useful in many nervous affections, as locomotor ataxia, writer’s cramp, and paraplegia due to myelitis (Murrell). Silver Phosphate, is of special value in sclerosis of the nervous substance and in myelitis (Wa). Shower Baths, cold, are often beneficial in nervous affec- tions unconnected with disease of the brain. [Compare Diabetes, Hemi- crania, Headache nervous, Hemiplegia, Hysteria, Insomnia. Loco- motor ataxia, Mania, Melancholia, Myelitis, Neuralgia, Neuras- thenia, Neuritis, Nervousness, Paralysis, Paralysis agitans, Spinal Paralysis, etc.] Opium, calms the nervous system and gives general repose to both body and mind (R); small doses, identity of drug to be carefully concealed lest the opium- habit be formed. Antipyrin, is efficient for nervous irritation. Ignatia, in small doses better than Morphine for mental excitement and nervous erethism (P) ; for the nervous exaltation of cinchonism (Pf). Strychnine, affords relief in functional irritability of the nervous system, manifested by restlessness and wandering neuralgic pains (B) ; especially useful as a tonic in nervousness from over-use of tobacco (H). Potassium Bromide, especially for women who are despondent, irritable, and sleepless, from overwork, grief, worry, etc. ; often connected with migraine (R); gr. ss-j of any Bromide every % hour, is very efficient for the nervous disturbances of children (Smith). Valerian, extremely useful as a sedative to reflex excitability, calms nervousness, does much good in fevers where restlessness, fidgets, anxiety, etc. (P). Aconite, gtt. j of tinct. at bedtime, repeated if needful, for restlessness and “ fidgets ” of men as well as women (R). 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 (Smith). Resorcin, produces quiet sleep in general nervous excitability. Conium, where a great deal of motor agitation, especially in the typhoid-like condition with insomnia, exaggerated nervousness .and delirium often resulting from mental overwork, acts charmingly in securing sleep, by removing the motor agitation; rr\,x of a fluid extract of the unripe fruit, every y. hour, carefully watched (Madigan). Musk, serviceable in nervous affections when due to uterine derangement (Wa). Sumbul, often invaluable in restlessness of pregnancy; npxxx-xl of tinct. with a little Chloric Ether as draught (P). Camphor, a powerful subduer of reflex ex- citability (P). Chloral, where restlessness, debility (R). Chloroform, the Spirit internally (R). Hop, the hop-pillow is deserving of trial. Lupulin, 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.] Nervousness. Prescriptions. R. Strychninse Sulphatis, . . gr. j. Quininae Sulphatis, . . . Tinct. Ferri Chloridi, . . gv. Ac. Phosphor. Dil., Syrupi Limonis, . . . . aa^ij. M. Sig.—A teasp. in water thrice daily. K. Potassii Bromidi, . . . . 5j. Ext. Guaranae FI., . . s^jss. Syr. Tolutani, £ iij. Aquae, q. s. ad£\]. M. Sig.—Teasp. to a dessertsp. three or four times daily. To relieve nervousness. NEURALGIA. 731 Neuralgia. Antipyrin, is prescribed in all forms of neuralgia (M) ; is highly efficient in neuralgia of the 5th nerve associated with neuritis (B). Acetanilid, is used with success in facial and intercostal neuralgias (M) ; is highly useful against pain due to inflammation of nerves (B). Phenacetin, is specially useful in the fugacious and variable neuralgias so common in the hysterical and neurotaxic (M) : of the three drugs named Phenacetin is probably the safest and most effi- cient in doses of 10 grains. Salipyrin has been employed with excellent results ; a dose of gr. viij being often sufficient. Phenocoll, is used successfully, especially for the neuralgic pains of epidemic influenza (grippe). Salol, is very efficient in some forms. Salicylates, in large doses, cured a case of tic douloureux of 12 years’ standing (Dercum). Opium, internally, or Morphine hypodermically, in the vicinity of the affected nerve, the best treatment; cau- tion ! morphine-habit (B) ; gr. 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 of 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 C) ; internally the best agent of all in essential neu- ralgia ; should be combined with Quinine in intermittent forms and those which resist quinine alone. [See formula below.] Belladonna, must be persisted with in full doses ; gr. of Atropine internally, or gr. -fo to hypodermically in vicinity of nerve, has special utility in tic douloureux and sciatica ; also in peri-uterine and dysmenorrhceal neuralgias (B); rr\J of solution of gr. j in 3ij of water hypodermically (P); for spinal irritation ; intercostal neuralgia; the Liniment or Ointment of Atropine in facial (R); gr. ijss of the extract every hour till giddiness, then lessen the dose and continue for several days (Tr). Veratrum Viride, tincture, said to be very useful (R); Veratrine Ointment for facial neuralgia and sciatica (R) ; the Oint., gr. viij to %j, frequently of much benefit (P). Quinine, large doses, gr. v-xx in sherry, just before the 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 selec- tive action upon supra-orbital form (Spender). Arsenic, cures by its influence on bodily nutrition ; directly so in neuralgia of malarial origin, though inferior to Quinine (B); in various neuralgias, also in angina pectoris (R); the Bromide of Gold and Arsenic rendered good service in an obstinate case of trifacial neuralgia diagnosed as due to syphilis, after other treatment besides anti- syphilitic had failed (E. A. Wood). Nux Vomica, is most useful in visceral neuralgiae, as gastralgia, hepatalgia, etc., the tincture with carminatives in the former affection ; or Strychnine, gr. to twice or thrice daily : in all forms of neuralgia this remedy should be used in small doses (P). Ignatia, in hysterical and intercostal neuralgia with nervous erethism, is valuable (P). Phosphorus, gr. every few hours, has made very effective cures (B); gr. to y every 3 hours ; very useful in all forms, especially when uncomplicated (R); always a good remedy, except for cases due to cold or inflammation, and those not depending on depraved nutri- tion (H). Ammoniated Copper, in neuralgia of the 5th, used with remarkable success ; l/z-grain doses pushed (Fereol). Physostigmine, very efficient in neu- ralgia of the eyeball, a solution of gr. ij to the 2; 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 the 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 732 NEURALGIA. neuralgia of fifth, dependent on syphiloma of the nervous system, pain noc- turnal 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 anaesthetic to relieve pain, is occasionally useful locally, also as spray for uterine neuralgia (R); n\,v-xv of pure Chloroform by deep injection into vicinity of affected nerve, 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 anal- gesic, and has prolonged influence, but must be aided by remedies to improve the nutritive state of the affected nerves, or those which are capable of remov- ing 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 administered 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 the head, tic douloureux, etc. (R); gr. j every >£-hour is a very efficient dose (Smith) ; rarely of any value, but when used is best given in 20-grain doses twice daily (H). Chloral and Camphor, equal parts, triturated together, and painted over surface (R): also with Morphine (B). Amyl Nitrite, inhaled in dysmenorrhceal neuralgia (B); and when of 5th nerve (R). Nitro-glycerin, has often afforded great relief (Wa). Sumbul, for certain types, of more value than any other remedy ; facial, sciatic, or ovarian neuralgias, in women of nervous constitution, often yield to it at once (P). Cimicifuga, in neuralgia of the 5th from cold, and in ovarian (B). Gelsemium, successful in neuralgia of 5th (B); especially dental branches (R) ; of value in trigeminal, ovarian, etc. (W); in suitable cases small doses answer as well if not better than large ones (Pf); rnjij of the tincture every hour often succeed miraculously with no ill results in neuralgias about the head and face (Smith); no better remedy in tic douloureux, but must be given in large doses, q,x-xv of a strong tincture or fluid extract (H). Zinc Valerianate, extremely beneficial in neuralgia from reflex irritation of female pelvic organs (B). Spigelia Anthelmia, is useful in the facial form (P). Ammonium Valeri- anate, or Zinc Valerianate in neuralgia of face or head (R) ; the latter in ner- vous cases, and uterine (Wa). Chamomile, in neuralgia of 5th nerve (R). Staphisagria, internally and externally often curative in obstinate facial and cervical neuralgia (P). Ergot, much employed in visceral forms, especially gastralgia (P) ; is said to be useful (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 infu- sion, on lint covered with gutta-percha (R). Coccus Cacti, has been very suc- cessful in 20-30 minim doses of a 1 to 8 tincture twice daily, the larger doses in the paroxysms (W). Peppermint, the Oil, painted over the part in facial neuralgia (R); especially the Chinese oil, which contains a large excess of Menthol, a very useful application in superficial neuralgise (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 neural- gia, every two hours (H). Osmic Acid, a one per cent, aqueous solu- tion with glycerin to prevent change, of which 5 to 10 drops hypodermically, has made striking cures of inveterate neuralgise, with no ill effects resulting (Shapiro). Carbonic Acid Gas, injected into vagina for neuralgia of uterus. Aquapuncture, strangely relieves pain in a superficial nerve, so much so, that some hold the curative effects of morphine injections to be due to the water (B). NEURASTHENIA. 733 Counter-irritation, Mustard poultices in neuralgic pains (P) ; blisters to a pos- terior branch of the spinal nerve-trunk from which the painful nerve issues (Anstie). Wet Pack, is of great benefit, especially in sciatica. Intense Cold, produced by a spray of Methyl Chloride, 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 di- rected to the naso-pharynx and Eustachian tubes (Masucci). Galvanism of the affected nerve, one of the most important curative 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 shampoo- ing. [Compare Gastralgia, Hemicrania, Hepatalgia, Otalgia, Ovarian Neuralgia, Sciatica, Tic Douloureux, etc.] For Internal Use. R . Phosphori, gr. ss-jss. Alcoholis, q. s .ad solv. Spt. Menthae Piperitae, . . q. s. Glycerini, , . . q. s. ad M. Sig.—A teasp. after each meal. (H-) Prescriptions, For Local Use. $. Chloroformi, Tinct. Aconiti, . . . aa Sss. Linim. Saponis, M. Sig.—Apply on flannel and cover with oiled silk. For superficial neuralgia. R. Cupri Ammonio-sulphat., . gr. j-iv. Syr. Aurantii Flor., . . . zj. Aquae Destil., 5'ij* M. Sig.—One-third as a dose, thrice daily. [Prof. Fereol.) R. Aconitinae (Duquesnel), . gr. iv. Veratrinae, gr. xv. Glycerini, 3 ij. Cerati, gvj. M. Sig.—To be rubbed over the part, avoiding any abraded surface carefully. [Da Costa.) R. Quininae Sulphatis, Ferri Pyrophosphatis, . aa 3j. Strychninae Sulphat., . . gr. ss. Ac. Phosphor. Diluti, . . 3 ij. Syr. Zingiberis, £ij. Aquae, q. s .ad % iv. M. Sig.—A tablespoonful twice daily. R. Mentholi, gr. xlv. Cocainse Hydrochlor., . . gr. xv. Chloralis Hydratis, . . . gr. x. Vaselini, 3 v. M. ft. ung. Sig.—For local use. [Poller.) R. Aconitinae Crystal., . . . gr. Quininae Hydrobrom., . . gr. xx. M. ft. massa, et div. in pil. no. xij. Sig.—One every 4 or 5 hours. [Poller.) R. Veratrinae, gr. xl. Adipis, vel Unguenti, . . j. M. Sig.—Local use. [Da Costa.) R. Theinse, Sodii Benzoatis, . . . aa gj. Sodii Chloridi, gr. x. Aquae Destil., §j. M. Sig.—3 to 20 drops hypodermically at central seat of disturbance, trpvj = gr. ss of Theine. [Mays.) R . Tinct. Aconiti, Tinct. Colchici Sem., Tinct. Cimicifugre, Tinct. Belladonnse, . . aapart. seq. M. Sig.—6 drops every hour until re- lieved. (Metcalf.) Neurasthenia. Ammonia, the Aromatic Spirit proves very serviceable; ss-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 734 NEURITIS. (Wa) ; the Syrup of the Hypophosphites with Strychnine is of service as a general tonic, in connection with other remedies. Arsenic, is often very serviceable; Fowler’s or Pearson’s solution, in doses of trUij-v, in water, after each meal. Aurum, the Bromide of Gold and Arsenic (Barclay), gave excel- lent results in 3 out of 4 cases of marked neurasthenia, in doses of of the solution 4 times daily (Love). Strychnine Acetate, a remedy of great promise, when combined with a rigid system of diet, mental discipline, etc. (Marshall Hall). Zinc Oxide, often excellent as a tonic and sedative, in nervous irrita- bility 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 -grain doses proves serviceable in nervous exhaustion (R): danger of cocaine-habit if identity known to the patient. Coca, as a stimulant has been used with benefit, but only for a short time, and acts deleteriously unless given in small doses (W). Kola-nut is used in France, contains Caffeine, and is subject to the same remarks as above. Musk, is a valuable remedy in such cases, being stimulant and antispasmodic ; it stimulates the nervous centres when exhausted, without producing any very pronounced symptoms (W). Orchitic Extract, has been used with benefit. Nuclein, is useful in many cases (Vaughn). Cerebrinin, has been used with advantage (Paul). Artificial Serum, in cases of lowered arterial tension (lessening of first sound, tachycardia embryocardia), an injection hypo- dermically of ttpxv of the solution formulated below, 2 to 4 times a day (La France Aledicale). Diet should be chosen from the most readily assimilable food, calling for a minimum amount of digestive work. As a rule, neurasthenics eat too much and drink too little ; plenty of water, at least a litre and a half per day, is the best drink ; it maintains the arterial tension, irrigates the tissues and assists the excretion of debris. Milk should be prohibited, also vegetable soups, peptones and extracts of meat. The albuminoid element of the food should not exceed one-sixth of the total (Vigoreaux). -Counterirritation, the actual cautery along the spine has rendered excellent service in several cases of neurasthenia accompanied by neuralgia of the superficial branches of the spinal nerves; its action is doubtless often a mental one, and it renders the carrying out of the rest-cure more thorough than when attempted without some- thing to enforce quiet. Rest-cure, with forced alimentation and systematic massage to keep up the muscles while holding the nervous system as inactive as possible, will do more than medicine in these cases. Many such will recover under the discipline and quiet of an hospital or sanitarium alone; while others are greatly benefited by removal from home influences and cares, and from association with certain persons who irritate them. [Compare Adynamia, Ex- haustion, Gout, Hysteria, Spinal Irritation.] Artificial Serum. R. Sodii Phosphatis Pur., . . giij. Sodii Sulphatis Pur., . . . gr. lxxx. Sodii Chloridi Pur., . . . gr. xxx. Ac. Carbol. Cryst., . . . . gr. v. Aq. Destil. Bullient, . . ad j|iv. Dose, hypodermically. R. Strychninse Acetatis, . . . gr. j. Ac. Acetici Diluti, .... tr^xx. Alcoholis, 3 ij. Aquae Destill., 3 vj. Sig.—Ten drops thrice daily. (Hall.) Prescriptions. Tonic and Stimulant. R . Tinct. Kolae, jss. Ac. Citrici, gr. xx. Sodii Arseniat., gr. j. Tinct. Cocas, . . q. s. ad iv. Dose, gj at each meal. R. Ac. Phosphorici Dil., . . Elixir Calisayae(U.S. Disp.),3 vj. Elix. Ammonii Valerian., . % ij. Glycerini, Vini Xerici, . . . q. s. ad Oj. M. Sig.— thrice daily. Neuritis. Strychnine, internally, is of value, and may be given in increasing doses (0) ; hypodermically, in multiple peripheral neuritis, is of great advantage ; no case NIGHTMARE NIPPLES NODES. 735 remembered in which it failed to cause improvement (Walker). Acetanilid, is so effective that it see.ms to have specific action (B). Antipyrin and Salicy- lates, are recommended in the acute cases with fever (O). Arsenic may be employed (O); the Bromide of Gold and Arsenic cured a case of neuritis with partial hemiplegia lasting five years, with inability to walk and considerable pain along the spine and in right arm and leg (Barclay). Potassium Iodide and Mercury, if there is a history of syphilis (O). Massage is probably the most reliable means at our command in the later stages, when the atrophy is marked and the pains have lessened. Contractures may be gradually over- come by passive movements and extension. The interrupted current is useful when the acute stage is passed (O). [Compare Alcoholism, Neuralgia, Spinal Irritation.] Potassium Bromide, in nightmare of adults ; and children’s attacks of night- screaming often associated with squinting: the digestive organs may also require attention (R). Camphor-water, a teaspoonful or two the most suitable medicine (H). Sleep, in abundance, may prevent nightmare (H). Diet, light; avoid late meals and indigestible food. Nightmare. Nipples, Sore, Fissured. Benzoin, an admirable local application (P); the tincture locally for slight erosions (Parvin). Silver Nitrate, touched lightly, is effectual (VVa). Sulphur- ous 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); better applications are Arnica cerate, the glycerite of Starch, or 2 parts of eau de Cologne to 1 of glycerin (R). Lime-water, is a useful application for cracked nipples. Alcohol, Brandy and water as lotion before delivery and after each suckling to prevent cracking (R). Borax, satu- rated 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 ap- plication for fissured nipples (B). Tannin, the Glycerite, one of the best appli- cations to fissured nipples (B). Lead Nitrate, in Glycerin, or ointment 3j to §j, in fissured nipples (B). Zinc Shield, constantly worn (R). Balsam of Peru or Tolu, valuable as application, with Oil of Almond, 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 Cacao-butter (Wa). Nipple-shield, to give the nipple rest while the child sucks, gives great comfort. [Compare Lactation, Mas- titis.] Prescriptions. R. Balsam. Peruvian., . . . jij. 01 ei Amygdalae, gjss. Mucil. Acaciae, . . . . 5 ij. Aquae Rosae, q. s. M. Sig.— Apply to the nipples after each nursing. (Phillips.) R. Liq. Plumbi. Subacet. Dil., [§ss. Ext. Opii, zj. Aquae Rosse, 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 increased by heat of bed (Wa). Stramonium leaves, locally, relieve (Wa). [Compare Exostosis, Periostitis.] 736 NYMPHOMANIA—OBESITY—ODONTALGIA. 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 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 Sulphuric Acid internally, when arising from hemorrhoidal congestion, not an infrequent cause (Wa). Orchitic Extract, has given satisfaction. Cerebrinin, has been used with benefit (Paul). Obesity. Iodoform is highly efficient, but causes wasting and anaemia, the latter by injuring red blood corpuscles (B). Iodol, in 2-grain doses thrice daily, is equally effective (B). Alkalies, as solutions of Oxides or Bicarbonates (R); alkaline mineral waters, with exercise and dietary (B); serviceable (Wa); Liquor Potassae gss jn milk, thrice daily, of established value (Wa) ; generally fails (R). Ammonium Bromide, sets up gastric catarrh (B); but lessens corpulency (Wa). Sulphurous Waters, especially Blue Lick, before each meal (B). Potassium Permanganate, for attendant dyspepsia and flatulence ; also useful for the obesity; gr. %-j ter die, in distilled water (B). Vinegar, only successful at expense of serious injury to the body (R). Fucus Vesi- culosus, has power to reduce adipose tissue ; an extract is sold under the title “ Antifat” as a proprietary medicine (W). Phytolacca, has been long known as a reducer of adipose tissue; a resinoid preparation, named Phytoline, is on the market as an " anti-fat,” the dose of which is tt\,x, six times daily, before and after each meal. Thyroid Extract, has been employed in several cases with uniformly good results (see page 132). Banting Dietary is alone sufficient to improve the condition; its chief feature is the exclusion of the 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 ; but it cannot be recommended indis- criminately. 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 (Smith). The Schweninger or CErtel method is similar, using chiefly albuminous food, excluding fat and carbohydrates, limiting the fluids drank, especially at meals, and enforcing exercise. Peanuts, are an excellent article of food for the cor- pulent (Furbringer). [See under Diabetes Mellitus.] 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, as 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 maybe mixed with Opium; it sometimes at first aggravates pain (R, W). Staphisagria, the alcoholic solution dropped into the cavity (P). Alum, a solution in Nitric Ether, 3ij to 3vij, is said to be an effect- ual application (B) ; Alum and salt powdered and placed in the cavity, excellent when nerve exposed. Chloral, rubbed up with an equal weight of Camphor, and placed in the cavity (R); these two, with Glycerin and Carbolic Acid, equal parts of each ingredient, applied on a little cotton after cleaning the cavity, will (ESOPHAGEAL AFFECTIONS ONYCHIA. 737 relieve the pain, and makes an excellent mixture for “ toothache drops ” (Brod- nax). Chloroform or Croton-Chloral, equal parts of the former and Creosote, a good application (R). Tannin, a solution in Ether is a good application to a carious tooth (B). Creosote, with Tannin or Opium or Chloroform, placed in the cavity of a decayed tooth, often gives relief (R). Cocaine, a 5 per cent, solution on cotton applied to a cavity will often bring instant relief. Coniine, a 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 Creosote inserted in cavity of painful tooth (R). Mor- phine, hypodermically for severe toothache (R). Oil of Cloves, inserted into cavity (P). Camphor, with Morphine and Flaxseed, as a cataplasm to the cheek (B). Xanthoxylum, a domestic remedy (B). Capsicum, a strong infu- sion on lint (R). Gelsemium, useful in some forms (R). Zinc Chloride, to de- stroy exposed painful pulp (R). Ginger, Mezereon, Pyrethrum, are useful masticatories in toothache (P). Preset iplions. R. Linim. Aconiti_(B. P.), Chloroformi, . . . . aa g iij. Tinct. Capsici, g). Tinct. Pyrethri, Olei Caryophylli, Pulv. Camphorae, . . aa g ss. M. Sig.—A few drops to be placed on a pellet of cotton and applied to the cavity. (Mason.) R . Creosoti, g ij. Ol. Caryophylli, ziv. Ol. Menth. Piperit., . . . X). Camphorae, !|ijss. Alcoholis, . . . . q. s. adOj. M. Sig.—Toothache Drops. R. Acidi Tannici, gr. xx. Mastiches, gr. x. vEtheris, g ss. M. Sig.—On cotton to cavity. (D.) R. Morphinae Sulph., . . . . gr. iv. Atropinae Sulph., . . . . gr. j. Aquae Destill., gj. M. Sig.—A few drops on cotton, placed in the cavity. (B.) CEsophageal Affections. 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.] Dilatation, by bougies, in non-spasmodic (structural) strict- ure, the only appropriate treatment (H). [Compare Choking, Dysphagia.] 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 io minutes in every hour ; poultices in interim (R). Arsenic, gr. ij ad § j 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 i 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 738 OPHTHALMIA. and to promote healing (B). Sodium Chloride, common salt roasted until the chlorine is driven off, equal parts of this, Castile Soap and Venice Turpen- tine, as a poultice, is a very efficient application. Carbolic Acid, to benumb surface during incision (R) ; which should be carried down to the bone, espe- cially in tendinous whitlow (D). Cocaine, hypodermically, will accomplish the local anaesthesia more thoroughly, if delivered deeply into the tissue. Mor- phine, powdered, as local application to relieve pain. Heat, by poultices, is very useful. 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 rendered useless (Ashhurst). Ophthalmia. Silver Nitrate, a strong solution, gr. xx to the in granular lids ; cautiously when corneal ulcers exist (B) ; solid stick diluted with 2 to 4 parts of Potassium Nitrate, appled lightly and quickly ; or a solution, gr. ij-x to the over the everted lids, which should be washed with a solution of common salt, and then with water before being replaced (C); in solution, gr. v to §j aquae destil- latae, 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). Boroglyceride, 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 to aquae, applied every % to }4 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 detach- ing scales rub in Brown Citrine Ointment every night, for eczema of margin of lids (B). Pulsatilla, as a lotion to conjunctiva 8 or 10 times in 24 hours, also internally (P); much used by homoeopaths (B). Spigelia, useful in rheumatic ophthalmia (P). Antimony, as 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 to §j aquas 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 to produces remarkable results (B). Lead Acetate, gr.j. ad §j aquae destillatae, applied by camel’s-hair pencil to sur- faces of everted lids, washed away before the lid is replaced ; or the Tannate of Lead to 3 parts fine Oil and 1 of fresh Lard, a very small piece as oint- ment to lid (C). Carbonic Acid Gas, said to relieve the pain and photophobia of strumous ophthalmia, when locally used (R). Physostigma, to reduce pupil and shut out the light (P). Iodine, is employed locally in scrofulous ophthalmia for its alterative stimulation (W). Iodoform, in gonorrhoeal ophthalmia, and purulent conjunctivitis, of very great value locally, but should be pulverized 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 is used with marked benefit; also a stronger solution, gr. ij-iv to the 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 to the is very serviceable in ophthalmia of infants or adults; Liquor Plumbi added improves it (Wa). Staphisagria, especially in tarsal ophthalmia (P). Colchi- cum, when gouty diathesis (P). Cod-liver Oil, in strumous subjects, tends to remove the manifestations of the disease (R). Cold Wet Compresses, or iced, OPIUM HABIT. 739 are held to be essential in early stage of acute purulent and gonorrhoeal ophthalmia (C). [Compare Blepharitis, Conjunctivitis, Keratitis.] Opium Habit. Sodium Bromide, in large and increasing doses, 3j twice daily, increased by 20 grains each day, to a maximum of ioo 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 : this drug, with Codeine and Trional, form a combination of unrivalled efficacy, if properly used in proper cases, and combined with minor aids make a method far in advance of any yet presented, to secure the minimum duration of treatment and maximum freedom from pain (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 re- sults of the bromides as commonly administered; this, with 3) of Warburg’s Tincture before breakfast each morning, with the use of Spt. Etheris Nitrosi to eliminate the bromides rapidly, electricity, a mixture of Iron and Strychnine, and an occasional hypodermic of 5 or 10 minims of a 4 per cent, solution of Cocaine for nervous restlessness, is the general line of my treatment (Mann) : Bromides may do great harm, if recklessly administered, paralyzing the mus- cular system and causing prolonged delirium. Cocaine, or the fluid extract of Coca, 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. In the treat- ment of the combined morphine and cocaine habit, the latter drug may be withdrawn entirely at once without any suffering, and the former may be re- duced one-half at the same time. Codeine, in doses of a grain or more, is very useful in combating the nervous agitation which succeeds to the final with- drawal of the opium. [See under Sodium Bromide above.] Trional, in dose of 30 to 40 grains as a hypnotic, is of special value in these cases. Paralde- hyde, in dose of 3jss—ij, as a hypnotic, is efficient, but its sleep is of briefer duration than that produced by Trional or Sulphonal. Gelsemium, subdues the restlessness and motor excitement; proved of great value in one case where 30 grains of morphine were used daily ; n\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 hypodermi- cally, at moment of systolic cardiac depression which answers to the period of craving, and corresponds to the truncated curve of the sphygmographic trace, 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 ephemeral (Id). Atropine, used with great benefit in one severe case, re- moving the copious exudation from the air-passages, bowels and skin, and moderating the distressing symptoms due to the withdrawal of the morphine (W. Koch). Physostigmine, gr. acts remarkably well at the crisis as a substitute for the drug. Duboisine, injected daily succeeded in destroying the craving for morphine in a case of long standing (Birnabee) ; is an excellent calmative and hypnotic at the crisis. Hyoscyamine, Merck’s amorphous, 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). Hyoscine, the Hydrobromate, in doses of gr. to -fo, hypodermically, is highly efficient for the same purpose, but must be used sparingly, as it excites high delirium in most subjects for a time. 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); or increasing doses of Hering’s solid extract, beginning with one or two grains. Chloral, as a hyp- 740 ORCHITIS. notic, 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 re- lied on (M). Galvanism, 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 worth- less (M). Strychnine, is invaluable, especially after the cure is nearly completed (Barr). Aurum, the Bromide of Gold and Arsenic, hypodermically, as a tonic, thrice daily, to complete the cure. Capsicum, is serviceable as a stimulant to the stomach and a cerebral sedative ; removes the sinking sensation at the epi- gastrium, and tones up the intestines. Catechu, the tincture in 3 doses, for the diarrhoea. Ergot, in full doses, for the headache. 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 [see formula below], are valuable, and are best given on alternate days (Fleming). Piscidia Erythrina, has been proposed as a substitute, and highly recommended, but is worthless, as are also Avena Sativa and many other falsely termed substitutes (M) ; there is no remedy for the opium habit (Da C). Zinc Oxide, for the vomiting and diarrhoea, begin- ning 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 Ger- mans, 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). Useless 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). It is very important to keep the patient in total ignorance of the rate of reduction. Prescriptions. Combination of Bromides. R. Ammonii Bromidi, Sodii Bromidi, . . . . aa Potassii Bromidi, . . . . g j. Liq. Potass. Arsenit., . . g). Syr. Tolutan., Aquae Menthae Piper., . . gjss. Syr. Hypophos. Comp., . iij. M. Sig.—g) to gij in water thrice daily. Has of total Bromides, gr. 21 in each g. {Mann.) R . Codeinae gr. xvj. Alcoholis, . . . . q. s. ad solv. Cocainae Hydrochlor., . . gr. xvj. Plixir Simplicis, . q. s. ad ij. M. Sig.— g) in water, occasionally, when great restlessness. Formula never to be given to the patient. {Potter.) &. Tinct. Cannabis Ind., . . tr^xl-lx. Spt. JEtheris, gj. Aquae, q. s. ad M. Sig.—One dose, if insomnia is very protracted. {Fleming.) R. Tinct. Capsici, Potassii Bromidi, . . . aa ziv. Spt. Ammonias Aromat., . iij. Aquae Camphorae, . q. s .ad g vj. M. Sig.—A dessertsp. several times daily, in the depression of alcoholism and opium habit. Instead of the bromide, Fowler’s Solution, npl, may be added ; or Tinct. Nucis Vomicae gij, or Tinct. Aur- antii Amari g v. (Ringer.) R. Tinct. Nucis Vomicae, . . g iij. Ac. Phosphor. Diluti, . . gv. Syr. Pruni Virg., . . . . g ij. Aquae, q. s.ad 3;iv. M. Sig.— gi) twice daily as a nerve tonic. (.Potter.) Orchitis. Pulsatilla, n\j or less of the tincture every hour, relieves pain rapidly, though not the oedema (St). Belladonna, int., and as oint., extract j ad iij OTALGIA OTITIS. 741 Adipis, when inflammation has subsided (Wa). Sodium Salicylate, in gonor- rhoeal orchitis, subdues the pain in a few hours. Iodine, tinct. locally to remove swelling after the acute stage has passed (B). Mercury, the Oleate 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 gr. \ hypodermically 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). Guaiacol, pure, as a local application for the pain. Alcohol, with equal quantity of water, as evaporating lotion (B). Ice, bene- fits the inflammation and relieves pain (B). [Compare Epididymitis.] Prescriptions. R. Ammonii Chloridi, . . gr. xl. Alcoholis, Aquae, . . . aa 3 ij. M. Sig.—Lotion, to be applied on cloths to the part. R. Hydrarg. Ammoniat., . . zj. Cerati Simplicis, . . . . gj. M. ft. unguent. Sig.—Apply locally, with gentle friction. Otalgia. Aconite and Opium, equal parts of the tinctures, a few drops well down the external meatus, will usually subdue the pain. Blistering Fluid, or Croton Oil Liniment behind the ear, often relieves earache (R). Glycerin, for dryness of meatus (R); or Olive 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 §, with gr. j-ij of Atropine, is an excellent application (B). Atropine, gr. in gxx 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); a solution locally is especially applicable in the earache of children from whatever cause, gr. j to the 55, of which gtt. iv dropped into ear to remain for io or 15 minutes. Pul- satilla, internally and externally, is often used with advantage (P). Cocaine, a 4 per cent, solution sprayed over the tympanic membrane through the exter- nal 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). Olive Oil, often used warm as local application, but is of no service and may do harm by under- going decomposition and becoming favorable soil for the growth of aspergillus or other vegetable fungi. [Compare Otitis.] Prescription. R. Chloralis Hydratis, Camphorse, Acidi Carbolici, . . . aa gr. xx. Olei Ricini, j. Sig.—Pour into the ear (after warming) enough to fill it; cover with cotton wet with warm water, and a cloth wrung out of hot water. i (Brodnax.) 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 the pain at once and checks progress; a solution in glycerin is best (Rohrer). Atropine, in the acute otitis media of children, is very efficient. [See Otalgia, above.] Blisters, behind ears, either kept discharging or repeated, are often very useful (Wa). Leeches, behind the ear, afterwards a small blister upon Otitis. 742 OTORRHCEA OVARIAN NEURALGIA OVARITIS. the same place, when the leech-bites have healed (H). Warm Douche fre- quently to the ear, to secure cleanliness, then dry the part thoroughly (Roosa). [Compare Otalgia.] Otorrhoea. Salol and Camphor, equal parts, heated together, have given good results in suppuration of the middle ear; the application causes neither pain nor inflam- mation (Pegon). Bismuth Subgallate (Dermatol), on cotton tampon, intro- duced after thorough syringing with a 3 per cent, solution of Boric Acid, and careful drying with absorbent cotton, the best means of combating an acute or chronic otorrhoea, outside surgical measures (Chaniavsky). Boric Acid, finely pulverized, as astringent and disinfectant application; may be mixed with pulv. Alum,‘and just enough powdered Lycopodium to keep it dry; this packed carefully through speculum, after washing with a weak and tepid alka- line 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 secretions out of tympanum and breaking up ad- hesions (Roosa). Mercury, in chronic cases, the Brown Citrine Ointment (B). Lead, lotions much employed (B). [See Gonorrhoea, for formula.] Potas- sium Permanganate, as injection or spray, gr. j to 3j aq. destil. (B). Silver Nitrate, locally, a solution of gr, iv to the (B) ; gr. x to the (Roosa). Cop- per Sulphate, gr. j-v to the 3 (Roosa). Tannin, the Glycerite, locally, is suc- cessful (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 to i$j rose-water (B). Liquor Sodae Chloratse, ad 3j aquae when discharge fetid ; is highly useful as injection (Wa). Quinine, with Sulphuric Acid, advis- able in otorrhoea after scarlatina (Wa). [Compare Otitis.J Ovarian Neuralgia. Codeine, has especial value against ovarian pain (Freund), whether of inflam- matory or neuralgic origin, in dose of gr. % at least. 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). Atropine, subcutaneously, the best remedy for pain in the pelvic viscera (Wa). Am- monium Chloride, gr. xxx with gtt. ij-v Tinct. Aconiti, repeated in if necessary, to remove pain (W). Camphor, with Cannabis Indica, of great ser- vice in relieving ovarian pain, especially when spasmodic in character (Wa). Conium, or, better still, its alkaloid, used as a vaginal pessary, in all cases of ovarian pain, whether neuralgic or inflammatory, is quite a specific (Meadows). Ether, the compound spirit, in doses of rt\,xxx-xl as a palliative (Anstie). Gelsemium, deserves a trial; its power is great but not certain (Wa). Hot Water, vaginal injections, night and morning; sunlight baths, fresh air (E). 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.] Ovaritis. 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 (Hewitt). [See formula below.] 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 OXALURIA OZ.ENA. 743 (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 Rbxxx 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). Aurum salts, have been found beneficial in dropsy of the ovaries (Martini). Ovarian Extract, has been used in ovarian disease (see page 139). Parotid Extract, used as an internal remedy in six cases of enlarged and tender ovary with menorrhagia, etc., with signal success (Bell). Turpentine, hot tur- pentine epithems applied over the seat of the disease (Wa). 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. Prescriptions. R . Ext. Opii, gr. iij. Ext. Cannabis Ind., Camphorse, aa gr. vj. M. ft. pil. no. vj. Sig.—One pill twice daily. (Graily Hewitt.') R. Ung. Hydrargyri, . . . . 3 vj. Camphorse, gr. xl. Ext. Belladonnse, . . . . M. ft. unguent. Sig.—To be rubbed in twice daily. (West.) Mineral Acids, when eructations of sulphuretted hydrogen (R). Nitro- muriatic Acid, renders 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, n\,vj-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). [Com- pare Dyspepsia.] Oxaluria. Aurum Salts, are very serviceable in syphilitic ozaena (B). Mercury, the 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-syphi- litic forms (R). Potassium Permanganate, 3j to Oj solution as an injection or spray (B). Hydrastis, the fluid extract locally (B) ; £>j to solution as lotion with TT\,v of the tincture internally thrice daily (P). Bromine, as inhala- tion [see formula below] ; or Iodine with Carbolic Acid, or the latter in one per cent, solution, as inhalations (B). Carbolic Acid, a 1 per cent, solution in- haled (B). Silver Nitrate, applied behind veil of palate ; gr. v-xx ad §j (B). Alum, solution, 3j to 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 ap- plications of Calomel, in powder, to the ulcerated portions of the mucous membrane (Massei). Hydrogen Dioxide, the solution as spray, is a most excel- lent application. Salol, has done good service, as insufflation. Strontium Iodide, has been used in scrofulous ozaena, with varied results. Cubeb, the Oleo-resin, gtt. xv-xx on sugar after each meal, to restrain the secretion and perhaps modify its character (Cohen). Calcium Chloride, gr. xxx-lx with Decocti Krameriae; of which 3^ij—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. 744 PAIN Prescriptions. R. Tinct. Iodi £iv. Acidi Carbolici, .... gj-ij. M. Sig.—Use on sponge in a wide- mouthed bottle as inhalation. To be va- porized by heat of hand. [Potter.) R. Sodii Carbonatis, Sodii Boratis, aagij. Liq. Sodae Chloratae, . . Glycerini, Aquae, ...... q.s. ad M. Sig.—Apply by means of a hand- spray apparatus. [Thornton.) R . Bromi, 3 ss. Alcoholis, gss. M. Sig—Use by inhalation when va- porized by heat of the hand. R. * Acidi Carbolici, rqpcx. Aquae Calcis, Oj. M. Sig.—Use as wash or spray. Pain. Opium, is the most efficient of all analgesics and is universally used to relieve pain (see page 367); the Liniment applied with friction relieves pleurodynia, superficial neuralgia, etc., and poultices containing the Tincture are useful ap- plications in the pain of inflammation. Opiates soon lose their power in any particular dose, and require increasing dosage to sustain their analgesic influ- ence, hence in chronic.cases all other means should be exhausted before re- sorting to them (R). Morphine, is the most analgesic alkaloid of opium ; hypodermically in the vicinity of the nerve is curative when not so by the stomach (B); the Sulphate, gr. l/(, to with Atropine Sulphate gr. to is very efficient, but the morphine-habit must be kept in mind; a single injec- tion thereof is sometimes curative in sciatica and other neuralgite; the con- joined administration of Morphine and Antipyrin is much more efficient in pain than the use of either agent alone. Codeine, has a special influence over abdominal pain and that of the ovaries, and is not liable to give rise to a drug habit. Antipyrin, is a most efficient analgesic in doses of 10 to 15 grains, being especially adapted to neuralgia, migraine and the pains of gouty and rheumatic origin, but is of no value in pain due to a local inflammation ; it may be used hypodermically. [See under Morphine, above; also page 145.] Ace- tanilid, is highly efficient in doses of 4 to 7 grains for the pains of locomotor ataxia and those of rheumatic origin ; also locally as a dry dressing for painful wounds, ulcers, etc.; it is the active ingredient in a host of recent proprietary remedies against pain (see page 67). Phenacetin, is efficient in 10 to 15 grain doses, for neuralgia, hemicrania, etc. Phenocoll Hydrochloride, in dose of 12 to 15 grains, is a good analgesic in the neuralgic pains of influenza, and in gouty and rheumatic pain. Belladonna, is the best remedy for every kind of pain in the pelvic viscera (Anstie). Atropine, hypodermically in local pain, neuralgia, sciatica, glaucoma, etc. ; when it succeeds, has more lasting effect than morphine (R) ; for sciatica, tic douloureux, etc. (B). Iodides, are magical in syphilitic nocturnal pains of head (B); the Ammonium Iodide, gr. iij ad gj 01. Olivse, with friction ; causes the disappearance of nocturnal syphilitic pains (W). Cimicifuga, relieves many kinds of pain, as neuralgia of 5th, rheumatic headache, ovarian neuralgia, dysmenorrhoea; inferior to Ergot in labor-pains or after-pains; 5j doses (B). Conium, in cancer, rheumatism, neuralgia, ovarian pain, 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 hour, well watched (Madigan). Iron, with Belladonna, for the wandering pains of anaemia, in which morphine is dangerous and bromides are useless (Waugh). 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). 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 percent, solution is generally employed (R); has many applications, as in odontalgia, otalgia, neuralgia of superficial PARALYSIS AND PARESIS. 745 nerves, etc. Eucaine, is fully as efficient as Cocaine in causing anaesthesia of the mucous membranes, and is much less poisonous (Schleich); is absolutely harmless in medicinal doses, and does not affect the heart (Reichert). 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 three drops on cotton into the ear for faceache or toothache ; the vapor on raw surface of cancers, for neuralgia of uterus, photophobic eye, etc.; by inhalation in renal and biliary colic, and to produce general anaesthesia [which see] (R). Ether, spray for local anaesthesia; in- haled for general anaesthesia (R).‘ Guaiacol, locally or by hypodermic injec- tion, i part in io of olive oil, or mixed with equal parts of glycerin for painting on the surface, is an efficient local anaesthetic, and is used successfully in or- chitis, in neuralgic pains of tuberculous subjects, also in sciatica and rheuma- tism (Moissy). 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 with gr. % (B): sometimes relieves neuralgia, also pain of chronic rheumatism, gall-stones, colic, gastralgia, and even of cancer (R). Iodoform, as suppository in painful diseases of the rectum or bladder (R). Stramonium, is used as ointment (R). Duboisine, used instead of Atropine (B). Rhatany, relieves the pain of ulcerative disease of mucous membranes, pain of burns, ulcers, and especially of blisters (Tr). Cannabis Indica, formerly used (B). Aquapuncture (B). [See under Neuralgia.] Galvanism, of an affected nerve gives certain relief; the positive pole on point of emergence, negative over superior ganglion of cervical sympathetic (B). Heat, if pain is without fever or inflammation (B); warm injections soothe the pain of cystitis, prosta- titis and abdominal pains generally (B). Hot Water, as bath, relieves pain most wonderfully : Napoleon, at St. Helena, suffering from cancer of the stomach, appreciated highly the pain-relieving power of the hot bath ; often staying half and even whole days therein. Cold, when pain is inflamma- tory (B). [Compare the Lists of Anaesthetics, Analgesics and Narcotics, on pages 33, 34, 35, ante; also in this part the articles entitled After-pains, Anaesthesia, Boils, Chest-pains, Colic, Gastralgia, Headache, Hepa- talgia, Inflammation, Lumbago, Myalgia, Neuralgia, Neuritis, Odon- talgia, Otalgia, Ovarian Neuralgia, Rheumatism, etc.] Prescriptions. R . Antipyrini, gr. xv. Cocainae Hydrochlor., . . gr. ss. Aquae Destil., rr\,xv. M. Sig.—One-half as hypodermic in- jection, or the whole when rapid action de- sired. [See.) R. Liquoris Magendie, . . . %j. Aquae, q. s. ad M. Sig.—A teasp. to a dessertsp. every six or eight hours, for pain. Each drachm contains l/% grain of Morphine Sulphate. [Potter.) Paralysis and Paresis. Nux Vomica, in hysterical paralysis and in that from lead-poisoning; only in chronic cases (P); in paraplegia due to softening and wasting of the cord (Brown-Sequard). Ignatia, in paralysis of the lower extremities (P). Strych- nine, hypodermically into the affected muscles, for hemiplegia, paraplegia, local, mercurial, paludal, rheumatismal, facial, infantile and diphtheritic paralyses ; in that of the spinal muscles, of the bladder and all local forms (B) ; in hysterical paralyses (P); in all forms except cerebral and spinal paralyses (Barwell) ; internally in doses of gr. to (R). Phosphorus, with Cod-liver Oil 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 in- flammation of the cord (R); externally as ointment along spine, with Ergot internally (Brown-Sequard). Physostigma, into the eye in ocular paralyses 746 PARALYSIS AGITANS. (B); in general paralysis of the insane, also in progressive muscular atrophy without much mental disorder, long-standing hemiplegia, paraplegia, locomotor ataxia (R). Ergot, in paralysis of bladder from over-distention (B); paralytic dysuria, 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 (Cur- ran). Cocculus Indicus, valuable in hemiplegia, paraplegia, and paralytic stiffness (P); Picrotoxin has greatly benefited several forms, especially paraly- sis of the sphincters, hemiplegia from cold, and glosso-labio-laryngeal paralysis. Cannabis Indica, for retention of urine in spinal paralysis (R). Rhus Toxico- dendron, is certainly efficacious in paralysis depending on rheumatism (P). Ammonium Iodide and Carbonate, to aid in absorption of thrombi, thus pro- moting 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, in paralysis of the bladder, and many forms (P). Orchitic Extract, has been thought to be beneficial in general paralysis (see page 135). Capsicum, in to 2-grain doses every 4 hours as general stimulant (P). Colocynth, in cerebral paralyses, sometimes seems to act favorably upon prin- ciples of revulsion or counter-irritation (P). Mustard, as an emetic to stimulate failing heart in certain forms of paralysis (P). Senega, in rheumatic paralysis, 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). Coun- ter-irritation, by blistering fluid in peripheral paralysis of the 7th nerve (R). Cod-liver Oil, when low nutrition and faulty assimilation (Anstie). Galvanism, in hemiplegia and many forms (B). Electricity, faradization of the muscles affected ; localized electricity probably of more importance in confirmed spinal paralysis than medicinal treatment. Massage, in infantile paralysis, given with Calcium Lactophosphate and Cod-liver Oil, and Strychnine injected into the muscles (B). [Compare Hemiplegia, Locomotor Ataxia, Tongue, Paralysis Agitans.] Prescriptions, R . Strychninse Sulph., . . . gr. iij. Aquae Destillatae (fervid.),. 3 x. M. Sig.—For hypodermic administra- tion : of Strychnine Sulphate. R. Ammonii Iodidi, . . . . Ammonii Carbonatis, . . g ij. Liq. Ammonii Acetatis, . gvj. M. Sig.—A tablesp. thrice daily. (B.) Hyoscyamus, full doses of the tincture will palliate the trembling; or Hyos- cyamine, gr. gradually increased to gr. (B). Hyoscine, gr. or less, efficiently but temporarily controls the tremor of paralysis agitans (Weatherly). Duboisine, acts well in most cases. Conium, has benefited some cases (Harley). Gelsemiqm, in full doses, to quiet the nervous irritation (Lavers); a combination of Conium, Hyoscyamus and Gelsemium (see under Tremor). Potassium Iodide, to promote absorption (Lavers). Cocaine, influences paraly- sis agitans more favorably than any other remedy, large doses and frequent administration are unnecessary (B). Cannabis Indica, in large doses, lowers reflex activity. Picrotoxin, has greatly benefited some cases. Opium, Arsenic and Hyoscyamine may be tried, but the disease is incurable, and nothing can be done except to attend to the physical comfort of the patient ; there is no treatment which can be recommended as satisfactory in any respect (O). Sodium Borate, gr. xv-xlv daily, in 3 or 4 doses, produced most striking improvement in a case of paralysis agitans which developed after a fall upon the shoulder (Sacaze). Phosphorus, in small doses, with Cod-liver Oil, is very useful (R). Hypophosphites, the Syrup ought to be of service, if taken steadily for a long time. Cod-liver Oil, long continued, is more constantly useful than any other medicine (Anstie). Orchitic Extract, has been used Paralysis Agitans. PAROTITIS PEDICULI PEMPHIGUS. 747 with benefit (see page 136). Sulphur Baths, are certainly of great value*in this disease (Lavers). Electricity, the constant current, anode over the spine, cathode drawn along the course of the nerves as they leave the vertebral column to the periphery (Id). [Compare Chorea, Tremor.] Parotitis. Aconite, in febrile conditions (R). Mercury, ]A, grain of Gray Powder, 3 or 4 times a day, is very useful, relieving pain and swelling (R). Poultice of Flaxseed meal, is a good local application for the gland. Leeching, often gives speedy relief, when pain is great and resists hot fomentations (Wa). Care to avoid chilling, important. Incision, when suppuration occurs. Stimu- lants and Tonics internally are very necessary in symptomatic parotitis, occur- ring as a complication or sequel of other diseases, with adynamic symptoms. Pediculi. Mercury, as Citrine Ointment or a wash of Corrosive Sublimate solution, for lice on all parts of the 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 tincture undiluted as a wash. Staphisagria, as Oil or an oint- ment of the powdered drug (R); “ 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. Benzol, is a very efficient, convenient and cleanly applica- tion for destroying pediculi capitis or pubis, if fire or light be carefully avoided : a single application is usually sufficient. Ether, washed over the parts, effectu- ally destroys crab-lice. Tobacco, a decoction of the leaf is an efficient appli- cation, but requires care, especially if the surface is abraded (Wa). Essential Oils, will kill pediculi, as Rosemary, Anise (P); or powdered Pyrethrum (R). Cleanliness, cannot be dispensed with, and in many cases may alone be suffi- cient. Boil the underclothing. Isolation of person, and of brushes, towels, etc., to prevent infection. In Vienna the following prescriptions are used:— Prescriptions. R . Bals. Peruvian., Petrolei, aa part. xv. Olei Pichuri, ..... . part. j. To be applied and washed off after 3 hours. R. Acidi Salicylici, . . . . part, ij-iij. Aceti, part. xxv. Alcoholis (8o per cent.), . part. lxxv. To be rubbed on with a bit of flannel. One application is often enough. Pemphigus. Antipyrin, internally, for the itching, is efficient. Arsenic, is curative, espe- cially when chronic (B) ; largest dose, of Liquor Arsenicalis 3 times a day, on full stomach (R) ; exercises a powerful influence (Wa). Mercury, as 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, gr. ij ad aquae in pemphigus, after the bullae have burst, and ex- coriations remain (Wa). Water Dressings, on lint, covered with oiled silk, ap- plied 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. 748 PERICARDITIS PERIOSTITIS PERITONITIS. 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, cyanosis 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, 01; 8 hours, is very beneficial (Wa). Veratrum Viride, extract made by inspissating the juice of the root, of which gr. ij with gr. 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) ; by 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.] 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-syphilitic periosteal thickening (R) ; holds the first place for syphilitic affections of the bones (Wa). Ammonium Iodide, cures periostitis most readily when syphilitic (Wa). Staphisagria, when the long bones are affected (P). Iodine, the tincture, or blisters locally, of great service in chronic form (R); under the external use of Iodine periostitis often rapidly improves (Wa). Poultices, after an early and free incision, when suppuration takes places (C). Incisions, carried deeply, should be made without waiting for fluctuation, when great tension 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. Phenacetin, as an antipyretic; is efficient and safe. Aconite, of great utility when sthenic reaction ; [see Opium belowj ; should be given early in all inflammations of serous membranes (P). Bryonia, exceedingly 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); Morphine, gr. y2 hypodermically, will often abort, if given early; Aconite and Opium, the tinctures, 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 of opium are easily borne in this affec- tion (Wa). Cocculus Indicus, for tympanites ; a few doses will often remove the pain and relieve distention (P). Quinine, strongly urged by Trousseau ; is naturally indicated in most inflammations (P). Turpentine, for tympanites (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 abdo- men, if patient plethoric, and of 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). Hot Water, as fomentations to relieve pain, sometimes cold compress better. Ice, sucked or swallowed, to assuage the vomiting; sips of cold water. PERITONITIS—PERSPIRATION. 749 Diet, after acuteness of the attack has passed; should be mild and unstimulat- ing. [Compare Puerperal Peritonitis.] Peritonitis, Tubercular. Quinine, in the acute form to reduce fever, as in acute tuberculosis, together with rest, poultices or warm fomentations, liquid diet, Opium, etc. (Whitla). Cod-liver Oil, by inunction with friction, also its continuous administration by the binder and mackintosh, is of great value in the chronic form of this disease (Id). Arsenic, children affected with tuberculosis involving the intestines and peritoneum have steadily and slowly improved and finally recovered under the Arsenic treatment (R). Laparotomy, has been done with uniform success and with complete cure of the disease in 80 per cent, of all cases of tubercular peritonitis in which the abdomen was opened, cleaned and drained (Tait): in 131 cases so treated 84 were cured and 23 greatly improved; only in 3 per cent, could death be ascribed to the operation (Konig). Perspiration. Belladonna, as liniment locally, also the tincture internally, especially in weakly children who sweat profusely (R). Atropine, gr. to hypoder- mically, or in exceptional cases even gr. -fo in pill, in sweating of phthisis and exhausting diseases (R); gr. at bedtime for sweats of phthisis (B). Duboi- sine, may be used instead of atropine. Pilocarpine, gr. thrice daily, checks profuse perspiration (R, Pf). Naphtol, 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 drunk ad libitum, and is a very efficient remedy for night-sweats, having stopped them when Atropine failed to relieve (Pope). Salvia, the ordinary Sage-tea is very efficient, used internally and locally by sponging the body ; the infusion for night-sweats of phthisis (Da C). Quinine, in that of exhaust- ing diseases ; in many cases a night-draught of Quinine, Zinc Sulphate and Sulphuric Acid is useful (R). Opium, as Dover’s powder, may succeed in profuse colliquative sweating (R); a fact, though hard to account for it (Wa). Agaricine, is used successfully (see formula below). Agaricic Acid, in dose of gr. to not hypodermically, one of the most efficient agents against sweating from various causes, especially that after influenza; in over two years’ use, it only failed me in one case (Richards). Camphoric Acid, gr. x-xxx, dry on the tongue, not over 2 hours before the expected sweating, is remarkably efficient against sweating from various causes,' especially that of phthisis even when very profuse (Jas. Wood). Aromatic 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 phthisis (Murrell). Zinc Oxide, gr. iij, wdth 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. Aluminum, the Oleate, checks hyperidrosis and antiseptizes the sweat, thus forming a useful application to the axillae and groins of children (Wa). Potassium Permanganate, gr. j in gj of water, for fetid perspirations of axillae, feet, etc. (B). Salicin, profuse sweats of hectic fever (Wa). Salicylic Acid, in solution with Borax, the most agreeable and efficient deodorant 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 sweat- ing 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.] 750 PERTUSSIS. Prescriptions. R. Acidi Gallici, ...... gr. xxx. Ext. Belladonna?, . . . . gr. ij. Ft. pil. x. Sig.—Two at bedtime. R. Acidi Tannici, gr. xxx. Pulv. Digitalis, gr. xv. Ext. Cinchonae, . . . . . q. s. Ft. pil. xx. Sig.—One at bedtime. R . Agaricinae (Merck), . . . gr. x. Atropinae Sulphatis, . . . gr. j. Acidi Sulph. Aromat., . . up 1200. Solve et filtra. Dose, rrp x in syrup or simple elixir, 5 or 6 hours before retiring, as the action of Agaricine is slow. Antipyrin, is successfully employed. Phenacetin, is highly praised. Aconite, in all acute congestions (P); as a preventive or abortive remedy very efficient, when associated with Ipecac and Cherry-laurel water (Dervieux). Amyl Nitrite, with Carbolic Acid, in steam atomizer, has proved a very efficient in- halation (Bayliss). Ipecacuanha, useful in many cases (R); rrpj for 5 years of age, every hour or two, gives the greatest relief (P); when bronchitic or pneu- monic complications, combined with Ammonium Bromide (Wa). Bromides, relieve spasmodic element (B); that of Ammonium will readily cure many cases; gr. ij or iij ter die for infants (Wa). Lobelia, in spasmodic stages ; well tolerated by children ; rrpx of tinct. every hour for child 2 years old ; also ad- ditional dose when cough is imminent (R, P). Alum, when acute stage is over and no complication exists, gr. ij-vj every three hours, or less every hour in glycerin or honey (R). Bromoform, in daily dosage of 5 to 20 minims, in gly- cerin and alcohol, very efficient in relief of paroxysms, and to reduce their num- ber, but has little other influence on the course of the disease ; must be pure, hence colorless; and increasing doses should not be pushed very far, for fear of toxic symptoms (Bedford) ; is almost a specific, acting as a local anaesthetic on the mucous membrane of the pharynx and larynx, given in doses of 1 to 5 drops 3 or 4 times daily (Carpenter) ; [see formulae below] ; it may be used by inhalation instead of chloroform or ether, to lessen severity of the paroxysms. Hydrogen Dioxide, the solution, in drachm doses diluted with 2 or 3 of water, internally, cuts short the paroxysms and lessens the duration of the disease. Benzol, is a reliable pulmonary antiseptic, and has been used for many years in this affection with unvarying success (Robertson); the vapor maybe diffused throughout the room, carefully avoiding a light or fire. Ouabain, in doses of gr. every three hours, is highly efficient in all stages of the disease (Gemmell). Resorcin in solution, applied to the perilaryngeal mucous membrane, has aborted an attack at the outset in 24 hours, has cured well-marked cases in from 9 to 14 days, and is a perfect method of prophylaxis for children living with those suffering from the affection (Moncorvo). Naphtalin, burned in the patient’s room, is of high value, both as a palliative and a curative agent (Chavernac). 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 spas- modic stage; children bear this drug well; npx of tinct. may be given hourly to a child 2 or 3 years old (R). [See formula below.] Sodium Benzoate is highly efficient. 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 (Cochineal), in doses of gr. y thrice daily for infants, has been highly recommended (W); proves very effective in most cases. Hydrocyanic Acid, very serviceable in cough from habit after cessation of whooping-cough proper, or in the nervous sympathetic cough of the mother (P). Myrtol, may be ex- pected to afford a large measure of relief (B). Formalin, as spray, is quite effi- cient. Opium, in the 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). Chloral, gr. v-x in spas- Pertussis. PHARYNGITIS. 751 modic 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 libitum (B); the fluid extract, in 3-doses, exercises a remarkable in- fluence 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). Camphor Monobromide, gr. v in mucilage and Syrup of Tolu 3 or 4 times a day, has been serviceable (B). Zinc Sulphate, gr. ]4~) with Ext. Belladon., gr. has varying degree of success (B). [See formula below.] Lactucarium, the syrup as vehicle for cough mixtures (B). Quinine, in solution, locally to fauces (Dawson) ; the Tan- nate with Sodii Bicarb, of each 5, and Pulv. Acacias 100 parts, used with an insufflator (Pollack). Petroleum, on rags around head of the bed, is recom- mended highly by Hildebrandt. Silver Nitrate, when acute stage passed (Tr) ; probably inferior to Alum (Wa). [Compare Cough.] R. Chloralis Hydratis, . . . gj. Potassii Bromidi, . . . . 3 ij. Syr. Pruni Virgin., Aquae, aa^j. M. Sig.—A teasp. thrice daily for in- fants in the convulsive stage. {Dessau.) Prescriptions. R. Bromoformi, n^xvj. Glycerini, i^jss. Tinct. Cardamom. Co., Alcoholis, aa^ij. M. Sig.—A teaspoonful at commence- ment of the paroxysm. {Bedford.') R. Olei Morrhuae, Mellis Despumat., Succi Limonis, . . . . aa partes aeq. M. Sig.—A teasp. or two as required. {Sir Wm. Gull.) R. Bromoformi, TTLxlviij. Alcoholis, ziv. Tinct. Cardamom. Co., . 3 iij. M. Sig.—A teaspoonful in water three or four times daily. (Carpenter.) R . Amyli Nitritis, 3 ss. Acidi Carbolici, .... n\,x. Glycerini, Alcoholis, aa^ss. M. Sig.—Use by inhalation with steam atomizer. (Bayliss.) R . Zinci Sulphatis, gr. iv. Tinct. Belladonnse, . . . TTLxlviij. Aq. Anisi, . . . . q. s. ad gij. M. Sig.—20 to 60 drops, according to age of child, every three hours. Pharyngitis. Aconite and Belladonna, for acute attacks (B) ; when high temperature (R). Belladonna, is very useful, relaxes the pharyngeal muscles (W). Capsicum, 3j of the tincture to 0)4 of water, as gargle in the very early stage only (R). Alum, gargles, in chronic throat inflammations (R). Silver Nitrate, gr. v-xx to the 3;, on sponge probang, successful if systematically applied (B) ; in early stage of inflammation ; also on brush, or as spray in the chronic form (R): the solid stick to each diseased follicle, after scraping (A). Ammonium Chloride, gr. ij with hVxv of Tinctura Cubebse, every half hour, often controls acute pharyngitis; when a gouty diathesis exists add of the Ammoniated Tinct- ure of Guaiac, and give every hour (Smith). Xanthoxylum, a decoction of the bark locally to throat, and of the fluid extract thrice daily, a very successful remedy for chronic pharyngitis (B). Tannin, by insufflation to affected surface (B). Cubeb, powdered, locally, useful (B). Glycerin, pure, locally, with Tannic Acid, very serviceable (B); in chronic inflammation of the throat (R). Glycozone, frequently applied, is of benefit in follicular pha- ryngitis (Edson). Hydrastis, the fluid extract locally, also internally (B). Alcohol, diluted, as gargle in relaxed throat (R). Cimicifuga, when pharynx dry and spotted over with inspissated mucus (R). Ipecacuanha, the wine as spray in non-inflammatory sore throat, with hoarseness from con- 752 PHIMOSIS—PHLEBITIS PHLEGMASIA. gestion of vocal cords (R). Pomegranate Bark, as gargle (P). Resorcin, in strong solution, a very efficient application (Tymowski). 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 Sul- phate, as gargle, occasionally employed in relaxed throat (R). Inhalation of vapors, or of pulverized fluids, by the atomizer, found very beneficial (Wa). Food, of piquant kind, spices, pepper, mustard, etc., should be strictly pro- hibited ; 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. [Compare Throat, sore, Tonsil- litis, and Formulae for Gargles on page 538.] R. Tinct. Aconiti, Tinct. Belladonnae, . . aa 3 ss. Tinct. Guaiaci Ammon., . 3 v. Syr. Limonis, 5 ss. Aquae Cinnamomi, q. s. ad 3 iv. M. Sig.—A teasp. every 3 hours for acute pharyngitis. Prescriptions. R. Aluminis, Sodii Boratis, Glycerini, Tinct. Myrrhae, gij. Aquae, . . . . q. s. ad £ iv. M. Sig.—Use as an astringent gargle, 4 or 5 times a day. R. Tinct. Aconiti, Ac. Hydrocyan. Dil., . . LiquorAmmoniiAcetat., ad 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, TT^xxx. Aquae Camphorae, . q. s. ad 3 iv. M. Sig.—An astringent gargle, to be used several times a day. Phimosis. Belladonna, as ointment, the extract 7 to 20 parts of Lard, has proven effect- ual (Wa). Lupulin, 5 to 15 grain 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 the edge of prepuce, as local anaesthetic during the operation of circumcision. Chloroform, or Ether, as an anaesthetic in paraphimosis, before attempting reduction (Wa). Phlebitis. Hamamelis, has as decided an influence on the venous system as Aconite on the arterial (Pf). 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, aperi- ents, Opium to relieve pain and insure quiet of mind and body (D). Blister, over the course of an inflamed superficial vein (R). Diet, nutritious, also wine, especially if great loss of blood (D). Stimulants, as Quinine and Iron, espe- cially the tincture of the Chloride, also milk-punch, are needed to combat the depression which is sure to arise: the disease is always dangerous and often fatal (Gross). Incisions; must be freely made if abscesses form, and the inter- nal 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.] Phlegmasia Alba Dolens. 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- PHLEGMON PHOTOPHOBIA PHTHISIS. 753 ployed (L). Ammonium Carbonate, often valuable where great prostration ; full doses (Wa). Hydrochloric Acid, £j 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, sprinkled on hot fomentations, if pain severe (L). Leeches, of great service during the acute inflammatory stage (Wa). Bandaging, when the more acute symptoms subside ; at first with flannel, afterwards with ordinary roller band- age (L). Regimen, should be tonic (L). Water, by compresses in active stage ; douches, hot and cold in chronic form. Phlegmon. Aconite, or Belladonna are certainly efficacious ; Aconite best (R). Sulph- ides, to abort, or when inevitable, to promote ; gr. ss-j every hour or two of Potassa Sulphurata (B). Silver Nitrate, a strong solution may check if ap- plied 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 to the §, for adult, dropped into the eye every 4 hours (C); if much lachrymation, so as to dilute the solu- tion, 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 3j 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). Potassium Chlorate, internally, is most useful in some cases (Vernon). Cocaine, in 2 to 4 per cent, solution, a few drops upon the conjunctiva, will be found promptly efficient in most cases. Phthisis. Creosotum, 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 Creosote should be used, in doses of tt\j in whiskey and glycerin, every 3 or 4 hours ; should be largely diluted to prevent irritation, and continued for many months (see page 258); relieves cough, diminishes expectoration, stops night- sweats, increases weight, decreases fever, promotes appetite, and in many cases improves the local condition, as shown by the physical signs (Robinson) : Creosote, Tar, or Carbolic Acid, to check expectoration (R, P); Creosote is often curative, 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). Guaiacol, the principal ingredient of Creosote, and equally efficient: may be given in the same doses; the Carbonate, in doses of 6 to 8 grains, up to 3jss daily, is better borne, and a useful substitute (see page 259). Benzosol, contains 54 per cent, of Guaiacol, which it yields up in the intestines: in doses of 4 grains, gradually increased to 12 grains, thrice daily, it has given results in phthisis, equal if not superior to those from Creosote (Walzer). Iodine, should be more used than it is; the compound solution, gtt. j—iij thrice daily, or when anaemia and not much fever use Ferrous Iodide, gr. xv of the Syrup pushed to 3j ter die (Da C); as inhalation in chronic phthisis ; to lessen 754 PHTHISIS. expectoration and cough ; also as liniment painted under clavicles, to allay harassing cough, and to check secretion (R); extremely useful; also as intra- pulmonary injection, a solution of the compound tincture of Iodine, i to 4 of distilled water, of which 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): Iodine or Iodoform, with Creosote, Carbolic Acid, Eucalyptus, Chloroform and Alcohol or Ether, as a combination for an antiseptic inhalation(Br). 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 advanta- geously substituted for Iodoform (B). Ichthyol, is far superior to Creosote or Cod-liver oil, and is very useful in pulmonary tuberculosis (Cohn); a mixture of equal parts of Ichthyol and water, of which 4 drops are taken thrice daily, the dose being increased by one drop daily until the maxi- mum of 40 drops three times daily is reached (Id). 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 3SS thrice daily one hour after meals, with of Ether, or an equal quantity of malt or whis- key ; do not give it in hot weather (Da C). Alcohol, an important remedy; may be given with Cod-liver Oil; or Spt. Frumenti, §j-§ij with some bitter, im- mediately after meals; if it disagrees, it harms : curiously, it induces an intractable form of phthisis (B). Sulphurous Acid, by inhalation, spray or fumigation, in chronic phthisis (R). Aconite, in small doses for the irritative fever, is a remedy of much value (Da C). Antipyrin in a 2)4-grain dose hourly for 3 doses daily, for the hectic fever. Phenacetin is better borne and is efficiently antipyretic ; extensively employed in the hectic of phthisis. Cinchona, for the hectic and sweats, Quinine, gr. xv- xx (B); if small doses fail, a dose of 6 or 8 grains at once, or in portions re- peated hourly (R). Ipecacuanha, the wine as spray to throat when bronchial asthma and emphysema combined with fibroid phthisis (R). Opium, or Mor- phine, in a viscid vehicle for cough, or as lozenges when cough due to inflamed throat (R); must in time be given for the cough, which is an irritative one. Codeine, gr. )4 to % in simple elixir, is useful and does not constipate (Da C). Apomorphine, with Morphine, makes a good combination for many symptoms, especially for dyspnoea, continual cough and thick, tenacious mucus (Br). Cannabis Indica, an aqueous solution (see page 209) relieves the cough and aids the patient in many ways (Lees). Hydrogen Dioxide, the solution inter- nally, in doses of 3j to iij diluted with 3 to 4 of water, renders good service by promoting digestion, palliating cough, and increasing the activity of chaly- beate remedies. Terebene, with Thymol and Carbolic Acid, equal parts of each, of which £>ss to a pint of hot water as an inhalation: is extremely useful for the dyspnoea (Camman). Verbascum, the Mullein-plant, has long been a popular remedy in phthisis ; it facilitates expectoration, improves the general condition, and palliates the cough. Calcium Phosphate, in diarrhoea, and in chronic forms of phthisis with little or no fever (R). Cimicifuga, useless in tuberculosis, but in phthisis it relieves cough, improves appetite, lessens inter- current bronchitis, and so improves the patient’s general condition (Wa). Aurum, the Bromide of Gold and Arsenic internally, with inhalations of Papoid as glycerole by the atomizer, gave astonishing improvement in two cases of fibroid phthisis with cavities, due to neglected pneumonitis; also in a case of grinders’ consumption (E. A. Wood); the Chloride has rendered ex- cellent service in the hands of Gibbes and Shurley. [See infra, under Chlor- ine.] Arsenic, valuable in chronic forms as no other remedy; but not in caseous or where much hectic ; may be given by stomach or fumigation (B); as cigarettes, useful in the diarrhoea, probably diminishes temperature, caution required! (R); of great value in early stage, in later stages it is of PHTHISIS. 755 no avail; Arsenous Acid, gr. Jg, or of Fowler’s solution, thrice daily (Da C). Cocaine, locally for the throat symptoms, to be applied just before meals are eaten (Da C). Sanguinaria, helps expectoration, and revives the enfeebled stomach (P). Camphorated Naphtol, undiluted, or Tt\,ij in olive oil hypoder- mically, used with very good results in 15 out of 32 cases so treated (Reboul). Chloroform, with glycerin or honey, for the cough in fibroid phthisis (R) ; by inhalation in small quantities for the cough and dyspnoea, gave extraordinary relief to a noble patient of mine during the last 8 months of his life (Spencer Wells) ; by continuous inhalation, kept short of full anaesthesia, maybe effective as a germicide in phthisis (Potter, in Pacific Med. Jour., Oct., 1890). Chlorine gas, by inhalation, also the hypodermic use of Iodine and Chloride of Gold and Sodium, extensively employed in pulmonary consumption with good results (Gibbes and Shurlv in Therapeutic Gazette, April, 1891, and April, 1892). Fer- rum, often prescribed ; has no especial influence on deposit (B) ; is prescribed in tuberculosis (Tr); the Liquor Ferri Perchloridi, 3j ad aquae, the most ser- viceable local application in laryngeal phthisis, diminishing irritability of the mucous membrane, and quieting cough (Mackenzie). Mercury, gr. of Corrosive Sublimate every two or three hours, for the diarrhoea (R). Benzoin, as inhalation, to lessen cough and expectoration (R). Mineral Acids, for the indigestion; especially the dilute Hydrochloric (B). Prunus Virginiana, has a domestic reputation, probably due to its influence over cough; the syrup is much used as a vehicle for cough-mixtures (B). Hypophosphites, are very use- ful in chronic cases (B); have no special effect (Da C). Digitalis, as an anti- pyretic; deranges intestinal canal, therefore injurious in phthisis (B). Copper Phosphate, 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 o. 15, Cryst. Phosphate of Sodium 0.75, Glycerin and Pulv. Liquorice, aa q. s. for one pill. Copper Sulphate, gr. or Silver Nitrate, gr. }(, or Bismuth, gr. xx, for the diarrhoea (Da C). Camphor, in oil, as subcutaneous injections during the period of softening (see page 206). Amick Chemical Cure consists in the use of Calomel, Iodoform, Guaiacol, etc., as described by Dr. N. B. Shade in various journals (Waugh). [See under Patent Medicines in Appendix.] Aseptolin, lately put on the market by Dr. C. Edson, is described on page 78. Tuberculin, (Koch’s lymph) described on page 473 ; 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). Tuberculocidin, a derivative of Tuberculin (Klebs) ; is described on page 476. Antiphthisin, is Dr. Klebs’ latest remedy, and is fully described on page 476. Antitoxin, advocated by Maragliano and Paquin, is described fully on page 153. Nuclein, has been employed with encouraging results by Vaughn (see page 134). 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 superalimentation 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 the 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 latter being especially suitable for cases having a co-existing bronchitis; for some cases Colorado is very good, and the Adirondack region for early cases in which there is no tendency to hemorrhage (Da C). [Compare Cough, Hemoptysis, Hectic Fever, Perspiration, Laryngitis, tubercular, Meningitis, tubercular, Peritonitis, tubercular, Tuberculosis, acute, Tuberculous Affections.] 756 PITYRIASIS. Prescriptions. R. Quininae Sulphatis, . . . 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.) R. Tinct. Belladonnas, . . . 3 ij. Syr. Scillae, 3 ij. Morphinae Sulph., . . . . gr. j. Syr. Tolutani, . . q. s. ad _^iv. M. Sig.—Tablespoonful at bedtime, for cough and restlessness; to be repeated if necessary. R. Pepsini (Jensen), .... gr. xl. Acidi Hydrochlor. Dil., . 3 ijss. Glycerini gv. Succi Limonis, giv. Aq. Aurantii Flor., q. s. ad £ iv. M. Sig.—Dessertspoonful with meals for the dyspeptic symptoms. R. Codeinae, gr. xv-xx. Alcoholis, . . . . q. s. adsolv. Potassii Cyanidi, . . . . gr. xij. Syr. Pruni Virgin., . . 3 iv. Aquae, q. s. ad Jvj. M. Sig.—A teasp. 4 to 6 times daily, for the cough. [Potter.) R. lodoformi, gr. xxiv. Creosoti, TT(Jv. 01. Eucalypti, rrpviij. Chloroformi, tt\xlviij. Alcoholis, Aitheris, . . . aa q. s. ad £ ss. M. Sig.—10 to 20 drops on the sponge of a perforated zinc inhaler, to be worn 20 minutes thrice daily. [Brunton.) R . Olei Morrhuae, 5 ss. Mucil. Acaciae, g ij. Sacchari, t^ij. Tinct. Lavandulae Co., . . npxx. Aquae, § ss. M. Sig.—Teaspoonful for children. An agreeable mixture. (Farquharson.) R. lodoformi, Creosoti, Pulv. Benzoini, Bals. Tolu., .... aa gr. j. In pill, of such 2 to 4 daily. [Huchard.) R . Creosoti (beech-wood), . rt\yj. Glycerini, 5j. Spt. Frumenti, 3 ij. M. Sig.—For one day’s use, as directed, in ss doses. (Robinson.) R. Petrolei Massse, j|j. Pulv. Cubebse, Pulv. Doveri, . . . . ■ Cinchonidinae Sulph., . . gij. M. ft. massa., et div. in pil. no. cclxx. Sig.—One pill every 3 or 4 hours. [Griffith.) R. Arseni Iodidi, Strychninae Sulph., Hydrarg. Chlor. Corr., . aa gr. j. Quininae Sulph., lodoformi, aa % ij. M. ft. pil. no. xl. Sig.—One thrice daily as a tonic in tubercular cases. [Mann.) [For a Cod-liver Oil Emulsion see formula on page 534.] Pityriasis. Alkaline and Tonic Remedies generally control mild cases, together with baths and emollients; the more severe ones requiring constant envelopment in linseed or cod-liver oil (Bulkley). Mercury, in obstinate cases, Donovan’s solution, is highly successful (Wa); the yellow 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, 5j to §j of vaselin applied every morning to the scalp, with sweet Almond Oil anointing at night (Jackson). Soap, the liniment of soft soap as shampoo every morning for cleanliness, or Borax and water, or the yolks of three eggs beaten up in a pint of Limewater with %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 Liq- uor Plumbi, with glycerin, equal parts of each, and two of water, as lotion for PLETHORA PLEURITIS. 757 cases where there is high inflammation 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, of Potassa Sulphurata to Oj of Lime-vyater, as a lotion, or the Bareges Pomade (see below for for- mula). Thyroid Extract, as a stimulant of the cutaneous circulation, has been used with satisfactory results (see page 132). Myrtol, is curative (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 Seborrhcea, and for Pityriasis versicolor see Tinea versicolor.] R. Sodse Sulphurate, Sodii Carbonatis, . . aazij. Axungise, 3 ijss. M. Sig.—Pomade de Bareges. Prescriptions. 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; and is decidedly the best remedy for apoplexy in the plethoric (P). Arsenic, is used with advantage when there is determination of blood to the head (Wa). Sulphur, as a mild purgative for plethora from cessation of the menses (Wa). [Compare Abdo- minal Plethora.] Pleuritis. Aconite, no remedy more effective prior to the stage of effusion (R); [See under Inflammation] ; the tincture in doses of )4 drop every 3 hours to a child 3 years old, for 2 or 3 days (J. Lewis Smith). Veratrum Viride, gtt. viij of tinc- ture every 3 hours, with a drop added to each dose until the pulse is reduced or nausea occurs (Wa) ; opinions differ as to whether it should be used in sthenic or asthenic forms (R). Bryonia, exceedingly valuable in second stage; should follow Aconite (P). Tartar Emetic, in early stages and young plethoric sub- jects, when much febrile action, small doses, gr. to %, may be useful (Wa) : [See under Inflammation.] 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). Quinine, has abortive power, increased by combination with Morphine, gr. xv -j- gr. ss; also as restorative tonic in low-type cases (B). Opium, cannot be too highly extolled (P); is especially 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). Antipyrin, is found effective in promoting the absorption of pleuritic effu- sions (see page 146). Diuretin, has caused a large pleuritic effusion to dis- appear (see page 199). Guaiacol, locally to promote absorption of effusion (see page 259). 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 Potassium Iodide, Alcohol or Ether (B); as a diuretic to remove effusion (Clark). Iodine, also as injections, with great benefit and without risk, in empyema and hydrothorax (R). Burgundy Pitch, the plaster externally as a mechanical support (P). Asclepias, the popu- lar pleurisy-root, is a favorite remedy in the south (W). Pilocarpus, in sub- acute cases to remove fluids (Caro); or Pilocarpine Nitrate, gr. \ bis die, for children (Vigier); is too depressing and therefore unsafe (Smith). Sodium Chloride, £ss in gj 0f water, flavored with Liquorice, in tablesp. doses every 3 hours, often very useful in causing absorption of pleuritic serous exudations; but is contraindicated when exudation is purulent (Br). Bloodletting, by cups or leeches, useful by reason of counter-irritation produced, and to relieve pain, only in robust sthenic cases (B). Blisters, often greatly abused; are harmful 758 PLEURODYNIA—PNEUMONIA. 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 movement of chest-walls (B). Thoracentesis, by aspiration, if the quantity of fluid seriously embarrasses respiration. [For Chronic Pleurisy see Empyema, also compare Hydrothorax, Pleuro-pneumonia.] Prescriptions. R. Potassii Acetat., .... %j- Infusi Digitalis, . q. s. ad t^iv. M. Sig.—Teasp. every 3 hours to a child of 4 or 6 years, in the second stage. R. Morph. Sulphat., . . . . gr. j. Tinct. Aconiti, rr^xxiv. Liq. Potassii Citratis, . . % ij. M. Sig.—A teasp. every 3 hours. Pleurodynia. Cimicifuga, curative when rheumatic and 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, the plaster or liniment; the latter generally best (R). Chloral, made liquid with an 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, as 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 the pain returns (R). [Compare Neuralgia, Myalgia.] Pleuro-pneumonia. Bryonia, is 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 every 3 or 4 hours, very useful in controlling the heart’s action (Wa). Pilo- carpine, gr. ss, or 3ij of the tincture of Jaborandi, benefits cases of pleuro- pneumonia (Wa). [Compare Pneumonia".] Pneumonia. Aconite, gives good results in catarrhal and fibrinous forms (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 the pulse is impressed (Da C). Veratrum Viride, valuable (P) ; in the very incipiency (B); opinions differ as to whether it should be used in sthenic or asthenic cases (R). Quinine or Salicylic Acid, to reduce temperature (R); Quinine as a tonic in cases which are asthenic from the first (P); in conjunc- tion with Aconite and Veratrum, gr. viij-xij daily at start, is beneficial (Da C). Antipyrin, to reduce pyrexia; is decidedly 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); such doses are too high and are dangerous (see page 143); with Camphor internally, successful in all of 22 cases of croupous pneumonia so treated at the Lorn Hospital, in 1894, Anti- pyrin gr. viij, Camphor gr. ij, Morphine Hydrochlorate gr. in powder every one or two hours (Ivanoff). Camphor in olive oil, in doses of from gr. j to gr. ij three or four times a day, hypodermically, in adynamic cases, used simul- PNEUMONIA. 759 taneously with the above antipyrin and camphor powder (Id); in fibrinous pneumonia these injections lower the temperature about a degree and amelior- ate the general condition. 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). Ammonia, the Aromatic Spirit as a substitute for the Carbonate, in doses of 3ss in simple elixir (Da C). Turpentine, as stimulant at crisis (B). Serpentaria, with Ammonium Carbon- ate in low types, as a stimulant about the crisis. Digitalis, of doubtful value ; may be useful for high temperature, ischaemia, and low tension of vessels (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). Bryonia, when pleural complications (P). Phos- phorus, especially when typhoid symptoms; approved by Fleischmann (R). Belladonna is useful in the first stage (P); Harley esteemed it highly in pneu- monia (Wa); as an adjuvant to Digitalis in infantile pneumonia, to soothe the irritable 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 commence- ment with alcoholic stimulants, if patient weak (R); may benefit young, robust subjects (Wa). [See under Pleuritis.] Sanguinaria, as a contra-stimulant, when fever has abated, and graver symptoms have amended (P). Iodides, no remedy more efficient; Ammonium Iodide with Arsenic, to prevent caseation of inflammatory products (R); Ethyl Iodide, gtt. v-xx ter die by inhalation, very valuable in catarrhal form (B); Sodium Iodide is useful in catarrhal pneu- monia (Da C). Ipecacuanha, the wine in infantile pneumonia, should never be dispensed with, as it promotes expectoration, controls hemorrhage and regulates secretion (Brown). Senega, in advanced stages as expectorant, when cough is dry, irritating and painful, tightness and oppression of chest (P). Opium, or Morphine by injection, sometimes needed for severe pain (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 per cent. Stimulants, in asthenic cases, those of malignant type, and those occurring in aged people (Wa). Blisters, useful at very begin- ning only, or at crisis of disease, 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 the whole chest in children (R). Diet, farinaceous, mucilaginous drinks, and rest in warm room (R). [Compare Pleuropneumonia.] Prescriptions, R . Tinct. Veratri Viridis, . . 11^x1. Spt. ALtheris Nitrosi, . . 3 vj. Liq. Potassii Citratis, . . Z ivss. Syr. Zingiberis, . . q. s. ad 3 vj. M. Sig.—A tablesp. every 3 hours, in the early stage. (Da Costa.) R. Potassii Iodidi, £j. Ammonii Chloridi, . . . zjss. Mist. Glycyrrh. Comp., . 3yj. M. Sig.—A tablesp. 4 times daily, to promote absorption, together with blisters to the chest. (Univ. Penna. Hosp.) R. Tinct. Aconiti, tTLxxiv. Tinct. Opii Camphorat., . 3 ij. Liq. Ammonii Acetatis, Syr. Zingiberis, . . aa ss. Aquae, . . . . q. s .ad 3vj- M. Sig.—A tablesp. every 2 hours, after free catharsis by calomel. (Ripley.) R. Sodii Iodidi, giij. Morphinse Sulph., . . . . gr. j. Elixir Simplicis, . . . . 3 M. Sig.—A teasp. ter die, also blisters over the apex. In catarrhal pneumonia. (Da C.) R. Ammonii Carbonat., . . gr. xl. Infusi Serpentariae, . . . 3 iv. M. Sig.—A teasp. every 3 hours, as a stimulant about the crisis. (B.) R. Ammonii Iodidi, . . . . gr. xl. Spt. Ammonii Aromat., . zij. Elix. Simp, et Aquae, . ad 3 viij. M. Sig.—Two tablesp. thrice daily. In syphilitic lobar pneumonia. (Da C.) 760 POLYPUS POULTICES—PREGNANCY. Sanguinaria, has been employed as snuff for nasal polypi (P); with doubtful benefit (W). 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 Chloride is advised as an interstitial application (Auger). Acetic Acid, glacial, injection into the body of the tumor, will cause it 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 specu- lum, or the ala slit to give access to the root of the tumor (D). Polypus. Poultices. 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 cotton-wool, 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 the skin is broken. Linseed-meal or Oatmeal, Starch, Bread, Bran, are best in the order mentioned; add the 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, of either of the fabrics known as Swiss and Cheese-cloth> filling each bag half full with the linseed meal or other agent used, then sewing up the 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 to rid it of the superfluous water, laid on the part and covered with oiled silk and a bandage. If too hot the poultice will scald the skin. Fomentations,—Flannel may be wrung very dry out of boiling water, ap- plied 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 or yeast; or by saturating it with any desired lotion or liniment. 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 leucorrhcea (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 the restlessness; Tt\, xxx-xl of the tincture with a little Chloric Ether, giving quiet nights for a long time (P). Galla, Unguentum Gallae 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 PROLAPSUS—PROSTATE—PROSTATITIS. 761 beneficial in the albuminuria (L). Potassium Acetate, with Basham’s mixture (Liq. Ferri et 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 confec- tion proves a mild and efficient purgative in the constipation of pregnancy (Wa). Milk-diet, the best remedy for albuminuria of pregnancy, if strictly carried out (Parvin). Injections, must be used carefully, even tepid water often induces uterine contractions (L). [Compare Albuminuria, Nephritis, Ner- vousness, Ptyalism, Vomiting of Pregnancy.] Prolapsus Ani. Nux Vomica, or Strychnine, especially when in children, with constipation ; in the latter event add Nux Vomica to a purgative, as tincture of Rhubarb (R, P); 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 to 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). Ferrous Sulphate, 3j to §viij aquae, of which one-third by enema twice daily. Podophyllin, in small doses for rectal prolapse in children (P). Tannin, by injection 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, as Decoctum Quercus, Decoctum Gallae (Wa) ; or Pomegranate bark (P). Tannin, as Catechu, Kino, Rhatany. Alum, a solution, gr. vj to the (R); lb. j ad Cj aquae, as hip-bath ; should also 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 Potassse, or the Citrate and Acetate of Potassium (B). Triticum Repens, bene- fit 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, hjis been tried in all forms, but is of no value (Thompson). Iodoform, as sup- pository in the 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 ; castration was suggested by J. Wm. White, and has been performed with successful results in three cases by Haynes, also by other operators. [Compare Cystitis.] Prostatitis. Cantharides, a drop of the tincture (5 may be required) 3 or 4 times a day (R). Triticum Repens, is found to be of benefit (Sir H. Thompson). Urino- 762 PROSTATORRHCEA—PRURIGO—PRURITUS. 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 to the 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); chaly- beate 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 Gou- lard’s Extract, 3j to §x of water, night and morning, for 10 minutes at a time (Gross). Ergot, when relaxation exists (B). Bougie, methodically intro- duced, is one of the best local measures (Gross). Hydrastis, locally applied, a useful medicine (B). [Compare Prostatitis.] Prostatorrhcea. Prurigo. Antipyrin, as a symptomatic remedy, is efficient in true prurigo. Alkaline Baths, followed by a carbolized ointment, and Carbolic Acid internally, are of value in the papular eruption known as prurigo (Bulkley). Sulphides, Potassa Sulphurata, with Tar and Benzoinated Lard, as ointment in genuine prurigo (R). Arsenic, in doses of tt\,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 Ammo- nium Chloride, gr. xxx, in Oj of pure water, as lotion in prurigo contagiosa, the so-called 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. 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 epidermis where the oleate or solution can penetrate at once to the true skin. Resorcin, in solution locally, gives marked relief, lasting for several hours, in the majority of cases. Carbolic Acid, is the opium of the skin (Unna), and the most useful antipruritic agent; in combina- tion with glycerin, as lotion 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). Chloral, with Carbolic Acid, locally (see page 224). Camphor, and Chloral, rubbed together, make a liquid which, added to vaselin, makes an ointment which is powerfully antipruritic (Bulkley); added to dust- ing powders, allays heat and itching of eczema and intertrigo (R). Tumenol, as tincture, is used locally with almost universal success (Neisser). Menthol, seems to be of marked value in almost all cases of pruritus, from whatever cause (Squibb). Antipyrin, internally as a symptomatic remedy against itching, is promptly efficient in nervous pruritus, true prurigo, urticaria, erythema, pem- PRURITUS. 763 phigus vulgaris and lichen ruber. Alkaline Baths, locally, followed by the application of carbolized ointment, give great comfort in all forms of pruritus (Bulkley); Sodium or Potassium Carbonate preferred (Tr); in solution locally, 3iij ad (B). Brucine, in 20 per cent, solution, has been employed with satisfaction in chronic pruritus, as a local application (Mays). Mercury, strong solutions of the Bichloride, Black or Yellow Wash or Mercurial Ointment, in the 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 vulvae et ani (Tr); for pruritus vulvae a lotion of the Bichloride 1 to 2500 parts of water, with Alum and Starch, is recommended (B): Calomel 3j to gj 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 vulvae (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, 3j to Oj of water, as lotion for pruritus 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 of the dilute Hey Acid of the Br. Ph. in £j of water or glycerin, may be used instead (R). Silver Nitrate, a solution, gr. xx to the jf, painted over the affected parts in pruritus vulvae, is very effective (B). Tobacco, is an effective but dangerous applica- tion (B). Iodoform, as ointment, Sj ad Adipis (R). Iodine, for itching of the nose or inner canthus, sneezing, etc., its inhalation has a marked effect (R). Arsenic, for itching of the nose accompanying 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 to the 3 of hot water (R). [See PRURIGO.] Balsam of Peru, is a very good application in pruritus ani, scabies, and many other forms of itching (Auerbach). Zinc Sulphate and Alum, equal parts of each, are almost a specific in pruritus ani (Agnew). Chloroform, as ointment to allay itching of skin diseases. Gelsemium, tTLxv of the tincture every half hour, up to 3j in all, 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 and excoriated (R). Piperazin, gives immediate relief in the pruritus of the uric acid diathesis. 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 (G). 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) ; ointments containing Tar give relief in many instances (Bulkley). Sulphur, may be employed as a bath, Potassa Sulphurata, ad C xv of hot water (Sparks); or the alkaline sulphites locally (Wa); the Iodide of Sulphur extern- ally and internally, in pruritus senilis (Wa). Chlorine, the Liquor Sodae Chloratae, diluted, a useful application in pruritus ani (Wa). [Compare Ec- zema, Erythema, Lice, Pediculi, Prurigo, Scabies, Urticaria.] Prescriptions. R . Hydrarg. Chlor. Corr., . . gr. j. Pulv. Aluminis gr. xx. Amyli, 3JSS- Aquae, gvj. M. Sig.—Apply locally. (Goodell.) R. Acidi Hydrocyanici Dil., . Zss-j. Infusi Altheae, v-viij. M. Sig.—Lotion. [Fox.) R. Acidi Hydrocyan. Dil., . 5jij. Sodii Boratis, zj. Aquae Rosa;, Jviij. M. Sig.—Lotion. [Fox.) R . Potassii Cyanidi, gr. vj. Pulv. Cocci, gr. j. Ung. Aquae Rosae, . . . • %)■ M. Sig.—Ointment. (.Anderson.) 764 PSORIASIS—PTERYGIUM PTOSIS. l£. Potassii Cyanidi, . . . . gr. xv. Aquae Laurocerasi, . . . viij. M. Sig.—Lotion. [Anderson.) . Gummi Camphorae, Chloralis Hydratis, . . Rub together until liquefied, then add slowly, with friction,— Unguenti Aquae Rosae, . . 35 j. Sig.—Ointment for itching. (.Bulkley.) R. Acidi Benzoici gr. cx. Olei Caryophylli, .... gtt. xl. Alcoholis 3 ijss. Solve et adde— Cerati Simplicis, . % viij. Balsami Peruviani, . . . %)■ M. ft. unguentum. Especially good for scabies, but may be used for any pruritus. 1£ . Acidi Carbolici, .... % ij. Glycerini, j|j. Aquae Rosae, . . . q. s. ad 5 viij. M. Sig.—Lotion for pruritus. Psoriasis. Chrysarobin, has the most decided effect on psoriasis, 3ss-ij ad §j of ung. aquas rosas; often irritates, and should be employed at first with caution (Bulkley); gr. x-xxx to the of Petrolatum, applied to each spot twice daily, invariably successful (Hughes). Thyroid Extract, several cases of psoriasis treated with this remedy alone recovered completely in the course of a few weeks (Bramwell). [See page 132.] Aurum, is useful in the squamous skin diseases. Ichthyol, is a very efficient application. Thiol, is probably a better remedy than Ichthyol; the dry form, used as a dusting powder, is remarkably efficient (Squibb). Aristol, is an excellent application. Arsenic, at first appar- ently aggravates, but soon heals the disease (R); must be persistently used for a long time (B) ; exercises a powerful influence (Wa); maximum dose trpv 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, cured several cases 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 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, occasionally in psoriasis of tongue and buccal mucous membrane; if syphilitic, mercurials best (R). Nitric and Nitro-Hydrochloric Acids, when symptomatic of imperfect digestion and assimilation (B). Phosphorus, 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 internally 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 is unavailing, and benefit is seldom derived from any operation (C). Arlt’s Operation, the most satisfactory ; cut away as little tissue as possible, dissect cleanly, close with suture (Green). Veratrine, gr. x in gij of Sulphuric Ether and jfj of Alcohol, brushed over the eyelids, brows and temples every morning, till a slight burning sensation Ptosis. PTYALISM—PUERPERAL CONVULSIONS. 765 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. Acids, as astringents, small medicinal doses (R). Sulphuric Acid, internally and with Decoctum Cinchonse as a gargle, of great benefit in mercurial ptyalism (Wa). Potassium Chlorate, in simple or mercurial ptyalism (R) ; in the latter form 3j ad §vj aquae as mouth-wash, and internally in teasp. doses, 4 or 5 times daily (St). Belladonna, very effective in mercurial ptyalism, and that of pregnancy ; gtt. v-x, or Atropine gr. to every 4 to 6 hours (B): is good treatment when ptyalism is the result of some reflex action, but not so when it is an effort of nature to eliminate some drug-poison, as mercury, iodine, etc., from the system (Whitla). Pellitory, to stimulate the salivary flow in the latter case, unless the gums are swollen and ulcerated (Id). Hyoscine or Opium, may be used instead of Atropine (Id). Astringents, 'in ptyalism from excessive mercurialism when the gums are swollen and ulcerated; Alum 1 in 40, Zinc Chloride 2 grains to the Tannic Acid 1 in 40, or other vegetable astringents (Id). Tannic Acid, in mercurial ptyalism is an excellent gargle, 3j of Tannin 4o Jjij of Mel Rosae, and 3-vj of water (B). Alcohol, dilated, as a gargle (R). Potassium Iodide, is sometimes beneficial in mercurial ptyalism, but often aggravates it (R). Iodine, the tincture 3ij in of water, as a gargle (R); is worthy of trial (Wa). Borax, the glycerite is an efficient local application, but must be used almost continuously (Whitla). Potassium Bromide, has proved useful in the salivation of pregnancy ; it may be combined with small doses of Belladonna or Hyoscyamus (Id). Chlorinated Lime or Soda, in weak solution, for the fetor (Id). Stimulants, may be needed in severe cases. Diet, liquid food when swallowing is difficult. [Compare the Lists of Sialogogues and Antisialics on page 43.] Ptyalism. &. Acidi Sulphurici, . . . . 5j ss. Tinct. Myrrhae, . . . . zj. Aquse, q. s. actgvj. M. Sig.—Mouth-wash. Prescriptions. &. Sodii Boratis, Pulv. Myrrhae, . . . . . zj. Aquae, vj. M. Sig.—Mouth-wash or gargle. Puerperal Convulsions. Chloroform, by inhalation to narcosis (R); its utility unquestionable when convulsions are not due to cerebrai hemorrhage (B); the combined chloroform and chloral treatment results in a death-rate of only 7.6 per cent. (Winckel). Chloral, after the chloroform, given with Bromides by the rectum to keep up the effect; full doses, 20 to 30 grains every 2 hours (B); a remedy of the greatest value, in full dose before proceeding to one of the bromides (Playfair, Barnes). Bromides, in large doses by enema, are distinctly indicated (P) ; Potassium Bromide, 3j-ij by the rectum, after venesection if convulsions return (Whitla). Veratrum Viride, in 3ss doses of fluid extract every 15 minutes, to nausea, invaluable (R); the fl. ext., in doses of hypodermically, may be re- peated in half-hour with Morphine, or tipc 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 seiz- ures was promptly cured by a hypodermic injection of n\,iv of Norwood’s tincture in a little water (Etheridge). Pilocarpine Nitrate, gr. hypodermically every 2 hours, very successfully used in several cases (Finniss); is dangerous, being liable to cause cedema of the lungs (P). Aconite, one of the best agents (P); gtt. j-ij of tinct. every 10 or 15 minutes for the first hour, then at longer 766 PUERPERAL DISORDERS FEVER. intervals (B). Belladonna, the tincture internally with Atropine hypoder., of verified utility (P). 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 vene- section (Idem); as Morphine hypodermically, the most important agent for cure of uraemic convulsions (B); with the lancet, sometimes required (P) ; Morphine is combined with the chloral treatment by many authorities. 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). Vene- section, 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): remove 15-20 ounces of blood, and follow by enemata of Potassium Bromide, 3j-ij. if convulsions return ; Chloroform should be very cautiously used, if at all, after blood-letting (Whitla). Compression of the Carotids, Trousseau’s method, often stops or materially modifies the attack, and may be used in most cases to gain time until chloroform narcosis is established (Id). Saline Purgatives, the best being Magnesium Sulphate, or the compound Jalap powder, with free use of the wet pack to act upon the skin, for the rapid elimination of the retained excrementitious products, urea, leucin, tyrosin, etc. (Id). Puerperal Disorders. Cimicifuga, in puerperal hypochondriasis, and depression (Wa, P). Opium, either alone or with alteratives, highly serviceable in puerperal intestinal irrita- tion ; a few drops of the 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 (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 useless if not promptly effi- cient (P). Veratrum Viride, is used with great benefit in most cases (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, internally and locally; gr. xv-xxx of Magnesium or Calcium Sulphite every 2 or 3 hours, with injec- tions every day (Wa). Stramonium, when cerebral excitement (P). Potassium Permanganate, 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 septicaemia, of three weeks’ standing, 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 the temperature (P). 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). Turpentine, when depression of vaso-motor PUERPERAL MANIA PULSE—PURPURA. 767 nervous system, cardiac weakness and tympanitic distention of abdomen (P). Resorcin, is much used in Vienna by Braun ; gr. xl repeated p. r. n. Strepto- coccus Antitoxin, has been used with success by several authorities (see page 154). Rest and quiet but attentive nursing, frequent liquid food. Water, hot fomentations frequently to the parts, valuable as preventive. Antiseptic Injec- tions into the uterus are used, but are strenuously opposed by many of the most prominent and experienced clinicians. [Compare Puerperal Peri- tonitis.] Puerperal Mania and Melancholia. Stramonium, will allay cerebral excitement, and soothe the nervous system ; when delirium mild and furious, but intermittent; tendency to suicide or to destroy the child ; rr\,x-xx of tinct. every 3-4 hours (P). Hyoscyamus, in the milder cases; when nervous system is greatly excited (P). Duboisine, as calmative and hypnotic, acts efficiently for a time in puerperal mania. Aconite, in puerperal mania with high fever, restlessness ; speedy and marked success if given soon after the chill (P). Cimicifuga, has cured (B); its effects are truly remarkable in the mania and hypochondriasis of the 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, Chloroform or 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 Chloridi, in the 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; nutritious and stimulating diet. Lochia, should be watched (P). Weaning, imperative in melancholia ; not so in acute mania. Puerperal Peritonitis. Aconite, has cured cases of the usual type (P). [See under Puerperal Fever.] Cimicifuga, especially in rheumatic form, has remarkable effects (P). Opium, its curative power in this, one of the best established facts in therapeu- tics (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 stimulant, tt\,x frequently repeated, better than Alcohol (B) ; by enema, also hot turpentine epithems may be used with advantage (Wa). Quinine, in con- siderable doses, with or without Opium (B) ; gr. x-xx twice daily as an antipy- retic (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 compresses 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 ; afterward quick, weak and irregular (R). Digitalis, for weak, quick pulse. [Compare Heart Dis- eases, Fever, etc., also the Lists of Vascular Stimulants, Tonics and Seda- tives on page 42.] 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 768 PYEMIA—PYROSIS RACHITIS. cured by hypodermic injections of Ergotin (Wa). Turpentine, has been used (R); with invariable benefit (Wa). [See Hematemesis.] Nux Vomica, no prescription more generally useful than the Syrup of Iron, Quinine, and Strych- 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, tincture of Ferric Chloride (Tr) ; Tannic and Gallic Acids, used in some cases (H). Alum, and brandy or whiskey and water at such tem- perature as is not chilling, applied by sponging the body, is the best local measure (H). Wines are generally indicated (B). [Compare Hemorrhage, Scurvy.] Pyaemia and Septicaemia. Quinine, only large doses, 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 Per- manganate, is 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 Oleum 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). Streptococcus Antitoxin, has been used successfully (see page 154). Turpentine, is a better stimulant 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 rt\,v-x of the tincture with tipxv of dilute Nitric Acid for one dose (P). Pulsatilla, a good medicine in the heartburn of dyspepsia in phlegmatic subjects (P). Podophyllin, gr. y night and morningin obstinate heartburn, with liver derangement (P). Almonds, six or eight blanched, said to relieve heartburn (P). Rhubarb, and other pur- gatives, are often useful; also Magnesia, Bismuth, and Ginger (Beale). Opium in small doses has been advocated for water-brash (Id). Catechu and Kino, also other astringents, sometimes do good, and bitter infusions, especially that of Calumba, have been given with advantage in water-brash (Id). 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-phos- phatis (B); in small doses (R); the Phosphate may be advantageously com- bined with Cod-liver Oil (Wa). Iron, the Syrup of the Iodide preferred ; Calcium and Ferric Phosphates excellent in combination (B); must be con- tinued a long time (R). Nitro-hydrochloric Acid, as baths, gives excellent RECTUM. 769 results (Wa). Quinine, often very valuable (P). Thymus Extract, is suggested as probably useful (see page 133). Aliment, food rich in Calcium Phosphate 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). 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 ex- cellent for burning pain following defecation ; or with mercurial ointment, equal parts of each, for fissures and ulcers (P). Acetanilid, in fine powder, is an excellent application to ulcers of the rectum. Phosphorus, in chronic inflam- mation of the rectum, has been highly recommended (R). Cocaine, gr. xl to £j °f glycerite of starch, applied by Seeley’s Pile-pipe, very efficient in control- ling spasm of the rectum. Potassium Bromide, in 5 parts of glycerin, locally, for fissures and painful growths (R). Iodoform, as suppository in painful diseases, relieves greatly (R). Pepper, the confection, as gentle stimulant in fistula, ulcers, hemorrhoids (P). Castor Oil, in fissure and hemorrhoids, is commonly used as purgative (R, P). Sulphur, with Confectio Sennae, in irrit- able rectum, is very soothing (Wa). Stramonium, an ointment of the fresh leaves to alleviate pain (P). Conium, the extract in doses of gr. x to allay pain and irritability in rectal cancer (Wa). Purgatives, are best for proctalgia (D). Surgical, an incision through mucous membrane, and in severe cases to divide part of the sphincter, in ulcer or fissure ; a flake of cotton should be laid in the wound, so that it may heal by granulation (D). [Compare Anus, Diar- rhoea, Dysentery, Rectum ulceration of, Hemorrhage intestinal, Hemorrhoids, Prolapsus.] Rectum, Diseases of. Rectum, Ulceration of. Mercury, the Red Oxide, 3j to the gj of Unguentum, as ointment in flat ulcers of rectum existing just within the anus (Coulson). Belladonna, the extract locally for rectal ulcers, is very efficient (P). Carbonic Acid, 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 poisoning 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 advantage, and a weak solution of the same, or of Silver Nitrate, locally (Curl- ing) ; the writer had a case resisting treatment for three years, in which a cure was effected by the persevering use of a pill of Cuprum Sulphate, Extract of Opium, and Quinine Sulphate (see below). Silver Nitrate, gr. %-J combined in pill with Opium, gr. ss ; and a solution, gr. x-xx to the pint, by enema (B). Glycozone, §j in gxij of lukewarm water, mixed immediately before using, and given by enema once daily, in ulceration and chronic inflammation of the rectum and lower gut (Edson). Prescriptions. R. Cupri Sulphat., Morphinse Sulphat., . . aa gr. ij. Quininse Sulphat., . . . gr. xxiv. M. ft. pil. no. xxiv. Sig.—One pill thrice daily. (Potter.) R. Chloroformi, Zinci Oxidi, 3 ss- Olei Olivse, gj. Cerati Cetacei, 3 iv. M. ft. unguentum. (Curling.) 770 RELAPSING FEVER RETINA—RHEUMATISM. Relapsing Fever. Cathartic, a mild one 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.] Antipyrin or Phenacetin, in full dose during pyrexia, to lower the temp., is very efficient treatment, especially if conjoined with Quinine during the remis- sion ; the latter drug being too slow of action to be of immediate service in the pyrexia. Aconite, in the hot stage, if any febrifuge is required, frequently re- peated doses (B); is next in value to Quinine for high fever and headache, gtt. j of a good tincture every hour (Da C). Quinine, 20 to 30 grains in single dose once or twice daily until the temperature is reduced, with other appropriate remedies (B) ; 15 to 20 grains at most (Maclean); 30 to 50 or 60 grains in severe cases of pernicious remittents several times a day without regard to exacerba- tion (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 the 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 afterwards, is very necessary during the course of the disease (Da C). Quassia, an excellent tonic in the convalescence, combined with mineral acids (Wa). Packing, by the wet sheet, is resorted to with advantage, except when hepatic or splenic congestion exists (Wa). Remittent Fever. 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 to benefit the congestion (C). Physostigmine, locally, to contract the pupil, and diminish the amount of light admitted to the eye (Wa). Iron, in full doses, generally the tincture of the Chloride, 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. [Com- pare Amaurosis.] Rheumatism, Acute. Plans of Treatment, may be resolved into three, viz.,—(i) that by Salicylic Acid, (2) that by Alkalies, (3) that by Iron. Salicylic Acid or the Salicylates, in 20-grain doses, to not less than 3>j 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. Salicin, gr. x-xxx every 2, 3, or 4 hours; gr. xv every 3 hours in powder mixed with water (Maclagan), or same dose of Salicylic Acid, is of great benefit; good effect generally ex- perienced within 48 hours (R); the Acid is better than the Salicylates, but must be abandoned if not effective after 3 or 4 days (Da C). Oil of Gaultheria, as a substitute for Salicylic Acid, used very successfully in form of emulsion RHEUMATISM, ACUTE. 771 (B). Alkalies, for flabby, fat subjects ; alkaline carbonates, as Potassium Car- bonate, 3jss, 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 main- tained for some days, when Quinine or Iron may be used ; if successful, this treatment brings about a cure in two weeks: the alkaline treatment is now seriously questioned ; an injurious dyscrasia results from their use (B); Potas- sium Bicarbonate, gr. xxx every 4 hours, in a dilute solution, until joint-symp- toms and fever disappear (Wa): cardiac complications require Ammonium Carbonate, in 5-grain doses frequently, also Infusion of Digitalis with hypo- dermics of Morphine, and a blister over the praecordium, followed by Iron and Quinine after the acute symptoms have subsided (B). Tincture of the Chloride of Iron, for feeble, anaemic, and nervous subjects, n\,xxx 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 joint (B); very serviceable in pale, delicate subjects, itlxx-xxx every 4 hours; also as prophylactic where tendency (Anstie); harmful to the plethoric and overfed (B). Iron and Salicylic Acid in combination, should be most valuable, but as heretofore prescribed has always made an insoluble pre- cipitate ; this is overcome by Dr. Peabody in the formula given below, which makes a ruby-red mixture, and has advantage of preventing the anaemia which results from the Acid given alone. Aconite, very serviceable when much heat and dry skin (B); subdues pain in inflamed joints and perhaps shortens the fever (R); in small doses fre- quently repeated of the greatest value, and if used from the start prevents organic cardiac disease (P); not reliable as a curative agent, but is a valuable adjunct to other remedies (Wa). Veratrum Viride, said to be useful (R) ; small doses, as antipyretic, may be combined with Opium (P). Salipyrin, has been employed with excellent results, in 15-grain doses every hour or hour, until about 3'j have been taken, continuing with smaller doses for a long time after convalescence, to prevent relapses. Salol, the great remedy, none superior (B); given in doses of 15 to 30 grains, up to gij in 24 hours, and continued for some time after acute symptoms have subsided ; may prove toxic in large doses, with symptoms of carbolic acid poisoning. Salophen, is said to be equally efficient and non-toxic, 3j~£>jss daily. Antipyrin, has held a high place for several years (see page 145). Phenacetin, is an efficient and safe antipyretic. Phenocoll, for the pyrexia, is used with marked success. Rhus Toxicodendron, positively invaluable in after-stage, also in subacute forms, muscular or ten- dinous, 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, reliev- ing pain and swelling in 18 to 24 hours (Craig). Cimicifuga, has excellent re- ports (B); much used, and is said to quell the pain speedily (R) * found very serviceable (P). Dulcamara, recommended especially for persons who are subject to catarrhal affections in cold and damp weather (P). Ammonium Bromide, a very excellent treatment, followed by Quinine; gives a very low proportion of cardiac complications; gr. xv-xx every 4 hours (Da C) ; dis- agreeable but strongly recommended (B). Arnica, lowers pulse and tempera- ture, relieves articular pain and swelling, diminishes urea (P). Trimethyl- amine, in Peppermint-water, often has remarkable power in acute rheumatism and gout (B). Bryonia, after the swollen joints have been reduced by other means, is extremely efficient for the pain and stiffness (P). Spigelia Anthelmia, for 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, by fumigation, the patient covered with blankets and exposed to strong fumes, produces perspira- tion, 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. 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 recommended as anti-rheumatic ; gr. j 772 RHEUMATISM, CHRONIC. every 2 or 3 hours, increased to gr. xij in 24 hours; tolerance remarkable in this disease ; in rheumatic carditis it is indispensable (Wa); a very good remedy in moderate doses (Ua 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 complica- tions with cyanosis and oedema. Lime-juice, §viij 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 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 use- ful. Spongiopiline 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 may be 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. R. Olei Gaultheriae, .... gj. Acidi Salicylici, gr. Ixxx. Sodii Boratis, g). Syr. Picis Liquidae, . . . g ij. Aquae Anisi, 3 ij. M. Sig.—Adessertsp. every two hours. Prescriptions. R. Acidi Salicylici, gi). Ferri Pyrophosphat., . . gj. Sodii Phosphatis, . . . . gr. xij. Aquae, gx). M. Sig.—A tablesp. every two hours. (Peabody.) R . Potassii Iodidi, g ij. Vini Colchici Sem., Syr. Simplicis, . . . . aagiv. Aquae Menthae Pip., . . . g v. M. Sig.—Tablesp. every 4 hours. (Now Orleans Charity, Hosp.) R. Ammonii Phosphatis, . . 2[jssl Tinct. Colchici Seminis, . Tinct. Aconiti, g ij. Syr. Simplicis, iij. M. Sig.—A teasp. every three or four hours. (Corson.) R. Sodii Salicylatis, . . . . ,5 ss. Tinct. Lavand. Co., . . . giij. Glycerini, . . . . , . . Zvj. Aquae, q. s. ad gx). M. Sig.—A tablesp. every three hours, well diluted. R. Propylaminae Clilorid., . . gr. xxiv. Aquae Menthae Pip., . . . g vj. M. Sig.—A tablesp. every two or three hours. (Tyson.) Rheumatism, Chronic. Arsenic, is very good in most cases, given in small doses steadily (Da C); is more efficient than Sulphur and should be used instead thereof in the Chelsea Pensioner (see page 530), an old remedy for chronic rheumatism (Fothergill). Sulphur waters are undoubtedly efficient (Da C); Sulphur locally, also the Sul- phides as baths (R) ; is certainly of benefit (B). Guaiac is another ingredient of the Chelsea Pensioner ; is used with varying success (B) ; the ammoniated tincture in milk often gives excellent results (Da C) ; is vile to the taste. 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 ; Iodides often prove very satisfactory, especially in strumous or syphilitic subjects (B). Rhus Toxicodendron, a very powerful agent in subacute 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). 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). Ichthyol, is invaluable given inter- nally in pill, gr. x-xxx thrice daily ; also as ointment with Lanolin 50 per cent. RHEUMATISM, CHRONIC. 773 (Illinsky); or as a liniment with Turpentine or an equal weight of a mixture of Lanolin and Olive Oil, with 30 per cent, of Chloroform. Cimicifuga, some- times 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). Lithium Bromide, gives excellent results, when smaller joints are swollen and tender (B). Lithium Salicylate, in 15- to 20-grain doses every four hours, gives good results in lingering, subacute cases after acute attacks (Da C). Colchicum, is of decided advantage in the neuralgia of chronic rheumatism (B). Colchicine Salicylate, is used with satisfaction (see page 250). Bryonia, is a useful remedy, especially for painful and stiff joints (P). Mercury, the oleate of Mercury and Morphine locally, for joint affections (R). Mezereon is strongly recommended (P). Phytolacca, has proved useful (B). Dulcamara, has been used with benefit (P). Iodine, locally, for pain around joints (R). 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; internally and externally as liniment (P). Aletris, is extensively advertised as an efficient remedy. Nuclein, has been used with decided advantage (Vaughn). Eucalyp- tus, the leaves wrapped around the affected part, renewing them daily for a week or more, often very efficient as a local stimulant, but will produce vesica- tion if too long continued (Gibbons). Xanthoxylum, has long had deserved reputation, of fluid extract (B). Thuja Occidentalis, is useful for rheumatic pains (P). Manganese Sulphate, is one of the remedies (B). Bel- ladonna, the extract locally very valuable for pains (P). Cod-liver Oil, inter- nally 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 spirits 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). Car- bonic Acid Baths are sometimes beneficial (see page 82). Red Flannel next skin, very popular, but white better, as the red often gives rise to eruptions (Da C). [Compare Arthritis, Lumbago, Myalgia, Pleurodynia, Sciatica.] 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.) Prescriptions. R. Linim. Aconiti (B. P.), Linim. Belladon., . . aa 55 ij. Glycerini, . . . . . .. . 5 ij. M. Sig.—Apply locally over the seat of pain. (Fothergill.) R . Olei Sinapis, % ss. Olei Terebinth., . . . . 3 iij. Camphorse, £ iv. Liq. Ammon. Fort., . . . 3 iij. Tinct. Capsici, iv. Alcoholis, . . . q. s. ad $ vj. M. Sig.—Russian Spirit, a liniment for rheumatism. R. Tinct. Guaiaci /Ether., . . j. Tinct. Colchici/Ether., . Tinct. Cann. Ind. /Ether., M. Sig.—25 to 30 drops on sugar, every 4 hours, for rheumatic and neuralgic symp- toms. [A flee.) R . Acidi Arsenosi, gr. iij. Pulv. Guaiaci, q iij. Pulv. Capsici, j^ss. Pil. Aloes et Myrrhae, . . 3 iij. Ft. pil. no. cxx. Sig.—One thrice daily. The modified Chelsea Pensioner. (Fothergill.) R. Potassii Iodidi, . ... gj. Potassii Nitratis, . . . . 3 ss. Ext. Cimicif. FI., Glycerini, aa j^ss. Vini Colchici Sem., q. s. ad % ij. M. Sig.—A teasp. after each meal. (Potter.) 774 RHEUMATISM—ROSEOLA—SARCIINLE SCABIES. Opium, as Dover’s powder, full doses in the acute stage (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 ripcx of Tinct. Ferri. Chlor. 4 times daily, with gr. x of Quinine daily, and good food (Da C). Aspirate, when pus is discov- ered around the joints, as the case will be one of pyaemic rheumatism, and may involve more joints than one (Da C). Rheumatism, Gonorrhoeal. Diaphoretics, as Dover’s powder, with Potassium Nitrate, or Ammonium salts, with dry heat to the part involved and rest in bed (Da C). Morphine and Atropine, gr. J and gr. together hypodermically, are of great service in most forms (R). Lithium Bromide, is almost specific (B) ; Lithium and its salts where there is a uric acid diathesis. Colchicine, a solution in 5-minim doses hypodermically thrice daily into the affected muscles, very effective in cases resisting other treatment. Colchicine Salicylate, is used with benefit (see page 250). Aurum, the Bromide of Gold and Arsenic is employed successfully (Barclay). Jaborandi, or Pilocarpine hypodermically, to get the skin acting freely, a great desideratum (Da C). Potassium Iodide and Colchicum, or Qui- nine, gr. xij-xvj in 24 hours, if the case lingers over a week (Da C). Capsicum, powdered, with Lard, 3ij to the 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). Xan- thoxylum, gives relief in some cases of muscular rheumatism (B). Lini- ments are of little use except to amuse the patient, but Chloral §j in §vj of Linim. Saponis, makes a good one (Da C). Electricity, the constant current daily renders good service. [Compare Lumbago, Myalgia, Neuritis, Pleuro- dynia, Rheumatism chronic, Torticollis.] Rheumatism, Muscular. 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 Ammonium Carbonate, 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). The treatment of these microscopic fungi is that of the primary gastric affection. [Compare Dyspepsia, Cancer, Gastric Dilatation.] Scabies. Sulphur, a solution of Potassa Sulphurata as local application ; an extemporaneous Sulphide may be made by boiling one part of quicklime 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). Sulphuric 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 SCARLET FEVER. 775 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, 3>j to 3J Adipis as ointment (B). Copper Sulphate, as lotion, §j to 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, re- lieves itching quickly and cures disease in 10 to 12 days (P). Anise or Ka- mala, as ointments, efficient (P). Benzoic Acid, gr. x-xx ad 0}4 aquae, as lotion, effectual for the pruritus (R). [See formula under Pruritus.] Beta- Naphtol, in 3 to 5 per cent, alcoholic solution or as a 10 per cent, ointment, is by far the best application (Shoemaker); a 2 per cent, ointment applied by friction has caused acute nephritis in two brothers aged 6 and 8 years, one of whom died therefrom (Baatz). Linen, should be immersed in boiling water, other garments should be baked in an oven or well fumigated with Sulphur vapor, to destroy the acari and their ova (R). Prescriptions. &. Styracis Liquidis, . . . . gij. Ung. Sulphuris, z iv. Ung. Petrolei, . . q. s. M. Sig.—Apply after washing. R. Sulph. Sublimat., .... ’7)\. Balsam. Peruv., . . . . . zss. Adipis, g j. M. Sig.—For children. (Duhring.) U. Hydrarg. Chlor. Corr., . . gr. iv. Alcoholis, 3 vj. Ammonii Chloridi, . . . % ss. Aquse Rosse, . . q. s. ad |;vj. M. Sig.—Lotion for scabies, phthiriasis, and tinea versicolor. (Fox.) . Sulph. Sublimat., Olei Cadini, aa ij. Cretse Preparatee, . ... 3 ijss. Saponis Viridis, Adipis aa % j. M. ft. unguentum. (Bulkley.) Scarlet Fever. Aconite, of the highest value for all marked increase of temperature (R); helps development of the eruption when due (P); in the early stage, when patient is not decidedly adynamic, is very useful (W). Belladonna, during the eruptive 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, gr. of Gray Powder every hour has marked effect on inflamed tonsils (R). Ammonium Carbonate, feeble circula- tion, 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 Cinnamon- water, every hour or two (Wa). Potassium Iodide, in full doses, a very satis- factory remedy (Mitchell). Mineral Acids, Muriatic internally and as gargle; Nitric, locally to sloughs in the throat (R). Salicylic Acid, given in 125 malig- nant cases, with mortality of only 3)4 per cent. (Shakowaki). Salol, in doses of 7 to 30 grains daily, according to age, internally, with gargles of a solution of Carbolic Acid, used in several cases with recovery in all and without albu- minuria or other complications (Quioc). 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 general effect on the disease ; TT\,ss, every 2 or 3 hours (Da C). Sodium Sulpho-carbolate, as a means of introducing Carbolic Acid into the system ; has been successfully 776 SCIATICA. employed (Wa). Chloral with Paregoric, is highly efficient for calming the patient (see page 224). Potassium Chlorate, in grain-doses every y2 hour, will not injure the kidneys, and will give results equal to those of larger doses on the throat inflammation (Smith). Asclepias, to promote the eruption (W). Zinc Sulphate, gr. 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 (DaC). Juniper, as diuretic when dropsy (R). Magnesium Sulphate, as purgative, to prevent sore throat and other sequelae (R). 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, lo- cally 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 used systematically from the start (Wa). Ferric Chloride, the tincture in doses of according to age, in advanced stage; when with albuminuria and hematuria, is very valuable (Wa). Mustard Bath, on recession of rash, to bring it back (R). Oil Inunctions, very grateful, espe- cially useful in desquamative stage ; Cacao-butter the most elegant (B). Ice, sucked, for 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 (R); 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 ; a strict milk diet was enforced during the illness in all the cases men- tioned above under Salol (Quioc). [Compare Albuminuria, Bright’s Dis- ease, Uremia.] R . Acidi Borici, 3 ss. Potassii Chloratis, . . . . fii). Tinct. Ferri Chloridi, . . _^ij. Syrupi, 5ij. Aquae, 5 ij. M. Sig.—Tablesp. every 2 hours, to a child of five years. (Smith.) Prescriptions, R. Acidi Salicylici, . . . . Tinct. Aconiti, gtt. xij. Infusi Digitalis, j^jss. Spt. Ammon. Aromat., . . Z iij. Syr. Aurantii Cort., . . . p, ss. Aquae, !|j. M. Sig.—Teasp. every 3 hours, for a child of five years. (Brown.) R. Acidi Carbolici, 2ss-j. Vaselini, 3 iv. M. Sig.—By inunction to the entire surface. R . Acidi Borici, % iij. Glycerini, iv. M. Sig.—For a pint of water as a gargle. (Da Costa.) Sciatica. Opium, internally and externally (Wa). Morphine, hypodermically, is espe- cially curative in sciatica (B); 3 or 4 injections of gr. ]/(, each may almost be re- garded as a specific (Wa); a single injection 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). Apo- morphine, gr. hypodermically, given by accident instead of morphine, caused immediate disappearance of the pain in a very severe and intractable case, not returning again for 12 months, and then only a slight attack which pro- SCIATICA. 777 gressed favorably under Potassium Iodide and Gelsemium (Owen). Antipyrin or Acetanilid, efficiently analgesic. Salipyrin, has been employed with excel- lent results in rheumatic sciatica. Salicylic Acid, as paste locally, 3j with 3iv of Lanolin and 01. Olivae, q. s., also Rhus Tox., gtt. j of a 1 per cent, solution of the fluid extract internally 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 (Aschen- berg). Ether, as spray, is generally of temporary value (R). Guaiacol, painted over the nerve as a local anaesthetic. Aurum, the Bromide of Gold and Arsenic has rendered good service in chronic cases. Chloroform, applied on flannel along the course of the nerve, and covered with oiled silk (Wa); Tffixv of the official spirit, or npv-xv of pure chloroform, by deep hypodermic injection into the vicinity of the affected nerve, gives the best results in old cases (B). Cocaine, a 4 per cent, solution, hypodermically along the course of the nerve, affords instant relief (Wa). Gelsemium, has been used with vary- ing success. Nux Vomica, is often successful in chronic sciatica (Wa). Belladonna, has afforded relief (R) ; Atropine, hypodermically, is curative, gr. stt t0 tit in the vicinity of the nerve (B). Stramonium, gr. X to V* every 3 or 4 hours for 4 or 5 doses, often affords decided relief, but should be stopped when the slightest symptoms of narcotism appear (P). Duboisine, is a good substitute for Atropine, and equally effective. Veratrine, in strong ointment or oleate locally ; the tincture of Veratrum Viride internally is also recom- mended (R). Aconite, locally (P); as ointment controls sciatica in some cases (R) ; valuable in many obstinate instances (Wa). Ammonium Chloride, in mild forms (R) ; in cases occurring in the young (Anstie). Iodides, in syphi- litic or metal poisoned subjects (B) ; often fails (R) ; Potassium Iodide in daily doses of 3j dissolved in Decoction of Sarsaparilla, most efficacious in sub- acute or chronic (Wa). Turpentine, causes an exquisite sensibility along the track of the great nerves (Tr); occasionally of great value in sciatica, yet not a specific, nor have we scientific indications for its use (P);. doses for 4 to 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 satisfac- tory in sciatica than in other neuralgias (R). Rhus Toxicodendron, a very powerful therapeutic agent in various rheumatic affections of the fibrous tissues (P). Cimicifuga, is highly extolled (R). Nitroglycerin, in doses of rr\j thrice daily, gradually increased to TtVv, of a one per cent, solution, promptly curative in a long-standing and severe case (Lawrence); its powerful anti-neuralgic properties were well exhibited in 3 cases which would not respond to other agents, two being cured and one remarkably improved thereby (Mikhalkine). [See formula below.] 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 vesi- cation (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). Poultices, applied very hot (R). Turkish- Baths, are often very useful (R). Electricity, produces excellent results (B); does great good, but often aggravates ; the continuous current best, when stage of acute inflammation past (W) ; galvanism often quickly relieves the pain (Pepper). Cod-liver Oil, should always be tried in obstinate cases (W). [Com- pare Neuralgia, Rheumatism chronic.] Prescriptions. R . Tinct. Colchici Seminis, Tinct. Belladonnse, Tinct. Aconiti, . . . . aa 3j. M. Sig.— every 6 hours. Remark- ably efficient. (Metcalf.) R. Tinct. Trinitrini (i p.c.) . gjss. Tinct. Capsici, gij. Aquae Menthse Piper., . . !|iv. M. Sig.—5 to io drops to be taken three times a day. (Mikhalkine.) 778 SCLERODERMA—SCLEROSIS SCROFULOSIS. 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). Strontium Iodide, has been used, with varied results. Scleroderma. Sclerosis. Aurum, the preparations of Gold are among the remedies which are believed by some writers to retard the progress ; others being Arsenic in full doses, Silver Nitrate in % grain doses, Physostigma and Ergot (Osier) : Gold is a specially curative agent in all forms of sclerosis, including cirrhosis of the liver, interstitial nephritis, cirrhosis of the lungs, etc.; and Dr. Barclay’s Liquor Auri et Arseni Bromidi is very efficient in these affections, and much superior to the Chloride of Gold and Sodium (E. A. Wood). [Compare the titles mentioned in this article, also Locomotor Ataxia, Atheroma, Paralysis Agitans.] Scrofulosis. Ammonium Iodide, when glandular enlargement (Wa); Ferrous Iodide, when debility and emaciation, a powerful and efficacious remedy ; also in anaemia of scrofula, the syrup ter die (Wa); useful in simple gland- ular hypertrophy, but disappointing in scrofulous (B). Strontium Iodide has been used with varied results in scrofulous otorrhcea. Iodine, tinct. or oint. applied over scrofulous glands—take care not to increase inflammation (R): Iodine and Iron the best remedies, but all medicines utterly useless without strict hygiene (A). Aurum, the Bromide of Gold and Arsenic has rendered good service in a case of adenitis with enormous enlargement of the neck (E. A. Wood). Calcium Salts, 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 Sul- phides 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, sup- purating glands; gr. or of Calcium Sulphide every hour or two (R). Coniine, gr. to 3j of Almond Oil locally, two or three times a day to con- junctivae 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 stimulant (P). Mezereum, strongly recom- mended (P). Sarsaparilla, useful by reason of its tonic and alterative proper- ties (P). Hyoscyamus, the bruised leaves as cataplasm for scrofulous ulcers (P). Prunus Virginiana, is found very useful in the hectic (P). Chimaphila, holds a certain amount of reputation as a useful remedy (P). Tussilago, was employed by Cullen (P). Gentian, is valued; the infusion a useful vehicle for chalybeates, 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 gj, doses of rt\,v-x, thrice daily after meals (Broadbent). Phosphates, see above, under Calcium and Iron. Aliment, raw or broiled meat, the latter for children. Abundance of fresh air and sun- shine. Sea-air, sunlight, moderate exercise, and light digestible food are nec- essary. [Compare Cachexi/e, Coxalgia, Glands, Ophthalmia.] SCURVY—SEA-SICKNESS—SEBORRHCEA SHOCK. 779 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; its efficacy believed to be due to its Potassium salts ; Oranges are 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 C). Potas- sium 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 Chloratse, £vj ad gxij 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.] Scurvy. Sea-sickness. Antipyrin, is successfully employed. Chloral, the most effective remedy; gr. xv-xxx every four hours (R). Staphisagria, has given relief (P). Creo- sote, checks the vomiting (R). Chloroform, drop doses pure (R); on sugar (B). Atropine, hypodermically, gr. in epigastrium, will relieve (B); gr. shs 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 administered. Bromides, in full doses (Beard); the Sodium Bromide preferred, in doses of 30 grains thrice daily for 3 days before sailing and continued for the first 3 or 4 days of the voyage, is by far the most effective treatment, and never produces evil effects (Rockwell). Cocaine, is quite efficient: the Hydrochlorate 1 in water 100, of which Rbiv-v on a bit of ice thrice daily (Otto) ; a 2 per cent, solution, as spray high up into nasal passages, is specific against nausea. [See under Nausea.] Morphine, gr. to £ hypodermically, will often relieve severe cases (B) ; often fails (Wa). Amyl Nitrite, by inhalation (B); is strongly recommended, but must be cau- tiously used. Champagne, iced ; tablespoon 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 full doses (Beard). [Compare Nausea, Vomiting.] Glycerin, especially useful; with Lead Acetate, Borax or Zinc, diminishing secretion ; also acts efficiently when there is a want of sebaceous secretion (Wa). Zinc Oxide, 3j, Plumbi Carbonat. 3j> Cetacei %j, 01. 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 soft soap in solution, followed later by mildly stimulating lotions (Bulkley). [Compare Acne, Pityriasis.] Seborrhoea. Codeine, in large dose, gr. j, hypodermically, immediately after laparotomy, quiets pain, prevents intestinal contraction, and relaxes the tonic spasm of the vessels which forms the first stage of shock, shown by the small and rapid pulse, before the second stage, that of paresis of the vaso-motor system, sets Shock, Surgical. 780 SICK-ROOM SNEEZING—SOMNAMBULISM. in, as shown by the soft, compressible pulse ; Morphine is the ideal relaxer of spasm, but has many objectionable qualities which Codeine is free from (Boise). Amyl Nitrite and Glonoin, relax arterial spasm, and are indicated in the first stage of shock. Strychnine hypodermically, is the best medicinal agent in the second or paretic stage of shock, when the vessels are relaxed and the pulse is soft and compressible ; a full dose, gr. is necessary, and may be repeated in Yz hour (W). Digitalin, hypodermically, may also be of great service in the second stage. Alcohol, as Brandy or Whiskey, hypodermically or by enema, is exceedingly useful. Heat, is a potent preventive of shock ; the room should be wanned to 720 F., exposed limbs should be wrapped in cotton bat- ting, and hot water bottles wrapped in towels should surround the patient’s body both during and after operation. Hot Water as clyster, a pint injected into colon, and repeated as required, after laparotomy, in which operation the handling of the intestines sets up irritation of the sympathetic system, and is a potent cause of shock ; this acts as a sedative thereto, and restores fluid to the blood, allaying thirst and supporting patient. Normal Salt Solution, consist- ing of °f one per cent, of Sodium Chloride in sterilized water, intraven- ously, to raise the volume of the pulse, stimulate the heart and restore volume to the blood, renders good service in the second stage of shock. Sick-room. Every home of any pretensions should contain a room especially arranged and kept ready for the use of sick members of the family. Such a room should be on the upper floor, and preferably in the south-east corner, so as to have the best sunny exposure; or still better, should be itself the upper floor of a two-story annex, separate from the main building, but joined thereto by a light, latticed bridge. It should have no upholstered furniture, a bare but painted floor, and rough-plastered and painted walls and ceiling, without pic- tures or paper, curtains or hangings. It should contain no sink, wash-basin, water-closet or any other convenience which connects with the sewers, and should communicate with the kitchen by a dumb-waiter, or have connected with it a smaller room, furnished with a gas-stove and the other requirements of a diet-kitchen. It should contain everything requisite for nursing a case of typhoid fever, scarlatina, diphtheria, measles or small-pox ; and all its arrange- ments should be supervised by the family physician. The possession of such an appendage to the home would enable the owner to defy the mandate of a Health Officer, in regard to removing an inmate thereof to a public pest- house, as it could be shown to the satisfaction of any reasonable court, that therein a case of infectious disease could be better isolated, and more humanely treated, than in any “ pest hospital ” ever yet erected by our political adminis- trators of health laws (Potter). 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. SPASM SPERMATORRHOEA. 781 Aconite, externally and internally for spasms not of a severe type (P). Aconi- tine, 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 has good effect (R). Camphor is said to relieve in many forms, as strangury, etc. (R). Hyoscine, is used with advantage in various spasms (Erb). Belladonna, of value for spasms of sphincter muscles, especially those of pel- vic organs (P); Atropine hypodermically in local spasm (R). Strychnine, of great value in spasmodic asthma (P); also in tetanus, chorea, and epilepsy (Pf, S). Veratrine, as solution, brushed over lids once a day in painful spas- modic contraction of the orbicularis (Wa). Opium, very useful as an anti- spasmodic, especially if given with a stimulant, as Alcohol, Ether, or Chloro- form (R). Ipecacuanha, in spasms of respiratory organs, of great value (P). Chamomile Oil, in spasms of hysterical persons, in 4 to 6 minim doses a very excellent remedy ; also useful in pseudo angina pectoris (P). Lobelia, a valu- able antispasmodic in cautious hands (P). Lupulin, in gouty spasms (P). Tobacco, in spasmodic asthma, and for relaxation of muscular spasms (P). Sumbul, is of use in gastric spasms (P). Cardamom, is usefully employed in gastric spasms (P). Ammonia, useful in children’s colic (R). Chloroform, in- haled 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 36, and in this section the titles Angina Pectoris, Asthma, Chorea, Colic, Cough, Convulsions, Croup, Dysuria, Epilepsy, Gastrodynia, Hydro- phobia, Hysteria, Laryngismus, Pertussis, Stammering, Tetanus, Tor- ticollis, Trismus.] Spasmodic Affections. Spermatorrhoea. Potassium Bromide, when due to plethora, erections normal, but persistent and teasing; is harmful in debilitated states, or daily losses (B) ; combined with cold sponging and the use of a hard bed (R). Digitalis, ffj or ij of the infusion twice or thrice daily; few remedies are more successful in arresting spermatorrhea (R, P); when feeble erections, frequent emissions, cold hands and feet (B). Cantharis, deficient tone of seminal vesicles, erections feeble, sexual feeling torpid ; the tincture 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, relaxa- tion and atony (B). Strychnine, in large doses, especially when impotence (R). Quinine, has been recommended (R). Belladonna, gr. X °f extract with gr. jss of Zinc Sulphate, 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 state (B). Hydrastis, is a use- ful injection, gtt. x of the fluid extract through a urethral tube to the prostatic portion of the urethra (B). Cimicifuga, useful in weak, relaxed conditions (B) ; when hypochondriasis exists it is very beneficial (P). Hyoscine, is a most use- ful remedy through its influence on the spinal centres (W). Silver Nitrate, a vesicating solution applied to perineum generally useful, and without danger (B); in solution, gr. xxx to the applied by urethral syringe to the prostatic portion of the urethra, is Lallemand’s treatment, and still finds favor with many surgeons (Whitla). Arsenic, when from weak and relaxed seminal vesicles. Kind Advice, frequently the best treatment, as this affection is often due to the phantasms of a morbid imagination. Bladder should be emptied after the first sleep. [Compare Emissions, Hypochondriasis, Impotence, also the List of Anaphrodisiacs on page 56.] 782 SPINA BIFIDA—SPINAL PARALYSIS. Prescriptions, R. Potassii Bromidi, . . . . gj. Sodii Bicarbonat., . . . . gr. xv. Infusi Digitalis, 3SS. Atropinse Sulphat., . . . gr. -fo. M. Sig.—One dose, to be taken at bed- time. (Gross.) R . Lupulini, gr. x. Pulv. Camphorse, . . . . gr. vj. Ext. Belladonnse, . . . . gr. ij. M. ft. pil. no. xij. Sig.—One pill thrice daily. (13.) R. Tinct. Cantharidis, . . . 3 ij. Tinct. Ferri Chloridi, . . ijvj. M. Sig.—20 drops in water thrice daily. In impotence with spermatorrhoea, of great utility. (ff. C. Wood.) R. Tinct. Gelsemii, .... £j. Tinct. Belladonnse, . . . 3 ij. M. Sig.—15 drops thrice daily. (B.) Iodine, injected into the sac, £>ss of tincture, or gr. ss, with Potassium Iodide gr. v, aquae 3j, has cured numerous cases (B); Iodi gr. $4, Pot. Iod. gr. *4 ad aquae 3j (Wa). Collodion, as a means of compression (B). Bayer’s Operation, treats the tumor as if it were a hernia; he dissects out two lateral flaps from the skin covering it and removes the sac, leaving only two lateral flaps of the dura, which he sews together, afterwards bringing the skin and muscles together separately. Spina Bifida. Spinal Concussion. Lead-water and Opium, as lotion over the seat of injury (A). Leeches, if pain persistent (A). During the early stage the treatment of shock must be instituted, stimulants and restoratives being freely administered ; traumatic neurosis may be treated with electricity, massage, hydropathy and the rest- cure ; inflammatory symptoms require the treatment for acute or chronic myelitis (Lyman). [Compare Myelitis.] Spinal Congestion. Ergot, gives excellent results (Brown-Sequard). Turpentine, as hot epithems, useful (Wa). Antiphlogistic measures, with rest and absolute diet; wet cups or leeches to the column ; cool affusions or ice-bags to the spine while patient is in a warm half-bath (Ros). [Compare Meningitis, Myelitis.] 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 (Pf). 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, the 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 so treated 133 were thoroughly cured (Hammond). [Compare Meningitis, Myelitis, Neu- ritis, Neurasthenia.] Spinal Paralysis and Softening. Ergot, to starve the inflammation by occluding the spinal arteries (Ham- mond). Electricity, best; galvanic current from spine to nerves and muscles SPLENIC AFFECTIONS—STAMMERING. 783 (Ros). Mercury and Potassium Iodide, a thorough course, in spastic para- plegia when syphilis is suspected (O). Massage, with forcible flexion and ex- tension and proper apparatus, to overcome rigidity and contracture in infantile spastic paraplegia, have often enabled a patient to get around comfortably (O). Baths, warm, of every description, are useful in spastic spinal paralysis (Ly- man). Suspension, has been tried with some degree of success (Id). In softening the treatment must be palliative and supporting only (H). [Compare Locomotor Ataxia, Myelitis.] Splenic Affections. Mercury Biniodide, gr. j to 3j of ointment, rubbed in before a hot fire, has given excellent results in chronic malarial enlargement of the 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 effectual remedy for enlarged spleen (Da C). Ammonium Iodide, effective in chronic splenitis, with Unguent. Hydrarg. Iod. Rubri externally ; also small doses frequently repeated in all splenic derangements from malaria (B). Iodine, locally in chronic forms (B). [Compare LeucocythaiMIA.] Sprains. Arnica, is very useful; the infusion internally and externally (P) ; the tinc- ture diluted as lotion is very effectual (Wa). Aconite, the liniment to painful sprains, often affords speedy relief (Wa). Turpentine, as a liniment (P). Ammonium Chloride, in solution, as lotion, or with bread as poultice, to re- move discoloration due to sprains (W). Rhus Toxicodendron, the tincture 3ss to Oj of water is a good external application to sprains. Oil of Bay, as a stimulating liniment (P). Cold Douche, salt may be added ; the force must be regulated by the condition of the tissues (R). Heat, by fomentations alternated with cold affusions (D). Rest, is the most essential measure and should be perfect; a roller bandage with splints may be required to secure rest of the part. Silver Nitrate Stains may be removed by washing with Potassium Cyanide 3ijss, Iodine, gr. xv, Water, j$iij ; or, after moistening the spots, drop on them a few drops of Tinct. Iodine, and wash out with a solution of Sodium Hyposul- phite, 3ss to §j (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 distinguish 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 solution 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. Vocal Training, the rhythmical method, the most successful, the chief end in view being to regulate the precipitate, irregular form of respiration ; but 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 Speech and its Defects, Lea Prize Essay, Philadelphia, 1882.] Stammering. 784 STERILITY STINGS AND BITES. Aurum, cures sterility when dependent on chronic metritis or amenorrhcea or coldness, more certainly than any other remedy ; the Chloride, gr. (B). Potassium Iodide, when due to syphilis (R). Dilatation 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 it may be caused by an acid discharge from the uterus, which kills the spermatozoa; for this Vichy water internally 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. Sterility. Stings and Bites. Quassia, a strong infusion used as a wash in Java on the mat-covered floors infested with fleas, the swarms vanishing as by magic (Neale). 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', npx-xx of Liquor Ammonias in water or wine, every half hour or oftener; also externally or hypodermically, 1 part to 2 aquas into a vein (Wa). Ammonium Carbonate, gr. v hypodermically, as used for wounds by poisoned arrows. [See under Wounds.] Carbolic Acid, a weak solution sponged over the body, to keep off mosquitoes (R). Salicylic Acid, I to 19 of flexible collodion, 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 internal remedy in Pennsylvania for rattlesnake-bite, and is successful in a remarkable 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 Tan- jore Pill, highly esteemed in India for bites of venomous snakes (Wa). Cal- cium Chloride, a filtered solution injected into wound from snake-bite, success- ful 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 poultice or paste, allays pain and irritation ; is regarded by some as almost specific (Wa). Antivenene (see page 155), is an effective antitoxin against the venom of several serpent species (Fraser). Stimulants, in snake-bites, freely, are most important; Liquor Ammoniae the best (Wa); stimulants are indicated in snake-bites, but there is no remedy of any value therefor (Gross). Sting, should always be removed if left in the wound; pressing upon it with the bar- rel of a small key will expose it. [Compare Wounds.] Prescriptions, R. 01. Picis Liquidae, 01. Olivas, 01. Hedeomas, . . . . aa^j. Spt. Camphorae, Glycerini, aa 2; ss. Acidi Carbolici, gij. M. Sig.—Shake well. Lotion against mosquitoes, for fishermen and hunters. R. Carbonis Vegetab., . . . lb j. Potassii Nitratis, . . . . £i). Acidi Carbolici, Persian Insect Powder, . . § viij. Mucil. Tragacanth., . . . q. s. To make fumigating pastilles for use against mosquitoes. STOMATITIS SUPPURATION. 785 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,-the fluid extract, locally in mercurial and aphthous stomatitis (B). Glycozone, frequently applied, is of benefit in ulcerative stomatitis (Edson). Carbolic Acid, a concentrated solution in glycerin, care- fully, as a mild caustic in aphthous stomatitis (Wa). Alcohol, Brandy-and- water an excellent lotion (B). Mineral Acids, pure Hydrochloric applied on pine wood to ulcers (B). Eucalyptus, a decoction of the leaves, an efficient local application (B). Glycerite of Tannin, in ulcerative stomatitis (R). Copper Sulphate, solution painted over edges of gums in ulcerative stomatitis; gener- ally dry Alum better (R). Alum, in ulcerative form, 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.] Stomatitis. 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. Nitric Acid, Ac. Nitrici Dil. 3ss-j, Bismuthi Subnit. 3ss, Tinct. Digitalis 3j> Glycerini §ss, Aquae Rosae applied to the affected parts frequently (Wa). Zinc Oxide, dusted freely over the part. Magnesia, or some other mild alkali, with improved feeding and aperients, to which measures this affection gener- ally yields in infants. Lancing the gums, is proper (H). [Compare Lichen.] Sunstroke. Veratrum Viride, and Gelsemium, as sedatives, instead of stimulants, when the pulse is full and strong (Ely). Water, as cold affusion when the patient is stricken down unconscious (R); absolute rest and quiet, free air, loose clothes. Potassium Bromide, in cold water by enema. Stimulants when the pulse is frequent and feeble. Chloroform, if convulsions. Leeching, in stage of re- action (Wa). 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). Iron and Manganese Iodide, the Syrup in cachec- tic states resulting from suppuration (B). Hydrogen Dioxide, is a most ener- getic pus-destroyer; the solution may be applied in full strength, or diluted with an equal part of water. Glycozone, acts similarly but more slowly; after cleansing by Hydrogen Dioxide solution, the application of Glycozone stimu- lates healthy action and hastens the cure; for which purpose it has no superior in the entire range of therapeutics (Edson). Bismuth Subiodide, dusted over a suppurating surface after cleansing, is highly efficient as an antiseptic and a 786 SURGICAL FEVER SYCOSIS SYNCOPE SYNOVITIS. stimulant of healthy granulation. Nuclein, has been used successfully in sup- purative disorders (Vaughn). [Compare Abscess, Boils, Carbuncle, Pyemia.] Surgical Fever. Aconite, quickly and repeatedly in early stages, during chill or soon after, the safest treatment (P). Salicylic Acid, or Sodium Salicylate, especially use- ful as an antipyretic (B). Chloral, gr. xv-xxx every 2 hours ; there is no better treatment (Wa). Sycosis. Nitric Acid, §j to Oj aquae, as wash, used frequently (R). Boracic Acid, 3jss finely powdered and incorporated with §j of Vaselin, is found most use- ful (Wa). Salol, as an antiseptic powder, has done good service. 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, internally is highly useful. Mercurial Ointments, are extensively employed (Wa). Sodium Sul- phite, 3j, Glycerin, §j, Aqua, 3iij, locally, when of parasitic origin (Wa). [Compare Condylomata, Mentagra.] Syncope. Nux Vomica, in drop doses of the tincture every 5 minutes, to restore the cardiac action in extreme cases of syncope approaching heart-failure, especially when of neurotic origin ; is promptly efficient (Macfarlan). Cinnamon, the Oil, as a powerful stimulant, sometimes employed (P). Alcohol, 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 con- sciousness (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). Duboisine, may be used instead of Atropine. Ammonia, internally, or breathed into the air-passages (R); the Carbonate as “ smelling salts ” (Wa). Lavandula, the compound tincture (Wa). Chloroform, internally, for hysterical 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 (B): cold affusion always (Wa). [Compare Heart Affections.] Synovitis. Potassium Iodide, with Iron and Quinine, in syphilitic patients with consti- tution broken down (D). Iodine, in chronic synovitis, painted around joint; the solution injected into white swelling (R). Quinine, and free stimulation in all cases of pysemic synovitis, such as occurs in acute rheumatism of gonor- rhoeal causation, occasionally in typhoid fever, and may result from a trifling injury in strumous subjects. Mercury, and Morphine, the Oleate locally (R) ; an elegant 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). Carbolic Acid, injected into joint (B). Alcohol, and water, equal parts, an excellent evaporating lotion (B). Blisters, a flying blister every night in chronic synovitis (R). Cod-liver Oil, in strumous cases (B). Surgical Treat- ment, splints to keep the limb motionless in all cases arising from injury ; during acute stage splint should be fastened at some distance above and below the joint, and not touch the joint itself; straight position, leeches to the joint, or cupping near it; ice, evaporating lotions or hot fomentations ; blisters inappli- SYPHILIS. 787 cable until the 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 ; bandage with cold water after alternate bathing with hot and cold water, in chronic synovitis. [Compare Coxalgia, Joint Affections.] Mercury, the mainstay in the earlier and later stages ; the Protiodide in pills of gr. ye each, one after each meal increased by one every third day, until teeth get sore or bowels disordered, then drop two pills from each dose (Keyes); the best remedy for primary and secondary forms, not so in tertiary ; 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 ozaena, psoriasis, rashes, condylomata, etc., the Bichloride, gr. ij-v in §j of Alcohol, painted over syphilitic mouth lesions daily (Keyes): Mercury believed to be a true vital antidote against the virus (R); used for at least two years can eradicate it (Keyes): internal administration best because most practicable; the two great preparations are the Bichloride and Protiodide, of the former the curative dose for a man is about Y grain daily, for a woman Y grain, below which the drug has no active effect on the disease ; dose of the Protiodide is larger, for a man about 2 grains, for a woman gr. iY daily (Fournier). Nitric Acid, in secondary forms (R); holds a high place as an internal remedy (Wa); when sponginess of gums excessive, 3iv to §ij aquae, teasp. 4 times daily; also use locally (St); as cautery for the initial lesion, the fuming acid, if used at all, should be applied early and thoroughly, followed by Blackwash locally on lint (Bulkley). Potassium Iodide, is approached by no remedy in constitu- tional syphilis ; also for mercurial cachexia, syphiloma of nervous system, and many disorders of syphilitic origin; will certainly arrest ulceration of nares, palate, etc., if given in large doses, gr. xx-3j every 4 hours (R) ; is of little value in early stages ; in the later should be combined with Mercury (St). Rubidium Iodide, is more pleasant than Potassium Iodide, having a milder taste, and is borne far better, especially by the stomach, and in regard to the production of iodism and cardiac difficulties (Neisser); is indicated in patients in a low state with weak cardiac activity (Mering); in doses of to of a 5 per cent, solution daily, gave the best possible results without troublesome disturbances (Bunge). Iodine, as gargle for ptyalism ; the tincture applied to syphilitic sores of the throat (R); or of tincture to 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, syph- ilitic bone-diseases (B); its beneficial action incontestable (Tr); the Bromide of Gold and Arsenic has rendered good service in trifacial neuralgia diagnosed as due to syphilis (E. A. Wood) ; Gold is unquestionably useful in the later stages, its best effects being obtained with very small doses (Pf) [see page 175J : the Bromide of Gold, Arsenic and Mercury (Mercauro) is highly praised in the late manifestations of syphilis, especially in those affecting the nervous system. Stillingia, with Nitric Acid in chronic cases of broken-down constitu- tions 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 forms 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 Sarsaparilla, in tertiary form (B). [See Guaiac, below.] Belladonna, with Mercurial Ointment, for secondary ulcerations of rectum (P); the tincture Siv ad aquae, a teaspoon- ful 4 times a day in water, instead of mercurials (St). Iron, the Iodide in constitutional syphilis, to promote constructive metamorphosis (B); where Syphilis. 788 TABES MESENTERICA. anaemia exists (R); the Potassio-Tartrate, gr. xv-xx, every 4 hours, especially in the gangrenous form (Otis). Guaiacum, in tertiary syphilis only, or as ve- hicle 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). Syphilis Antitoxin, has been used with encouraging results (see page 155). Denutrition, the Arabic “hunger- cure ” efficient, but unpopular (B). Turkish Baths, or wet packing, ameliorate and aid cure of constitutional syphilis (B). Hygiene, is of the greatest import- ance in syphilis (Bulkley). Cod-liver Oil, remarkably improves condition resulting from prolonged use of Mercury and Iodides, the syphilodermata, and squamae ; internally and by inunction (R). [Compare Chancre, Condylo- mata, Ulcers, Ptyalism.] Prescriptions. R. Hydrarg. Iodidi Rubri, . gr. iij. Potassii Iodidi, 3 iij—vj. Tinct. Aurantii Cort., Syrup. Aurantii Cort., . aa3j. Aquae, 3 viij. M. Sig.—A teasp. thrice daily after meals. (Otis, for the Mixed Treatment.) R . Hydrarg. Iodidi Rubri, gr. ij. Ammonii Carbonatis, . . gr. xx. Potassii Iodidi, 3 iij. Tinct. Gent. Co., q. s., ad 3iv. M. Sig.—A teasp. in water after each meal. (Fox, for the Mixed Treatment.) R. Hydrarg. Bichloridi, . . . gr. iv. Tinct. Benzoini, . . . . 5ss. Aquae Cologniensi, . . . Sj. Aquae Rosae, ivss. M. Sig.—Apply locally with sponge to skin for 20 minutes. For squamous syphil- ides. {S. IV. Gross.} R. Hydrarg. Chlor. Mitis., Lycopodii, aa 3 ij. M. Sig.—Use as snuff thrice daily, in lesions of the nostrils. (Diday.) The Three Eights. R. Hydrarg. Chlor. Corr., . . gr. viij. Potassii Iodidi, .... viij. Syr. Sarsaparilla Co., . . 3 viij. M. Sig.—A teasp. thrice daily. R. Massse Hydrargyri, . . . gr. ij. Ferri Sulph. Exsiccat., . gr. j. Extr. Opii, gr. In pill, thrice daily. (Otis.) R. Hydrargyri Bichloridi, Ammonii Chloridi, . . aa gr. iij. Tinct. Cinchonse Comp., Aquae, aa if iij- M. Sig.—A teasp. thrice daily. Each contains gr. fa of Corrosive Sublimate: (Bumstead.) & . Potassii Iodidi, 3 ij. Ammonii Carb., . . . . 3 ss. Tinct. Cinchonse Comp., . giv. Glycerini, ....... 5j. Syr. Aurantii Cort., . . 3jss. M. Sig.—A teasp. in plenty of water after each meal. {Keyes.) Tabes Mesenterica. Calcium, 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. Cinchonas, 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 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). Chaulmoogra Oil, is of benefit, used by inunction (Wa). Aliment, raw meat, cream, chocolate, and cocoa, are valuable nutriments in these cases TASTE TEETH—TESTICLES—TETANUS. 789 (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) ; }/$ gr. of Gray Powder 3 or 4 times a day will generally remove the disagreeable taste in the mouth due to dyspepsia, in the course of chronic dis- ease, or in early convalescence from acute illness (R). Electricity, faradiza- tion as a stimulant of the nerves in the tongue, may aid the recovery of function when loss of taste is due to nerve disease (Gowers). Teeth. Potassium Iodide, in doses of gr. x, thrice daily, often cures looseness of teeth from periostitis of alveolar processes (Wa); Iodine, the 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). Col- lodion, on cotton, as stopping for carious teeth (P). Liquor Sodse Chloratae, 3vj ad aquae, a highly useful application in fetid discharges from carious teeth (Wa). [Compare Dentition, Gums, Odontalgia.] Testicles. Mercury, the ointment, locally in indurations and enlargements of testes (Wa); Corrosive Sublimate, with Cinchona or Sarsaparilla in sarcocele (D). Camphorated Naphtol, used hypodermically in tuberculosis of the testis with very gratifying results (Reboul). Aurum, is highly recommended in hypochon- driasis accompanying testicular disease, and as a tonic for low-spirited, pining boys with undeveloped testes. Water, cold applications in neuralgia of testes with tonics and neuralgic treatment generally (D). Suspensory Bandage, with rest, in many affections of the testes (D). [Compare Hydrocele, Orchitis, Varicocele.] Tetanus. Potassium Bromide, not less than gss during the day, with Chloral at night as a hypnotic: out of 21 cases so treated but 3 died; its physiological action indicates it to be the best remedy known (W); in very large doses, 3j every 3 or 4 hours, has given better results than any other remedy (B). Chloral, in large doses, gr. xx, no remedy more effectual (B); has sometimes cured (R); best used in combination with Potassium Bromide (W). Chloroform, in small and frequently repeated inhalations, also by friction, has been useful in many instances (Wa); anaesthetics give temporary relief (B); four cases of acute tet- anus treated successfully by chloroform inhalations, the daily dose varyingfrom 3ij to iv ( Preobrajensky). Paraldehyde, promises well, in full doses, 3ij-ijss, and does not depress the heart, as chloral and the bromides do (B). Strych- nine, of decided service (P); cured 8 cases of traumatic form in doses of gr. tV t0 i (S); the evidence as to its curative power is of doubtful credence, but it is most successful in spontaneous and in chronic cases rather than in the traumatic form (B). Aconite, has benefited many cases (P) ; its success war- rants further trial (W). Belladonna, successfully used in many cases ; the ex- tract, internally, and locally to wound (Wa) ; Atropine, gr. injected into muscle (B); bleeding, vapor-baths, and large doses of Belladonna have cured tetanus (Tr). Nicotine, 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). Physostigma, has been used with 790 THIRST—THROAT, SORE. 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 dis- crepant (W). Apomorphine, may prove antagonistic (P). Curare, hypoder- mically, has much evidence for its power (P). Cannabis Indica, used with marked success in traumatic form (P); it is difficult to obtain an active extract (W). Cocaine, and Morphine, of each a 5 per cent, solution, 3 syringefuls hypodermically, immediately relieved and finally cured a bad case of idiopathic tetanus unrelieved for 3 days by chloral, morphine, etc. (Lopez). Gelsemium, has cured several cases (P) ; its spinal action is opposed to that of tetanus (B). Hyoscyamine, or Duboisine, gr. -fa gradually increased to gr. y is very efficient (Oulmont). Antipyrin, antagonizes excitability of the motor nerve centres, and has been used with benefit. Amyl Nitrite, used in 3 cases with marked benefit as spinal sedative (W); has been used with success (R). Morphine, hypodermically, deeply into tetanized muscles, and if possible to the point of entrance of the nerves, used with successful results (Demarquay); as ordinarily used is of no value (Wa). Tetanus Antitoxin, is unquestionably the most effi- cient remedy known for this disease (see page 152). Conium, is indicated, but has not been successful (B). Water, as warm baths, and cold, or ice, af- fords only temporary amelioration (B). Spinal Ice Bag, extremely useful (R). Division, or stretching of any nerve-trunk connecting the wound with the spinal cord. [Compare Spasmodic Affections.] Thirst. Acid Drinks, allay thirst by promoting the secretion of the alkaline saliva ; but excessively used will derange the stomach (R). Bitters, in drinks with acids slake thirst most effectually (R); a weak infusion of Cascarilla or Orange- peel, acidulated slightly with HC1 acid, an efficient thirst-quelling drink for fever patients (Graves). Ice, sucked, is very grateful and allays thirst in fevers (R). Tepid Drinks, are useful in the thirst of diabetes (Prout). Fruit Juices, or these made into drinks, but the most harmless agents must be used in mod- eration, and their consumption has to be checked, otherwise patients will take them to excess and may thus do themselves considerable injury (Fenwick). Throat, Sore. Aconite, when temperature high, half-drop doses of the 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 Aconite (R, P). [Se.e Catarrh, Acute.] Nitre, dissolved in mouth, to abort a sore throat (Wa). Tannic Acid, as powder, gargle, spray (P); the Glycerite of Tannin, after acute inflammation ; in ulceration of aphthous sore throat daily when tendency to catarrh (R). Ipecacuanha, the wine as spray, in non-inflammatory sore throats and hoarseness 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 (Smith). Alum, dry, or in solution (R). Myrrh, as gargle in ulcerated sore throat (P). Guaiac, the compound guaiac gargle (see page 538) is often very efficient in simple sore throat and commencing tonsillitis. Chloral, internally and locally, is an ex- cellent remedy for ulcerated sore throat (Brodnax). Cimicifuga, in simple sore throat (P); also in malignant forms when the mucous membrane is dry and spotted with inspissated mucus (R). Mercury, in acute tonsillitis, which see (R) ; the Bichloride as a gargle (see below for formula), in ulcerated forms of syphi- litic sore throat (Sir Chas. Bell). Rhus Glabra, a decoction, to Oj boiled to , with Potassium Chlorate is a very efficient gargle (W). Arsenic, in medic- inal doses, for sloughing of throat or malignant sores (R): the Iodide is an excellent remedy for the so-called diphtheritic sore throat, gr. iij triturated with TIC DOULOUREUX TINEA. 791 gr. xx of sugar of milk, one-half of which is dissolved in of water, and a teasp. given every hour or so. Methylene Blue, in simple, non-diphtheritic ulceration of the throat, patients would express themselves with delight as being cured, after one or two applications of the solution (Rose). Iodine, the tincture, locally to sores, whether syphilitic or not(R). Nitric Acid, undiluted, 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 Diphtheria, Pharyngitis, Tonsillitis ; also the formulae for Gargles on page 538.] Prescriptions R. Tinct. Guaiaci Ammon., Liq. Potassse, aa^iij. Tinct. Opii, zij. Aq Cinnamomi, . q. s. ad% viij. M. ft. gargarysma. Sig.—To be used as a gargle, every hour, in clergyman’s sore throat. {Garner.) &. Hydrarg. Bichlor., . . . gr. iv. Alcoholis, !§ij Solve, et adde— Decocti Cinchonse, Mellis Rosse, Tinct. Myrrhee, . . . . aa^ij. M. ft. gargarysma. Sig.—Gargle, to be diluted if too severe. (Sir Chas. Bell.) Tic Douloureux. Croton-Chloral, has special effect on the 5th nerve (B); is palliative in doses of gr. v every *4 hour till gr. xxx taken (W). Salicylates, in large doses, cured a case of 12 years’ standing. Stramonium, gr. % to Y* °f the extract every 3 or 4 hours for 4 or 5 doses, often affords decided relief; stop if narcotic symptoms appear (P). Laurocerasus, sometimes removes (P). Arsenic, cures by influencing nutrition (B). Phosphorus, is useful in doses of gr. gr. T\ every 3 hours (R). Morphine, with Atropine hypodermically, gives relief (B). Aconitine, has lately been given with good results (B). Antipyrin, and Acetanilid, are sufficiently analgesic to relieve the pain in many cases. Iodides, are promptly curative when tic is due to syphiloma of the nervous system, the pain being nocturnal chiefly (B). Cimicifuga, is frequently very effective (B). Turpentine, when rheumatic in origin or produced by fecal accumulations (B). Quinine, holds a foremost place in the list of remedies (Wa). Ammonium Chloride, in doses of 30 grains 4 times daily, is of great service in numerous cases, especially when the pain partakes more of a rheumatic than of a neuralgic character (Sir Thos. Watson). Cannabis Indica, gr. to rarely gr. j of a good extract, is very effective and ranks in value next to morphine and atropine (Reynolds). Physostigma, a few drops of a solution of the extract, 1 in 30, or one or more gelatine discs of Physostigmine introduced within the eyelids of the affected side, effectively relieved or cured several cases (Munro). Chloro- form, the liniment applied with friction is sometimes serviceable (Wa); a few drops by deep injection in the vicinity of the nerve trunk (B). Galvanization of the fifth nerve, gives decided relief to the pain, and frequently results in permanent cures in cases which belong to the category of the so-called essen- tial neuralgias (B). [Compare Hemicrania, Neuralgia, Neuritis, Odon- talgia.] Tinea Circinata—Ringworm of the Body. Mercury, the Bichloride, I part to 250 of water, as parasiticide application, after depilation (A); Calomel, as ointment, 3j to the §, is useful (B); strong Citrine ointment rubbed in twice daily is often effectual (Wa) ; the ointment of the Red Oxide often cures ringworm on the body or limbs when other remedies fail (Wa). Carbolic Acid, 3j to the if of glycerin, or equal parts of each, is a very efficient application (B). Boric Acid, is an excellent topical application, especially in that form affecting the scrotum and inner side of the thigh 792 TINEA. (Watson). Copper Acetate, in ointment, gr. x to the is a very effective application (B). Sulphites, are used in parasitic skin diseases to destroy the parasites (B). Sulphurous Acid, is better than Carbolic and safer (A); must be fresh to be of use (Bulkley). Cocculus Indicus, the decoction 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). Iodine, as liniment once applied (R); with Oil of Tar, 1 to 4, is excellent (Wa). Kamala, used locally by the Hindoos (P). Tar Ointment, is used with good effect (P). Acetic Acid, strong, applied to ringworm of any part of the body except the scalp; no treatment is easier, more speedy or certain in its action (R). Sodium Chloride, common salt in ointment is very effective (see below under Tinea Tonsurans). Cod-liver Oil, is a powerful auxiliary in weakly and cachectic subjects (Wa). Diet and Hygiene, are important; the food should be nutritive and abundant, especially animal fats; daily baths, out-of-door exercise. Fungus, is the Tricophyton tonsurans (A). Parasiticide Lotions, must be used after epilation and washing of head daily with soft or black soap. Collodion, with Cantharidal Ether, equal parts, as a stimulant after the fungus is destroyed (A). Oxygen, locally applied to the scalp by a close-fitting rubber bag, to restore the hair (see under Alopecia). Tonics, are necessary, especially for the nervous system (Bulkley). Fungus— Microsporon Audouini (A); but I have never seen it, though having made repeated and thorough searches (Bulkley). Tinea Decalvans—Alopecia Areata. Mercury, is efficient when used early ; the Bichloride, gr. xx to jfj of simple cerate (B); or gr. ij to the 3 of water applied after each epilation (R). Myrtol, is curative of favus (B). Carbolic Acid, in glycerin or cod-liver oil, as a local application (B). Sulphurous Acid, as a parasiticide ; Acidi Sulphurosi Dil. §ss, Sodii Hyposulphitis Aquae q. s. ad (Startin); is useful in favus, but when cases are unusually obstinate its action should be assisted by epilation (R). Simple Oils, to soften and facilitate the removal of scabs (R). Poultices, are useful preparatory to epilation (R). Iron, the tincture of the Chloride, internally in doses of TAx thrice daily for a child ten years old; and combined with cod- liver oil if the disease is associated with scrofula (Sir E. Wilson). Sulphur Iodide, in weak ointment, gr. xx to the well rubbed in after removal of crusts, is the most reliable preparation of its class (Whitla). Epilation, must be resorted to and carried out with care and patience (Id). All the remedies use- ful for ringworm of the scalp may be used against favus, and success depends upon the judicious way in which these agents are used one after the other than in the persistent use of any one of them (Id). It is clearly demonstrated that the disease is conveyed from the mouse to the cat and then to the children who play with or nurse the affected cat (Id). Fungus—Achorion Schonleinii (A) ; a very rare affection in this country (Bulkley). Tinea Favosa—Favus. Tinea Tonsurans—Ringworm of the Scalp. Mercury, the Bichloride, gr. xx to the § of simple ointment, is an effective application when used early (B) ; must be used with caution. Carbolic Acid, gj in the % of glycerin (B). Sulphurous Acid, the acid of the Brit. Phar. with an equal part of glycerin, is useful; must be assisted by epilation when the affection is obstinate (R) : or Startin’s formula (see above under Tinea Fa- vosa). Potassium Sulpho-cyanide, jfss in glycerin §j and water 3vij, as lotion applied on lint covered with oiled silk, after washing the patches twice daily TONGUE TONSILLITIS. 793 with warm water and soap and drying (Gee). Sodium Chloride, in ointment, equal parts of common salt finely powdered and vaselin, thoroughly mixed, and well rubbed in night and morning after shaving the part, until the skin becomes very sore; is most efficient even in apparently intractable cases (Perkins). Iodine, 3>j to the § of the oil of wood tar, is an efficient applica- tion, producing no pain and preventing the extension of the disease (R). Arsenic Iodide, is the best constitutional remedy; gr. increased to gr. for an adult, gr. to for children, with alkaline lotions locally (Wa). Viola Tricolor, the leaves are employed in Italy for tinea capitis (P). Cocculus In- dicus, a decoction locally applied after washing the part well, is efficient (P). Quinine, dissolved in glycerin, or a mild mercurial pomade, as grease to the hair of the patient and uncontaminated members of the family, to prevent the sporules reaching unaffected parts (R). Oils, may be used to facilitate the re- moval of the scabs (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 cura- tive results. Isolation of person, and brushes, towels, etc., necessary to prevent infection. Fungus—Tricophyton tonsurans (A). [Compare Tinea Cir- CINATA.] 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). Potassium Bromide, 3j to water as wash, may soothe morbid sensibility of the tongue (A). Borax, Sodii Boratis gr. xl, Glycerini §j, 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). Aurum, internally and locally, has cured hyper- trophy of the tongue with induration thereof in scrofulous subjects, also stru- mous ulceration of the tongue. Conium, is 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 gargles. Cloves, Mezereon, Pepper, as masticatories, in paralysis (P). Frsenum, 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 frsenum may proceed from the sublingual (Holmes). [Compare Glossitis, Ranula.] Tonsillitis. Aconite, when accompanied by fever and elevated arterial tension, relieves greatly, gtt. ss-j of tincture every yi-hour or hour (B); every 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. or Hydr. cum Creta, gr. £ every 2 hours; not in chronic forms (B); gr. '/$ of Gray Powder every hour when tonsils 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) ; doses of tincture every 4 hours has remarkable power; should be given in emulsion with mucilage or yolk of an egg (B); makes an excellent gargle. [See page 538 for formula] : the tincture of Guaiac and glycerin, equal parts, in 3 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 (Shoe- maker). 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 palatal muscles, so 794 TONSILS. that liquids regurgitate through nose (Boeckel): a strong solution painted freely over the affected tonsil in cases which commence on one side of the fauces, will cut short the attack in most cases and prevent suppuration. Emetics, at the very onset of the disorder, will sometimes succeed in cutting it short (Sir Thos. Watson). Alum, dry or in solution (R). Potassium Iodide, locally, gr. j-v to the if, is useful (B). Potassium Chlorate, in grain doses every half-hour, very efficient (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 538.] Ice and wet pack, extremely grateful (B). Hydrogen Dioxide, the solution as gargle, is used with great benefit. Cold Wet Compress, around neck, covered with oiled silk and a dry bandage, ap- plied nightly, is very useful. Sodium Bicarbonate, locally by wetted finger to surface of tonsils every five minutes for ]/2-hour, then every hour during the same day, will prevent necessity for lancing (Lyon Medical). Incision of the tonsils gives immediate and marked relief in all cases especially those which are not amenable to ordinary treatment. Prescription. R . Tinct. Aconiti, g ss. Tinct. Guaiaci, Syr. Zingiberis, ... aa f, ss. Syr. Simplicis, §ij. M. Sig.— every 2 hours, ac- cording to age. In severe cases, with high fever, bounding pulse, severe headache. (,Shoemaker.) Tonsils, Enlarged. Ammonium Iodide, gss in (f j of glycerin, applied every night by a camel’s- hair brush, very efficacious (Wa). Baryta Iodide, in hypertrophy of the tonsils, effects a rapid diminution in their size, even when indurated for years (Hale). Liquor Ferri Chloridi, diluted, 3>j-ij to the §, painted over tonsils twice daily, is one of the most effective astringents (Mackenzie). Aluminum Sulphate, a saturated solution applied daily by a brush, as a mild caustic (W). Ergot or Ergotin, by 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, in giij aquas, 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 gvj 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 the 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 Sodium Sulphite in water (3j~,?j) (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). Cimi- cifuga, a decoction of the root as a gargle (Wa). TORTICOLLIS—TREMOR—TRICHINIASIS. 795 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). Potassium Bromide, in large doses, with Arsenic, may always be tried in the spasmodic form, which is sometimes one of the most obstinate complaints (Whitla). Gelsemium, some cases have been reported as cured by its hypodermic administration after tenotomy or myotomy had failed (Id); very large doses, of Wyeth’s fluid extract thrice daily, increased until eight times this amount is taken, so as to produce very pronounced physiological symptoms, in spasmodic torticollis (Weir Mitchell). Surgical Treatment, by stretching or resection of a portion of the spinal accessory nerve, has succeeded sometimes in spasmodic torticollis, but it has also failed, and being so unsatisfactory should not be tried except as a last resort (Whitla). Electricity, galvanization of the affected muscles and faradization of the opposed ones, quickly relieves (B); has given excellent results in spasmodic torticollis, and if resorted to early may succeed, but must be persisted in for some time (Whitla). Torticollis. Tremor. Hyoscyamus, the tincture in full doses will palliate mercurial tremor; or Hyoscyamine, gr. gradually increased to (B). Hyoscine, is a useful drug in diseases in which tremor is a marked symptom, as disseminated sclerosis, delirium tremens, etc., having also the great advantage of being usually quite safe (Weatherly). Coniine, will control excessive tremor in many instances. Gelsemium, in full doses may palliate excessive tremor; a combination of Hyoscyamus, Conium and Gelsemium, the first to keep the brain quiet, the latter to quiet the nervous irritation at both the central and peripheral extremities (Lavers). Cocaine, influences alcoholic and senile tremor more favorably than any other remedy ; large doses and frequent adminis- tration are unnecessary (B). Veratrine, has been used successfully in alcoholic tremor and that of disseminated sclerosis, also in the trembling weakness of typhoid fever (Ferris). Calcium Salts, were given by me in one case of tremor at the beginning of general paralysis, resulting in its cessation for several months (Br). Arsenic, TT\,ij-iij of Fowler’s solution, diluted with two parts of water and given hypodermically, was successful in several cases (Eulenberg). Phosphorus, in alcoholic and mercurial tremor (De Mussy). Silver Nitrate, gr. iij daily, used in six cases of mercurial palsy with fairly rapid recovery (Sementini). Zinc Phosphide, is effective in the tremor of mercurial and arsenical poisoning (De Mussy); not so in the tremor of sclerosis (P). [Compare Chorea, Delirium tremens, Paralysis agitans ; also B run ton's Pharmacology, 3rd edition, page 133, for the Pathology of Tremor.] Trichiniasis. Benzol, in doses of every hour or two, up to 3jss daily, followed by a brisk laxative, has been very successful in 27 cases, treated simultaneously (Putter). Purgatives, as Rhubarb and Senna, or an occasional dose of Calo- mel, to thoroughly evacuate the gastro-intestinal canal. Glycerin, in large doses, to destroy the worm by its hygroscopic qualities, has been recommended The indications, in the stage of invasion, are to relieve the pains, to secure sleep, to combat the fever, and to support the patient’s strength ; there are no medicines which have any influence upon the embryos in their migration through the muscles (O). 796 THISMUS—TUBERCULOUS AFFECTIONS. Aconite (A), Atropine (R), hypodermically. Cannabis Indica, has been used successfully in trismus neonatorum (B). Opium, doses of Laudanum, with Castor Oil and warm bath, in trismus infantum. Ether, Chloral, Gelsem- ium, Physostigma (B). Treatment of any kind is seldom effectual (D) ; is never effective (El). Trismus Neonatorum, lock-jaw of the new-born infant, may be due to many causes; one of which is bathing in very hot water. A midwife, whose hands could not distinguish the difference of temperature of the bath, sent me over 100 cases (Weber). Trismus. Tuberculosis, Acute. Quinine, to subdue the fever, also Salicylic Acid for the same purpose, with repeated blistering over different parts of the chest and many dry cuppings of the lower limbs and the trunk morning and evening ; this, with wine and alco- hol, broths, jellies, milk and peptonized foods, is my plan of treatment for acute miliary tuberculosis, by which one case was absolutely cured (Jaccoud). Arsenic, appears to reduce the temperature gradually and is useful in many ways (R). Cold, to the surface of the abdomen, with ice sucked freely, the body sponged with iced vinegar and water, food and drinks to be iced, and even iced enemata sometimes ; with Quinine, gr. x-xxx once in 48 hours, or the pill of Quinine gr. j, Digitalis gr. ss, and Opium gr. every 4 hours, fluid food every hour or half hour day and night, in acute miliary tuberculosis, may bring about a cure if energetically followed from the beginning (McCall Anderson). [Compare Phthisis.] Tuberculous Affections. Arsenic, children affected with tuberculosis involving the lungs, intestines and peritoneum, have steadily and slowly improved and finally recovered under Arsenic treatment (R). Salicylic Acid, Unna’s strongest plaster, applied repeatedly for several days, to remove the horny covering in tuberculosis verrucosa cutis ; this will remove much, and the rest is destroyed by the fuming Acid Mercuric Nitrate, applied to a small portion of the growth at a time as it is painful (Crocker). Camphorated Naphtol, hypodermically in tuberculosis adenitis, tuberculosis of the testis and of the bladder, etc. (see ante, page 351). Potassium Cantharidinate, gr. to gr. hypodermically, produces an exudation of serum throughout the body, and may cause a con- centration at an affected spot of efficacious substances which would not ordin- arily find their way there, but it should not be employed when kidney disease exists (Liebrich). Hydrargyrum Thymol-aceticum, in solution injected into the glutei muscles every eight days, followed after a few injections by Potassium Iodide, gr. iij thrice daily by the mouth, as a cure for tuberculosis (Tranjen, Ewald). Zinc Chloride, in dilute solution, deeply injected into the tissues sur- rounding tubercular deposits, in order to induce a condition of sclerosis fatal to the growth or existence of the bacilli; in tuberculosis of the epididymis and in spina ventosa a 1 in 20 solution ; for tuberculous disease of the joints, ribs and glands a 1 in 10 solution, of which 20 drops to be injected in a number of places around the periphery of the diseased part (Lannelongue). Iodoform, a 10 per cent, emulsion filled into the cavity after free opening and scraping, the cavity being then sewn up, gives excellent results in tuberculous abscesses (Billroth); a sterilized 10 per cent, emulsion made with glycerin or olive oil, injected every 14 days or oftener into tuberculous joints and abscesses after thorough aspira- tion, also in tubercular empyema (Bruns); this may be well employed for all forms of local tuberculosis of soft parts, as the glands, testes and lungs (Tren- delenburg). Cod-liver Oil, is the remedy from which we can expect the most good in the tuberculous diathesis (Wa). Antitoxin, Paquin’s serum has given good results in knee-joint tuberculosis (Cale); also in other forms (see ante, TUMORS TYMPANITES TYPHOID FEVER. 797 page 154). Antiphthisin, is doing good service in cases of pure tuberculosis (see page 476). Tuberculin, as a diagnostic agent for latent tuberculosis (see page 475). [Compare Laryngitis, tubercular, Lupus, Meningitis, tuber- cular, Peritonitis, tubercular, Phthisis, Scrofulosis, Tabes mesen- TERICA.] Tumors. Mercuric Bromide, in ]/z grain 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 them. Hyoscyamus, the leaves as cataplasm or fomentations to painful tumors, afford great relief (Wa). Iron, the Liquor Ferri Chloridi 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). Electrolysis, is employed with more or less benefit in sebaceous, lipoma, bronchocele, enlarged glands, etc. (Wa): Apostoli’s method is now generally adopted for the dispersion of fibroid tumors ; it will dissipate pain, improve nutrition, and diminish size without danger to life (Bigelow); the treatment of fibroid tumors by the gal- vanic current has of late been universally recognized by the profession (Massey); solid tumors, as goitre, enlarged glands and similar growths have been repeatedly cured by electrolysis (B). [Compare Cancer, Cysts, Gland- ular ENLARGEMENT, GOITRE, POLYPUS, UTERINE TUMORS, WEN.] Tympanites. Turpentine, often greatly benefits (P,Wa) ; 3j every 6 hours in tympanites of typhoid, with prostration but without diarrhoea (R). Asafcetida, in hysterical tympanites, internally or as enema, beneficial (P); also in that of fever (Wa). Capsicum, gr. ss-ij, every 4 hours (P). Cocculus Indicus, a few doses of tinc- ture 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 salt may be used, but no drastics (B). Leeches, should never be omitted when tenderness and fever begin (B). Ice-bag, over the swelling (B). Guaiacol Carbonate, in two daily doses of 25 to 30 grains, is highly efficient, sixty cases treated thereby with no deaths ; is non-poisonous,but does not affect the temperature, hence antipyretics may be required (Hoelscher); is the princi- pal ingredient in the Woodbridge abortive treatment, which also includes Menthol, Thymol, Eucalyptol, Calomel and Podophyllum in combination [see formulae below], and aims at aborting the disease by intestinal antisepsis and elimina- tion ; Dr. Woodbridge and others report extraordinary success with this method. Guaiacol, 10 to 15 drops of pure Guaiacol painted over the skin of parts where it is readily absorbed, is very efficient in reducing temperature when exceeding 1020 (Montagnon). Carbolic Acid, 3j with tincture of Iodine 3>j, of which mix- ture 1 to 3 drops every two or three hours, is a very good plan of treatment (Da C): all typhoid cases during the past year were treated with a mixture of Carbolic Acid and Chloroform, without the loss of a single case, by Dr. Quill of the Indian Army [see page 79]. Chloroform, the spirit in mixture with Car- bolic Acid (as above); a per cent, solution of Chloroform will kill the bacillus Typhoid Fever. 798 TYPHOID FEVER. of enteric fever (Werner). Copper Arsenite, in divided daily doses of gr. commenced early and continuously used, will maintain a moderately low tem- perature, a good pulse rate, comparative freedom from great abdominal pain and tympanites, and will lessen materially the number of stools, while it greatly improves their character and consistence (Aulde); used in 90 cases with but one death ; leaves condition of the alimentary tract after the fever is over (Thomas). Salol is of great value as an intestinal disinfectant, promot- ing healing and preventing reinfection. Salophen has proven equally efficient. Nitro-hydrochloric Acid, is to be preferred overall other plans of treatment, 20-drop doses in simple elixir; Sulphuric is useful for intestinal hemorrhage (Da C). Mineral Acids, are very useful generally, especially HC1 acid (Wa). Thymol may also be employed, in doses of gr. ss-ij in solution (Da C). Sulphurous Acid, is highly praised by Dewar, and has real antidotal power; rrQjss-xx 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.] Cinnamon, the Oil is efficiently used to abort the disease (see ante, page 243). 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). Arnica is highly extolled; its “ picture” shows definite powers in this disease (P); small doses in asthenic conditions (B); when vital powers are greatly depressed (Wa). Baptisia is very useful in the early stage (W). Turpentine, invaluable when hemorrhage and extreme tympanites (P, R): n\,xxx-lx in Starch mucilage, TTx of Tinct. Opii (P); TtVv-x frequently for hemorrhage or every 2 hours in advanced stage, with dry tongue (R); when coma, stupor, etc. ; often arouses the vital powers (Wa); with gr. fa 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). Opium, small doses at night, for insomnia with delirium ; also as in- jection for the diarrhoea (R); in one case when vital powers seemed hopelessly depressed, gr. caused improvement (Wa); for spreading tenderness (peri- tonitis), give 10-minim doses of the deodorized tincture, also gr.j in suppository every four hours (Da C). Belladonna, when contracted pupils, low, muttering delirium (B); is thought to counteract the poison of typhoid (Wa). Mercury, Corrosive Sublimate 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. }4~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 in- testinal hemorrhage (Da C). Tartar Emetic, with Opium, when wakefulness and delirium ; minute doses, gr. frequently, are of great service (B); Antimony cuts the disease short with such certainty that it is almost doubtful whether the lesion of typhoid is specific or is not rather incidental or ad- ventitious (Lawrie) ; should be given with cardiac tonics. Digitalis, of value in many cases as a sustainer of heart power, but may be dangerous in the later stages (Anstie, Murrell); used by the Germans when there is no cardiac weakness; gr. x-xx as antipyretic, over a period of 36 hours (P). Quinine, may have efficacy in tvpho-malarial fever, 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). Antipyrin, Phenacetin, Acetanilid, are extensively used as antipyretics; for the dangers depending on the extensive employment of the latter drug see ante, page 68. Phenocoll Hydrochloride as an antipyretic, is used with marked success. Veratrum Viride, to reduce temperature (R) ; for delirium ferox (B); strongly recommended (Wa) ; its efficacy difficult to believe (S). Serpentaria, useful when much depression exists, cautiously, if intestines at all irritable (B). Hydrastine, when copious sweats (P). Lead Acetate, with Opium, for the purging (R); also Alum (R). Lime-water, as an astringent and antacid, is efficient. Ergot, for intestinal hemorrhage, hypodermically, if symptoms TYPHOID FEVER. 799 urgent (R). Sodium Chloride, should not be withdrawn from the food (Wa). Aromatic Spirit of Ammonia, for great accumulation of mucus in the throat (Da C). Copper Sulphate, gr. with Opium, gr. for the diarrhoea (Da C). Strychnine, is the remedy for the functional palsies (Da C). Purgatives, only the very mildest, and they with the greatest caution (Wa). Medicine, will never abort a case of true typhoid, its natural duration is from 28 to 30 days (SirWm. Jenner). Typhoid Antitoxin, has been used in a few cases, apparently with good results (see page 156). Cold Baths, when the temperature rises above 102°, a most important agent (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 F., or better 950 cooled gradually to 6o° (R) ; this, the Brand (more justly Currie’s) method, increases the flow of urine and its toxicity, restoring the latter to normal and sometimes to double the normal, thereby clearing the system of a large quantity of toxins (Ausset). Stimulants, freely, with Quinine, for pyaemic cases, showing joint complications (see under Synovitis). Aliment, by 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 un- digested great evils arise; give essence of meat alone (Sir Wm. Jenner): avoid the extremes ; an absolute milk diet required if intestinal symptoms are grave; no solid food until health is restored fully ; a scalded-milk diet exclu- sively 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 Sublimate, and buried instantly. [Compare Hemorrhage intestinal, Rec- tal ULCERATION, TYMPANITES.] Prescriptions. R. Resin. Podophylli, . . . gr. Hydrarg. Chloridi Mitis, Guaiacoli Carbonatis, Mentholi, aa gr. . Eucalyptoli, . . . . q. s. Ft. tabella no. j. Sig.—One or more of these tablets every hour during the first 3 days, to secure 5 or 6 free evacuations daily. ( Woodbridge No. /.) &. Tinct. Iodi, Acidi Carbolici, .... aa p. aeq. M. Sig.—gtt. j-ij every 4 or 6 hours. In typho-malarial fever, and in typhoid. R. Acidi Sulphurosi, Acidi Sulphurici Dil., aa Tinct. Opii Deodor., . . . rrpxx. Syr. Aurantii, ziij. Aquae, . . . . q. s. adgvj. M. Sig.—One-sixth to be taken every 4 hours. ( Wilks.) R. Resin. Fodophylli, • . . gr. Hydrarg. Chloridi Mitis, Mentholi, Thymoli, aa gr. TC. Guaiacoli Carbonat., . . • gr. %■ Eucalyptoli, q. s. Ft. tabella no. j. Sig.—One tablet every hour or two, after third or fourth day, re- duced so as to gradually lessen frequency of evacuations, until the temp, is normal. (Woodbridge No. 2.) R . Acidi Sulphurosi, .... npxv. Syr. Aurantii g iij. Aquae, q. s. adgj. M. Sig.—For infants, one-sixth every four hours. ( Wilks.) R. Ant. et Potassii Tartrat., . gr. j-ij. Morphinse Sulphat., . . . gr. ss. Aquae Laurocerasi, . . ■ M. Sig.—A teasp. every two, three or four hours. R • Mentholi, gr. ss. Thymoli, . . . . . . . gr. j. Eucalyptoli, rr^v. Guaiacoli Carbonat., . . . gr. iij. Ft. capsula no. j. Sig.—One capsule every 3 or 4 hours, alternating with the tablets, after the fourth or fifth day of treat- ment. All the medicines to be washed down with large draughts of distilled or sterilized water. ( Woodbridge No. 3.) R. Quininae Sulphatis, . . . gr. x. Acidi Ilydrochlor. Dil., Vel Ac. Sulphurici Dil., . j§ss. Syr. Aurantii, ,^j. Aquse Carui, . . q. s. adgvj. M. Sig.—A tablesp. in an equal quan- tity of water, every three or four hours. (Murchison.) 800 TYPHUS FEVER ULCERS AND SORES Phenacetin, is extensively used for the pyrexia. Baptisia, is said to have proved very useful (W). Belladonna, to cleanse and moisten the tongue ; controls the delirium, slows and strengthens the pulse, reduces the tempera- ture, shortens course of disease (R, P); in the early stages, relieves severity of symptoms (P) ; give when contracted pupils (Wa). Arnica, very highly ex- tolled (P, Wa). Hyoscyamus, for mild brain symptoms (P). Opium, fulfils many important indications ; never give when pupils are contracted (Wa). Mineral Acids, 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); its use has often been followed by amelioration of the symptoms (Wa). Antipyrin 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 ad- vanced stages (P). Serpentaria, in low stages, delirium, watchfulness, tongue dry and brown, or black ; combine with Ammonium Sesquicarbonate (P); is given occasionally to excite diaphoresis, and support the vital powers (Wa). Camphor, a remedy of considerable value, but contraindicated when flesh-red tongue, tender abdomen, diarrhoea (Wa). Purgatives [see under Typhoid Fever]. Coffee, better than alcohol for the adynamia (P). Stimulants, 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, nutri- ent enemata. Isolation, imperative, as the disease is eminently contagious (B). [Compare Delirium, Typhoid Fever.] Typhus Fever. Ulcers and Sores. Arsenic, improves rodent ulcer (B). Belladonna, has a remarkable influ- ence over various ulcerative processes (P). Chloral, as lotion for sluggish sores, 5 to 20 grains to the 3 of water (Keyes); is highly efficient in ulcerated sore throat or ulceration from any cause (Brodnax). Mercury, Calomel finely levi- gated and dusted on, is highly efficient in ulcer of the conjunctiva; Calomel Ointment or Black Wash in scrofulous or tuberculous lupus, and in open scrofu- lous sores (R); Corrosive Sublimate, in 1 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 to the 3 of vaselin, in syphilitic ulcer- ations (Keyes). Lime, as the Carbonate or Lime-water to check discharge ; the Sulphide when thin ichorous discharge ; the Phosphate has influence on scrofu- lous 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 decid- edly curative value in phagedenic and indolent ulcers ; not so useful in so- called irritable ulcers (Pf, P). Ichthyol. pure as oint. or with Lanolin, has done excellent service in ulcers of the leg. Thiol, the dry form, as dusting powder, has been of great benefit. Piperazin, in 1 per cent, solution, locally to gouty sores, relieves the pain and reduces the inflammation. Resorcin, in strong or supersaturated solution, locally applied to tuberculous and other ulcerations of the larynx, is efficient and painless (Tymowski). Tannin, or Glycerite of Tan- nin, to coat over wounds, or discharging sores (R). Potassium Chlorate, in so- lution as a wash to clean and stimulate foul ulcers (R); in impalpable powder, a better application than Iodoform (B). Cinchona, 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, in solution as a wash for sloughing and indolent sores (R) ; the gas as a local stimulant to promote healing in old ulcers, is highly efficient (for the ULCERS AND SORES. 801 method of application see page 233). Iodide of Starch, cold, as a poultice (R). Acetanilid, in fine powder, dusted on, is an excellent application to ulcers and sores, mucous patches and ulcers of the rectum (see page 69). Lead, the solu- ble salts of lead as lotions to unhealthy over-secreting sores (R). Pyrogallic Acid, is an excellent application to venereal ulcers (Vidal). Nitric Acid, as escharotic, applied with a glass rod, Oil to protect the surrounding tissues ; ar- rest by alkaline wash ; to Oj is a good acid lotion for washing (B); the lotion for indolent and painful ulcers (R). Hydrastis, internally and externally, em- ployed with excellent results in rodent ulcer, and ulcers of legs, rectum, and uterus (R). Sanguinaria, locally, to repress fungous granulations of indolent ulcers, 1 part to 80 of glycerin (P). Carbolic Acid, and Salicylic, locally (B) ; the Glycerite 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, locally to cover sores with thin protecting layer of coagulated albumen (R). Alum, dry or in solution, applied 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 its action a dilute acid (B). Zinc Chloride, the most efficient escharotic consistent with safety (B). Zinc Sulphate, dried, dusted over sores (R). Iodoform, dusted over surface (B) ; prevents granulation in all ulcers, and does no good except to relieve pain (Gross). Aristol, is highly praised; an excellent substitute for Iodoform, being quite as efficient, and odorless ; has given excellent results in treatment of indolent soft ulcers, syphilitic ulcerative processes, etc. Silver Nitrate, as caustic, quickly rubbed over surface (B); applied to unhealthy ulcers, also ulcers of the mouth (R). Copper Sulphate, to indolent ulcers: touch with a crystal, or frequently apply a solution, gr. ij-x to the (R). Coptis, the infusion has high reputation (B). Chimaphila, Copaiba, Catechu, Myrrh, Rhatany, Rhubarb, Storax, Benzoin, Tar- water,locally, are useful (P). Oxygen,toatonic,painful ulcers(R); locally applied to ulcers (see page 372) is highly efficient (Stoker). Nuclein, locally applied, cured an ulcer of 20 years’ standing in 4 months (Vaughn). Aurum, locally and internally, is highly recommended in scrofulous ulceration. Galvanic Couplet (see under Bedsores). Yeast, as a poultice (R); its action probably due to the Nuclein contained in it. Section of exposed nerve-filament, in irri- table ulcer, by bistoury passed beneath the sore (Hilton). Cod-liver Oil, espe- cially for ulcerations of the glands, or indolent ulcers with excoriated edges, lupus, etc. Water, is sufficient as dressing in the majority of cases. Restand 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. [Com- pare Chancre, Chancroid, Bedsores, Throat, Gastric, Intestinal, and Uterine Ulceration, Syphilis.] Prescriptions. & . Iodoformi, 3 ij. Mucil. Acaciae, rr^xv. Ol. Menthae Pip, .... Ttyj. Glycerini, TT\,xx. M. Sig.—For unhealthy ulcers. (Bronson.) R. Hydrarg. Chlor. Cor., . . gr. xv. Acidi Carbolici, . . . Tt\xx. Aquae, . . . . q. s. ad g iv. M. Sig. — For syphilitic ulcers, pack on cotton, and renew daily. (Box.) R. Emplas. Plumbi, . . . . 5ij. Ung. Hydrargyri, . . . • 5 ss. Olei Cadini, 55 ij. M. Sig.—Spread on linen, and apply to inflamed patches on palms from syphilis. (Bumstead and Taylor.) R. Ung. Petrolei, ij. Ung. Hydrargyri, . . . . 5J iv. Olei Cadini, gij. M. Sig.—Apply after removing scales to chronic palmar and plantar lesions. [ Bumstend and Taylor.) 802 URAEMIA—URETHRAL STRICTURE—URETHRITIS. Pilocarpine, as an active diaphoretic, on the first appearance of uraemic symptoms (headache, drowsiness, convulsions), and free purgation by salines or Elaterium (Y) ; a weak or fatty heart is a positive contraindication for this drug (B); it must not be used if oedema of the lungs exists, as further oedema and death will result (Whitla). Digitalis, the infusion internally, or a poultice of the leaves to the back and abdomen, to procure free action of the kidneys (B). Morphine, hypodermically, is most efficient (Loomis, Scanzoni); in acute not in chronic uraemia (Pf); is of remarkable value in uraemic convulsions (B). Oxygen, by inhalation, 10 litres thrice daily, is used with success (Jaccoud); is as useful in practice as it is rational in theory (Carter); used with remarkable success in a very bad case of uraemic coma (Macalister). Sodium Benzoate, 15 grains 4 times daily, has been found very serviceable in threatening uraemia (Whitla). Sodium Bromide with Chloral, in full doses, by the bowel, for uraemic convulsions (Id). Potassium Salts given in Bright’s Disease increase the danger of uraemia, hence Sodium salts are preferred (Id). Naphtalin, also Iodoform and Charcoal, as intestinal disinfectants, as much of the toxic material in the blood has been reabsorbed from the bowel (Bouchard). Amyl Nitrite or Nitroglycerin, and brisk purgation, to relieve the dyspnoea. Ether, in doses of 3j for the dyspnoea. Saline or Hydragogue Cathartics, are of great importance to se- cure elimination by the intestinal canal and to relieve the blood-pressure (B); pur- gation by salines on the first appearance of uraemic symptoms (Y). Colchicum, is an excellent derivative in these cases and acts best when combined with other purgatives (B). Elaterium, gr. xV to to procure free watery evacua- tions,—cautiously ! (B); the compound powder of Elaterin, gr. \ to iij, may be thrown on the tongue and washed down with a teaspoonful or two of water (Y). Transfusion, in uraemic convulsions (B). Hot Pack or vapor-bath, to induce powerful diaphoresis (B); the hot wet-pack or hot air bath, may be given daily or oftener when uraemia is threatening. Milk is the only admissible food. Venesection, 10 to 20 ounces of blood from the arm gives striking relief in acute forms of uraemia in the robust (Y); leeches to the temples for the headache (Id). [Compare Coma, Convulsions, Bright’s Disease, Scarlet Fever, and the Lists of Diaphoretics and Diuretics on pages 52 and 54.J Uraemia. 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, 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). Electricity, a weak galvanic current, with negative pole to the stricture, will destroy it in 2 or 3 sittings by electrolysis, and if carefully done, is the most efficient and least painful method of treatment for radical cure. Urethral Stricture. Urethritis. Aconite, is used to advantage in urethral fever; also for prevention of chill after passage of sound (Pf, W). Strophanthus, efficient in preventing rigors after instrumentation on the urethra, the tincture in doses of 5 minims (Fen- wick). Silver Nitrate, locally, very efficient in chronic urethritis in females (W). Tannin, on bougies, once a week for 15 minutes, most efficient for URINARY DISORDERS. 803 urethritis in the female (Wa). Zinc Sulphate, cast in sticks, for introduction into the urethra (Wa). Myrtol, internally, in chronic inflammation of the bladder and urethra (Br). 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 fe- males, etc.; many cases of aborted gonorrhoea (so-called) were really simple urethritis (Otis). [Compare Gonorrhoea.] Urinary Disorders. Aconite, of great service in sub-inflammatory retention from chill (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). Diuretin, a remarkably efficient diuretic in cardiac and renal dropsy, 15 grains several times daily will increase the urine three and fourfold. Digitalis, holds high rank as a diuretic, 3j or ij of the infusion night and morn- ing, or oftener if necessary ; in sudden suppression from cold or damp, or after scarlatina if danger threatens (P). Benzoic Acid, or Sodium Benzoate, in 10 to 15-grain doses, to render alkaline urine acid, and check the formation of phosphates (B); this acid and its salts are the only certain means we possess by which to neutralize morbid alkalinity of the urine (see page 184). Salol, is quicker in its action on the urine than Ammonium Benzoate (see page 53). 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, a favorite remedy with Sir Henry Thompson, in pint doses daily of its infusion or decoction ad Oj), for strangury, cystitis, and many other complaints, connected with the urinary ap- paratus. Alkalies, to neutralize acid urine, and control chronic cystitis ; the Liquor Potassse preferable to the bicarbonates, tartrates, and citrates, which all have diuretic action and increase the frequency of micturition ; Liquor Potassae mixed with the tinctures of Hyoscyamus or Belladonna, may undergo chemical changes, but the combination 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 implicat- ing the ureters, and even the kidneys (P). Water, copious injections are bene- ficial in some cases of suppression (R). [Compare the Lists of Diuretics and other agents acting on the urine, on pages 52 et seq. also the articles entitled Bladder irritable, Bladder paralysis of, Chyluria, Cystitis, Dia- betes insipidus, Dysuria, Dropsy, Enuresis, Hematuria, Lithiasis, Nephritis, Oxaluria, Uraemia, Urethral Stricture.] R. Pulv. Scillse, Pulv. Digitalis, Hydrarg. Chlor. Mitis, aa gr. xij. M. ft. pil. no. xij. Sig.—One pill as a diuretic twice daily. (Sir A. Clark.') Prescriptions. R. Tinct. Digitalis, .... gss-j. Spt. Nitrosi, . . g iij. Liq. Ammon. Acetat., . . Aquse, q. s. ad 3 vj. M. Sig.—One-sixth every 3 hours, to re-establish the renal secretion. (Goodeve.) R. Potassii Citratis, 3j. Sodii Bicarbonat., . . . . Z v. Syr. Limonis, ,^j. Aquse, q. s. ad 3 iv. M. Sig.—A teasp. every 2 hours, to render the urine alkaline. (Roberts.) R. Potassii Bicarb., .... 3 iijss. Acidi Acetici, z vj. Aquse, J iij. M. Sig.—Teasp. doses as required, as a diuretic. Each dose contains about gr. x of Potassium Acetate. 804 URTICARIA—UTERINE AFFECTIONS—CANCER. R. Acidi Benzoici, gij. Sodii Boratis, . . . . ziij. Aquae, 3 XU- M. Sig.—A teasp. in water, thrice daily, to keep urine acid. {Evimett.) R. Ext. Belladon. FI., . . . gss-j. Ext. BuchuFl., .... 3j. Spt. Aitheris Nitrosi, . . 3 ij. M. Sig.—A teasp. 3 or 4 times daily, for dysuria in women. Urticaria. Antipyrin, internally, is promptly efficient in urticaria, also in the urticaria- like eruptions of children. Chloroform, as ointment to allay itching (R). Potassium Cyanide, or Hydrocyanic Acid (R). [See PRURIGO.] Nitric Acid, as dilute wash, controls itching and prevents wheals (R). Benzoin, the com- pound tincture painted on the skin for itching (R). Sodium Salicylate, gr. ij every hour, is remarkably efficient (Smith) ; gr. xx thrice daily is effective. Copaiba, in full doses will produce urticaria, but drop-doses every hour will sometimes control it (Smith). Strychnine, with emetics and purgatives, when the affection is chronic (Guibout). Colchium, in gouty persons (R). Lead, in lotions to ease itching (R). Alkalies (R). [See Prurigo.] Warm Baths, may be employed with benefit. Prescriptions. R. Acidi Benzoici, gr. viij. Aquae, ]§iv. M. Sig.—Lotion for urticaria. [Squire.) R. Atropinae Sulphat., . . . gr. ]/(,. Aq. Destil., Glycerini, . Pulv. Tragacanthae, . . . q.s. Ft. pil. no. x. Sig. One bis die. Uterine Affections. 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. uV ter die, after meals (Wa). Carbonic Acid, injected up the vagina for neu- ralgia of the uterus (R). 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 and villosities, regulates the menses, improves appetite and digestion, acts as a general alterative, over- comes barrenness, 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 uterine 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 Abortion, Amenorrhcea, Climacteric, Dysmenorrhcea, Endometritis, Hemorrhage post-partum, Leucorrhcea, Menorrhagia, Menstrual Disorders, Metritis, Metrorrhagia, Prolapsus uteri, etc.] Uterine Cancer. Conium, useful as a palliative, 5iij—iv ad Oj aquae, as injection for the ex- treme pain of uterine cancer (Wa). Arsenic, small doses for a long time, with a strong solution of Iodine and Glycerin locally (Atlee); is believed to retard the growth of uterine cancer (Br). Carbonic Acid, injected vaginally, to relieve the pain (R). Opium, stands first in the list of palliatives, quieting irritation, allaying pain (Wa). Morphine, the specific action thereof upon the uterine circulation should be utilized in hopeless cases of this disease (Lutaud). [See UTERINE CONGESTION AND HYPERTROPHY. 805 page 367.] 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 ; is still better 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). Chloro- form Spray, for some minutes (R). Cannabis Indica, to allay the pain (W). Thyroid Extract, used internally with apparent curative results in three cases of carcinoma of the cervix (Bell). Surgical Measures, are to be advised, as medicines can only serve as palliatives. Uterine Congestion and Hypertrophy. Aurum Salts, often beneficial in chronic metritis with scanty menstruation (B). Ergotin, 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 (G). Carbolic Acid, undiluted, on cotton-wrapped probe, no better treatment for uterine catarrh (B). Iodine, has proved the most valuable of all remedies as a local stimulant, and a reliable alterative (E) ; and excitant of uterine contraction ; 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 conditions ; 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 (G); 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 (Thomas). Glycozone, as an application in tumefied conditions of the cervix and uterus, is far superior to pure glycerin (Edson). Potassa, Caustic Potassa and Potassa cum Calce, are said to be effective in chronic metritis ; must be used cautiously (B). Chromic Acid, a strong solution to interior of uterus, a very useful appli- cation. Ipecacuanha, in subacute metritis of the puerperal state (Tr). Iron, locally in uterine catarrh (R); as a tonic, Iron and other restoratives, a 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 hyper- trophied; 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). Mammary and Parotid Extracts, used with signal benefit as internal remedies in several cases of subinvolution and menorrhagia (Bell). Scarification, after dry cupping, in chronic metritis (Thomas). 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 con- gestion, which is generally venous ; elevated 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, abdominal bandage, skirt-supporters, pessary if anteversion or retroversion, abstinence from sexual intercourse (Thomas). R. Ext. Humuli, £). Elix. Ammon. Valerianat., Syr. Lactucarii, . . . . aa 3; ss. M. Sig.—A dessertsp. at bedtime, or during the day when needed, as an anti- spasmodic. (Goodell.) Prescriptions. R. Iodi, Potass. Bromidi, . . . aa gr. xx. Tinct. Iodi, gj. Aq. Destillat., . . q. s. ad giv. M. Sig.—npxxx to be injected into the cervix by 3 to 5 punctures. (Goodell.) 806 UTERINE DISPLACEMENTS TUMORS—ULCERATION. Anteversion, without prolapsus, is 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 where cellulitis exists (E). Cotton Roll, as a substitute for the orthodox pessary, is far superior ; use Borated Cotton in flat sheets, rolling it into a roll 2 inches long by 1 inch diameter, and saturating in Boroglyceridi %j, Alumini Acetatis §j, Glycerini Pur. q. s. ad Oj; if an astringent is required, the Acetate may be replaced by Alumini Sulphas (Wylie). [Compare Prolapsus Uteri.] Uterine Displacements. 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-grain 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 thus 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 fibroid tumors should be used freely, regardless of the opium habit (Editorial, N. Y. Medical Record, Dec. 10, 1887). Mammary Extract, used as an internal remedy with signal benefit in two cases of uterine fibroid (Bell). Ammonium Chloride, in fibrous tumors, gives more benefit than any other remedy, gr. x, twice or thrice daily, for weeks and months consecutively (Atlee). Ferrous Subsulphate, in jected to restrain bleeding, cautiously ! (B) Saline Mineral Waters, especially those at St. Catherine’s, Canada, are useful (B). Aliment, carefully regulated, chiefly animal food, with recumbent 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 a topical appli- cation 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, lb 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 Creosote 1 part, an excellent application to ulcers of the neck. Gly- cozone, as an application to ulcerated cervix, is far superior to pure glycerin (Edson). [See under Leucorrhcea, for manner of application.] Bismuth Subnitrate, with enough glycerin to make a thick cream, is the best of all appli- cations for ulceration of the os and cervix uteri (Suesserott). Vegetable Astringents, infusions or decoctions of Galls, Oak-bark, Hamamelis, Geran- ium, Alum-root, etc.; the Glycerite of Tannin, or Iodoform and Tannin, packed around the cervix (B). UVULA VARI CELL A. 807 Uvula. Tannin, Rhatany or Zinc, as .astringent lozenges, for relaxed uvula (A). Cocaine combined with extract of Krameria, in a pastile, is often very effectual as a local astringent for elongated uvula (Hall); a 20 per cent, solu- tion applied by the spray or brush, will often suffice to give relief in acute uvu- litis (Id). Ammonium Bromide, gr. xx ad jfj aquae, as gargle, is one of the best applications, being as soothing as it is astringent (Muirhead). Amputation of the elongated part (A); after applying a 20 per cent, solution of cocaine, by Mackenzie’s uvulatome, or the uvula may be seized with forceps and a portion be cut off with scissors (Hall); the hemorrhage may be severe and may recur some hours after the operation, but will be arrested by slowly sipping a mix- ture of Tannin 360 grains, Gallic Acid, 120 grains and Water gj (Mackenzie). Aconite, with Belladonna Ointment for erysipelatous redness after vaccina- tion (R). Zinc Oxide, dusted over, to allay the subsequent local irritation (Wa) ; with Pulv. Amyli, equal parts, over the surface. Lead Acetate, 3j 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, as anaesthetic, to ascertain cause, usually a displacement, fissure, or cellulitis (E). Hygiene, sun-baths, hot-water injections, fresh air, removal from husband, etc. (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): Atthill removed a narrow strip of mucous membrane on each side of the vaginal orifice with marked success in a very severe case. Cocaine, in ointment with Morphine and Conium, smeared over the painful spot with the finger; or in a pessary with Iodoform and extract of Belladonna, may give speedy relief (Whitla). Iodoform, in suppository when redness and excoriation ; but Belladonna, the extract i part with 8 or 9 of fresh lard, when pain alone (Gallard). Tents, to gradually dilate the vagina, may be impregnated with various sedatives (Id). Vaginitis. Silver Nitrate, in solution, gr. xl to the applied within the cervical canal and over the vaginal mucous lining (E). Pinus Canadensis, the concentrated, colorless extract, locally, has a very soothing effect in acute vaginitis. Tannin, the glycerite in chronic vaginitis of children (R). Emolients, with Opium, as injections (Goodsell). [Compare Gonorrhoea, Leucorrhcea.] Varicella. Ammonium Acetate, in diaphoretic and antifebrile mixture. [See Fever, Simple, for formula.] Inunction, with Camphorated Oil, or thin starch, to relieve itching and allay inflammation (P). 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). 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 symp- tomatically. 808 VARICOCELE—VARICOSIS VARIOLA. 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 obliterating 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. yi-] every 3, 4 or 6 hours, to dilatation of pupil and some stupor, found effectual (Wa). Carbolic Acid, is used with decided advantage (Wa) [See Measles] ; has been much used on theoretical grounds, but not with success (B). Ammonium Carbonate, has had cheering success (Wa). [See Scarlet Fever.] Quinine, small doses in adynamic states, larger in hyper- pyrexia (B). Chloral, temperature high, much delirium and restlessness (B). Opium, low, muttering delirium ; not so much used now as formerly (B) ; Mor- phine 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). Carron Oil (see page 200), makes a good dressing for the face. Vaccinia Antitoxin, has been used in a few cases with much success by Beclere (see page 156). Iron and Quinine, in large doses by the mouth, also Ergotin by deep parenchymatous injection, and Turpentine by the bowel, in the hemorrhagic form of the disease (Whitla) ; these two drugs are the most valuable antiseptics in variola (Moore). Eucalyptus, the Oil as inunction from the very commencement of the disease, is to be strongly recommended as an antiseptic application to the skin (Whitla). Water, as cold baths and cold pack, of great utility (B) ; packing especially on retrocession of rash (R). External Applications, as powdered starch, flour, or 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 drunk freely. Fats, bacon-fat smeared over the face, to allay itching and prevent pitting. Treatment, in no way differs from that of the other eruptive fevers. Stokes’ three indications for treatment are accepted by other authorities and are: (1) exclusion of air, (2) keeping the parts in a permanently moist state so as to prevent hardening of Variola. VERTIGO VOMITING. 809 the scabs; and (3) lessening of the local irritation (Whitla). [Compare Vac- cination.] Vertigo. Digitalis, in small doses, alternately month by month with tincture of Larch, and a long course of Iron Citrate 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 bowels and diet. Cod-liver Oil, for giddiness of the aged, when no serious brain-disease (R). Aurum, in vertigo and vertiginous sensations connected with gastric disorders or due to cerebral anaemia, which are often removed by a course of the salts of gold (B). Quinine, in aural vertigo (Meniere’s disease), 10 to 15 grains daily, continued with intervals for several weeks (Charcot). Electricity, the constant current daily, anode over cervical vertebrae, cathode over the ear, the current strength being gradually increased to toleration and continued from 3 to 5 minutes at a sitting, is of great benefit in aural vertigo, ameliorating the condition in most cases. Nitro-glycerin, gives good results in epileptic vertigo (Br). Vertigo is usually symptomatic of disorder of the stomach, or of the liver (cholaemia), sometimes of general debility, rarely of disease of the brain (H). Vomiting. 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 morning vomiting of drunkards, and that of pregnancy (Smith). Nux Vomica, stands next to Arsenic, is useful in many ways (B); maybe given with Ipecac, especially when tongue coated (R). Ipecacuanha, in small doses, will arrest certain kinds—a curious fact; especially useful in certain forms, try of Vinum Ipecac every ]/2 hour or more (B, R, P); in sick stomach of nervous origin, minute doses are of undoubted value (W). Cocaine, in doses of gr. % thrice daily, controlled the vomiting of gastric carcinoma, 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 (Jennings). Potas- sium 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 (Smith). Opium, will arrest many kinds, best in that of biliary or renal calculi, dysmenorrhoea, sea-sick- ness, pregnancy; Morphine, hypoder. gr. T to *4 (P). Codeine, in doses of gr. usually answers exceedingly well in vomiting from almost any cause (Braithwaite). Cocaine, in 2 per cent, solution as spray high up the nasal passages (see under Nausea). Bryonia, for bilious vomiting and headache (P). Veratrum Album, in vomiting and purging of summer diarrhoea (R). Hydrocyanic Acid, often very serviceable in nervous vomiting, acts promptly if at all (R). Hydrobromic Acid, gss jn Qf 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 vomiting only ; not in the gastric form (B); Potassium Bromide in 810 VOMITING OF PREGNANCY. that of uterine disease (W); Strontium Bromide is excellent in vomiting due to various causes ; gr. x-xv twice daily with meals. Phenocoll, with Piperazin, gr. xv of each daily in a pint or more of carbonated water, was of great service in a case of uncontrollable vomiting which had resisted every known remedy. Menthol, has successfully checked persistent vomiting after all the usual remedies had failed, in the hands of many well-known observers ; tt\,x of a 20 per cent, solution in Olive Oil, dropped on powdered sugar, each dose being about 1 grain (Weil). Sulphurous Acid, b\,v-3j. well diluted, or less effec- tively, Sodium Sulphite; 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). Iris, in vomiting with blinding right supraorbital pain, liver deranged (P). Bismuth, in many forms of vomit- ing in children, especially when from gastric catarrh (R). Carbolic Acid, with or without Bismuth (B) ; in nervous vomiting (W). Creosote, in the vomiting of cancer, gastric ulcer, etc. (R) ; gtt. j-ij (W). Cinnamon or Cloves, will check vomiting (P). Calumba, in vomiting from kidney disease and renal calculi; frequently allays that of pregnancy and dentition (P). Serpentaria, for bilious vomiting (P). Cerium Oxalate, in that of pregnancy and from cancer (B): gr. j every three hours (R). Ammonium Carbonate, may relieve vomiting when the ejected matter is acid (B). Peptenzyme, is highly efficient. Pepsin, for vomiting of food after meals, gr. x-xv before or during meals. Lime-water, is a favorite remedy for vomiting, especially in children: Milk and Lime-water often relieve when other methods fail (B). Sodium Bicar- bonate, 3ss-j to a pint of milk, for infants, especially if constipated (R); the effervescing soda powders in the vomiting of acute diseases and the exanthe- mata (B). Kumyss, proves effective when no other food will be retained. Carbonated Water, is an efficient remedy. Ice, sucked, with horizontal posture, also absolute rest and quiet (Wa) ; iced champagne, every % hour (B). Alcohol, iced brandy or champagne in spoonful doses every hour in vomiting of cholera, pregnancy, and delirium tremens (B). Counter- Irritation, at epigastrium (R). Nutrient Enemata. (See under Enemata.) [Compare the list of Anti-emetics, on page 45, also the articles entitled Cholera, Hematemesis, Nausea, Sea-sickness, Vomiting of Pregnancy.] Prescriptions. R. Ac. Hydrocyan. Dil., . . zj. Aquae Laurocerasi, . . . !|ij. M. Sig.—A teasp. every 2 hours, for nervous vomiting. R. Ac. Hydrobromici Diluti, . Sig.—Half a teasp. in a winegl. of water, 4 times daily. Vomiting of Pregnancy. Ipecacuanha, or Nux Vomica, either will generally succeed where the other fails (R) ; no other remedy of equal value to Ipecac (P). Nux Vomica, is use- ful 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). Creosote, 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); 3ss doses thrice daily, exceedingly effective in the combined diarrhoea and vomiting of pregnancy; the first dose should be given an hour before rising. Strontium Bromide, proved entirely successful in severe cases ; gr. xv in water with meals, twice daily, for a month. Hydrocyanic Acid, often the best remedy (P). VULVA AND VULVITIS WARTS. 811 [See ante, Vomiting.] Copper Sulphate, sometimes effective, not more than gr. ter die (B). Iodine, of the tincture in of sweetened water repeated in hour, of magical effect in a bad case which had resisted every other treatment; is often useful (B). Menthol, has proven very successful in obstinate cases (see formula below). Cocaine, locally to cervix, promptly cured a most intractable case of several months’ duration, though it failed when used internally (Boys) ; has given excellent results when used internally in tablet triturates of grain each (or see formula below): a 2 per cent, solu- tion sprayed high up the nasal passages (see under Nausea). Calumba, as tincture often useful, drop-doses every hour or two (B). Bismuth, and Car- bolic Acid are effective (B). Atropine, frequently effective (R) ; never failed to give relief in many years of using it (Boys). Ether, sprayed over the epi- gastric 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 to this complaint, having acted marvellously in several cases in which I have used it (Sweringen). Peptenzyme, is said to be very efficient. 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, it maY be said that it is a safe and sure remedy (Copman). Ice- bag to spine, an efficient measure (R). Vesication, a single blister over the 4th and 5th dorsal vertebrae, never failed for many years to put an end at once to the sickness of pregnancy for the whole remaining period of gestation (Harkin, in Lancet). R. Atropinae Sulphatis, . . . gr. j. Morphinae Sulphatis, . . . gr. iv. Acidi Sulphurici Aromat., 7, iij. Aquae, gv. M. Sig.—Ten to twenty drops, thrice daily. [Boys.) Prescriptions. R. Cerii Oxalatis, gr. xij. Ipecacuanha;, gr. xv. Creosoti, gr. xxiv. M. ft. pil. no. xij. Sig.—One every hour. (Goodell.) R. Bismuthi Subnitrat., . . . gr. clx. Cerii Oxalatis, gr. xl. Morphinae Sulf>hatis, . . . gr. jss. Syrupi, et Acaciae, q. s. ad%ij. M. ft. emulsum. Sig.—A teasp. every hour until vomiting ceases. ( Van Va/zah.) R. Cerii Oxalatis, ... . gr. xxiv. Ext. Hyoscyami, .... gr. xxxvj. M. ft. pil. no. xij. Sig.—One pill twice daily. (Goodell.) R. Cocainae Hydrochlor., . . gr. xv. Acidi Carbolici, .... TT^x. Aq. Cinnamomi, . . . . Sss. Syr. Zingib., . . . q. s. ad£j. M. Sig.—io drops gradually increased to 20, in a little water every hour until re- lieved, then every 2 or 3 hours. [Potter.) R. Mentholi, gr. xx. Alcoholis, Z vjss. Syr. Simplicis, . . q. s. adf, ij. M. Sig.— every hour. [Potter.) Vulva and Vulvitis. Sodium Hyposulphite, an unfailing remedyjin lotion for aphthae of the vulva (R). Arsenic, much used for eczema (T). Lead Acetate, a concentrated solu- tion in glycerin locally for eczema of vulva (T). Alum, as lotion in vulvitis of children ; gr. lx to Oj aquae, or less strong if found to increase discharge (R). Lead, solutions of the Acetate as wash, after the acute stage has subsided. Lime-water, as wash (R). [Compare Pruritus, Prurigo, 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, 812 WEN—WORMS. night and morning (P). Iron, the tincture of the Chloride and dilute HC1 Acid, equal parts applied night and morning, very effective (Bulkley). Nitric Acid, 3 j-ij of the dilute acid to a pint of water, as wash to keep small syphilitic warts constantly moist (R). Sabina, as caustic (P) ; 1 part to 2 of Alum (Wa). Rue, the Oil, with honey, locally (P). Arsenous Acid, as a caustic ; enough to be used to excite active inflammation ; or Liq. Arsenicalis painted over warts (R); may be taken internally (B). Mercurial Ointment, containing 5 per cent, of Arsenic, ora plaster having in each 8 square inches 154grains 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 aquae, 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 be best 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 (Wilson). [Compare Condylomata.J 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. Worms. Santonin, the best anthelmintic, a laxative in the morning, fast 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 (P); for round and thread-worms, give in Castor Oil by mouth, or as injection (R). Iron, the strup of the Iodide internally and a solution of the tincture locally, for ascarides (B); the Tinct. Ferri Chlor. ad Oj aquae, a good injection for thread-worms, coagulating their albumen (R). Quassia, the infusion an effectual injection, conjoined with simple bitters internally, for ascarides (R). Lime-water, as injection for thread-worms (R); iij—iv 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). Eucalyptus, as injection, for ascarides (B). Aloes, are efficacious for ascarides (P). 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). Myrtol, is efficient against ascarides and round worms (B). Filix Mas to be taken on an empty stomach for tape-worm, and followed by a purge (P). Pepo, %\j as emulsion, taken fasting, one of the most efficient remedies against taenia (B). 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, 3) in %j of mucilage, after 20 hours’ fasting, followed one hour later by of Castor Oil, this is an adult dose, 3) should never be exceeded (Wilde). Kamala (Rottlera), excellent for taenia, WOUNDS. 813 requires no purge (P); gr. cl-clxxx for an adult (Wa). Cusso, the fluid extract in dose of 3ij to 5j, or the same quantity of the flowers infused in giv of boil- ing water, for both varieties of the tape-worm [see page 264]. Naphtalin, an excellent all-round anthelmintic, of high value for ascarides and taenia, thor- oughly reliable for all kinds of intestinal worms, giving prompt and complete results invariably, with entire absence of all unpleasant symptoms; a single dose of gr. xv removed tape-worms entire (Mirowicz); for adults a dose of Castor Oil should follow, but for children it is preferable to give both together (see page 350). Potassium Iodide, gr. xxxvj, Iodine, gr. xij, Water ten drops thrice daily in water, caused the expulsion of a tape-worm 11 yards long, of which there were no previous symptoms, and proved successful in other cases (Newington). Ailanthus, a decoction of the fresh bark, for taenia (B). Turpen- tine, as poison for tape- and thread-worms (R); for taenia (Wa). Tonics, as Iron, Cod-liver Oil, etc., to restore the intestinal canal to a healthy condition (R). [Compare Chyluria, also the List of Anthelmintics on page 49.] R . Chloroform i, Ext. Filicis Maris, . . . aa:jj. Emulsi. Ol. Ricini (50 per cent.), ........ iij. M. Sig.—One dose after 24 hours’ fast- ing. Does just as well if Male Fern be omitted. {Smith.) Prescriptions. R. Granati Corticis, gij. Ft. infusum. Sig.—To be taken before ii A. m.—and followed after 2 hours by— R. Ol. Ricini, g iij. 01. Terebinth., Ext. Filicis Maris .Ether., sjj. M. ft. haustus. Fasting unnecessary. (Wilde.) R. Ext. Spigelise FI., . . . . Sj. Ext. Sennse FI., ... 3SS. M,. Sig.—A teasp. to a child of 3 to 5 years. {Smith.) R. Magnesii Sulphat, . . . 5 ij. Sodii Chloridi, J ss. M. Sig.—An ounce in half a glass of water, with gtt. v of Carbolic Acid, night and morning, for ascarides. Persevere. (Barkley.') R. Ext. Spigelise et Sennse FI., % j. Santonini, gr. viij. M. Sig.—A teasp. to a child of <5 years. (Smith.) 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). Bismuth Subiodide, dusted into a wound one of the most efficient antiseptics, non-irritant, and a prompt stimulant of granulations ; an excellent dressing for wounds after approximation of the edges, the powder to be dusted thickly over the edges, and thoroughly smeared with Flexible Collodion. Dermatol (Bismuth Sub- gallate), is an excellent non-irritant vulnerary, having great stability, and valuable drying and bactericidal qualities. Europhen, is an ideal application to sores and wounds, also for the many protective requirements of minor surgery ; is used as a dusting powder, or as a 5 to 10 per cent, ointment, with Lanolin, as a base. Aristol, is very efficient, or a mixture of Aristol and Europhen, equal parts of each ; Aristol is an excellent substitute for Iodoform, and odorless. Acetanilid, in fine powder dusted over the surface of wounds and other breaches of tissue (see page 69). Alumnol, a powerful astringent, dessicant and antiseptic, and reaches the deep recesses of wounds (see page 121). Iodoform, powdered and dusted over sloughing wounds, irritable and ill- conditioned ulcers and 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. 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 antiseptics, for washing a wound or cavity, and for Wounds. 814 YELLOW FEVER. saturating the dressings (see List of Antiseptics on page 60). Boracic Acid, also applicable as Carbolic Acid (B). Balsam of Peru, excellent for closing recent wounds (P). Benzoin, the basis of all the healing balsams (P). Aloes, topically as a slight stimulant; often purges (R). Gum Tragacanth, a thick aqueous solution to granulating surfaces, to protect them from the air (Wa). Opium, internally to quiet intestinal movements in wounds of the abdomen (R); forwards the reparative processes (P). Tannin, or Glycerite of Tannin, to coat over wounds (R). Collodion or Liquor Gutta-perchae, to secure primary union of incised wounds (B); as protective coyering (P). Ammonium Carbonate, gr. v hypodermically in the vicinity of wounds caused by poisoned arrows, repeatedly used with success in saving life, by Dr. Parke, the surgeon to Stanley’s last expedition in Africa. Sulphurous Acid, in solution, diluted or not, constantly 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 it to Carbolic; may be applied pure in powder to gangrenous and sloughing wounds (B). Formalin, is now the favorite surgical antiseptic (see ante, page 287). Aloes, pulverized fine, is an efficient dressing for wounds, closing them and favoring cicatrization, also relieving the pain at once, requires removal only at long intervals (Millet). Nitric Acid, as escharotic for gangrene (B). Turpentine, one of the most efficient applications in hospital gangrene (B). Galvanic Couplet, to wounds of indolent form (B). Alcohol, an excellent antiseptic dressing when suppuration ; also favors cica- trization of open wounds (B). Poultices, are often abused; of Yeast or Charcoal best for foul wounds (B). Water, in universal use as dressing ; cold water often abused, hot-water dressing as advocated by Hamilton, promises better results (B). Turkish Baths, for pain in the seat of old wounds (R). Ice and Salt, applied to wounds prevents inflammation (R). [Compare Bed- sores, Gangrene, Hemorrhage, Inflammation, Pyaemia, Surgical Fever Ulcers.] Prescriptions. R. Collodii, §j. Olei Ricini, Acidi Carbolici, . . . . aa^ss. M. Sig.—Carbolized Collodion, for wounds. R. Acidi Tannici, Alcoholis Absolut., . . . Sss. Aitheris, g ijss. Collodii, 3 xij. M. Sig.—Styptic Collodion. 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 C). Diaphoretics and Diuretics, also Laxa- tives, are very important throughout the disease (Da C). Pilocarpine, in dose ofgr. X 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- 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). Lime-water, 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, io-minim doses of a 4 per cent, solution, by mouth, every hour for 2 or 3 doses, acts like a charm Yellow Fever. YELLOW FEVER. 815 (Jennings). Chloroform, for the vomiting, a few drops to prepare the stomach for reception and retention of food; its 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, accord- ing to age, till pulse and temperature subdued ; successfully used in connection with Mercury, etc. (White and Ford). Stimulants, only in the 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 quan- tities, is the best aliment; in convalescence, the utmost care is necessary in giv- ing aliments (B). Rest is very important (Da C). Iced Champagne, in table- spoonful doses every % hour, for the vomiting (B). Purgation, throughout the disease (Da C). [Compare Remittent Fever.] Prescriptions. H- Potassii Carbonat., . . . gr. xx. Tinct. Opii Camphorat., . gj. Aquse, 5yi>j- M. Sig.— every hour or two, as a diaphoretic. (Dickson.) 1£. Chloroformi, Tinct. Camphoree, . . aa ss. M. Sig.—Two drops as required for the vomiting. APPENDIX. LIST OF CONTRACTIONS AND LATIN PHRASES USED IN WRITING PRESCRIPTIONS, WITH THE CORRESPONDING ENGLISH EQUIVALENTS. Contraction. Word or Phrase. English Equivalent. aa. Ana Of each. Abd. Abdomen, gen. inis The belly. Abs. feb. Absente febre Fever being absent. Acc. . Accurate Accurately. Acerb. Acerbus, a, um Sharp, sour, harsh (to taste). Acerbit. Acerbitas, gen. atis. Sourness. Ad. Ad (prep. gov. acc.) To, up to. Ad concil. gust. Ad conciliandum gustum To suit the taste. Ad 2 vie. Ad duas vices At twice taking. Ad sec. vie. Ad secundum vicem To the second time. Ad 3 tiam vie. Ad tertiam vicem For the third time. Add. Adde, Addantur Add, Let them be added. Add. Addendus, Addendo To be added, By adding. Add. c. trit. Adde cum tritu Add with trituration. Ad def. an. Ad defectionem animi To fainting. Ad grat. acid. Ad gratam aciditatem To an agreeable sourness. Ad grat. gust. Ad gratum gustum To an agreeable taste. Adhib. Adbibendus To be administered. Adjac. Adjacens Adjacent. Ad lib. Ad libitum At pleasure. Admov. Admove, Admoveatur Apply, Let it be applied. Ad. part, dolent. Ad partes dolentes To the painful (aching) parts. Ad. sat. Ad saturandum To saturation. Adst. feb. Adstante febre The fever being on. Adv. Adversum Against. Aig. The sick one, the patient. Aggr. feb. Aggrediente febre While the fever is coming on. Agit. Agita Shake, stir. Agit. Agitetur Let it be shaken or stirred. Agit. ante sum. Agita ante sumendum Shake before taking. Agit. vas. Agitato vase The vial being shaken. Alb. Albus, a, um White. Aliq. Aliquot Some. Alt. Alter The other. Alt. hor. Alternis horis Every other hour. Aluta Aluta Leather. Alv. Alvus The belly, the bowels. Alv. adst. Alvo adstricta The bowels being confined. Amp. Amplus Large. Ampul. Ampulla A large bottle. App. Appone, Applica Apply, Lay or put on. Aq. Aqua Water. 816 LIST OF CONTRACTIONS AND LATIN PHRASES. 817 Contraction. Word or Phrase. English Equivalent. Aq. astr. Aqua astricta Frozen water. Aq. bull. Aqua bulliens Boiling water. Aq. com. Aqua communis Common water. Aq. ferv., vel calid. Aqua fervens, vel calida Hot water. Aq. fluv. Aqua fluviatilis River water. Aq. font. Aqua fontana, vel fontis Spring water. Aq. gelid. Aqua gelidus Cold water. Aq. mar. Aqua marina Sea water. Aq. niv. Aqua nivialis, vel nivalis Snow water. Aq. phag. Aqua phagedsenica Yellow wash. Aq. pluv. Aqua pluvialis Rain water. Aq. pot. Aqua potabilis Drinkable water. Aq. satur. Aqua saturni Lead-water. Aq. urb. Aqua urbis City water. Aqual. Aqualis Pertaining to water. Aquil. alb. Aquila alba Calomel. Aut Aut Or. B. A. vel Bal. ar. Balneum arense Sand-bath. B. M. vel Bal. mar. Balneum maris Salt-water bath. B. V. vel Bal. vap. Balneum vaporis Vapor-bath. Bals. Balsamum Balsam. B. B. Barbadensis Barbadoes. Bene Bene Well, good. Bib. Bibe, vel Bibatur Drink (thou), Let it be drank. Bid. Biduum Two days. Bis Bis Twice. Bis die Bis in die, vel dies Twice a day. Bol. Bolus A large pill. Bon. Bonus Good. Brach. Brachium l'he arm. Brev. Brevis Short. Bull. Bulliat, vel Bulliant Let it (or them) boil. But. Butyrum Butter. C. Cum With. Cc. Centimeter cubicum Cubic centimeter. Cserul. Cseruleus, gen. i Blue. Calef. Calefactus, gen. i Warmed. Calom. Calomel, vel Calomelas Mild Chloride of Mercury, Calomel. Calor. Calor, gen. oris Heat, warmth. Cap. Cape, vel Capiat Take (thou), Let him take. Cap. quant, vis Capiat quantum vis Let him take as much as he will. Capil. Capillus, gen. i A hair. Capsul. Capsula, gen. se A capsule. Caput Caput, gen. Capitis The head, of the head. Carbas. Carbasus, gen. i Linen, lint. Caute Caute Cautiously. Ccu. Cucurbita A cupping-glass. Celer. Celeriter Quickly, immediately. Cena Cena, vel Coena Supper. Chart. Charta Paper. Chart, cerat. Charta cerata Waxed paper. Chartul. Chartula A small paper. Chin. Chininum Quinine. Cib. Cibus, gen. i Food, victuals. Circit. Circitu Near, around, about. Cit. Cito Quickly. Cito disp. Cito dispensetur Let it be dispensed quickly. Clar. Clarus, a, um Bright, clear. Claus. Clausus, a, um Closed, inclosed. 818 LIST OF CONTRACTIONS AND LATIN PHRASES. Contraction. Word or Phrase. English Equivalent. Coch., Cochleat. Cochleare, Cochleatim A spoonful By spoonfuls (3 j). Coch. amp. Cochleare amplum A dessertspoonful (,^ij). Coch. mag. Cochleare magnum A tablespoonful (3SS). Coch. med. Cochleare medium A dessertspoonful (gij). Coch. parv. Cochleare parvum A teaspoonful (3 j). Coct. Coctio Boiling. Cog. Cogantur Let them be combined. Col. Cola Strain. Colatur. Colaturse To (or of) the strained liquor. Colat. Colatus Strained. Colet. Coletur Let it be strained. Colent. Colentur Let them be strained. Coll. Collum, gen. i The neck. Collun. Collunarium, gen. i A nasal wash. Collut. Collutorium A mouth-wash. Collyr. Collyrium An eye-wash. Coloret. Coloretur Let it be colored. Commis. Commisce Mix together. Commod. Commode Rightly, properly, suitably. Comp. Compositus Compound, compounded. Con., Concis. Concisus Cut. Concus. Concuscus, gen. i Shaken. Concut. Concuti, Concutiatur Shake, Let it be shaken. Conf. Confectio Confection. Cong. Congius A gallon. Conquas. Conquassando By vigorous shaking. Cons. Conserva, Conserve A conserve; keep, preserve. Dust, sprinkle. Consperg. Consperge Contere Contere Rub together. Cont. rem. Continuentur remedia Let the medicines be continued. Contus. Contusus Bruised. Coq. Coque, Coquantur Boil, let them be boiled. Coq. ad med. con- Coque ad medietatis con- Boil to the consumption of half. sump. Coq. S. A. sumptionem Coque secundum artem. Boil according to art. Coq. in S. A. Coque in sufficiente aquae Boil in sufficient water. Coq. simul. Coquantur simul Boil them together. Cor. Cor, cordis The heart, of the heart. Cort. Cortex, corticis The bark, of the bark. Cot. Cotula A measure. Cox. Coxa The hip. Cras. Cras. Crastinus To-morrow. Cras mane sumend. Cras mane sumendus To be taken to-morrow morning Cras nocte Cras nocte To-morrow night. Cras vesp. Cras vespere To-morrow evening. Crast. Crastinus For to-morrow, early. Cru. Cruor Blood, gore. Cucur. Cucurbitula A cupping-glass. Cuj. Cujus, Cujus-libet Of which, of any. Cum Cum With. Curs. hod. Cursu hodie During the day. Cynth., C. vinar. Cyathus, vel C. vinarius A wine-glass (^j-ij). Cyatho these Cyatho these In a cup of tea. D. Dies, Dosis A day, A dose. Da, Det. Da, Detur Give, let it be given. De De (prep. gov. ablative') From, down. Deaur. pil. Deaurentur pilulae Let the pills be gilded. Deb. spiss. Debita spissitudo To a proper consistence. Deb. Debitus, a, um Due, proper. LIST OF CONTRACTIONS AND LATIN PHRASES. 819 Contraction. Word or Phrase. English Equivalent. Dec. Decanta Pour off. Decern. Decern, Decimus, Ten, The tenth. Decoct. Decoctum A decoction. Decoq. Decoque Boil down. Decub. Decubitus Lying down. De d. in d. De die in diem From dav to day. Dein. Dein, vel Deinde Thereupon, afterward, then. Deglut. Deglutiatur Let be swallowed. Dej. alv. Dejectiones alvi Stools. Dejic. Dejiciatur Let be purged. Dent. Dentes; Dentur The teeth ; Let them be given. Det. in dup. Detur in duplo Let twice as much be given. Dext. Dexter, Dextra The right. Dieb. alt. Diebus alternis Every other day. Dieb. tert. Diebus tertiis Every third day. Dies vel D. Dies, gen. diei A day. Dig. Digere, Digeretur Digest, Let it be digested. Diluc. Diluculo At break of day. Dil. Dilue, Dilutus, a, um Dilute (thou), Diluted. Dim. Dimidius, a, um One-half. D. P., vel Dir. prop. Directione propria With a proper direction. Disp. Dispensa, Dispensetur Dispense, Let it be dispensed. Div. in p. seq. Dividatur in partes Let it be divided into equal parts. Divid. sequales Dividendus, a, um Dolor, Dolore To be divided. Dol. Pain, In pain. Don. Donee Until. Don. alv. dejec. Donee alvus dejecerit Until the bowels move. Don. alv. sol. ft. Donee alvus soluta fuerit Until the bowels shall be opened. Don. dolor, neph. Donee dolor nephriticus Until the nephritic pain is removed. exulav. Don. hab. colat. exulaverit Donee habeas colaturse Until you have of strained liquor. Don. len. dol. Donee leniatur dolor Until the pain is relieved. Don. sint res. Donee sint residuse Until there is ... of residue. Dos. Dosis A dose. Dr., 3 Drachma A drachm (60 grains). Dulc. Dulcis, Dulcitas Sweet, Sweetness. Dup. Duplico In duplicate. Dur. dolor. Durante dolore While the pain lasts. Ead. Eadem (fem.) The same. Eburn. Eburneus Made of ivory. Ejusd. Ejusdem Of the same. Elect. Electuarium An electuary. Em. Emesis Vomiting. En. Enem. Enema, Enemata A clyster or enema, Enemas. Epistom. Epistomium A stopper, bung. Et Et And. Etiam Etiam Also, besides. Evan. Evanuerit Shall have disappeared. Ex Ex (gov. ablative) From, out of. Ex quib. sum. Ex quibus sumatur From which are given. Ex mod. p. Ex modo pnescripto After the manner prescribed. Ex paul aq. Ex paululo aquae From (In) a very little water. Ex parte Ex parte Partly. Exhib. Exhibeatur Let it be exhibited. Exper. Experime Try (thou). Ext. Extende, Extendatur Spread, Let it be spread. Ext. sup. alut. Extende super alutem Spread upon leather. Ext., Extr. Extractum An extract. 820 LIST OF CONTRACTIONS AND LATIN PHRASES. Contraction. Word or Phrase. English Equivalent. Extr. Extrahe, Extrahatur Extract (thou), Let it be extracted. F. Fac Make (thou). F. L. A. Fiat lege artis Let it be made by the rules of art. F. pil. xij Fac pilulas duodecim Make 12 pills. Far. Farina Flour. Fas. lint. Fascia lintea A linen bandage. Fascic. Fasciculus A small bundle. Febr. Febris Fever. Febr. dur. Febre durante During the fever. Fern, intern. Femori interno To the inner thigh. Ferv. Fervens, gen. ends Hot. Fict. Fictilis, e Earthen, An earthen vessel. Fil. Filtra Filter (thou). Fill. Filtrum, gen. i A filter. Fistul. arm. Fistula armata A syringe ready for use. Flav. F'lavus, a, um Yellow. Flor. Flores (//.) Flowers. Fluid., FI. Fluidus Liquid. Form. Formula, Formentur A prescription, Let them be formed Frig. Frigor, gen. oris Cold. Frust. Frusdllatim In small pieces. Ft. Fiat, Fiant (//.) Let it (or them) be made. Ft. cerat. Fiat ceratum Let a cerate be made. Ft. chart, xij Fiant chartulre duodecim Let 12 powders be made. Ft. collyr. Fiat collyrium Let an eye-wash be made. Ft. emuls. Fiat emulsum Let an emulsion be made. Ft. en. Fiat enema Let an enema be made. Ft. inject. Fiat injectio Let an injection be made. Ft. pil. xij Fiant pilulse duodecim Let 12 pills be made. Ft. pulv. Fiat pulvis Let a powder be made. Ft. pulv. xij F'iant pulveres duodecim Let 12 powders be made. Ft. sol. Fiat solutio Let a solution be made. Ft. suppos. viij Fiant suppositoria octo Let 8 suppositories be made. Ft. troch. xx Fiant trochisci viginti Let 20 troches be made. Ft. ung. Fiat unguentum Let an ointment be made. Ft. venesec. Fiat venesectio Let a bleeding be done. Fuerit F'uerit Shall have been. Fus. Fuscus, a, um Brown, dark. Garg. Gargarysma A gargle. Gelat. quav. GelatinS. quavis In any kind of jelly. Ging. incid. Gingivas incide Lance (or cut) the gums. Gm. Gramma A gramme. gr- Granum, Grana A grain, grains. gr. vj pond. Grana sex pondere Six grains by weight. Grad. Gradatim By degrees, gradually. Grat. Gratus Pleasant. Gros. Grossus, a, um Large, coarse. Grum. Grumus A clot (of blood). Gtt. Gutta, Guttae, Guttas A drop, Drops. Guttat. Guttatim By drops. Gtt. quibusd. Guttis quibusdam With a few drops. H. Hora An hour. Flar. pil. Harum pilularum Of these pills. Haust. Haustus, gen. i A draught. H. p. n. Haustus purgans noster My own purgative draught. Hebdom. Hebdomada, Hebdomas A week. Herb. Herba, gen. ae An herb. Herb, recent. Herbarum recentium Of fresh herbs. Heri Heri Yesterday. LIST OF CONTRACTIONS AND LATIN PHRASES. 821 Contraction. Word or Phrase. English Equivalent. Hie, Hsec, Hoc Hie, Hsec, Hoc This. Hirudo Hirudo, gen. inis A leech. Hirud. app. Hirudines appone Apply leeches. Hor. Hora, gen. se An hour. Hor. decub. Horse decubitus At bedtime. Hor. j spat. Horse unius spatio After one hour. Hor. interm. Horis intermediis In the intermediate hours. Hor. som. Hora somni At the hour of sleep. Hor. xi matut. Hora undecima matutina At the eleventh hour of the morning. Id. Idem The same. Iden. Identidem Repeatedly, often. Idon. Idoneus, a, um Suitable, proper, convenient. Idon. vehic. Idoneo vehiculo In a suitable vehicle. 111. Illico Then, immediately. Immit. Immitatur Let it be placed in. Imp. Impone Lay on, Apply. Impr. Imprimis First, chiefly. In In In, within, upon, not. Inc. Incide, Incisus Cut (thou), Being cut. Ind. In dies Daily, or From day to day. Inde Inde Therefrom. Infun. Infunde Pour in. Infus. Infusum An infusion. Ing. Ingere, Ingerendus Put into, Putting into. Injec. Injectio An injection. Injic. enem. Injiciatur enema Let a clyster be injected. In lag. bene obt. In lagena bene obturator In a well-stoppered bottle. In loco frig. In loco frigido In a cold place. In mass. cog. In massam cogantur Let them be combined in a mass. In pulm. In pulmento In gruel. Instar Instar As big as, the size of. Inter Inter Between. Int. Internus, a, um Inner, internal, between. Intus Intus Inwardly. Invol. gel at. Involve gelatina Coat [or cover) with gelatin. Invor. Invoruntur Let them be moistened. Ita Ita In such manner. Iter. Iteretur, Iterentur Let it (them) be repeated. Jam Jam Now. Jentac. Jentaculum, gen. i Breakfast. Jucund. Jucunde Pleasantly. Jul. Julepum A julep. Juscel. Juscellum A broth. Juscul. Jusculum Soup. Jux. Juxta, Juxtim Near to, close by. K. Kali, Kalium Potassa, Potassium. Kal. ppt. Kali prseparata Potassium Carbonate. Lac. Lac, gen. Lactis Milk, of milk. Lag. Lagena, gen. se A flask, or bottle. Lam. Lamella Plate, leaf, layer, scale. Lan. Lana, en. se Flannel, wool. Lang. Languor, gen. oris Faintness. Lapid. Lapideus, a, um Stony, made of stone. Larg. Largus, a, um Abundant, plentiful. Larid. Laridum, gen. i Lard. Lat. Latus, a, um Broad, wide. Lat. Latus, gen. eris The side. Lat. admov. Latere admoveatur Let it be applied to the side. Lat. dol. Lateri dolenti To the painful side. 822 LIST OF CONTRACTIONS AND LATIN PHRASES. Contraction. Word or Phrase. English Equivalent. Lax. Laxus, a, um Loose, open. Lb., lb Libra A pound. Lect. Lectus, gen. i A bed. Len. Leniter Easily, gently. Len. ter. Leniter terendo By rubbing gently. Lev. Leviter Lightly. Lig. Ligatura A ligature. Linct. Linctus, gen. i A linctus. Linim. Linimentum, gen. i A liniment. Lint. Linteum, gen. i Lint, linen. Liq. Liquor, gen. oris A solution. Lot. Lotio A lotion. Lut. Luteus, a, um Minimum, gen. i Yellow, golden yellow. M., *1 A minim. M. Misce Mix (thou). M. Manipulus, gen. i A handful. Macer. Macera Macerate (thou). Mag. Magnus, a, um Manipulus, gen. i Large. Man. A handful. Mane Mane (indecl.) Morning, in the morning. Mane primo Mane primo Early in the morning. Manus Manus, gen. i The hand. Mass. Massa, gen. ae A mass, a pill-mass. Mat. ae A vessel, a chamber-pot. Matut. Matutinus In the morning. Med. Medius, a, um Middle. Mens. Mensura By measure. Mic. pan. Mica panis A crumb of bread. Min. Minimum A minim. Minut. Minutum * A minute. Mis. Misce, Miscetur Mix (thou), Let it be mixed. Mis. bene Misce bene Mix well. Mis. caut. Misce caute Mix cautiously. Mist. Mistura A mixture. Mit. Mitte, M i 11 a t u r , Mit- Send (thou), Let it be sent, Let tantur them be sent. Mit. sang, ad uncias Mitte sanguinem ad uncias Take away blood to 12 ounces at xij salt. duodecim saltern least. Mit. tal. Mitte tales Send of such. Mod. diet. Modo dictu As directed. Mod. pr. Modo praescripto In the manner prescribed. Modic. Modicus, a, um Moderate-sized, middling. Mol. Mollis, Molle Soft. Mor. Mora, gen. ae Delay. Mor. diet. More dictu In the manner directed. Mor. sol. More solito In the usual manner. Mort. Mortarium, gen. i A mortar. Natr. Natrium, gen. i Sodium. Ne tr. s. num. Ne trades sine nummo Do not deliver without the money. Necn. Necnon And also, and yet. Nig. Niger, nigra, nigrum Black. Nisi Nisi Unless. No. Numero, Numerus In number, A number. Noct. Noctis Of the night. Noct. maneq. Nocte maneque At night and in the morning. Non Non Not. Non repetat. Non repetatur Let it not be repeated. *This is medical Latin, or “bog-Latin.” The proper Latin for a minute of time is Sexagesimal pars horce. LIST OF CONTRACTIONS AND LATIN PHRASES. 823 Contraction. Word or Phrase. English Equivalent. Noxa Noxa, gen. x An injury. Nucha Nucha The nape of the neck. Nunc Nunc Now. Nut. Nutricius, a, um Nutritious. Nutrit. Nutritus, gen. us Nutriment. Nux Nux, gen. nucis A nut. Nux Mosch. Nux Moschata A nutmeg. 0. Octarius A pint (|xvj). Obd. Obduce Cover, conceal, coat. Obduct. Obductus, a, um Covered, coated. Obtrit. Obtritus, a, um Crushed. Occlus. Occlusus, a, um Enclosed. Oct. Octo, Octavus Eight, Eighth. Octup. Octuplus Eight-fold. Ocul. Ocul us, gen. i The eye. Odor. Odora, Odoretur Perfume, Let it be perfumed. Odorat. Odoratus, a, um Perfumed, odorous. Ol. Lini sine ig. Oleum Lini sine igne Cold-drawn Linseed Oil. 01. 0. Opt. Oleum olivse optimum Best olive oil. Olla Olla, gen. se A pot, a jar. Ollic. Ollicula, gen. se A little pot. Omn. hor. Omni hont Every hour. Omn. bih. Omni bihorio Every two hours. Omn. quadr. hor. Omni quadrante horse Every hour. Omni mane Omni mane Every morning. Omn. noct. Omni nocte Every night. Op. Opus Need, occasion. Opt. Optimus, a, um Best. Oryza Oryza, gen. se Rice. Os Os, gen. oris The mouth. Ov. Ovum, gen. ovi An egg. P. Pondere By weight. P. P. A. Phiala prius agitata The bottle having been first shaken. P. r. n. Pro re nata Occasionally, as needed. Pab. Pabulum, gen. i Food. Pallid. Pallidus, a, um Pale. Pan. Panis, Pannus Bread, A cloth or rag. Para, Parat. Para, Paratus Prepare, Prepared. Par., Pt. Pars, Partis A part, Of a part. Pt. seq. Partes sequales Equal parts. Pt. affect. Parte affecta On the affected part. Part. vie. Partitis vicibus In divided doses. Parv. Parvus, a, um Little. Parvul. Parvulus, a, um An infant, a parvule. Pastil. Pastillus, Pastillum A pastille, a lozenge. Pauc. Paucus, a, um Little, few. Paul. Paulatim Little by little, gradually. Pect. Pectus, gen. oris The breast. Pediluv. Pediluvium A foot-bath. Penicil. cam. Penicillum camelinum A camel’s-hair pencil or brush. Per Per (prep. gov. accus.) Through, by means of, very. Peract. operat. emet. Peracta operatio emetici When the emesis is finished. Percalef. Percalefactus, a, um Thoroughly heated. Percol. Percola Strain through, percolate. Per deliq. Per deliquium By deliquescence. Per fistul. vit. Per fistulam vitream Through a glass tube. Perg. Perge, Pergetur Proceed, Let be continued. Perind. Perinde Just as. Permit, vir. Permittentibus viribus The strength permitting. 824 LIST OF CONTRACTIONS AND LATIN PHRASES. Contraction. Word or Phrase. English Equivalent. Perpur. Perpurus, a, um Very clean. Pervesp. Pervesperi Very late in the evening. Pes Pes, gen. pedis The foot. Pess. Pessarium, Pessulum A pessary. Ph. Phiala, gen. se A vial, a bottle. Pil. Pilula, gen. se A pill. Pil. Pilus, gen. i The hair. Ping. Pinguis, gen. is Fat, grease. Pist. Pistillum, gen. i A pestle. Plac. Placebo I will satisfy (please). Plas. Plasma, Plasmetur Mould, Let it be moulded. Plen. Plenus, a, um Filled. Poc. Poculum, Pocillum A cup, A little cup. Pon., P. Pondere By weight. Pon. civ. Pondus civile Civil weight (avoirdupois). Pon. med. Pondus medicinale Medicinal (apothecaries’) weight. Pone aur. Pone aurem Behind the ear. Post cib. Post cibos After meals. Post sing. sed. liq. Post singulas sedes liquidas After every loose stool. Postrid. Postridie On the next day. Pot. Potus, gen. us A drink. Prse Prse (prep. gov. abl.) Before, very. Prsep. Prseparatus, a, um Prepared. Prand. Prandium, gen. i Dinner. Prid. Pridie On the previous day. Prim. man. Primo mane Very early in the morning. Primus Primus, a, um Pro (adv. and prep. gov. abl) The first. Pro For, before, according to. Prop. Proprius, a, um Special, particular. Pro rat. set. Pro ratione setatis According to the age of the patient. Pro r. n. Pro re nata Occasionally, as needed. Prox. Proximo Nearest. Pug. Pugillus A pinch. Pulm. Pulmentum, gen. i Gruel. Pulv. Pulvis, gen. eris Pulvis grossus A powder. Pulv. gros. A coarse powder. Pulv. subtil. Pulvis subtilis A smooth powder. Pulv. ten. Pulvis tenuis A fine powder. Pulvz. Pulverizatus, a, um Powdered. Pur. Purus, a, um Purgativus, gen. i Pure, clean. Purg. A purgative, a purging. Pyx. Pyxis, gen. idis A small box, a pill-box. Q- Quadrans, gen. tis A fourth part, a quart. Q. lib. Quantum libet As much as you please. Q. p. Quantum placet a a u 66 Q. q. Quoque Also. Qq. Quisque, Quaque Each, or Every. Qq. hor. Qustqujl hor& Every hour. Q. s. Quantum sufficiat As much as is sufficient. Q. s. Quantum satis 66 66 66 66 ii Q. v. Quantum vis As much as you please. Q. vol. Quantum volueris 66 66 66 66 66 Quad. Quadruplo Quadruple, in four-fold. Quam Quam As much as. Quart. Quartus, gen. i Fourth. Quat., Quater Quatuor, Quater Four, Four times. Quibus Quibus From which. Quinq. Quinque Five. LIST OF CONTRACTIONS AND LATIN PHRASES. 825 Contraction. Word or Phrase. English Equivalent. Quint. Quintus The fifth. Quoq. Quoque Also. Quor. Quorum Of which. Quotid. Quotidie Daily. Quoties req. Quoties requiritur As often as is required. R Recipe Take (thou), A recipe. Rar. Rarus, a, um Loose, thin, rare. Rat. Ratio, gen. onis Relation, proportion. Rec. Recens, gen. entis Fresh, recent, newly. Red. in pulv. Redactus in pulverem Reduced to powder. Redig. in pulv. Redigatur in pulverem Let it be reduced to powder. Reg. umbil. Regio umbilici The umbilical region. Rel. Relectus, a, um Opened, loosened. Reliq. Reliquus, gen. i Remaining, the remainder. Renov. Renova, Renovetur Renew, Let it be renewed. Renov. semel Renovetur semel Let it be renewed once only. Rept. Repetatur, Repetantur Let it (them) be repeated. Res Res, gen. rei A substance, thing, affair. Resid. Residuus, a, um Residual, remaining. Respon. Responde Answer (thou). Retin. Retinetur Let it be withheld. Rict. Rictus, gen. us A wide (distended) opening. Rig. Rigidus, a, um Rigid, hard, inflexible. Rub. Ruber, Rubra, Rubrum Red, ruddy. Rudic. Rudicula, gen. se A spatula. Rudis Rudis, gen. is A stirring-rod. Rum. Rumen, inis The throat. S. expr. Sine expressione Without expressing. S. A. Secundum artem According to art. S. L. Secundum legem According to law. S. N. Secundum naturam According to nature. s. s. s. Stratum superstratum Layer upon layer. S. V. R. Spiritus vini rectificatus Alcohol. S. V. T. Spiritus vini tenuis Proof spirit. Sac. lac. Saccharum lactis Sugar of milk. Sac. sat. Saccharum saturni Sugar of lead. Ssep. Soepe Frequently. Sal Sal, gen. salis Salt. Sal am. Sal amarum Magnesium sulphate. Sal mir. Sal mirabile Sodium sulphate. Sal vol. Sal volatile Ammonium carbonate. Saltern Saltern At least. Saltim Saltim By leaps. Sang. Sanguis, Sanguineus Blood, Bloody. Sap. Sapor, gen. oris A flavor, delicacy. Sat. Satis Enough, sufficient. Saturat. Saturatus, a, um Saturated. Scarif. Scarifica Scarify (thou). Scarif. expl. Scarificatione explicata Scarification having been effected. Scat. Scatula, gen. se A box. Scil. Scilicet Namely. Scrup., 9 Scrupulum, gen. i A scruple (20 grains). Scut. pect. Scuto pectori For protection to the breast. Sec. Secundo, Secundum Secondly, According to. Secund. Secundus Second. Sed. Sedes, gen. is The fundament, the feces. Semel Semel Once. Semidr. Semi-drachma Half a drachm. Semih. Semi-hora Half an hour. 826 LIST OF CONTRACTIONS AND LATIN PHRASES. Contraction. Word or Phrase. English Equivalent. Sensim Sensim Gently, gradually, slowly. Separ. Separatim Separately. Sept. Septem Seven. Septim. Septimana A week. Sero Sero Late, at a late hour. Sesq. Sesqui One and a half. Sesqh. Sesquihora An hour and a half. Sesunc. Sesuncia An ounce and a half. Sev. Sevum, gen. i Suet, tallow. Sex, Sext. Sex, Sextus Six, Sixth. Si Si If. Sic! Sic ! So, thus. Sic. Sicca, Siccetur Dry (thou), Let it be dried. Sic. Siccus Dry, dried. Sig. Signa, Signetur Write (thou), Let it be marked. Sig. nom. prop. Signatur nomine proprio Let it be written upon (marked) with its proper name. Sign. Signanter Clearly, distinctly. Sile hujus! Sile hujus! Keep silence concerning this. Simp. Simplex, gen. simplicis Simple, unmixed. Simul Simul Together. Sin. Sine Without. Sing. Singulorum Of each. Si non val. Si non valeat If it does not answer. Si op. sit. Si opus sit If necessary. Si vir. perm. Si vires permittebant If the strength will permit. Sit Sit Let it be. Sit in promp. Sit in promptu Let it be in readiness. Sitis, Siti Sitis, Siti Thirst, For thirst. Sol. Solus Alone, only. Solat. Solatium, gen. ii A soothing, assuaging. Solit. Solitus, a, um Accustomed, ordinary. Solut. Solutus, a, um Dissolved. Solut. Solutio, gen. onis A solution. Solv. Solve, Solvetur Dissolve, Let it be dissolved. Solv. c. calor. Solve cum calore Dissolve with heat. Som. Somnus, gen. i Sleep. Spiss. Spissus, a, um Dense, hard. Spt. Spiritus, gen. us Spirit. Spt. vin. rect. Spiritus vini rectificatus Rectified spirit of wine (Alcohol). Spt. vin. ten. Spiritus vini tenuis Proof spirit. Spt. vinos. Spiritus vinosus Ardent spirit (of any strength). ss. Semis, Semissis, Semi- A half. St. Stet, Stent Let it (or them) stand. Stat. Statim Immediately. Stib. Stabium, gen. ii Stillatim Antimony. Stillat. By drops, drop by drop. Stom. Stomachus, gen. i The stomach. Strat. Stratum, gen. i Layer, stratum. Strat. superst. Stratum superstratum Layer upon layer. Suav. Suavis Pleasant, agreeable. Sub Sub Under, somewhat. Subact. Subactus Subdued, sinking. Sub. fin. coct. Sub finem coctionis When the boiling is nearly done. Subind. Subinde Frequently. Subtil. Subtilis Fine, smooth, nice. Sue. Succus, gen. i Juice, sap. Suggil. Sugillationi To the bruise. Sum. Sume, Sumat Take (thou), Let him take. LIST OF CONTRACTIONS AND LATIN PHRASES. 827 Contraction. Word or Phrase. English Equivalent. Sum. Sumatur, Sumantur Let it (them) be taken. Sum. tal. Sumat talem Let him take one like this. Sumend. Sumendus To be taken. Summit. Summitates The highest points, summits. Sum. mane sum. Summo mane sumendus To be taken very early in the morning. Summ. Summus, a, um Highest, summit. Sup. Super, Supra Above, upon, over. Sup. bib. haust. Superbibendo haustum Drinking afterwards this draught. Suppos. Suppositoria, gen. ae A suppository. Suppos. rect. Suppositoriae rectales Rectal suppositories. Suppos. ureth. Suppositoriae urethrales Urethral suppositories. Syr. Syrupus, gen. i Syrup. T. d., vel T. i. d. Ter die, vel Ter in die Thrice daily. Tab. Tabella, gen. ae A lozenge, tablet. Tal. Tabs, gen. is Of such, like this. Tam Tam So far, in so far. Tan. Tandem At last, finally. Tant. Tantum, gen. i So much, so many. Teg. Tegmen, gen. inis A cover. Temp. Tempus, gen. oris Time, temple. Temp. dext. Tempori dextro To the right temple. Ten. Tenuis Fine, weak, thin. Tep. Tepidus, a, um Tepid, lukewarm. Ter Ter Thrice, three times. Tere, Terel. Tere, Teretur Rub (thou), Let it be rubbed. Tere sim. Tere simul Rub (thou) together Teres Teres, gen. etis Rubbed, smooth, polished. Tert. Tertius Third. Test. ov. Testa ovi An egg-shell. Thion. Thionas, gen. atis Sulphur, sulphate. Tinct., vel Tr. Tinctura, gen. ae Tincture. Tinct. Herb. Recent. Tincturae Herbarum Re- centium Tinctures of Fresh Herbs. Tinct. Theb. Tinctura Thebaica Laudanum. Tr. Tres, Tria Three. Trid. Triduum, gen. ui The space of 3 days. Trit. Tritura, Trituretur Triturate, Let it be triturated. Troch. Trochiscus, Trochisci A lozenge, or troche, Lozenges. Turn Turn Then, next, furthermore. Turb. Turbidus, a, um Turbid, muddy. Tus. Tussis, gen. is A cough. Tuto Tuto Safely. Ubi Ubi Where, wherever, whenever. Uln. Ulna, gen. ae The arm, elbow. Ult. Ultime, Ultima Lastly, at the last. Ult. praesc. Ultimo praescriptus The last ordered. Una Una Together. Unc., g Uncia, gen. ae An ounce. Unct. Unctus, a, um Anointed, besmeared. Unctul. Unctulus, a, um Unguentum, gen. i it it Ung. An ointment, unguent. Unguil. Unguilla, gen. ae An ointment-box. Urg. Urgens, gen. entis Pressing, urgent. Ust. Ustus, a, um Burnt. Ut Ut, Uti That, so that, in order that. Ut diet. Ut dictum As directed. Utend. more sol. Utendus more solito To be used in the usual manner. Utere Utere Use (thou), make use of. Vas Vas, gen. vasis A vessel, utensil, bottle. 828 NUMERALS. Contraction. Word or Phrase. English Equivalent. Vas vit. Vas vitreum A glass vessel. Vehic. Vehiculum, gen. i A vehicle, menstruum. Vel Vel [or Ve as a suffix') Or. Vensesec. brach. Vensesectio brachii Bleeding in the arm. Venen. Venenum, Venenosus A poison, Poisonous. Ver. Verus, a, um True, real, genuine. Vesp. Vesper, gen. eris The evening. Vesper. Vesperma, gen. se Supper. Vic. Vicis, Vices Change, changes. Vin. Vinum, gen. i Wine. Vir. Vires [pi. of Vis) Strength, vigor, life. Virid. Viridis, Viride Green. Vis Vis, gen. viris Strength, vigor, life. Vitel. Vitellus, gen. i Yolk. Vitel. ovi Vitellus ovi Yolk of egg. Vitel. ovi sol. Vitello ovi solutus Dissolved in the yolk of an egg. Vitr. Vitrum, Vitreus Glass, Of glass, glazed. Vol. Volatilis, Volatile Volatile. Vom. urg. Vomitione urgente Vomiting being severe. For Dangerous Abbreviations, see ante, page 508, under the title Prescriptions NUMERALS. Cardinals. Ordinals. Unus One. Primus First. Duo Two. Secundus Second. Tres Three. Tertius Third. Quatuor Four. Quartus Fourth. Quinque Five. Quintus Fifth. Sex Six. Sextus Sixth. Septem Seven. Septimus Seventh. Octo Eight. Octavus Eighth. Novera Nine. Nonus Ninth. Decern Ten. Decimus Tenth. Undecim Eleven. Undecimus Eleventh. Duodecim Twelve. Duodecimus Twelfth. Tredecim Thirteen. Tertius decimus Thirteenth. Quatuordecim Fourteen. Quartus decimus Fourteenth. Quindecim Fifteen. Quintus decimus Fifteenth. Sexdecim Sixteen. Sextus decimus Sixteenth. Septemdecim Seventeen. Septimus decimus Seventeenth. Octodecim Eighteen. Octavus decimus Eighteenth. Novemdecim Nineteen. Nonus decimus Nineteenth. Viginti Twenty. Vicesimus Twentieth. Viginti unus, or\ Unus et viginti J Twenty-one. Vicesimus primus Vicesimus secundus Twenty-first. Twenty-second. Triginta Thirty. Tricesimus Thirtieth. Quadraginta Forty. Quadragesimus Fortieth. Quinquaginta Fifty. Quinquagesimus Fiftieth. Sexaginta Sixty. Sexagesimus Sixtieth. Septuaginta Seventy. Septuagesimus Seventieth. Octoginta Eighty. Octogesimus Eightieth. Nonaginta Ninety. Nonagesimus Ninetieth. Centum One hundred. Centesimus. Hundredth. GENITIVE CASE-ENDINGS—VERBS. 829 GENITIVE CASE-ENDINGS. Nom. Gen. Exceptions. a se 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 um os on i Rhus, Rhois; Flos, Floris; Bos, Bovis ; Limon, Limonis; Erigeron, -ontis. Fructus, Cornus, Quercus, Spiritus, Haustus, Potus, do not change, being ol 4lh declension. as atis Asclepias, -adis ; Mas, Maris. is idis Pulvis, -eris ; Arsenis, -itis; Phosphis, -itis; Sulphis, -itis, and all salts ending in -is, have genitive in -itis. 0 onis Mucilago, -inis ; Ustilago, -inis ; Solidago, -inis. i —lis Fel, Fellis; Mell, Mellis; Sumbul, Sumbuli. en ps rs r X inis pis rtis ris cis Words which do not change in the Genitive. * Amyl. * Coca. Haustus. Quercus. Azedarach. Cornus. Hydrastis. Sassafras. Berberis. Cundurango. Jaborandi. Sago. Buchu. Curare. Kino. Sinapis. Cannabis. Digitalis. Matico. Spiritus. Catechu. Fructus. Potus. * But some authorities give Amylis, Cocae. Pronunciation. Attention is particularly directed to the accentuation of words commonly mispronounced; as, for example, ac6tas, angina, atropa, chimaphila (kimaphila), chlbridum, codeia, co- nlum, enema, iddidum, radlcis, ricinus, sin&pis, syrupus, eczema, umbilicus, abdbmen, brbmidum, paresis. 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. Misce, mix. Recipe, take. Signa, write. Solve, dissolve. 'Fere, 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. Coletur, let be strained. Coloretur, let be colored. Bulliat, let boil. Capiat, let take. Detur, let be given. Dividatur, let be divided. Sit, let it be. Sumatur, let be taken. Participles or Verbal Adjectives are occasionally used, and should agree with their respective nouns in gender, number and case. Such are— Participles. Adhibendus, a, um, to be administered. Dividendtis, a, um, to be divided. Sumendus, a, um, to be taken. 830 HYPODERMIC FORMULAE. Prepositions. Those in the first column require the noun following to be in the accusative case,— those in the second column require the ablative case. Ad, to, up to. In, into. Supra, upon. Cum, with. Pro, for. 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 saturandum, to saturation. Numero, to the number of. Quantum supficiat, as much as necessary. Pro re nat&, according to need. In partes (equates, into equal parts. Redactus in pulverem, let be pulverized. Secundum artem, according to art. Non Repetatur, let it not be repeated. HYPODERMIC FORMULAE. Apomorphine. R. Apomorphinae Hydrochlor., gr. j. Div. in pulv. xvj. One to four in TT\xx of water as required. Coniine. R. Coniinae Hydrobromat., . . gr. j. Aquae Destiliat., jj. M. Sig.— contain gr. Atropine. R. Atropinae Sulphatis, . . . . gr. j. Aquae Destillatae Jj. Solve. Sig.—For hypodermic use, TT\vj = gr- sV- "liv=gr- T2TT- Cocaine. R. Cocainae Hydrochlorat., . . gr. v. Aquae Destillatae, 3 ij. Solve. Sig.— contain gr. ss. Caffeine. R. Caffeinae Citratis, gr. xxiv. Aquae Destillatae, . •••§]■ Solve. Sig.—ttpxx contain gr. j. Curare. R. Curare (Merck), gr. j. Acidi Acetici, n\v. Aquae Destillatae, . q. s. ad M. et filtra. Sig.— contain gr. Carbolic Acid. R. Ac. Carbol. Purif., . . . . gr. x. Aquae Destil., §j. M. Sig.— contain gr. *4 of the acid, which may be given up to gr. ij or iij. R. Curarinae Sulphat., . . . . gr. j. Aquae Destiliat. ss. M. Sig.—rqjv contain gr. Daturine. R. Daturinae, gr. ss. Aquae Destil. j. Solve. Sig.—rq,iv contain gr. Dose, TT\,iv-x. Chloral. R. Chloralis Hydratis, . . . . 5j iv. Aquae Destil., M. Sig.— contain gr. xv of Chloral Hydrate. Digitalin. R. Digitalini, gr. ss. Alcoholis, Aquae Destil., aa gij. Solve. Sig. — contain gr. Dose, riyv-viij. Chloroform. R. Chloroformi Purif., . . . . t^ss. Sig.— can be used as one deep injection. (See page 230.) The spirit is safer, in somewhat larger doses. HYPODERMIC FORMULAS. 831 Duboisine. R. Duboisinae Sulphat., . . gr. j. Aquae Destil., gj. M. Sig.—rqiv contains gr. R. Morphinae Sulphatis, . . . gr. xxiv. Atropinae Sulphatis, . . . gr. j. 01. Amygdalae Amar., . . gtt. j. Aquae Destillat., § ij. Solve. Sig.— contain gr. of Morphine Sulphate, and gr. fa of Atropine Sulphate. (Didatna's Solution.) Ergot and Ergotin. R . Extr. Ergotse Fluid, . . . ss. Filtra. Sig.—Dose, n^x. R. Extracti Ergotae (Squibb), 3 j. Aquae Destillat., . . . . 3j. Solve et filtra. Sig.—TT\,x contain gr. j. Dose, tr^x-xx. Physostigmine (Eserine). R. Physostigminae Sulph., . . gr. j. Aquae Destillatae, . . . . §}. Solve. Sig.— contain gr. fa. Hyoscine, Hyoscyamine. R. Hyoscinae Hydrobrom., vel Hyoscyaminae Hydrobrom., gr. j. Aquae Destillatae, . . . . §j. M. Sig.— contain gr. fa. Pilocarpine. R. Pilocarpinae Hydrochlor., . gr. xvj. Aquae Destillat., . . . . §j. M. Sig.—h\v contain gr. *4- Mercury. R. Hydrarg. Chlor. Corr., . . gr. j. Aquae Destillat., . . . . §j. M. Sig.—n\x contain gr. fa. Potassium Iodide. R. Potassii Iodidi, 3j. Aquae Fontanae, . . . . 3 iv. Solve. Sig.—Dose, TT\vj-xx. R. Hydrarg. Chlor. Corrosivi, Ammonii Chloridi, . . . aa gr. iij. Misce et solve in— Aquae Destillatae, .... 3jss. Dein adde— Albuminis Ovi, 3jss. Aquae Destillatae, . . . .3 V. Filtra, et adde— Aquae Destil., . . . q.s. ad 3 x. Sig.—rr\J contains gr. Dose,rr\jij-x. Quinine. R. Quininae Disulph., . . . gr. 1(50). Ac. Sulphurici Dil., . . . rr^c(ioo). Ac. Carbolici, rrpv (5). Aquae Fontanae, Solve. Sig.— 3 j contains gr. vj. (Lente.) Is irritant (B.) R. Quininae Hydrobrom., . . gr. xlviij. Aquae Destillat., . . . . 3 iv. Solve. Sig.— contain gr. iv. R. Hydrarg. et Sodii Iodidi, . gr. iij. Aquae Destillatae, .... 3 iijss. Solve. Sig.— contain gr. Dose, every second day. Morphine. R. Morphinae Sulphatis, . . . gr. xvj. Acidi Carbolici, .... npiij. Aquae Destillat., . . . . §j. Solve et filtra. Sig.—Ttpvijss contain gr. (Antiseptic Magendie's.) R . Quininae Bimur. Carbamidat., Aquae Destillatae, . . . . aa 3 iv. Solve. Sig.— contain gr. v. Strychnine. R. Strychninse Sulphat., . . gr. j. Aquae Destillatae, . . . . %)■ Solve sine alcohol. Sig.—TT\pc contain gr- iV Morphine and Atropine. R. Morphinae Sulphatis, . . . gr. xvj. Atropinae Sulphatis, . . . gr. ss. Acidi Carbolici, rr\_iij. Aquae Destillat., . . . ■ §j. Solve et filtra. Sig.— contain gr. % of Morphine Sulph., and gr. of Atropine Sulphate. R. Strychninae Nitratis, . . . gr. iij. Aquae Fervid. 3 x. Solve. Sig.—TT\x contain gr. fa. {Portugaloff.) 832 CHLORODYNE. Acetanilid, in minute proportion, added to aqueous solutions for hypodermic use, is said to preserve them from decomposition more efficiently than any other agent hitherto employed for that purpose. Solutions for hypodermic injection should be neutral in reaction, neither acid nor alkaline, and freshly prepared, especially solutions of the alkaloids, which soon 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 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. An exception to this rule is in the case of Cocaine, which is injected into the skin itself to produce local anaesthesia thereof (see page 247). After using the syringe force out all liquid, and wipe the needle-point dry between the fingers, before returning it to the case ; the sebaceous matter on the fingers will keep it free from rust. Avoid puncturing a vein ; if you do so, watch the patient and prepare an injection containing gr. of Atropine Sulphate, to administer if dangerous symptoms arise. Never, except under special circumstances, administer the salts of Morphine or Atropine hypodermically to children less than 15 years of age. [Com- pare The Hypodermic Method, ante, page 25.] CHLORODYNE. A Comparison of Ten Formula therefor, the Quantities being calculated for each to a Four- Ounce Mixture, or 1920. Quantity of each article in a Siv mixture, as per the formula of Articles. Squire, P.* Smith, Edw.f Chandler. | U. S. Disp. Nat’l Disp. * * £ <3 Q ol p£S IS £ Bartholow. Brit. Phar.-ft Collis Browne.{l Morphine Hydrochlorate, srr. I l6 l6 32 33/4 14 l6 4 24 Chloroform, in 236 392 240 372 375 207 24O 247 240 240 Ether, in 59 96 120 62 60 Cannabis Indica, Tincture, m 248 250 207 20 Cannabis Indica, Extract, Sr- 32 24 Hydrocyanic Acid, 2 p. c., HI I l8 192 5° 5° 42 90 123 120 48 Ol. Menthae Piperitae, . . in 2 6 l6 IO 8 7 7 2 2 Capsicum, Fluid Extract, in 4 Capsicum, Tincture, . . . m 29O 37 7 120 Capsicum, Oleo-resin, . . m 4 Alcohol, m 236 810 994 IOIO 690 247 24O Hydrochloric Acid, . . . m 126 62 3° Sugar, Burnt, 20 Glycyrrhizae, Extract, . . sr. M7 154 24O Acacia, Mixture, .... Ml 384 Tragacanth, Mucilage, . m 9°3 Theriaca, or Syr. Fusci, . in 236 760 150 247 24O 1632 Syrup, m 760 992 q. s. Glycerin, in io33 818 "60 Water, m 126 128 240 Morphine Hydroch. in U\xv, gr- T55 Vs Vs Vk y Vs ris 35 1 Note.—See ante, page 227, for remarks on this preparation, and the number of formulae representing it * Author of “A Companion to the Br. Pharmacopoeia.” f See Hartshorne’s “ Essentials,” 5th ed., p. 625. ** Parke, Davis & Co., Detroit. j Made by Eli Lilly & Co. f 2d ed., page 430. , Indianapolis. ffTinct. Chloroformi et Morphinae, B. P. § As given by Stokes and Blyth in " Hygiene.” PATENT MEDICINES. 833 PATENT MEDICINES. These formulae have been published from time to time in various journals and formu- laries, 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, 30.24 Rush, 34-20 Peruvian, .... 22.40 Hoofland, 20.85 Oxygenated, I9-23 California Wine Bitters, 18.20 Walker’s Vinegar Bitters, .... 7.20 Ayer’s Sarsaparilla. Alcohol, Fl. Extr. of Sarsaparilla, Fl. Extr. of Stillingia, aa 3 iij. Fl. Extr. of Yellow Dock, Fl. Extr.of Podophyllum ij. Sugar, . . 'Jj. Potassium Iodide, .... 3 jss. Iodide of Iron gr. x. Mix. Amick’s Consumption Cure. The Amick advertisements appeared shortly after the publication of Dr. N. B. Shade’s paper in this and other journals. Amick copied Shade’s language, speaking of the “ chemical ” cure,etc., and, I believe, adopted Shade’s methods of treatment. These were fully described by Shade, and consist in the use of Calomel, Iodoform, Guaiacol, etc. {Dr. Waugh, in Times and Register.) Brandreth’s Pills. Podophylli Radicis, . . . gr. x. Extracti Podophylli, , . . gr. x. Extr. Phytolaccae Baccse, . gr. xxx. Pulv. Caryophylli, . . . . gr. x. Cambogise, gr. ij-v. 01. Menthse Piperitse, . . rrpiij. Croci, gr. ij. Misce, fiat massa, et div. in pil. xxiv. (Hager.) Castoria. Senna, av.oz. 2. Pumpkin seed, dr. 6. Rochelle salts dr. 4. Wormseed, Levant, . . . dr. 3. Sodium Bicarbonate, . . dr. 2. Anise Seed, dr. x. Oil of Gaultheria, . . . . dr. Oil of Peppermint, . . .dr. y^. Sugar, av.oz. 8. Water, enough to make . . fl. oz. 16. Exhaust the vegetable drugs by boiling with water, evaporate to the proper volume, and dissolve the sugar and other ingredients. (Western Druggist.) 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 Cinchonine, 0.7 grain Cinchonidine, 0.8 grain Quinine, and one grain of Quinidine. Ayer’s Cherry Pectoral. Morphinre Acetat, . . . . gr. iij. Vini Antim. et Potass. Tartrat., Vini Ipecacuanhse, . . . aa 3 iij. Tinct. Sanguinariae, . . . 3 ij. Syr. Pruni Virginian., . . 3 iij. Chlorodyne, Collis Browne’s. Morphine Hydrochlorate, gr. 6. Chloroform dr. 6. Cannabis Indica, . . gr. 6. Prussic Acid (Scheele’s), . 6. Treacle, to make, .... oz. i. Dose.—io to 30 minims. (Hygiene.) Ayer’s Pills. Consist of Colocynth, Gamboge and Aloes, coated with Starch and Sugar. 834 PATENT MEDICINES Clarke’s Blood Mixture. Potassium Iodide, . . . . gr. 48. Chloric Ether dr. 4. Liquor Potassae, 30. Water, colored with Burnt Sugar, oz. 7^. Dose.—One tablespoonful four times a day. [Hygiene.) Holloway’s Ointment. Has in 159 parts— Olive Oil, 62^parts. Lard, 50 “ Resin, ........ 25 “ White Wax, 12\ “ Yellow Wax, ..... 3 “ Turpentine, 3 “ Spermaceti, 3 “ Ely’s Cream Balm. consists of Vaselin, 1 ounce; Thymol, 3 grains ; Bismuth Carb.. 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 inhalations. [Medical Record.) Holloway’s Pills. Have in 144 Pills— Aloes, gr. 62. Rhubarb, gr. 27. Saffron, gr. 3. Glauber’s Salt, gr. 3. Pepper gr. 7. [Dorvalt.) Garfield Tea. consists chiefly of Senna leaves and Couch- grass (Triticum), with aromatics. [Prof. Lengfield.) Hostetter’s Bitters. Sacchari Albi, Aurantii Corticis, Calami, Cinchonas, Gentianae aa lb j. Rhei Pulv. 5 iv. Cinnamomi, 5ij. Caryophylli, gj. Alcoholis Diluti, .... Cij. [Med. Bulletin, 1884.) Hamburg Tea. Sennse Foliorum, . . . . pt. viij. Mannse, pt. iv. Coriandri, pt. j. The Keeley Gold Cure. The hypodermic injection, administered 4 times daily for 3 weeks, contains Strych- nine (or Brucine) and Atropine (or Hyos- cine), with Codeine and Cocaine for the opium cases. The whiskey supplied to the victims contains about gr. of Apomor- phine to each average drink. The “ cross- shot ” is an injection of Apomorphine. The “ tonic ’’contains— Ammonium Chloride, . . gr. j. Aloin, gr. ij. Tinct. Cinchonas Comp., . Water, to make, 3 iv. (TV. Y. Med. 'Record.) Hamlin’s Wizard Oil. Spt. Camphorse, Spt. Ammonise, Olei Sassafras, . . . . aa 3 ss. Olei Caryophylli, . . . . 3 ij. Chloroformi, Olei Terebinthinae, . . aa gss. Alcoholis, . . . . q. s. ad 3 v. Helmbold’s Buchu. Said to resemble the genuine. Short Buchu, ..... oz. 9. Uva Ursi, oz. \)/2. 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, pints 2. Peppermint Oil, oz. 1. Water, sufficient to make . pints 12. [Lillard's Prac. Hints and Formula.) Laville’s Gout Mixture. Calcium Chloride, Chinoi- din, of each, .... grm. 5. Extract of 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 251, ante. ] PATENT MEDICINES. 835 Morrison’s Pills. Powdered Colocynth, . . gr. 3. Powdered Gamboge, . . . gr. 6. Powdered Aloes, . . . . gr. 9. Cream of Tartar, . . . . gr. 12. Also syrup enough for 12 pills. Serious results are often produced by large doses of these pills. Radway’s Ready Relief. Tinct. Capsici, Aquae Ammoniae, Alcoholis, . . - . . . Linimenti Saponis, . . . £ iij. {Hager.) Radway’s Resolvent. Vini Zingiberis, Vini Cardamomi, . . . aa iij. Sacchari Albi, q. s. {Hager.) Orange Blossom. Zinc Sulphate, gr. 60. Alum, gr. 15. Expr. Oil of Almond, . gr. 90. Extract of Hyoscyamus, . gr. I. White Wax gr. 30. Oil of Theobroma, . . . gr. 180. Made into oblong suppositories, one inch long, one and a half wide and half an inch thick, weighing 32 grains each. Recamier Balm. Zinc Oxide lbs. 5. Glycerin, dr. 2. Alcohol, oz. 2. Mercuric Chloride, . . . oz. 4. Distilled Water, .... qts. 64. {Boston Herald.) Perry Davis’s Pain Killer. Tinct. Capsici, 5j. Spt. Camphorse, %i). Guaiaci Resinae, . . . . ss. Alcoholis, 5 iij. Tinct. Myrrhse, q. s. ad coloret. Recamier Cream. Rice Flour, oz. 48. Zinc Oxide, oz. 60. Glycerin, oz. 640. Cacao Butter, oz. 48. Lard oz. 48. Mercuric Chloride, . . . oz. 4. Make 32 pints. {Boston Herald.) Pierce’s Favorite Prescription. Sabinse, Cinchonse, Agarici Albi, aa^ij. Cinnamomi, gr. xv. Coq. in aq.suff.,ut ft. decoct. 3 viij. Deinde cola, et adde— Sacchari Albi, t^ss. Acaciae, gj. Solve, et addantur— Tinct. Opii Deodorat., Tinct. Digitalis, . . . . aa^ss. Ol. Anisi, gtt. viij, in Alco- holis Misce. (Hager.) Revalenta Arabica Food. Consists solely of Lentils ground up into a fine powder. {Stokes in “ Hygiene.”) Sage’s Catarrh Remedy. Salis 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. Pulv. Hydrastis Canadensis,partes v. Pulv. Indigo, part. yz. Pulv. Camphorse, Acidi Carbolici, . . . . aa partes ij. Sodii Chloridi, partes 1. {New Remedies.) Pierce’s Golden Discovery. Ext. Lactuci, zj. Mellis, }|j. Tinct. Opii Deodorat, . . Alcoholis Diluti, Aquae, aa^iij. (Hager.) 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.) Radam’s “ Microbe-Killer.” Oil of Vitriol (impure), . dr. 4. Muriatic Acid (impure), . dr. 1. Red Wine, oz. 1. Water, gall. I. {Eckels.) Seigel’s (Mother) Syrup. Contains Aloes, gr. 30 to the oz. Also Borax, Capsicum, Liquorice, and Treacle. {Stokes in “ Hygiene.”} 836 PATENT MEDICINES Sequah’s Oil. A mixture of % Turpentine and l/3 Fish Oil, scented with a few drops of Oil of Camphor. {Stokes in ‘ ‘ Hygiene.' ’) Thompson’s Eye-Water. Copper Sulphate, . . . . gr. 10. Zinc Sulphate, gr. 40. Rose-water, pints 2. Tincture of Saffron, . . . drm. 4. Tincture of Camphor, . . drm. 4. Mix and filter. Sequah’s Prairie Flower. Has to the ounce— Aloes, gt-52X- Carbonate of Soda, . . . gr. 17/4- Water, gr.362^. and a few drops of the Tinctures of Capsi- cum and Myrrh. {Stokes in “ Hygiene.") Van Buskirk’s Sozodont. Saponis Albi, ss. Alcoholis, 3J. Aquae, 3 vj. Glycerini, 3 ij. Olei Gaultheriae, Olei Caryophylli, Olei Menthse Piperitae, aa q. s. ad saporem grat. Cocci Cacti, q. s. ad coloret. St. Jacob’s Oil. Gum Camphor, Chloral Hydrate, Chloroform, Sulphuric Ether, . of each, oz. I. Tinct. of Opium, Oil of Origanum, Oil of Sassafras, . of each, oz. y2. Alcohol, gal. 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.) Calcis Praecipitat., Magnesii Carbonatis, Iridis Florent. Radicis, . aa p. aeq. M. et triturat. {Hoffmann.) Vita Nuova. Cocaine, gr. 8 Pepsin (golden scale), . . gr. 48. Port Wine, gall. 1. {Boston Hera/d.) Walker’s Vegetable Vinegar Bitters. Aloes Socotrin, gij. Guaiaci Resinae g iv. Sassafras Mucil., . . . . 3 j. Aceti, 3 ij. Aquae, q. s. Coque, et ft. decoctum, ad deinde cola, et addantur— Sodii Sulphatis, §j. Acaciae, £ij. Spt. Anisi, iop. c., . . . gij. Alcoholis, jjj. M. Dose, £ij. (Eberbach.) Swift’s Specific, “ S. S. S.” Fluid Extr. ofSmilax Sarsaparilla, 16 parts. Fluid Extr. of Stillingia Sylvatica, 16 parts. Fluid Extr. of Lappa Minor, . . 16 parts. Fluid Extr. of Phytolacca, . . . 16 parts. Tinct. of Xanthoxylum, .... 8 parts. {Registered Pharmacist.) Stearns’ New Idea gives the following : Stillingia, Pokeroot, and Sarsaparilla, with Nitrate of Potash and a small quantity of Iron, and enough alcohol to preserve it. 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 loo boluses. Roll in the following mixture : Cream of Tartar, 5 ; White Su- gar, 35 ; Sugar-of-milk, 35 ; Tragacantli, 2 ; Tartaric Acid, 2 ; powd. Red Sandal, 25 (all parts). Dry and put up in tin foil. {American Druggist.) Warner’s Safe Kidney and Liver Cure. In Germany each maker of patent medi- cines must furnish the government with the formula for the patent he makes. This is the one furnished by Warner for “ Safe Kidney and Liver Cure.” Each bottle contains:— Extr. Lycopus Virginiana, gr. 308. Extr. Hepatica (herb), . . gr. 322. Extr. Gaultheria, . . . . gr. 7 l/i- Potassium Nitrate, . . . gr. 39. Alcohol (90°), oz. 2J^. Glycerin, dr. 10. Water sufficient to make one pint. (.Formulary and Druggists' Magazine.) DIFFERENTIAL DIAGNOSIS. 837 TABLES OF DIFFERENTIAL DIAGNOSIS. Forms of Bright’s Disease. Compared with Acute Nephritis and with each other. 4 (1) Acute Bright’s Disease. Acute Parenchy. Nephritis. Chronic Bright’s Disease. Clinical Phenomena. CU ss in half a pint of water at one draught, has a marvellous effect in generally straightening up the victim, an- tagonizing stupor and restoring faculties. Hyoscine or Duboisine, as hypnotic, gr. hypodermically. [Compare Alcoholism and Delirium Tremens in Part III, also page 114, ante.] Alkalies. Antidotes,—Acids, diluted, especially the vegetable acids, as Vinegar, Lemon-juice, etc. Albumen, Milk, Gelatin. Oils to protect the mucous surfaces. [Compare Ammonia below.] Antagonists,—Opium for the shock and vital depression, also Caffeine, Alcohol, and other stimulants. Alkaloids. Antidotes,— Tannin holds high rank, forming tannates, which are comparatively insoluble. Potassium Permanganate (see ante, page 339). Albumen. Iodine. Charcoal. Emetics and cathartics afterwards. Antago- nists,—differ for each. [See their several titles below.] Alum. Antidotes,— Carbonates of Ammonium, Potassium, etc. Other treatment as for corrosive salts. [See Metallic Salts below.] Ammonia. Sources of Danger, the use of Smelling Salts or Spirit of Harts- horn in excess, and the strong solution of Ammonia kept by housekeepers for laundry purposes. Antidotes,—Vinegar, Lemon- or Orange-juice, any Vegetable Acid, followed by demulcents to protect the mucous surfaces. When inhaled, give vapor of Acetic or Hydrochloric Acids or Chlorine-water by in- halation, the two latter forming the chloride. Antagonists,—Aconite, Vera- trum, Digitalis, as cardiac sedatives. Amyl Nitrite. Antagonists,—Ergotin, Atropine, Strychnine, also Brucine, Digitalis, Picrotoxin, and all other agents which increase the functional activity of the spinal cord and sympathetic, are antagonistic, though not always avail- able by reason of their slower rate of diffusion. Stimulants, artificial respira- tion, the alternate cold and hot douche, with cold to the head, and Ergotin or Atropine hypodermically, are the best measures to be used in cases of poison- ing by the Nitrites. Anaesthetics (Ether, Chloroform, etc., by inhalation). Antagonists,—Atro- pine, hypodermically, is of great value in combating the cardiac and respira- tory failure of Ether (Amidon); and is equally efficient in Chloroform poison- ing, as I have found by experience (Potter). Strychnine, hypodermically, has done good service in chloroform narcosis and has many advocates. Amyl Nitrite, by inhalation. Oxygen, by inhalation. Venesection, to relieve the engorged right heart, supplemented by Galvanism to stimulate the cardiac action (Spooner). Artificial Respiration, Fresh Air, Coffee. Faradism of the respiratory muscles. Heat applied to the body and limbs. Ice in the rectum. Ammonia, 10 minims of the Liquor in 40 of water, intravenously,—unsuccess- ful (Bartholow). Invert the patient, draw the tongue well forward with forceps, compress and relax the chest, maintain the inverted position until the pulse and respiration are good (Nelaton). Antimony (as Tartar Emetic, etc.). Antidotes,— Tannin, or any substance containing it, is the antidote, forming the insoluble tannate. Albumen or Milk. Carbonates of Magnesium and Sodium. Magftesia, in milk, especially for the Chloride of Antimony. Alkalies and Salts of Lead decompose Tartar Emetic. Emesis by tickling the fauces. Demulcent drinks freely, to protect the mucous membranes. Water, warm, in large draughts; or lavage of stomach with water first, then with solution of Tannin. Antagonists,— Opium, Alcohol, Ether, and other antispasmodics. Antipyrin. See above, under Acetanilid, for the treatment of poisoning by Antipyrin, Phenacetin, Kairin, and similar compounds. 854 TREATMENT OF POISONING. Arsenic (Arsenous Acid). Two grains have been fatal. Common Sources of Danger: arsenical wall-papers, Arsenic mistaken for “ salts” or for “ magnesia,” adulterated confectionery, also Paris Green (Cupric Aceto-Arsenite) taken with suicidal intent. Antidotes,—Hydrated Ferric Oxide, freshly precipitated by precipitating a solution of Ferric Chloride with Sodium Carbonate or Ammo- nia,—or as the official Ferri Oxidum Hydratum cum Magnesia (see ante, page 282), in the proportion of gr. viij for each grain of the poison ingested. Dia- lyzed Iron, is quite efficient as an antidote, is more easily obtained than the hydrated oxide, and has rendered good service in many cases of poisoning from inhaling arsenical fumes. Ferri Subcarbonas is equally good, 3ij followed by Castor Oil (Leale) ; or Hydrated Magnesia, or Magnesia and Sugar (Carl). Magnesium Bicarbonate or other alkalies (R). Charcoal, or more (R). Saccharated Ferric Oxide. Basic Ferric Acetate. Apomorphine, hypoder- mically, or Zinc Sulphate, as emetic (avoid Tartar Emetic). Emesis by feather-tickling. Oil and Lime-water mixed, before and after emesis (Taylor). Milk or other bland fluids to wash stomach. Castor Oil after emesis. Mag- nesia and Linseed tea. Poultices and fomentations over abdomen. Potassium Iodide afterwards to promote elimination. Antagonists,—None. Barium Salts. Antidotes,—Sulphates of Magnesium, Sodium (Epsom and Glauber’s salts), Calcium, or Potassium. Diluted Sulphuric Acid. Bee and Insect Venom. Antidotes,—Aqua Ammonice, Sodium Bicarbonate or Chloride, or Carbolic Acid, applied to the wound ; or of a 2 per cent, solution of the first hypodermically, with Liquor Ammonii Acetatis internally. [Compare the article on Stings in part III.] Belladonna and Atropine. Caustic Alkalies decompose Atropine and are therefore incompatible with the preparations of Belladonna. Antidotes,— Tannin, Zinc Sulphate or Apomorphine, as emetics, or the Stomach-pump. Purgation. Magnesium Bicarbonate, and other alkalies (R). Charcoal, §ss or more is necessary (R). Antagonists,—Morphine is the physiological an- tagonist to the effects of Atropine on the cerebrum, pupils, heart, respiration, arterial tension and kidneys; Aconite, Physostigmine, Pilocarpine and Quinine are each antagonistic to some of its effects, Muscarine to most of them. Brandy or strong Coffee. Capsicum. Faradism of respiratory muscles. Flagel- lation. Cold to the head. Ammonia, breathed into air-passages (R). Bromides. Antidotes,—Nitrous Ether is incompatible with Ammonium Bromide, Acids and Metallic Salts are so with all the Bromides. Poisoning thereby is always chronic, never acute, hence no antidotes can be employed. Antagonists,—Morphine is the most efficient, especially for the mental symp- toms. Digitalis, Ergot, Belladonna, and other vaso-motor stimulants, antag- onize many of the effects of the bromides. Cocaine is useful in chronic depres- sant poisoning thereby, and Alcohol with Opium as a nervous stimulant. Bromine. Antidotes,—Albumen, Starch, Gelatin, Sodium and Potassium Carbonates and Bicarbona’tes. Against the irritant vapor, Ammonia vapor by inhalation, or steam inhalations. Antagonists,— Opium and Alcohol as stimu- lants, if much depression ensues. Calcium Chloride. Antidotes,—Albumen, Mucilaginous drinks, or Oils, Milk, Flour and water. Avoid acids. Antagonists,— Opium, Alcohol, for vital depression. Camphor. Antidotes,— Water to precipitate 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. Antagonists,—Aconite and other arterial sedatives. Coffee. Cold. Alcoholic stimulants. Opium and Bromides for the convulsions. Cannabis Indica. Antidotes,—Emetics to remove as much as possible. Caustic Alkalies are incompatible. Antagonists,—Alcohol, as stimulant. Strychnine as respiratory stimulant. Faradism of muscles of respiration. Lemon-juice is said to antagonize its effects, which last over 24 hours from a large dose. TREATMENT OF POISONING. 855 Cantharis. Avoid Oils, also fats and milk, which promote its absorption. Antidotes,—Emetics. Demulcents (as linseed tea, gruel, barley-water), freely. Water in large quantity, to flush the kidneys. Oleaginous injections into the bladder to allay irritation. There is no chemical antidote. Antagonists,— None, but Opium may be given for the gastro-enteritis. Carbonic Oxide. See below, under Coal-gas, for the treatment of poisoning by Carbonic Oxide and Carbonic Acid gases. Chloral Hydrate. All Alkalies are incompatible as they decompose it. Anti- dotes,—Liquor Potassce, in hourly doses of 3ij well diluted, which amount will decompose 20 grains of chloral each time in the blood (Dougall). Emetics or the stomach-pump, if patient is seen shortly after ingestion of a toxic dose. Reliance must be placed on the antagonism of the following. Antagonists,— Strychnine, but only to a limited extent; though Chloral is the most perfect antagonist to strychnine, opposing its spinal action (but see page 223). Heat to the body and limbs, by hot blankets, hot water bottles, etc., is the most effi- cient antagonist. Atropine antagonizes its cardiac, respiratory and spinal de- pression, and should be used hypodermically, in small doses (gr. re' quently repeated, until its effects are apparent. Morphine administered with Chloral antagonizes its tendency to produce cardiac failure, while synergistic to the hypnotic action of the drug. Cocaine is of value for the cardiac and respira- tory depression. Alcoholic stimulation. Amyl Nitrite by inhalation. Frictions. Coffee, black, a pint injected into rectum, as for narcotic poisoning. Artificial Respiration. Chlorine. Antidotes,—Albumen for Chlorine preparations in the stomach, also Aqua Ammoniae in small quantity, well diluted. Ammonia vapor in- haled against Chlorine inhalations, forming Ammonium Chloride. Am- monium Sulphide has similar reaction, but should be used in great modera- tion. Fresh air. Steam inhalations. Emesis with warm water, then white of egg or milk, flour, or lime-water. Antagonists,— Chloroform by inhalation to ease the cough. Chloroform (swallowed). Recovery has occurred after the ingestion of one, two and even three ounces of chloroform (H. C. Wood). Antidotes,—Sodium Carbonate in plenty of water. Emetics. Treatment as for irritant poisoning. Antagonists,—Atropine or Strychnine, hypodermically. Amyl Nitrite, by in- halation. Coffee, black, a pint into the rectum. Heat to the body and espe- cially to the cardiac region. Rouse by slapping with wet towel. Mustard to calves of legs and over the heart. Relapse may occur, hence the patient should not be left for some time after apparent restoration. Coal-gas. Antidotes,— Chlorine-water as spray, inhaled. Antagonists,— Oxygen by inhalation, 4 or 5 quarts. Ammonia vapor inhaled. Galvanism, by interrupted current to extremities. Artificial Respiration, to be maintained steadily for hours. Rhythmic traction of the tongue. Fresh air, in plenty ; open all doors and windows. Coffee, black, a pint as enema. Venesectio7i may be of service. Douche, alternately cold and warm, to head and chest. Hori- zontal position, clothing removed. Alcohol moderately by mouth or rectum. Catheter may be required in prolonged cases. Subsequently, a warm bed, heat applied to the body and limbs, open windows, perfect quiet, Condy’s fluid about the room, stimulants sparingly, cold acid drinks freely. Cocaine. Antidotes,—See Alkaloids, above. Antagonists,— Chloral is the most direct antagonist, so also are Chloroform and Ether. Morphine is directly antagonistic at almost all points of action. Amyl Nitrite combats the earliest symptoms of cardiac depression, then Alcohol and Opium as cardiac stimulants. Artificial Respiration may be required. Colchicum. Antidotes,— Tannic or Gallic Acid, followed by emetics and cathartics. Demulcent drinks, warm. Antagonists,—Alcoholic stimulants. Morphine, hypodermically for the cardiac depression. Treatment is the same as that for Aconite poisoning. 856 TREATMENT OF POISONING. Conium. Antidotes,— Tannic or Gallic Acid, followed by emetics and cathartics. Antagonists,—Nux Vomica and its alkaloids, also Picrotoxin and other tetanizers. Alcohol. Muscular Movement. Heat applied externally, as soon as the stomach has been evacuated. Copper Salts. Antidotes,—Albumen, Soap, Gluten, Milk, Sugar, Mag- nesia. Potassium Ferrocyanide, is the most efficient chemical antidote, but Magnesia or Albumen may be used. In the absence of eggs, give a thin paste of flour and water. Any antidote should be followed by prompt evacuation of the stomach, and Potassium Iodide to saturation of the system. Antagonists, —Opium and Demulcents for the gastro-enteritis. Corrosive Sublimate (Corrosive Mercuric Chloride). Antidotes,—Albumen, Gluten, Magnesia, Milk, Lime-water. Albumen, in some form, is the most efficient; the white of one egg to each 4 grains of the poison, forms the albu- minate, which must be at once evacuated by emesis or the stomach-pump, it being soluble in an excess of albumen, also in the alkaline contents of the in- testines. Potassium Iodide for after-treatment, converts the poison into solu- ble combinations and promotes their elimination. Charcoal, or more neces- sary (R). Hydrated Protosulphide of Iron, if given within 20 minutes, is said to be an efficient antidote. Antagonists,—See under Mercury, below. Fatal Dose,—gr. iij have proved fatal. Creosote. Antidotes,—Mucilage, Oils, are the most easily obtained. An- tagonists,—Ammonia, for depression. Treatment is the same as for Acid, Carbolic, which see. Curare. Antidotes,—Ligate above the wound, if any; incise the part freely and suck it strongly. Evacuation of the bladder repeatedly, to prevent reab- sorption. Caustic Alkalies destroy the poison. Antagonists,—Artificial Re- spiration is the most efficient antagonist, maintaining life until elimination- occurs. Strychnine, though from a member of the same family of plants, is an- tagonistic as to the action upon the heart and respiration. So also is Atropine. Cyanide of Potassium. Antidote,—Ferrous Sulphate to form Prussian Blue (Ferric Ferrocyanide), followed by evacuation of the stomach. Cobalt Nitrate, is a perfect antidote (Johann). Antagonists,—Ammonia, intraven- ously. Digitalin, Strychnine, Alcohol. Artificial Respiration, general friction, and galvanism. [Compare Acid, Hydrocyanic, above.] Digitalis. Antidote,— Tannic Acid, to form the tannate, which, however, is not inert, so that the stomach should be immediately evacuated. Antag- onists,—Aconite for the effects of large doses, Opium for those due to its con- tinued use. Saponin and Senegin are its most complete physiological antag- onists. Alcohol, Galvanism, Horizontal posture. The treatment is similar to that for Aconite. Ergot. Antidote,— Tannic Acid, followed by an emetic. Antagonists,— Amyl Nitrite, Aconite, Veratrum Viride, Tobacco and Lobelia, antagonize its action on the circulation. Fish-poison. Antidotes,—Emetics and Cathartics. Antagonists,—Potas- sium Chlorate freely, Liquor Ammonii Acetatis, Opium, Capsicum, Chloroform. Fungi, Poisonous. Antagonist,—Atropine, is practically specific as an antagonist in many cases of fungi poisoning. [Compare Muscarine, below.] Gamboge. Antidotes,—Potassium or Sodium Carbonates. Magnesia in milk. Emetics. Mucilaginous drinks. Antagonists,— Opium for the depres- sion. Alcoholic stimulants. Gases and Vapors. See Ammonia, Acid Hydrocyanic, Chlorine, Coal-gas, Nitrous Oxide Gas, Sulphur. Gelsemium. Antidote,— Tannic Acid, followed by an emetic or the stomach-pump, if recent. Antagonists,—Morphine is the most complete. Digitalis, Ammonia, Alcohol, Atropine, and to some extent the tincture of Xanthoxylum, are also antagonistic. Heat externally, Faradization of the TREATMENT OF POISONING. 857 respiratory muscles, and Artificial Respiration are measures of prime import- ance. Brandy and Capsicum are useful. Glass (coarse or powdered). Antidotes,—Bread-crumbs freely to envelope it, then emetics. Gold Salts. Antidotes,—Ferrous Sulphate. Albumen, as eggs or flour. Mucilage. Emetics. Treatment as for Corrosive Sublimate. Hyoscyamus. See Belladonna, above. Hypochlorites, as Javelle Water (Potassium Hypochlorite), Labarraque’s Solution (Sodium Hypochlorite), and Bleaching Powder (Calcium Hypo- chlorite). Antidote,—Sodium Hyposulphite, in dose of gr. xv, well diluted and frequently repeated, reducing them to chlorides, itself undergoing oxidation to the sulphate. Iodine. Antidotes,—Starch, Albumen, Flour, Gelatin, Sodium and Potassium Carbonates and Bicarbonates. Starch is the antidote to free Iodine, but the stomach must be evacuated, as the Iodide of Starch is not inactive. In chronic poisoning by the Iodides, a free salivary flow induced by chewing Pyrethrum-root will hasten elimination of the drug. Antagonists,— Quinine, Digitalis, and other restorative agents and vaso-motor tonics. Amyl Nitrite. Morphine, for pain. Ipecacuanha. Antidotes,— Vegetable Acids and Astringents are incom- patible with Ipecac, and may be used as antidotes. Antagonists,—Bismuth, Carbolic and Hydrocyanic Acids, also Narcotics, antagonize the emetic action. Iron. Antidotes,—Ammonium and Sodium Carbonates, Magnesia, Mucil- aginous drinks. Lead Salts. Antidotes,—Sodium or Magnesium Sulphate, Sodium Phos- phate, Diluted Sulphuric Acid, Magnesium Bicarbonate, Ferrous Sulphate, freshly precipitated. Albumen, Milk. Emetics or the stomach-pump. Potas- sium Iodide, gr. xv-xxx, 3 or 4 times daily, in cases of chronic poisoning, as eliminative (R). The cachexia is much relieved by a combination of Quinine Sulphate, Ferrous Sulphate and Diluted Sulphuric Acid (B). Baths of Potassa Sulphurata or more in the necessary water), are also very useful in chronic poisoning by Lead (R). Antagonists,— Opium, to allay irritation. Belladonna, the extract, gr. ]/%, with Pulv. Rhei, gr. ij, in pill twice daily, for the great pain at defecation (Da C). Alum, is the most efficient remedy for the colic; to a pint of boiling milk add 90 grains of powdered Alum, separate the curd and sweeten with sugar; give a wineglassful every hour or two (B). Strychnine, for the paralysis, gives good results; also Atropine, gr. with Potassium Iodide, gr. v. Electricity, a slowly interrupted current until it causes reaction, for the paralysis of extensors (dropped wrist); cure to be completed by the faradic current (B). Marked Diagnostic Signs of chronic poisoning by Lead are—the dropped wrist, due to paralysis of extensor muscles and a dark, blue line around margin of gums. Lime. See Alkalies, above. Lobelia. Antidotes,— Tannic Acid, to form the insoluble tannate. Char- coal, powdered in water. [See Aconite, above.] Antagonists,—Alcohol, Digitalis, Belladonna, Ergot, the vaso-motor excitants, antagonize its effects on the circulation; Strychnine, Picrotoxin, and Thebaine, those on the nervous system. Mercury. [See Corrosive Sublimate above, also Metallic Salts below.] Antidotes,—Albumen, Gluten, Flour, Milk. Vegetable astringents. Hy- drated Protosulphide of Iron. Charcoal. Alkalies, especially Magnesium Bi- carbonate (R). Potassium Iodide, to saturation of the system, as after-treat- ment; converts the metal into soluble combinations (B). Baths, simple or sulphurous (R). Antagonists,—Bismuth, Tannin, Sodium Sulphite, Diluted Nitric Acid in water, as gargles and mouth-washes for salivation. Belladonna, ti\,v—x of tincture every 4 to 6 hours, to lessen secretion in ptyalism (B). Hyos- cyamine, for the tremor, gr. gradually increased to gr. (Oulmont). 858 TREATMENT OF POISONING. Metallic Salts. Antidotes,—Albumen, Milk, Magnesia, Starch, Soap. Oils and other demulcents. Sodium or Potassium Carbonate and Bicarbonate. Lavage of stomach. Emetics and cathartics. Antagonists,—Opium, Alcohol, Cocaine, and other stimulants, when shock and vital depression. Mezereum. Antidotes,—Albumen, Milk, Oils and fats, Mucilaginous drinks. Antagonists,—Opium, as stimulant against shock and depression. Poultices, cool, to abdomen. Morphine. See Opium, below. Muscarine. Antidotes,—[See Alkaloids, above.] Antagonists,—Atro- pine exactly opposes Muscarine, and vice versa. Digitalis is antagonistic to some extent, so also is Physostigmine. There is no example of physiological antagonism so complete in all particulars as that between Atropine and Mus- carine. [See ante, page 105.] Mushrooms. Antidotes,—Emetics, if poisoning very recent; Cathartics, especially Castor Oil, if some time has elapsed. Tannic Acid, has been recom- mended. Antagonists,—Atropine. Alcoholic stimulants. Poultices, warm, to abdomen. [Compare Muscarine, above.] Narcotics. See Alkaloids above, also Opium, Belladonna, Alcohol, Chloral Hydrate, Cannabis Indica, Carbolic Acid, Chloroform, Coal-gas, Hydrocyanic Acid, etc. Vegetable Acids antagonize their after-effects to some extent. Nitrobenzol. Antidotes,—Ammonia, diluted, by inhalation. Emetics. Antagonists,—Alcohol, Liq. Ammoniae (3ss in water), or Chloric Ether (3j in water), frequently repeated, as stimulants, given internally, by enema or hypo- dermically (brandy). Atropine. Artificial Respiration. Galvanic current, in- terrupted, to chest-walls, and over cardiac region. Fatal Dose,—Death has resulted from merely tasting it. Nitroglycerine. See Amyl Nitrite, above. Nitrous Oxide Gas. Antagonists,—Artificial Respiration, to be commenced at once and kept up for two hours if necessary, not faster than 18 per minute. Fresh air, open all doors and windows, and fan the patient. Oxygen by in- halation, 3 or 4 pints. Douche to chest, alternately hot and cold. The tongue should be pulled well forward, and the mouth cleared of any obstruction to respiration, as artificial teeth. In apparently hopeless cases, two or three violent blows on the chest, delivered in quick succession, may restore the cardiac action (Murrell). Nux Vomica and Strychnine. Antidotes,— Tannic Acid, forms the very insoluble tannate. Iodme in dilute solution, or a soluble salt thereof. Animal Charcoal, largely. Potassium Permanganate, has been taken in large dose by Dr. Fahr, of Milford, N. J., after having ingested gr. of Strychnine, resulting in the entire absence of any symptoms of strychnine poisoning. Emetics or the stomach-pump should follow the administration of any antidote. The bladder must be frequently evacuated to prevent reabsorption. Antagonists,— Quiet, as perfect as possible, is very important. Chloral is the antagonist, gr. xxx as soon as possible, repeated in 20-grain doses at hourly intervals, as long as reflex exal- tation continues. Butyl-chloral Hydrate, is a very energetic antagonist (Gri- gorescu). Potassium Bromide, is almost too slow of action to be of much prac- tical service. Chloroform or Ether inhalation, to procure muscular relaxation. Physostigma, is antagonistic (R). Chamomile Oil, remarkably subdues reflex excitability in frogs after poisoning by Strychnine or Brucine (P). Amyl Nitrite, by inhalation (R). Veratrum Viride, cured a bad case ; 3j was given at once, then gtt. ij every ten minutes (R). Urethan. Methyl and Ethyl compounds of Strychnine, Brucine, and Thebaine. Monobromated Camphor. Ice to spine. Tobacco, by enema. Valerian mitigates the spasms (P). Curare.gr. hypo- dermically; is warmly recommended, but its claims are doubtful (P). Apo- morphine, hypodermically, is very effective in dogs (Wills). Nicotine, many cases prove its curative power (P). Hydrastinine Hydrochlorate, in doses of gr. j hypodermically, has been successfully employed. Artificial Respiration, if possible. Fatal Dose of Strychnine,—gr. \ for an adult, gr. for a child. 859 TREATMENT OF POISONING. Opium and Morphine. Antidotes,— Tannic Acid, or vegetable astringents, followed by evacuation of the stomach, if the poison has been taken by the mouth. Charcoal, or more (R). Apomorphine, as emetic, gr. to hy- podermically; must be administered before narcosis sets in (B). Stomach- pump better than emetics, which by the mouth are generally useless in these cases. Potassium Permanganate, an efficient antidote if given soon after inges- tion of the poison (see pages 339, 366). Compound Tincture of Iodine. An- tagonists,—Atropine, hypodermically, gr. every 15 minutes for three doses (B); antagonizes the cerebral action, also that on the respiration, heart, and arterial tension ; but, if given too freely, will endanger the case by deepening the narcosis (see page 366). No one is warranted in omitting it (P). Caffeine, is antagonistic and may be given hypodermically, though generally used in the form of strong coffee, frequently administered by mouth or rectum. Cocaine, is of especial value against the cardiac and respiratory depression. Strychnine, efficiently antagonizes the respiratory paralysis, and may be used in lieu of Atropine, or in conjunction therewith. Amyl Nitrite, by inhalation, ox Ammonia by intravenous injection, when the heart shows signs of failure; the former proved eminently successful in a case wherein Atropine proved useless to restore the patient. Capsicum, the tincture, |jss-j by rectal injection, is said to antagonize the stupor almost instantaneously. Vegetable Acids, as Vinegar and water, Lemon-juice, Cream of Tartar in water, etc., every 10 minutes (R); to antagonize the narcotism. Douche, alternately cold and hot, or hot water and ice alternately to nape of neck, for the narcosis. Artificial Respiration, should be kept up for at least two hours (Murrell). Oxygen, by inhalation, is of great value (Macalister). Venesection, has proved effective after all other measures failed ; is especially beneficial when death is impending from failure of respira- tory action due to distention of the right heart with backward pressure (Marshall). Potassium Bromide removes some of the cerebral effects of Opium, as the vertigo and mental confusion; others are antagonized by Quinine, and the general intracranial effects of the drug are to some extent opposed by Digitalis and Tartar Emetic. The Important Measures indicated in Opium or Morphine poisoning are—(1) the removal of the poison, (2) the maintenance of respira- tion, (3) the keeping up of the circulation. The stomach should be evacuated at once, and then washed out repeatedly at short intervals, in order to recover the morphine which is constantly excreted into that viscus. Faradization of the chest muscles, cold affusion and artificial respiration are of great value, and evacuation of the bladder frequently is important, to prevent reabsorption. Flagellation is a very dangerous procedure, from the exhaustion which may be thereby induced,—strong faradic currents are much more efficient. The anode should be placed over the lowest conjoined root of the phrenic nerve, the ca- thode three inches below the ensiform cartilage and a little to the left of the median line. Common Sources of Danger,—Overdosing with cough mix- tures, or Paregoric, or the Soothing Syrups so much used for quieting children, all of which contain Opium (see page 362). The American Journal of Pharm- acy estimates the loss of life from the latter cause at 150,000 yearly. Fatal Doses,—see page 366. Phenacetin. See above under Acetanilid, for the treatment of poisoning by Phenacetin, Antipyrin and similar compounds. Phosphorus. Antidotes,—Potassium Permanganate, is probably the most reliable. Copper Sulphate, as an emetic and a chemical antidote, doses of 3 grains in dilute solution every 5 minutes, until emesis occurs; is recommended by authority but does more harm than good. Turpentine, old and acid, con- taining oxygen, given rapidly in a gum emulsion, is said by some to be the best antidote; it is generally unattainable and has proved useless in many cases. Lime-water or Charcoal, to prevent action on the tissues. Hydrated Magnesia, as a quickly acting purgative; may be given in Linseed tea. Copper Car- bonate, with sugar and water. Avoid Oils, Fats and Milk, as they dissolve the poison and promote its absorption. Antagonists,— Opium, to counteract the cardiac and systemic depression. Transfusion, to repair the blood. 860 TREATMENT OF POISONING. Physostigma. Antidotes,—Emetics or the stomach-pump. Tannic Acid or vegetable astringents. Antagonists,—Atropine, as to the effects on the respiration, heart and pupil; gr. fa to fa hypodermically, repeated until effects are evident. The one nine-thousandth of a grain of Atropine, injected 5 minutes before giving a minimum fatal dose of Physostigma, prevents its fatal result (R). Chloral, is also antagonistic, and over a greater field of action, but to be effec- tive must be administered very early in the case (R); gr. x by mouth or rectum every hour. Strychnine, gr. fa of the sulphate or gr. fa of the nitrate, hypo- dermically ; or the tincture of Nux Vomica, tt\,xx by mouth or rectum, in very bad cases (Murrell). Stimulants, freely. Artificial Respiration. Fatal Dose,— gr. i^0 is given as the minimum fatal dose. Picrotoxin. Antidotes,—Emetics or stomach-pump. Acetic Acid gives relief in overdosing, and may have some antidotal power. Antagonists,— Chloral, is antagonistic to its cerebral and spinal action, but synergistic to its depressant power over the heart and respiration. Ancesthetics, against its spasm-producing action. Potassium Bromide, in addition to Chloral, if tetanus (Murrell). Pilocarpine (Jaborandi). Antidotes,—Persalts of Iron and salts of the metals generally, are chemically incompatible. Antagonists,—Atropine, gr. riff f°r gr- & °f the poison, is a complete antagonist, the most so known to physiological experimentation. Conversely, Pilocarpine is exactly antagonistic to Atropine, but Jaborine acts similarly to the latter. Morphine controls the nausea and vomiting. Potash. See Alkalies, above. Potassium Bichromate. Antidotes,—Sodium and Potassium Carbonates and Bicarbonates. Soap. Antagonists,— Opium or Alcohol, for the nervous and muscular depression. Potassium Nitrate (Saltpetre). Antidotes,—No chemical antidote. Emetics or stomach-pump. Demulcent drinks and emollient enemata. Milk. An- tagonists,— Opium, for the subsequent depression. Aromatics. Brandy. Pulsatilla. Antidotes,— Tannic Acid, followed by emetics. Antagonists,— Alcohol, Opium, Digitalis. Quinine. Antidotes,—Emetics and cathartics, also diuretics and sudorifics to promote elimination. Antagonists,—Alcohol, Opium, Coffee. Morphine antagonizes its cerebral action, Atropine that on the nervous system and heart, also its antipyretic power. Rat-pastes,—contain Phosphorus or Arsenic. Ratsbane is Arsenous Acid (Arsenic). Rough-on-Rats contains Arsenic (which see). Resorcin. Antidotes,—Albumen. Soda or Saccharated Lime, in plenty of tepid water, as wash for stomach. Emetics or the stomach-pump. Antago- nists,—Stimulants freely. Heat to the extremities. Amyl Nitrite, inhaled. Atropine and other cardiac and respiratory stimulants, cerebral excitants, and agents which raise the arterial tension, are physiologically antagonistic. Fric- tion with warm hand. Galvanism, the interrupted current. Fatal Dose,— Sij nearly proved fatal (Murrell). Rhus (Poison Oak or Ivy). Antagonists,— Cocaine, a 5 per cent, aqueous solution, or a 10 per cent, oleate, locally, is by far the most efficient application, promptly relieving the burning and itching. Grindelia Robusta, the fluid ex- tract, 1 to 10 of water, or undiluted, is a very serviceable lotion. Other appli- cations found useful are:—Carbolic Acid, 5 per cent, solution ; Lobelia, as infu- sion, gj to the pint; solutions of Corrosive Sublimate, Lead Acetate, Chlorin- ated Soda, Lime-water with Linseed Oil, Alum-curd. R. Plumbi Acetatis, 3>j I Ammonii Chloridi (crude), Jjss; Aquae, ; as lotion on cloths constantly wetted therewith, is used with uniform success (Burns). Soap-suds and Hot Water, frequent washing therewith the surest, speediest and best treatment (Couch). Aristol, freely dusted over the part, gives magical relief (Levick). Hydrogen Dioxide, a solution washed over the face and hands, as a preventive 861 TREATMENT OF POISONING. (Behringer). Sassafras, an infusion of the bark, taken internally and applied locally, is almost specific for the rash (Hinton). Sodium Sulphite, granular, 3j; Glycerin, j$ss; Camphor-water, q. s. ad 3jiv, is preferred as a topical appli- cation (Behringer). Opium or Coffee, to relieve the nervous irritability. Rest, low diet, and laxatives are appropriate measures. Sanguinaria. Antidotes,— Tannin, Alkalies, and most of the metallic salts are incompatible. Antagonists,— Opium, Atropine, Amyl Nitrite, etc., to an- tagonize the depression of the circulation and the local irritant action. Savine. Antidotes,—Epsom salt. Demulcents. Emetics and purgatives, especially Castor Oil. Antagonists,—Morphine, gr. % hypodermically. Poul- tices of linseed meal to abdomen. Serpent-venom. Antidotes,—Potassium Permanganate, hypodermically into the vicinity of the wound, after ligating the part above it (Weir Mitchell). Chloride of Lime (Chlorinated Lime) in solution, i in 60, injected in doses of 20 minims, produced recovery (Hodgson); after ligature applied above the wound a solution, i in 12, was injected in doses of 30 minims, 25 injections in all in different parts of the body, brought about recovery after severe symptoms from the bite of a tiger snake (Mackenzie). Hypochlorites of Lime or Sodium, Chloride of Lime, and Gold Chloride, are absolute antidotes against serpent- venom (Calmette). Antivenene (see ante, page 155). Carbolic Acid, strong, or a Mineral Acid, as caustic, after forcible sucking of wound by a person with perfect mucous surface of lips and mouth, and thorough cleansing. Atmnonia, TTLxij of Liq. Ammoniae, diluted with 3 volumes of water, hypodermically into the radial vein, for snake-poison (Halford); is shown to be unavailing by Brunton and Fayrer (B). Antagonists,—Strychnine, hypodermically, has proved eminently efficient in numerous cases (Baron von Muller). Alcohol, as brandy or whiskey freely. Arsenic, for the rapid prostration (R). Potassium Iodide, R. Potassii Iodidi, gr. iv; Hydrarg. Chlor. Corr., gr. ij ; Bromi, gv ; Aquae, 3j; of which gtt. x in 3'j of Brandy, repeated if necessary (Hammond). Viola Cucullata, the common Violet, is used in Pennsylvania against rattlesnake venom. [See ante, page 487.] Agave Virginica, is known in South Carolina by the name of “ rattlesnake’s master.” Silver Salts. Antidotes,—Sodium Chloride (common salt), dissolved in water, largely diluted and freely used; precipitates the silver as the insoluble and harmless chloride, and acts as an emetic (R). Alkalies, especially Mag- nesium Bicarbonate (R). Albumen. Antagonists,—Milk, to allay the result- ing irritatior*; it may serve as food until the stomach is restored. Opium, against results of irritation. [See also Metallic Salts, above.] For the treatment of chronic poisoning, and regulation of a course of silver medication, see ante, page 162. Soda and Sodium Salts. See Alkalies and Potassium Nitrate, also Metallic Salts, above. Stramonium. See Belladonna, above. Strychnine. See Nux Vomica, above. Sulphonal. Antagonists,—Stimulants. Diuretics. Sulphur and Sulphides. Antidotes,— Chlorine-water. Sodium Chloride (common salt). Potassium Chloride. Ferrous Sulphate. Chlorine Gas ox Cal- cium Hypochlorite, for Sulphuretted Hydrogen ; the former should be well diluted with common air. Antagonists,—Artificial Respiration is the best treatment for poisoning by Sulphuretted Hydrogen. Tartar Emetic. See Antimony, above. Tin. Antidotes,—Albumen, Ammonium and Sodium Carbonates, Milk. [See also Metallic Salts, above.] Tobacco. Antidotes,— Tannin, followed by emetics, or the stomach-pump. Iodides. Antagonists,—Strychnine is the true physiological antagonist to Nicotine (or Tobacco) and vice versa. Alcohol, Ammonia, Ergot, Digitalis, Belladonna, antagonize its action on the circulation ; Brandy is efficient, also 862 SPECIFIC GRAVITIES AND VOLUMES. strong Coffee. Warmth applied to the surface, also friction. Artificial Respi- ration. Recumbent position should be strictly maintained. Turpentine. Antidotes,—Magnesium Sulphate (Epsom salt), in water. Emetics or the stomach-pump. Demulcent drinks, as milk, barley-water, etc. Antagonists,— Opium or Morphine, if much pain, and for shock. Tyrotoxicon (in milk, cheese, ice-cream, etc.). Antidotes,—Emetics, if vomiting is not free; also the stomach-pump or siphon to rinse out the stomach with water. Thymol, Salol, Naphtalin, or other antiseptics. Antagonists,— Opium, or other sedatives, to allay irritation. Stimulants, when prostration. Veratrum and Veratrine. Antidotes,—Emetics or the stomach-pump. An- tagonists,—Alcohol, Opium, Ammonia, Digitalis, and Belladonna counteract the cardiac depression. Morphine with Atropine hypodermically, or Lauda- num internally, with alcoholic stimulants. Heat, dry, applied to the body. Recumbent posture strictly maintained. Coffee, strong, as enema. [See also Aconite, above.] Wounds, Poisoned. Antidotes,—Ammonium Carbonate, gr. v hypodermi- cally in the vicinity of wounds caused bv poisoned arrows, was repeatedly used with entire success by Dr. Parke, surgeon to Stanley’s last African expedition. [See ante, page 124; also Serpent-venom above, and the article on Wounds, in Part in.] Zinc Salts. Antidotes,—Sodium or Potassiutn Carbonate dissolved in warm water, largely diluted, used freely. Albumen, as eggs and milk, with tepid water, freely. Tannic Acid, or vegetable astringents, or strong tea. Lime- water. Soap-suds, freely. Mucilaginous drinks. Antagonists,— Opium, or Morphine hypodermically. Linseed-meal as poultices to abdomen. Enemata of gruel or starch-and-water, if much abdominal pain. TABLE OF SPECIFIC GRAVITIES AND SPECIFIC VOLUMES. (Temperature at 590 F., except when otherwise stated. Where the sp. gr. is variable, the mean specific gravity is stated.) Liquid. Specific Gravity. Specific Volume. Liquid. Specific Gravity. Specific Volume. Acid, Acetic, 1.048 •954 Liq. Ferri Tersulph., . 1.320 •757 Acid, Acetic Dil., . . . I.C08 .992 Liq. Potassae, ... 1.036 •9b5 Acid, Hydrobromic (34 Liq. Sodas, 1059 •944 per cent.), I-3°3 .767 Mel (Honey), 1-375 .727 Ac. Hydrobrom. Dil , 1.077 .928 Ol. Adipis, .915 1.092 Ac. Hydrochloric, . . 1.163 .860 Ol. Amyg. Expres., . . .917 I.C9I Ac. Hydrochlor. Dil., . 1.059 •952 Ol. Aurant. Cort., . . . .8=0 1.176 Acid, Lactic, I.213 .824 Ol. Bergamottae, . . . .883 I.132 Acid, Nitric, 1-414 .709 Ol. Caryophylli, . . . 1.065 939 Acid, Nitric, Dil., . . . 1.057 .946 Ol. Copaibae, .9CO 1.1 I I Acid, Oleic., .goo I.Ill Of Cubebae .920 1.086 Acid, Phosphoric, . . . 1.710 .584 Ol. Eucalypti, .... .920 1.086 Ac. Phosphoric, Dil., . 1.057 .946 Ol. Gaultheriae, .... 1.180 .838 Acid, Sulphuric, . . . 1.835 •545 Ol. Gossyp. Sem., . . . •925 1.081 Ac. Sulphuric. Dil., . . 1.070 ■934 Ol. Lavandulae, .... .886 1 128 .(Ether, •725 *•379 Ol. Limonis, .858 1.165 Alcohol, at 6o° F., . . .820 I.219 Ol. 1 ini, •936 1 068 Alcohol, at 770 F., . . .812 I.231 Ol. Menthae Pip., . . . .910 1.098 Alcohol, Dil., at 6o° F., •937 1 c66 Ol. Morrhuae, .923 1.083 Alcohol, Dil., at 770 K., .930 1.075 Ol. Olivae .9'6 I.C92 Aqua Destil., at 590 F., I.OOO I.OOO Ol. Ricini .960 1.042 Aq. Ammoniae, .... .960 1.042 Ol. Rosmarini, .... •905 1.104 Aq. Ammon., Fort., . . .901 1.109 Ol. Sassafras, 1.080 •925 Benzin, .670 I 493 Ol. Sesami, .921 1.194 Carbon Disulphide, . . 1.268 .788 Of Terebinthinae, . . .§62 1 160 Chloroform, .... I-49° .671 Spt. iEtheris Nitrosi, . .839 I.191 Chloroform, Venale . . 1.470 .680 Spt. Frumenti .920 1.086 Glycerin, 1.250 .800 Spt. Vini Gallici, . . . •933 1.071 Liq. Ferri Acet., . . . 1.160 .862 Syrupus 1317 • 759 Liq. Ferri Chlor 1.387 .721 Vinum Album, .... I.OOO 1 OOO DROPS IN A FLUIDRACHM. 863 TABLE SHOWING THE NUMBER OF DROPS IN A FLUIDRACHM OF VARIOUS LIQUIDS, ALSO THE WEIGHT OF ONE FLUIDRACHM IN GRAINS. (Compare page 497.) Liquid. Drops in I 3j. (ITllx.) Weight of f5j in grains. Liquid. Drops in f 5j (mix.) Weight of f5j in grains. Acetum Opii, 9° 6l Liq. Iodi Compos., .... 63 59 Acetum Sciilae, 68 57 Liq. Potassae, 62 58 Acid, Acetic 108 58 Liq. Zinci Chloridi, .... 89 88 Ac. Acetic, Oil., .... 68 55 Oleores. Aspidii, 130 52 Acid, Carbolic III 59 Oleores. Capsici, . . 120 5’ Ac. Hydrochloric, . . . 70 65 Oleores. Cubebae, 123 S® Ac. Hydrocyanic, .... 60 54 Oleum Anisi, 119 54 Acid, Lactic, III 66 Oleum Bergamottae, . . . 130 46 Acid, Nitric, 102 77 Oleum Cari, I32 5° Ac. Nitro-hydrochloric, . 76 66 Oleum Juniperi, .... 148 49 Ac. Phosphoric L)il., . . 59 57 Oleum Limonis, 129 47 Ac Sulphuric, 128 IOI Oleum Ricini, 77 5’/4 Ac. Sulph. Aromat., . . . 146 53 Oleum Rosae, I32 47 Ac. Sulph. Oil., . . 60 58% Oleum Terebinthinae, . . . ’36 45/4 Ac. Sulphurosum, .... 59 55 Oleum Tiglii, 104 50 /Ether 176 39 Spt. /Etheris Comp. ,* . . 148 45 Alcohol, 146 44 Spt. /Etheris Nitrosi, . . . 146 47 Aqua 60 55 Spt. Camphorae, ’43 47 Aqua Destillata 60 53/4 Syrupus, 65 72 Balsam Peruvian, .... IOI 60 Syrupus Acaciae, 44 73 Bromine 25O ’65 Syrupus Ferri Iodidi, . . . 65 77 Chloroform 25O 80 Syrupus Sciilae,...... 73 74 Copaiba I IO 5i Syr. Sciilae Comp., .... 102 70 Creosote 122 St'A Syrupus Senegae 106 70 Ext. Beiladon., FI., . 156 57 Tinctura Aconiti, . . . 146 46 Ext. Buchu FI' , *5° 47J4 Tinctura Belladonnae, . . . ’37 58 Ext. Digitalis FI., .... ’34 62 Tinct. Benzoini Comp., . . 148 48 Ext. Ergotae FI., ... ’33 60 Tinct. Cantharidis, .... 131 5’ Ext. Ipecac. FI., . . 120 60 Tinct. Digitalis, 128 53 Ext. Rhei FI. 158 6l Tinct. Ferri Chlor., .... ’5° 53 Ext. Senegae FI ’37 62 Tinct. Iodi, 148 47 Ext. Valerianae FI., 150 49 Tinct. Opii, ’3° 53 Ext Zingib. FI., .... 142 48 Tinct. Opii Camph., . . . 130 52 Glycerin, 67 68 Tinct. Opii Deodor., . . . no 54 H ydrargyrum ISO 760 Vin. Colchici Rad., .... 107 55 Liq. Acidi Arsenosi, . . 57 55 Vin. Colchici Sem., .... III 54 Liq. Ferri Chloridi, . . 71 72 Vinum Opii, 100 55 WEIGHTS AND MEASURES. apothecaries' or troy weight. Pound. Ounces. Drachms. Scruples. Grains. ft 3 3 9 gr. 1 = 12 = 96 = 288 = 5760 1 = 8 = 24 = 480 1 = 3 — 60 1 = 20 apothecaries’ or wine measure. Gallon. Pints. FI’ounces. FI’dr’ms. Minims. C. O. f3 f 3 rr\ 1 = 8= 128 = 1024 — 61440 1 = 16 = 128 = 7680 1 = 8 = 480 1 = 60 METRIC WEIGHTS. i Milligramme, .... o ooi = gr. j,1, i Centigramme, . . . o.oi = gr. | i Decigramme, .... o.i = gr. ij i Gramme, i. = gr. 15.432 1 Kilogramme, .... 1000. = { ft Av°Y APPROXIMATE EQUIVALENTS. TTljorgr. j, = .06 gramme. I 5j or 5j = 4- grammes. f 3j, =30. Sj, = 31- fSj of Glycerin, = 37. f 3j of Syrups, =40. “ 864 METRIC CONVERSIONS. TABLE FOR CONVERTING APOTHECARIES’ WEIGHTS AND MEASURES INTO METRIC. (Adapted from Maisch.) [Multiply all grains, or fractions of a grain, by 6479 (or 648) for the metric equivalent in milligrammes.—Potter.] Troy Weight. Metric. Apothecaries' Measure. Fluid Grammes or Cubic Centimeters. Grains. Grammes. Liquids Lighter than Water.* Liquids of Specific Gravity of Water, f Liquids Heavier than Water 1 l 1 tV JZ l TTT 1 J 1 1 f 1 Z 1 Z 3 f 1 2 3 4 5 6 7 8 9 IO i5 20 Oj) 24 26 30 (gss) 40 50 60 (3J) 100 120 (gij) 180 240 (3 ss) 3°° 360 420 48o (|j) 960 (3 ij) 1000 Milligramme. .OOI .0015 .002 .003 .004 .005 .O06 • O08 Centigramme. • OI • • Ol6 .02 •03 •OS .065 Decigramme. •13 .20 .26 •32 •39 •45 •52 •59 •65 Gramme. I.OO I.30 1.50 1.62 i-95 2.60 3.20 3-90 6.48 7.80 11.65 i5-5o 19.40 23-5° 27.20 31.10 62.20 64.79 "1 1 2 3 4 5 6 7 8 9 10 12 15 16 20 25 30 35 40 48 50 60 (f3j) 65 72 80 9° (f3iss) 96 100 120 (fgij) 150 (f 3 ijss) 160 180 (f3iij) 210 240 (f^iv) 300 (fzv) 33° (f3 vss) 360 (f5 vj) 420 (fzvij) 48o (fgj) 540 (f£ix) 600 If 3 x) 720 (fgxij) 840 (f 2 xiv) 960 (fgij) 1000 •055 . IO .16 .22 .28 •32 •38 •45 •50 •55 •65 .80 .90 1.12 1.40 1.70 2.00 2.25 2.70 2.80 3- 3.60 4.00 4- 5.10 5- 5.60 6- 8.50 9.00 10. xo 11.80 i3-5o 16.90 18.60 20.25 23.60 27.00 •30.40 33-75 40.50 47-25 54.00 56.00 .06 .12 .18 .24 •3° •36 .42 •50 •55 .60 •72 .90 1.00 1-25 i-55 1.90 2.20 2.50 3.00 3.12 3- 4.00 4- 5.00 5.60 6.00 6.25 7-5o 9-5o 10.00 11.25 13.00 15.00 18.75 20.75 22.50 26.25 30.00 33-75 37-5° 45.00 52.50 60.00 62.50 .08 •15 .24 •32 .40 .48 •55 .65 •73 .80 .96 1.20 1.32 1.60 2.00 2.50 2.90 3- 4.00 4- 15 5.00 5- 6.00 6.65 7-5o 8.00 8.30 10.00 12.50 i3-3o 15.00 i7-5o 20.00 25.00 27.50 30.00 35-oo 40.00 45.00 50.00 60.00 70.00 80.00 83.00 * Lighter than water are tinctures, spirits, compound spirit of ether, sweet spirit of nitre, fixed anc volatile oils. YEther, f5j = grammes 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 = grammes 5.50. INDEX. The salts of the metals are usually described in the text under the titles of their metal- lic constituents; some few (as the Arsenates, Phosphates, etc.), also the salts of the alkaloids and those of active elementary substances (as the Bromides, Iodides, etc.) are placed under the titles of their most active constituents. Salts are therefore not mentioned individually in the Index except when their places in the text are exceptional and do not come within either of the above rules. Abbreviations, their use, 508 Table of, 508, 816 Abdominal Plethora, 567 Abasia and Astasia, 567 Abies, 392 Abies balsamea, 465 canadensis, 393 excelsa, 392 Abietic Anhydride, 410 Abortion, 567 Abrin, 65, 147 Abrus, 65 Abscess, 568 of the Liver, 692 Mammary, 568 Absinthe, 66 Absinthium, 66 Acacia, 66 Catechu, 216 Accommodation, Agents affecting, 37 Aceta, 528 Acetanilid, 66 Compound, 67 Antidotes and Antagonists, 851 Acetates,—See their basic titles. Acetone, 455 in Urine, Test for, 846 Acetous Preparations, 527 Acetum, 70 Acid, Abietic, 410 Abric, 65 Acetic, 69, 107 Antidotes, etc., 852 Aconitic, 96 Agaricic, 104 Aloetic, 118 Anemonic, 405 Angelic, 461 Arabic, 66 Arsenous, 165 Antidotes and Antagonists, 854 Artanthic, 340 Benzoic, 183, 239 Boracic, 70 Acid, Boric, 70 Brassic, 443 Butyric, 345 Calumbic, 203 Camphoric, 204, 206, 466 Camphretic, 204 Capronic, 163 Caprylic, 163 Carbazotic, 92 Carbolic, 72, 238 Antidotes and Antagonists, 852 Gauze, 73 Solution, 73 Carbonic, 80 Antidotes and Antagonists, 852 Carminic, 248 Caryophyllic, 214 Caryophyllinic, 215 Catechuic, 216 Catechu-tannic, 216 Cathartic, 440 Cathartogenic, 440 Cerotic, 217 Cetraric, 218 Cevadic, 484 Chelidonic, 218, 430 Chromic, 82 Chrysammic, 1x8 Chrysophanic, 234, 413, 421 Cinnamic, 177, 183, 454 Citric, 330 Coca-tannic, 243 Copaibic, 254 Cresylic, 73, 256 Cubebic, 260 Digallic, 94 Ergotic, 274 Ergotinic, 275 Erucic, 443 Eugenic, 347 Euonic, 279 Euphrastic, 280 Filicic, 170 Fluoric, 83 865 866 INDEX, Acid, Formic, 341; Gallic, 288 Gallo-tannic, 94 Gambogic, 204 Gelsemic, 289 Gentesic, 291 Gentianic, 291 Glycyrrhizic, 293 Guaiac, 297 Guaiaconic, 297 Guaiarec, 297 Gurjunic, 298 Gynocardic, 218 Hydriodic, 316 Hydrobromic, 85 Hydrochloric, 85 Hydrocyanic, 87, 404 Antidotes and Antagonists, 852 Hypophosphorous, 380 Hypopicrotoxic, 386 Igasuric, 351 Ipecacuanhic, 321 Juglandic, 325 Kinic, 236 Kinotannic, 236, 326 Kinovic, 236 Kinovo-tannic, 236 Lactic, 89, 359 Lactucic, 328 Laricic, 104 Linoleic, 331 Lobelic, 333 Lupulinic, 301 Maizenic, 488 Malic, 179 Mastichic, 340 Meconic, 359 Melassic, 424 Methyl-salicylic, 289 Mezereinic, 344 Mineral, 85 Antidotes and Antagonists, 852 Morrhuic, 345 Muriatic, 85 Myristic, 347 Nitric, 90 Nitro-hydrochloric, 85, 90 Nitro-muriatic, 85, 90 Nucleinic, 133 Oleic, 91, 358 Ophelic, 220 Ortho-phenol-sulphonic, 74 Ortho-phosphoric, 91 Oxalic, 56, 575 Antidotes and Antagonists, 852 Palmaric, 410 Palmitic, 358 Phenic, 72 Phosphoric, 91, 345 Phytolaccic, 385 Picric, 92 Picrotoxic, 386 Pinic, 410 Acid, Piperonylic, 256 Podophyllinic, 398 Polygonic, 398 Protocatechuic, 398, 483 Prussic, 87 Punico-tannic, 295 Pyrogallic, 84, 238 Pyroligneous, 392 • Quercitannic, 409 Rhatania-tannic, 326 Rheotannic, 413 Rheumic, 413 Ricinoleic, 417 Robustic, 296 Rosolic, 73 Sabadillic, 484 Salicylic, 239, 425 Salicylous, 427 Salicyluric, 427 Sanguinarinic, 430 Scheele’s, 87 Sclerotic, 275 Sclerotinic, 275 Silvic, 4x0 Sozolic, 74 Sphacelinic, 275 Stearic, 99 Strychnic, 351 Sulphuric, 92 Sulphuric, Aromatic, 92 Sulphurous, 93 Succinic, 119 Tannic, 94, 288 as an Antidote, 848 Tartaric, 95 Thebolactic, 359 Tiglinic, 471 Toxicodendric, 415 Tropic, 180, 311 Valerianic, 461, 482 Vanillic, 483 Vegetable, 70 Veratric, 484 Viburnic, 486 Xylic, 73 Acids,—their action, 44, 70, 85 as Antidotes, 849 Antidotes and Antagonists, 852 Acidity, 569 Acipenser Huso, 314 Acne, 569 Rosacea, 570 Acocanthera Ouabaio, 454 Aconine, 96 Aconite, 95 Antidotes and Antagonists, 852 Aconitine, 96 Aconitum, 95 Acorin, 199 Acorus Calamus, 199 Acrinyl, Sulpho-cyanate, 443 Acrolein, 292 Actinomycosis, 571 INDEX. 867 Adeps, 98 Benzoinatus, 98 Lanse Hydrosus, 98 Addison’s Disease, 571 Adenitis,—See Glandular Affections, 669 Administration of Medicines, 23 Adrenal Extract, 138 Adynamia, 571 Hither, 99 Acetic, 99 After-pains, 572 Agalactia, 572 Agaricin, 104 Agaricus, 104 Agathin, 67 Agave Americana, 118 Agents acting on each other, 61 Agropyrum repens, 480 Ague,—See Intermittent Fever, 703 Ailanthus, 105 Alabastrine, 349 Albau, 273 Albumen, as an Antidote, 848 in Urine, Test for, 845 Albumin, 487 Phosphorized, 136 Albuminuria, 572 Alcohol, 106 Amyl, 107 Antidotes and Antagonists, 853 Caustic, 445 Ethyl, 106 Methyl, 107 Phenic, 72 Alcoholic Preparations, 527 strength of Bitters, 833 Alcoholism, 112, 115, 573, 853 Aldehyde, 107 Acetic, X07 Ethyl, 107, 373 Formic, 107, 287 Proto-catechuic, 483 Alder Bark, 84, 118 Black, 404 Buckthorn, 288 Ale, 108 Aletris, 117 Alexins, 147 Alkalies, their action, 44 Antidotes and Antagonists, 853 Alkaline Mineral Waters, 157 Alkaloids, 21 Antidotes and Antagonists, 853 Liquid, 21, 462 Allium, 117 Allspice, 390 Allyl Sulphide, 117, 168 Sulpho-cyanide, 443 Almond, 87, 125 Alnus, 84, 118 Aloe Socotrina, 118 Aloes, 118 Aloin, 1x8 Alopecia, 574 Areata, 792 Alstonia scholaris, 271 Alteratives, 50 Uterine, 57 Althaea, 119 Alum, 120 Ammonio-ferric, 283 Antidotes and Antagonists, 853 Alum-root, 84 Alumen, 120 Exsiccatum, 120 Aluminum, 120 Alumnol, 121 Amanita Muscaria, 104 Amaurosis, 574 Amber, 455 Amblyopia, 38, 574 Amenorrhcea, 575 Amick’s Consumption-cure, 833 Amido-benzene, 238 Ammonia, 121 as an Antidote, 849 Antidotes and Antagonists, 853 Ammonia-alum, 120 Ammoniated Copper, 261 Glycyrrhizin, 293 Mercury, 303 Ammoniacum, 121 Ammonio-ferric Alum, 283 Tartrate, 283 Ammonium, 121 Benzoate, 183 Carbonate, as Antidote, 851 Picrate, 92 Sulpho-ichthyolate, 458 Ammonol, 67 Amorphous Bodies, 520 Amygdala, 125 Amygdalin, 87, 125, 404 Amyl Alcohol, 107 Chloride, 102 Hydrate, 107 Hydride, 102 Nitrite, 126 Antidotes and Antagonists, 853 Amylamine, 345 Amylene, 102 Hydrate, 221 Amylum, 128, 424 Iodatum, as Antidote, 851 Anacyclus Pyrethrum, 408 Analgen, 67 Analgesics, 35 Analgesine, 67 Anamirta paniculata, 386 Ananassa Sativa, 376 Anaphrodisiacs, 56, 554 Anarcotine, 365 Anasarca,—See Dropsy, 637 Andira Araroba, 234 Anaemia, 576 Cerebral, 605 868 INDEX Anaesthesia, 101, 228, 577 Local, 33, 245, 258 Therapeutics of, 577 Anaesthetics, 33, 35, 100, 102, 228 Antidotes and Antagonists, 853 Local, 33, 245, 258 Mixtures, 100 Modes of using, 230 Anemone, 405 Anemonin, 405 Aneurism, 577 Angelate of Butyl, 140 Angina,—See Croup, Laryngitis, Pharyn gitis, Throat, Tonsillitis, etc. * Angina Pectoris, 578 Anhidrotics, 55 Anilin, 238 Red, 288 Animal Extracts, 129 Anise, 139 Star, 3x5 Anisum, 139 Anodynes, 33, 35 Local, 33 Ant-acids, 44 Antagonism of Drugs, 62 Antagonists, 62, 851 List of, 64, 851 Table of, 64 Anthelmintics, 48, 432 Anthemis, 140 Anthrax, 578 Antiabrin, 147 Antibilious Pills, 554 Antidote, Arsenic, 282 Bouchardat's, 850, 851 Jeaunel’s, 851 Antidote-bag, 851 Antidotes, 61, 847 General, 851 Anti-emetics, 45 Anti-fat, 288, 386 Antifebrin, 66 Antigalactagogues, 57 Antikamnia, 67 Antikol, 67 Antilithics, 54 Antimonial Powder, 140 Antimony, 140 Antidotes and Antagonists, 853 Sulphurated, 140 Antinervin, 67, 69 Antiperiodics, 51 Antiphlogistics, 51 Antiphthisin, 154, 476 Antipyretics, 50, 259 Antipyrin, 142 Antidotes and Antagonists, 853 Salicylate, 143, 426 Antiricin, 147 Antiseptic Fluid, 470 Injection, 309 Solution, 309, 709 Antiseptics, 60, 470 Antisialics, 43 Antispasmodics, 36 Antitoxin, 147 Diphtheria, 149 Streptococcus, 154 Syphilis, 155 Tetanus, 152 Tuberculosis, 153 Typhoid, 156 Vaccinia, 156 Antitoxins, 146 Antivenene, 155 Antizymotics, 59 Antrum, Disease of, 578 Anus, Fissured, 579 Prolapse of, 761 Aperients, 46, 554 Aphonia, 579 Aphrodisiacs, 55 Aphthae, 580 Apiin, 156 Apiol, 156 Apis mellifica, 217, 341 Apnoea, 583 Apocynin, 156 Apocynum, 156 Apomorphine, 359, 362, 365, 367 Apoplexy, 580 Apotheme, 535 Apparatus for testing urine, 846 Appetite, 581 Approximate Measures, 497, 863 Weights, 863 Aqua, 157 Carbonata, 80 Regia, 90 Aquae, 528 Arabin, 66, 480 Arbor Vitae, 469 Arbutin, 219, 289, 481 Arctium Lappa, 328 Arctostaphylos glauca, 481 Uva-ursi, 481 Argentum, 161 Antidotes and Antagonists, 861 Argol> 399 Argyria, 162 Aristol, 320 Aristolochia, 441 Aristolochine, 441 Arnica, 163 Arnicin, 163 Aromatic Fluid Extract, 243 Powder, 243 Sulphuric Acid, 92 Arsenate, Iron, 283 Sodium, 165 Arsenates and Arsenites, 165 Arsenauro, 173, 176 Arsenic, 165 Antidote, 282 Antidotes and Antagonists, 854 INDEX. 869 Arsenite, Copper, 165 Potassium, 165 Strychnine, 352, 357 Arsenum, 165 Artemisia Absinthium, 66 pauciflora, 432 Arterial Transfusion, 25 Arthritis, Rheumatoid, 581 Asafoetida, 168 Asagrsea officinalis, 484 Ascarides,—See Worms, 296, 812 Ascites, 582 Asclepias, 169 Aselline, 345 Aseptol, 74 Aseptolin, 74 Ash, Flowering, 340 Prickly, 487 Asparagin, 119, 279, 293 Asphyxia, 583 Aspidium, 169 Aspidosperma, 170 Aspidospermine, 170 Assay, 525 Astasia, 567 Asthenia,—See Adynamia, Convalescence Asthenopia, 584 Asthma, 584 Astigmatism, 586 Astragalus gummifer, 480 Astringents, 50, 58 Intestinal, 47 PiU, 554 Powder, 556 Urinary, 53 Vegetable, 84, 94 Atheroma, 586 Atropa Belladonna, 179 Atrophy, 586 Atropine, 179, 180 and Morphine, 369, 831 Antidotes and Antagonists, 854 Atrosin, 179 Aurantiin, 171 Aurantium, 171 Aurin, 73 Aurum, 172 Authorities, List of, 566 Ava kava, 326 A vena Sativa, 177 Ayer’s Ague Cure, 833 Cherry Pectoral, 833 Pills, 833 Recamier Balm, 835 Cream, 835 Sarsaparilla, 833 Vita Nuova, 836 Azedarach, 177 Azoturia,—See Urinary Disorders, 803 Azulen, 341 Balanitis, 587 Baldness,—See Alopecia, 574, 792 Balm, 342 Cream, 834 of Gilead, 465 Recamier, 835 Balnea, 157, 528 Balsam of Copaiba, 254 of Fir, 465 Friar’s, 183 Gurjun, 298 of Peru, 177 of Tolu, 178 Balsamum Dipterocarpi, 298 Peruvianum, 177 Tolutanum, 178 Bandoline, 264 Banting Dietary, 736 Baptisia, 178 Baptisin, 178 Barbaloin, 118 Barberry, 184 Bark, Blackberry, 420 Casca, 215 Chittem, 412 Cramp, 486 Cuprea, 236 Elm, 481 Honduras, 215 Huxham’s Tincture of, 237 Oak, 409 Ordeal, 215 Peruvian, 235 Sacred, 412 Sassy, 215 Soap, 410 Willow, 427 Barley, 337 Barium Dioxide, 179 Barium Salts, Antidotes, etc., 854 Barosma, 191 Barosmin, 192 Basham’s Mixture, 282 Basilicon Ointment, 410 Bassorin, 480 Baths, 528 Formulae, 528 Battley’s Sedative, 361 Bay, Sweet, 336 Bay-berry, 347 Bay Rum, 347 Bear-berry, 481 Bed-sores, 587 Bee-venom, Antidotes, etc., 854 Beer, 108 Ginger, 492 Behring’s Law, 147 Belladonna, 179 Antidotes and Antagonists, 854 Belladonnine, 179 Benne Oil, 442 Benzene, 102, 182, 238 870 1N DEX. Benzin, 182 Benzoates, 183 Benzoin, 183 Benzoinated Lard, 98 Benzol, 102, 182, 238 Benzosol, 256, 259 Benzoyl Guaiacol, 256 Sulphonic-imide, 423 Benzyl Cinnamate, 177 Berberine, 184, 203, 309, 342, 374, 397, 488 Hydrochlorate, 184 Berberis, 184 Bergamot, Oil of, 185 Bergaptene, 185 Beta-naphtol, 349 Beta vulgaris, 423 Betula lenta, 425 Bhang, 207 Bibliography and References, 566 Bichlorinated Methyl Chloride, 226 Bichromate of Potassium, 83 Antidotes and Antagonists, 860 Bile, Agents affecting the, 48 Bile Pigment in Urine, Test, 845 Biliary Solvents, 54 Biliousness, 308, 587 Bilious Remittent Fever, 842 Bind weed, 301 Birch, Sweet, 425 Bird-lime, 487 Bismuth, 185 Mixture for Children, 546 Subgallate, 186, 321 Subiodide, 186, 321 Bitartrate, Potassium, 400 Nicotine, 462 Bites and Stings, 784 Bitters, Action of, 203 Alcoholic Strength of, 833 Hostetter’s, 834 Vinegar, 836 Bittersweet, 272 Blackberry, 84, 420 Black Draught, 440 Drop, 360 Haw, 486 Paste, 673 Bladder, Inflammation of, 625 Irritable, 588 Paralysis of, 588 Bladder-wrack, 288 Blancard’s Pills, 281 Blaud’s Pills, 281 Bleaching Powder, Antidotes, 857 Blende,489 Blepharitis, 588 Blistering Cerate, 209 Collodion, 209 Blisters, 58 Blood-root, 430 Blood-stains, 783 Blue Cohosh, 216 Blue Flag, 323 Mass, 302 Methylene, 343 Ointment, 302 Pill, 302 Boiling, 527 Boils, 589 Boldine, 187 Boldo, 187 Boldus, 187 Bolus, 548 Bone Diseases, 589 Marrow Extract, 133 Boneset, 279 Borax, 71 Borine, 71 Borneol, 466 Boro-glyceride, 71, 72 Bos Taurus, 280 Botkin’s Cholera Drops, 609 Bots, 177 Bouchardat’s Antidote, 850, 851 Bougies, 558 Boxwood, 374 Brain Disorders,—See Cerebral Anaemia, Cerebral Concussion, etc. Extract, 137 Fever,—See Meningitis, Cerebro- spinal Meningitis, Typhoid Fever, Typhus. Brandreth’s Pills, 833 Brandy, 107 Brassica, 443 Brayera, 264 Breasts,—See under Abscess, Lactation, Mastitis, Nipples. Breath, Fetid, 590 Bright’s Disease, Acute, 590 Chronic, 591 Diagnosis, 837 Bromelin, 376 Bromides, 187 Antidotes and Antagonists, 854 Formulae for, 654, 740 Bromidrosis,—See Feet, 660 Bromine and Bromides, 187, 189 Antidotes and Antagonists, 854 Bromism, 188 Bromoform, 187, 190 Bronchiectasis, 592 Bronchitis, Acute, 592 Capillary, 593 Chronic, 594 Bronchocele,—See Goitre, 671 Bronchorrhcea, 595 Broom, 437 Brown Mixture, 293 Brucine, 301, 314, 352, 357 Bruises, 596 Bryonia, 190 Bryonin, 190, 191 Bubo, 596 Buchu, 191 INDEX. 871 Buchu, Helmbold’s, 834 Buckthorn, 288, 412 Bulimia, 581 Bunion, 596 Burdock, 328 Burnett’s Disinfectant, 60, 490 Burns, 597 Bursitis, 597 Butternut, 324 Butyl Angelate, 140 Chloral Hydrate, 225 Chloride, 102 Hydride, 102 Valerianate, 140 Butylamine, 345 Buxine, 374 Buxus sempervirens, 374 Cacao-butter, 468 Cachets, 555 Cachexiae, 597 Cactine, 192 Cactus Grand iflora, 192 Cadmium, 192 Caffea, 193 Caffeine, 193 Citrated, 193 Caffenol, 67 Caffeol, 193 Caffeone,193 Cajuput, Oil of, 199 Cajuputene Bihydrate, 199 Cajuputol, 199 Calabar Bean, 383 Calabarine, 383 Calamine, 489 Ointment, 491 Calamus, 199 Calcauro, 173 Calcination, 522 Calcium, 199 Chloride, Antidotes, etc., 854 Hydrate, as an Antidote, 850 Sulphide, 458 Calculi, Biliary, 598 Renal, 598 Solvents of, 54 Vesical, 598 Calendula, 203 Calomel, 303 Calumba, 203 Calx, 200 Chlorata, 232 Sulphurata, 458 Cambogia, 204 Camp Fever,—See Typhus, 800 Camphene, 466 Camphor, 204, 466 Antidotes and Antagonists, 854 Baldrian, 482 Bergamot, 185 Carbolated, 205 Camphor-Chloral, 205 -Cymol, 204 Monobromated, 205 Naphtol, 350 Peppermint,—See Menthol, 342 Pulsatilla, 405 Salicylated, 205 Camphylene, 349 Canadian Hemp, 156 Moonseed, 342 Cancer, 599 Diagnosis of, 838 of Uterus, 804 Cancrum Oris, 600 Cannabene, 207 Cannabin, 207 Cannabis, 207 Antidotes and Antagonists, 854 Cantharides, 209 Cantharidin, 209 Cantharis, 209 Antidotes and Antagonists, 855 Caoutchouc, 273 Capsicin, 211 Capsicum, 211 Capsules, 528 Caraway, 214 Carbinol, 107 Carbo, 212 Animalis, 212 Ligni, 212 Carbon, 212 Disulphide, 102, 212 Dioxide, 102, 212 Antidotes and Antagonists, 855 Monoxide, 102, 212 Tetrachloride, 102, 228 Carbonei Disulphidum, 102, 212 Carbonated Mineral Waters, 158 Carbonates, as Antidotes, 849 Carbonization, 519 Carbuncle, 600 Carcinoma,—See Cancer, 599 Cardamom, 213 Cardiac Disorders,—See Heart, 679, 680 Sedatives, 42 Stimulants, 41 Tonics, 41 Cardialgia,—See Pyrosis, 768 Cardine, 137 Carditis, Diagnosis of, 838 Carduus, 214 Carica Papaya, 376 Caries, 601 Carminative, Dal by’s, 362 Dewees’, 168, 335 Carminatives, 46 Carmine, 248 Caroval, 263 Carragheen, 234 Carron Oil, 200, 331 Carthamus tinctorius, 260 Caruen, 214 872 INDEX, Carum, 214 Caruol, 214 Caryophyllin, 214 Caryophyllus, 2x4 Casca Bark, 215 Cascara Amarga, 215 Sagrada, 412 Carcarilla, 215 Cascarillin, 215 Cassia acutifolia, 440 angustifolia, 440 Cinnamon, 242 Fistula, 216 Purging, 216 Castanea, 84, 216 Castor Oil, 417 Emulsion ; Formula, 619 Castoria, 833 Catalepsy, 602 Cataplasmata, 529 Cataract, 602 Catarrh, Acute Nasal, 602 Broncho-pulmonary,—See Bronchitis, Bronchorrhoea. Chronic Nasal, 604 Duodenal, 638 Epidemic,—See Influenza, 700 Gastric,—See Gastritis, Chronic, 666 Genito-urinary,—See Bladder, Catarrh of, Cystitis, Endometritis, Gonor- rhoea, Leucorrhoea, etc. Intestinal,— See Dysentery, Jaundice. Sage’s Remedy, 835 Sanford’s Cure, 835 Summer,—See Hay Fever, 675 Catechol, 239 Catechu, 84, 216 Cathartics, 46 in Poisoning, 848 Catharto-mannite, 440 Caulophyllin, 217 Caulophyllum, 216 Caustic, Lunar, 161 Mitigated, 161 Potash, 399 Soda, 444 Caustics, 58 Cedar, Oil of, 432 Red, 422 White, 469 Celandine, 218 Celerina, 244 Cellulose, 294, 424 Centaurea benedicta, 214 Century-plant, 118 Cephaelis Ipecacuanha, 321 Cephalalgia,—See Headache, 676 Cera, 217 Cerata, 529 Cerate, 217 Blistering, 209 Cantharides, 209 Cetaceum, 217 Cerate, Goulard’s, 395 Lead, Subacetate, 395 Resin, 410 Savine, 422 Theobroma, 468 Cerates, 529 Compounding of, 564 Ceratum, 217 Cerebellum, Agents affecting, 36 Cerebral Anaemia, 605 Compression, Diagnosis, 838 Concussion, 606 Diagnosis, 838 Congestion, 606 Depressants, 34 Excitants, 33 Softening, 606 Vomiting,—Diagnosis, 842 Cerebrine, 137 Cerebrinin, 137 Cerebro-spinal Fever, 722 Cereus, Night-blooming, 192 Cerium Oxalate, 217 Cerolein, 217 Cetaceum, 217 Cetin, 218 Cetraria, 218 Cetyl Palmitate, 218 Cevadilla, 484 Cevadilline, 484 Cevadine, 483 Chalk, 200 Chalybeate Waters, 158 Chamomile, 140 German, 341 Chamomilla, 140, 341 Chancre, 606 Diagnosis of, 838 Chancroid, 607 Diagnosis of, 838 Change of Life,—See Climacteric, 613 Chapped Hands and Lips, 607 Charcoal, 212 as an Antidote, 849 Chart* (Papers), <29 Chartulse, 555 Chaulmoogra Oil, 218 Chekan, 349 Chekanine, 349 Chelerythrine, 218 Chelidonine, 218 Chelidonium, 218 Chelidoxanthin, 218 Chelsea Pensioner, 530 Chemical Incompatibility, 511 Chenopodium, 218 Cherry-laurel, 87, 89 Cherry Pectoral, 833 Cherry, Wild, 404 Chestnut, 216 Chestnut-leaves, 84 Chest-pains, 607 Chian Turpentine, 465 873 Chicken-pox,—See Varicella, 807 Chilblains, 607 Children, Dosage for, 28, 362 Chimaphila, 2x9 Chimaphilin, 219 China, Pride of, 177 Chinicin, 239 Chininum Amorphum Boricum, 237 Chinoidin, 238 Chinolin, 219, 239 Chirata, 220 Chiratin, 220 Chiretta, 220 Chittem Bark, 4x2 Chloral, 220 Analogues, 221 Antidotes and Antagonists, 855 Butylic, 225 Formidate, 225 Hydrate, 220 Chloralamid, 225 Chloral-habit, 223 Chlorates,—See their metallic titles. Chlorides,—See their metallic titles, as Antidotes, 850 in Urine, Test, 845 Chlorinated Waters, 158 Chlorine, 231 as an Antidote, 850 Antidotes and Antagonists, 855 Chlorine-water. 232 Chlorodyne, 227 Collis Browne’s, 833 Formulae for, compared, 832 Chloroform, 226 Antidotes and Antagonists, 855 Sayre’s method of using, 231 Chlorosis, 608 Chlorum, 231 Chocolate, 195, 468 Choking, 608 Cholagogues, 47 Pills, 554 Purgatives, 46 Cholera Asiatica, 609 Diagnosis of, 839 Infantum, 609 Mixture (Squibb), 361, 609 Simplex, 610 Toxin, 478 Cholesterin, 487 Chondodendron tomentosum, 374 Chondrus, 234 Chordee, 611 Chorea, 611 Choroiditis, 612 Chromic Trioxide, 82 Chrysarobin, 234 Chrysophan, 413 Churrus, 207 Chyluria, 612 Cigarettes, Formulae for, 586 Ciliary Excitants, 41 INDEX. Cimicifuga, 234 Cimicifugin, 234 Cinchona, 235 Rubra, 236 Cinchona Red, 236 Cinchonamine, 236 Cinchonidine, 236 Cinchonine, 236, 238 Cinchonism, 240 Cineol, 348 Cinnamein, 177 Cinnamomum, 242 Camphora, 204 Cinnamon, 242 Cinquefoil, 749 Circulation, Agents affecting, 41 Cissampeline, 374 Cissampelos Pareira, 374 Citrates,—See their basic titles, also 330 Citrine Ointment, 303, 304 Citron, 330 Citrullus Colocynthis, 250 Citrus acris, 330 Aurantium, 171 Bergamia, 185 Limonum, 330 medica, 330 vulgaris, 171, 330 Clarification, 519 Clarke’s Blood Mixture, 834 Classification of Medicines, 30 Claviceps purpurea, 274 Clavus,—See Headache, 676 Clemens’ Solution, 165 Climacteric Disorders, 613 Cloves, 214 Club-moss, 334 Clysters, 539 Cnicin, 214 Cnicus benedictus, 214 Coal-gas, Antidotes and Antagonists, 855 Coca, 195, 243 Cocaine, 195, 244 Antidotes and Antagonists, 855 Cocaine-habit, 246 Cocculus Indicus, 386 Coccus, 248 Coccyodynia, 613 Cochineal, 248 Cocoa, 195 Codamine, 359 Codfish, 344 Codeine, 359, 362, 365, 368 Cod-liver Oil, 344 Emulsion, 344, 534 Coffee, 193 Cohosh, Black, 234 Blue, 216 Cola acuminata, 196 Colation, 519 Colchiceine, 249 Colchicine, 249 Colchicum, 249 874 INDEX. Colchicum, Antidotes and Antagonists, 855 Coldness, 613 Colic, Hepatic, 614 Intestinal, 613 Lead, 614 Renal, 614 Colic-root, 117, 271 Collapse, 615 Collodia, 530 Collodion, 294, 530 Blistering, 294 Cantharidal, 209, 294 Flexible, 294 Styptic, 94, 294 Colloids, 521 Colloxylin, 294 Collunarium, 539 Collyrium, 541 Formulae for, 542 Colocynth, 250 Colocynthein, 250 Colocynthin, 250 Colocynthis, 250 Colocynthitin, 250 Cologne-water, 108 Colophony, 410, 466 Columbo, 203 Coma, 615 Alcoholic, 114 Opium, 363 Combination, Principles of, 505 Combustibles, 513 Comminution, 519 Commiphora Myrrha, 348 Compounding Medicines, 517 a Mixture, 545 Compounds, Explosive, 512 Poisonous, 513 Condylomata, 615 Condy’s Fluid, 60, 338 Confectio Damocratis, 530 Confections, 530 Formulae for, 530 Conhydrine, 251 Coniine, 251 Conium, 251 Antidotes and Antagonists, 856 Conjunctivitis, Catarrhal, 616 Diphtheritic, 617 Gonorrhoeal, 617 Granular, 617 Phlyctenular, 617 Purulent, 618 Conspergatives, 549, 550 Constipation, 618 Constituents of Vegetable Drugs, 20 Contractions, List of, 508, 816 Convalescence, 620 Convallamarin, 253 Convallaria, 253 Convallarin, 253 Convolvulin, 323, 436 Convolvulus Scammonia, 435 Convulsions, 620 Infantile, 620 Puerperal, 765 Copaiba, 254 Emulsion, 254, 534 Copaifera Langsdorffii, 254 Copper, 261 Carbonate, as Antidote, 850 Salts, Antidotes, etc., 856 Coral, 201 Cordial, Cascara, 413 Godfrey’s, 362 Coriander, 255 Coriandrum, 255 Corn, Indian, 488 Corn-silk, 488 Corn-smut, 488 Corneal Opacities, 621 Corneitis,—See Keratitis, 708 Cornin, 255 Corns, 621 Cornus, 255 Cornutine, 275 Corpulence,—See Obesity, 736 Corrosive Sublimate, 302 Antidotes and Antagonists, 856 Coryza,—See Catarrh, Acute, 602 Coto Bark, 255 Cotoin, 256 Cosmoline, 378 Cotton, 294 Gun, 424 Iodized, Formulae for, 683 Cotton-seed Oil, 294 Couch-grass, 480 Cough, 368, 621 Mixtures, Formulae for, 623, 721, 751, 756 Counter-irritants, 57 Court Plaster, 314 Coxalgia, 623 Coxe’s Hive Mixture, 140, 436 Crab Lice,—See Pediculi, 747 Crabs’-eyes, 201 Cramp Bark, 486 Cramps, See Trismus, Spasmodic Affec’ns. Cranesbill, 84, 291 Cream, Cold, 218, 419 Recamier, 835 of Tartar, 400 Creosote, 74, 256, 258 Antidotes and Antagonists, 856 Creolin, 74, 79 Creosol, 256 Cresol, 73 Creta, 200 Crocq’s Solution, 383 Crocus, 260 Croton-chloral, 225 Croton Eleuteria, 215 Oil, 471 Tiglium, 471 Croup, Catarrhal, 624 INDEX. 875 Croup, Membranous, 624 Diagnosis, 839 Cryptopine, 359, 366 Crystallization, 520 Cubeb, 260 Cubeben, 260 Cubebene, 260 Cubebin, 260 Cuca, 243 Cucumber, Squirting, 274 Cucumber Tree, 336 Cucurbita Pepo, 374 Cucurbitine, 374 Culver’s Root, 329 Cuprea Bark, 236 Cuprum, 261 Ammoniatum, 261 Curare, 263 Antidotes and Antagonists, 856 Curarine, 263 Cusso, 264 Cutaneous Irritants, 57 Cuttle-fish Bone, 201 Cyanides,—See their metallic titles. Cyanosis, 625 Cydonin, 264 Cydonium, 264 Cymene, 278, 466, 470 Cynips Gallae tinctoriae, 288 Cypripedin, 265 Cypripedium, 265 Cystitis, Acute, 625 Chronic, 626 Cysts, 627 Cytisus Scoparius, 437 Dalby’s Carminative, 362 Damiana, 265 Dandelion, 464 Dangers of Incompatibility, 514 Dandruff,—See Pityriasis, 756 Daphne Mezereum, 344 Daphnin, 344 Datura Stramonium, 450 Tatula, 265 Daturine, 265, 450 Deafness, 627 Death, Signs of,—See Asphyxia, 584 Debility,—See Adynamia, Anaemia, Con- valescence. Decantation, 520 Decimal Weights, etc., 496 Decocta (Decoctions), 531 Decoloration, 521 Deer, Musk, 346 Deflagration, 521 Deliquescence, 520 Deliquescent Salts, List of, 552 Deliriants, 33 Delirium, 628 Tremens, 112, 115, 628 Delphinine, 449 Delphinium Staphisagria, 449 Dementia, 701 Paralytica, 629 Demulcents, 59 Dengue, 629 Dentition, 629 Dentifrices, 42 Deodorants, 61 Deposits in Urine, 846 Depressants, Cerebral, 34 Hepatic, 48 Renal, 52 Respiratory, 39 Uterine, 57 Dermatol, 185, 187, 321 Desiccation, 521 Destructive Metamorphosis, 50 Dew-berry, 420 Dewees’ Carminative, 168, 335 Dextrin, 424 Dextrose, 341, 424 Diabetes Insipidus, 630 Mellitus, 630 Diabetin, 425 Diacetyl-tannin, 95 Diachylon Ointment, 395 Plaster, 395 Diagnosis, Differential, 837 Dialysis, 521 Dialysed Iron, 283 Diaphoretics, 54 Diarrhoea, 632 Diastase, 337 Pancreatic, 376 Dichlor-methyl Chloride, 226 Dichloro-methane, 227 Didymin, 135 Diethylsulphon-diethylmethane, 457 Diethylsulphon-dimethylmethane, 455 Diethylsulphon-methylethylmethane, 45 6 Diffusate, 521 Digestive System, Agents affecting, 42 Digitalein, 266 Digitalin, 266 Digitalis, 265 Antidotes and Antagonists, 856 Digitin, 266 Digitonin, 266, 439 Digitoxin, 266 Dihydrotoluidine, 345 Diluents, 54, 544 Dimethyl-ethylcarbinol, 221 Dimethyl-piperazin Tartrate, 392 Dimethyl-xanthin, 195 Dioscorea, 271 Dioscorein, 271 Diospyros, 84 Dipentene, 466 Diphtheria, 150, 634 Diagnosis of, 839 Temperature in, 844 Dipsomania,—See Alcoholism, Delirium Tremens. 876 INDEX. Discutients, 50 Disinfectants, 60 Burnett’s, 60 Condy’s, 60 Labarraque’s, 60 Disinfecting Fluid, 490 OH, 75 Dislocations, 664 Dispensatories, 494 Dispensing, 517 by Physicians, 516 Displacement, 523 Distillation, 522 Dita Bark, 271 Ditaine, 271 Ditamine, 271 Dithymol-Iodide, 320 Diuretics, 52 Formulae for, 638, 803 Diuretin, 198 Dizziness,—See Vertigo, 809 Dobell’s Nasal Wash, 540 Dock, Yellow, 420 Dog-wood, 255 Jamaica, 392 Domestic Measures, 497 Donovan’s Solution, 165 Dorema Ammoniacum, 121 Dosage of Medicines, 28 Official Preparations, 29 Doses, Average, 29 Table of,—See inside of cover. Dover’s Powder, 321, 360 Fluid, 321, 360 Drastic Purgatives, 46 Draught, 538 Black, 440, 538 Effervescing, 538 Drink, 554 Imperial, Formula, 554 Drops, 497 Botkin’s Cholera, 609 Table of Drops to a Drachm, 498, 863 Dropsy, 637 Drosera, 271 Drowning,—See Asphyxia, 583 Drugs, Their Constituents, 20 Drug-experimentation, 19 Dryopteris Filix-mas, 169 Marginalis, 169 Duboisia, 271 Duboisine, 271 Dulcamara, 272 Dulcamarin, 272 Dulcin, 423 Duodenal Catarrh, 638 Dutch Liquid, 227 Dyscrasiae,—See Cachexia, 597 Dysentery, 639 Dysmenorrhoea, 640 Dyspepsia, 641 Dysphagia, 644 Dyspnoea, 644 Dysuria, 644 Ear Affections, 645 Agents affecting it, 38 Earache,—See Otalgia, 741 Eau Sedative, 122, 205 Ebullition, 527 Ecballium Elaterium, 274 Ecbolics, 56 Ecboline, 274 Ecchymosis, 645 Ecgonine, 243 Eclampsia,—See Puerp. Convulsions, 765 Ecthyma, 645 Ectropion, 645 Eczema, 646 Efflorescence, 520 Efflorescent Salts, List of, 552 Egg-shells, 201 Egg, Yolk of, 487 Eights, The Three, 788 Elastica, 273 Elaterin, 274 Elaterium, 274 Elder, 430 Elecampane, 315 Electuaries, 530 Electuary for Piles, 530 Elettaria repens, 2x3 Elixir, Aromatic, 172 McMunn’s, 360 Simple, 172 of Vitriol, 92 Yvon’s Hypnotic, 703 Elixiria, 531 Elm, Slippery, 481 Elutriation, 526 Ely’s Cream Balm, 834 Emaciation, 648 Embrocation, 541 Emetics, 45 General or Systemic, 45 Local, 45 in Poisoning, 847 Emetine, 322 Emissions, 648 Emmenagogues, 56 Formulae for, 576 Pills, 554 Emollients, 59 Emphysema of Lungs, 648 Emplastra, 531 Empyema, 649 Emulsa, 532 Emulsification, 533 Emulsin, 87, 125, 404 Emulsions, 532 Encephaloma,—See Cancer, 599 Diagnosis of, 838 Endarteritis,—See Atheroma, 586 Endermic Method, 27 INDEX. 877 Enepidermic Method, 27 Endocarditis, 649 Diagnosis of, 838 Endometritis, 649 Enemas, Formulae for, 540, 650 Enemata, 539,650 Enteralgia,—See Colic, Intestinal, 613 Enteric Fever,—See Typhoid, 797, 841 Enteritis, 650 Entropion, 645 Enuresis, 651 Epidermic Method, 28 Epididymitis, 651 Epilation,—See Tinea Circin., 791 Epilepsy, 652 Diagnosis of, 839 Epispastics, 58 Epistaxis, 654 Epsom Salt, 335 Epulis,—See Teeth, 789 Equinia,—See Glanders, 668 Erections, 648 Ergot of Rye, 274 Antidotes and Antagonists, 856 of Corn,—See Ustilago, 488 Ergota, 274 Ergotin, 275 Ergotine, 274 Ergotinine, 274 Ergotism, 275 Ericolin, 289, 481 Erigeron, 277 Eriodictyon, 277 Errhines, 40 Eructations, 642, 663 Eruptions caused by Drugs, etc., 655 Erysipelas, 655 Toxin, 477 Erythema, 657 Erythrophloein, 215 Erythrophlceum Guinense, 215 Erythroretin, 413 Erythroxylon Coca, 195, 243 Escharotics, 58 Eserine, 383, 384 Ethene, 102 Chloride, 102 Dichloride, 102 Ether, 99 Acetic, 99 Chloric, 227 Chlorinated Muriatic, 227 Hydrobromic, 99, 103 Hydriodic, 99, 103 Methylene-di-methyl, 222 Methylic, 102 Nitrous, 100, 103 Petroleum, 182 Ethereal Oil, 100 Preparations, 527 Ethyl Acetate, 99 Alcohol, 99, 106 Aldehyde, 107, 373 Ethyl Bromide, 99, 102 Carbamate, 222 Chloride, 102 Hydrate, 99, 106 Hydride, 102 Hydrosulphide, 455 Iodide, 99 Nitrite, 100, 127 Oxide, 99 Ethylate of Sodium, 445 Ethylene Bichloride, 227 Ethylidene Chloride, 227 Oxide, 107 Ethylirtes Chloral-urethan, 221 Eucalyptene, 278 Eucalyptol, 278 Eucalyptolen, 278 Eucalyptus, 278 Euchlorine, 233 Eugenia aromatica, 214 Jambolana, 324 Eugenin, 214 Eugenol, 215 Euonymin, 279 Euonymus, 279 Eupatorin, 279 Eupatorium, 279 Euphrasia, 280 Europhen, 320 Evaporation, 526 Spontaneous, 527 Exalgin, 67, 69 Exanthemata, Diagnosis of, 840 Excipients, 533, 544, 549 Excitants, Cerebral, 33 Ciliary, 41 Motor, 32 Excoriation,—See Intertrigo, 705 Excretion, Agents affecting, 52 Exhaustion, 657 Exodyne, 67 Exophthalmos, 658 Exostosis, 658 Expectorants, 40 Explosive Compounds, 512 Expression, 522 Exsiccation, 520 Extemporaneous Pharmacy, 516 Extract, Adrenal, 138 Bone Marrow, 133 Goulard’s, 39S Lymphatic, 139 Orchitic, 135 Ovarian, 139 Pancreatic, 139 Pineal, 137 Pituitary, 137 Pond’s, 299 Renal, 139 Splenic, 139 Thymus, 133 Thyroid, 131 Uterine, 139 878 INDEX, Extracta, 534 Extracta Fluida, 535 Extractive, 535 Extracts, 534 Animal, 129 Eye-bright, 280 Eye, Agents affecting, 37 Diseases, 658 Ointments, Formulae for, 616 Sensibility, Agents affecting, 38 Water, Formulae for, 616, 836 Eyelids, 659 Fabiana imbricata, 386 Face, 659 Face-ache,—See Neuralgia, 731, Tic Dou- loureux, 791 Fainting,—See Syncope, 786 False Pains, 660 Farcy, 668 Fat,—See Obesity, 736 Hog, 98 Wool, 98 Fats and Oils, 345 as Antidotes, 848 Fatigue,—See Exhaustion, 657 Favus,—See Tinea Favosa, 792 Febricula,—See Fever, Simple, 662 Febrifuge, 238 Febrinol, 67 Feet, 660 Fehling’s Solution, 261, 845 Fel Bovis, 280 Tauri, 280 Felon,—See Onychia, 737 Fennel, 287 Fermentation, Lactic, 425 Ferments, Agents affecting, 59 Fern. Male, 169 Marginal Shield, 169 Ferratin, 283 Ferrier’s Snuff, Formula, 604 Ferro-cyanide of Potass., 87, 89 as an Antidote, 850 Ferrum, 280 Dialysatum, 283 Reductum, 280 Ferula foetida, 168 Galbaniflua, 288 Sumbul, 461 Fever, 660 Bilious Remittent, Diagnosis, 842 Cerebro-spinal, 722 Enteric,—See Typhoid, 797, 841 Hay, 675 Hectic, 082 Intermittent, 703 Miliary, 726 Milk,—See Lactation, 709 Pernicious,— See Intermittent Fever, Remittent Fever. Puerperal, 766 Fever, Relapsing, 770 Remittent, 770 Diagnosis of, 842 Rheumatic, 770 Scarlet, 775 Diagnosis of, 840 Simple, 662 • Spotted,—See Typhus Fever, also Meningitis Cerebro-spinal. Surgical, 786 Traumatic,—See Surgical Fever, 786 Typhoid, 797 Diagnosis of, 841 Typho-malarial,—See Typhoid, 797 Typhus, 800 Diagnosis of, 841 Yellow, 814 Diagnosis of, 842 Ficus (Fig), 286 Filix Mas, 169 Filtering-paper, 522 Filtration, 522 Fir, Balsam of, 465 Scotch, 393 Silver, 465 Firs, 392 Fish-berries, 386 Fish-poison, Antidotes and Antagonists, 856 Fistula, 662 Fits,—See Apoplexy, Convulsions, Epi- lepsy, Hysteria, Syncope. Flatulence, 663 Flavoring Agents, 545 Flaxseed, 331 Flea-bane, 277 Fleming’s Tincture of Aconite, 96 Flooding,—See Hemorrhage Post-partum, Menorrhagia and Metrorrhagia. Fluavil, 273 Fluid, Antiseptic, 470 Condy’s, 338 Disinfecting, 490 Fluid Extract, Aromatic, 243 Fluid Extracts, 535 Flushing-heats, 663 Fly-agaric, 104 Fceniculum, 287 Fomentation, 541, 760 Food, Horlick’s, 337 Mellin’s, 337 Parrish’s, 381 Foods, 49 Foreign Bodies, 583, 663 Formaldehyde, 107 Formalin, 107, 287 Formamide, 225 Formulae, Hypodermic, 830 Formyl Iodide, 316 Fotus, 541 Fowler’s Solution, 165 Fox-glove, 265 Fractures, 664 INDEX. 879 Franciscea uniflora, 337 Frangula, 288 Frangulin, 288 Frankincense, 466 Franklinite, 489 Fraxin, 340 Fraxinus Ornus, 340 Freckles, 664 Friar’s Balsam, 183, 455 Fuchsin, 288 Fucus Vesiculosus, 288 Furuncle,—See Boils, 589 Fusel Oil, 107 Fusion, 523 Gaduin, 344 Gadus Morrhua, 344 Galactagogues, 57 Galbanum, 288 Galla, 84, 288 Galena, 394 Gallipots, 565 Gall-stones,—See Calculi, Biliary, 598 Gallus Bankiva, 487 Gamboge, 204 Antidotes and Antagonists, 856 Gangrene, 664 of Lungs, 716 Garcinia Hanburii, 204 mangostana, 340 Garfield Tea, 834 Gargarysma, 537 Gargles, Formulae for, 538, 636, 752, 791 Garlic, 117 Gaseous Preparations, 539 Gases, Agents affecting, 59 Antidotes and Antagonists, 856 Gastralgia, 665 Gastric Dilatation, 666 Fever,—See Fever Simple, Gastritis Remittent Fever, Typhoid Fever. Pain, 45 Sedatives, 45 Tonics, 43 Ulcer, 668 Vomiting, Diagnosis, 842 Gastritis, Acute, 666 Chronic, 666 Gastrodynia, 665 Gaultheria, 289, 425 Gaultherilene, 289 Gauze of Carbolic Acid, 73 of Thymol, 470 Gelatin, 314 as an Antidote, 848 Capsules, 528 Gelsemine, 289 Gelsemium, 289 Antidotes and Antagonists, 856 Generative System, Agents affecting, 55 Genitive Case-endings, 829 Gentian, 290 Gentianin, 291 Gentopicrin, 291 Geranium, 84, 291 Gigartina, 234 Gin, 108, 325 Ginger, 492 Glanders, 668 Glandular Affections, 669 Extracts, 129 Glass, Antidotes for, 857 Soluble, 400, 443 Glauber’s Salt, 445 Glaucoma, 669 Gleet, 669 Glonoin, 126 Glossitis, 670 Glottis, (Edema of, 670 Glusidum, 423 Gluco-pepsine, 375 Glucose, 424 Glucosides, 22 Glucusimide, 423 Gluten, as an Antidote, 848 Glycerin, 291 Preparations, 527 Glycerites, 538 Glyceryl, 358 Borate, 71 Trinitrate, 126 Glycocholate, Sodium, 280 Glycocoll, 379 Glycogen, 424 Agents affecting its production, 48 Glyconin, 487 Emulsion, 344 Glycozone, 371 Glycyrrhetin, 293 Glycyrrhiza, 293 Glycyrrhizin, 293 Glycyrrhizinum Ammoniatum, 293 Gnoscopine, 359 Goa-powder, 234 Godfrey’s Cordial, 362 Goitre, 671 Gold, 172 Antidotes and Antagonists, 857 “ Bichloride,” 177 Bromide, 173 Chloride, 173 Cure, Keeley’s, 834 Golden Seal, 309 Gonorrhoea, 671 Gossypii Radicis Cortex, 294 Gossypium, 294 Goulard’s Cerate, 395 Extract, 391; Gout, 673 Diagnosis of, 839 Granatum, 84, 295 Granular Lids,—See Conjunctivitis, Oph- thalmia. Granulation, 523 Granule, 548 880 INDEX. Grass, Ribbed, 394 Worm, 449 Gravel-root, 280 Graves’ Disease,—See Exophthalmos, 658 Gray Powder, 302 Griffith’s Mixture, 281 Grindelia, 296 Grindeline, 296 Grippe,—See Influenza, 700 Guaiac, 297 Guaiacol, 256, 259 Guarana, 193, 195, 298 Guaranine, 193, 195, 197, 298 Gum Arabic, 66, 480 as an Antidote, 849 Sweet, 454 Gumboil, —See Gums, 694 Gum-resins, 23 Gum-tree, Blue, 278 Gums, 674 Gun-cotton, 294, 424 Gunjah, 207 Gurjun Balsam, 298 Gutta, 273 Gutta-percha, 273 Guttae (Drops), 497 Gynocardia odorata, 218 Gypsum, 200 Haematics, 49 Haematoxylin, 299 Hsematoxylon, 84, 298 Hagenia abyssinica, 264 Hager’s Tincture, 237 Hair, 675 Hair-tonic, 675 Hair Washes, Formulae, 675 Haller’s Dictum, 19 Halogen Elements, 231 Hamamelin, 299 Hamamelis, 84, 299 Hamburg Tea, 834 Hamlin’s Wizard Oil, 834 Hands,—See Chapped Hands, 607 Hashish, 207 Haustus, 538 Haw, Black, 486 PI ayah, 215 Hayden’s Viburnum Compound, 486 Hay-fever, 675 Head-ache, Bilious Sick, 676 Congestive, 677 Nervous, 678 Heart Affections, 679 Dilated, 680 P'atty, 680 Hypertrophied, 680 Palpitation, 681 Valvular Disease, 681 Heartburn,—See Pyrosis, 768 Heart’s-ease, 487 Hectic Fever, 682 Hedeoma, 299 Helenin, 315 Hellebore, 300, 483, 484 Helleborein, 300 Helleborin, 300 Helleborus, 300 Helmbold’s Buchu, 834 Hematemesis, 682 Diagnosis of, 840 Hematocele, Pelvic, 683 Hematuria, 683 Hemeralopia, 684 Hemicrania, 684 Hemiopia, 683 Hemiplegia, 686 Hemlock, 251 Spruce, 393 Hemoptysis, 686 Diagnosis of, 840 Hemorrhage, 687 Intestinal, 688 Post-partum, 688 Hemorrhagic Diathesis, 687 Hemorrhoids, 53°> 689 Hemostatics, 59 Hemp, 207 Canadian, 156, 207 Indian, 207 Henbane, 311 Hepar Sulphuris, 458 Hepatalgia, 690 j Hepatic Abscess, 692 Cirrhosis, 690 1 Congestion, 690 Depressants, 48 Diseases, 692 Stimulants, 47 Vomiting, Diagnosis, 842 ] Hepatitis, 692 i Hernia, 693 | Herpes, 693 Zoster, 694 | Hesperidin, 171, 330 Heuchera, 84 j Hevea, 273 ; Hexylamine, 345 I Hiccough, 694 j Hip-joint Disease,—See Coxalgia, 623 Hive Mixture, 140, 436 Syrup, 140, 436 Hives,—See Urticaria, 804 Hoang Nan, 301 Hoarseness,—See Aphonia, 579 Hoffman’s Anodyne, 100, 103 Hoff’s Malt Extract, 337 Hog, 376 j Holloway’s Ointment, 834 Pills, 834 Homatropine, 180 i Homoeopathic Practices, 5°9 Honduras Bark, 2x5 Honey, 341 Ploneys (Mellita), 542 INDEX. 881 Hong-Pang Chong, 414 Hooper’s Female Pills, 554 Hope’s Mixture, Hops, 301 Hordeolum,—See Eyelids, 659 Hordeum distichum, 337 Horehound, 340 Horlick’s Food, 337 Horse-nettle, 448 Hostetter’s Bitters, 834 Housemaid’s Knee,—See Bursitis, 597 Humulus, 301 Hunger,—See Appetite, 581 Hunyadi Water, 619 Huxham’s Tincture of Bark, 237 Hwang-Nao, 301 Hydragogue Purgatives, 46 Hydrangea, 302 Hydrargyrism, 305 Hydrargyrum, 302 Ammoniatum, 303 Antidotes and Antagonists, 857 cum Creta, 302 Hydrastin, 184, 309 Hydrastine, 309 Hydrastinine, 309 Hydrastis, 309 Hydrates,—See their metallic titles. Hydrides,— “ “ “ “ Hydrobromates,—See their basic titles. Hydrocele, 695 Hydrocephalus, 695 Acute,—See Meningitis Tubercular, 723 Hydrochlorates,—See their basic titles. Hydrocotarnine, 359 Hydrocotyle, 310 Hydrogen Dioxide, 370 Peroxide, 370 Sulphide, 458 Sulphuretted, 458 Hydroleine, 344 Hydronaphtol, 350 Hydrophobia, 695 Toxin, 479 Hydroquinone, 238, 239, 481 Hydrothorax, 695 Hydroxymethane, 107 Hygrine, 243 Hygroscopic Bodies, 520 Hyoscine, 311 Hyoscyamus, 311 Antidotes and Antagonists, 857 Hyoscyamine, 311 Hyperidrosis,—See Perspiration, 749 Hypnal, 143, 221 Hypnone, 107, 221 Hypnotics, 34, 221, 703 Hypochlorites, Antidotes, etc., 857 Hypochondriasis, 696 Hypodermic Formulae, 830 Injections, 25, 832 Method, 25 Hypodermic Solutions, 832 Tablets, 27, 563 Hypophosphites, 380,—See also their basic titles. Hyposulphites, 93,—See also their basic titles. as Antidotes, 850 Hysteria, 696 Diagnosis of, 839 Ice, 160 Iceland Moss, 218 Ichthyocolla, 314 Ichthyol, 458, 460 Ichthyosis, 697 Icterus,—See Jaundice, 706 Ignatia, 314 Antidotes and Antagonists, 857 Ignition, 523 Ileus,—See Intestinal Obstruction, 705 Ilex Paraguayensis, 195 Illicium, 315 Impetigo, 697 Impotence, 697 Incineration, 523 Incompatibility, 511 Chemical, 511 Dangers of, 514 Pharmaceutical, 513 Rules for avoiding, 514 Therapeutical, 514 India-rubber, 273 Indian Corn, 128, 488 Hemp, 207 Poke, 483 Tobacco, 333 Indigestion,—See Dyspepsia, 641 Indigo, Wild, 178 Inflammation, 698 Influenza, 700 Infusa (Infusions), 538 Ingluvin, 376 Inhalations, 539 Injection Brou, 540 Injections, 539 Antiseptic, 309 Formulae, 540, 673 Hypodermic, 25, 832 Parenchymatous, 27 Urethral, 540 Injuries,—See Bruises, Burns, Ecchymosis, Fractures, Sprains, Wounds. Inoculation, 28 Inosit, 424 Insanity, 701 Insolation,—See Sunstroke, 785 Insoluble Salts, 512 Insomnia, 702 Intemperance,—See Alcoholism, Delirium Tremens, Opium Habit. Intermittent Fever, 703 Intertrigo, 705 882 INDEX Intestinal Astringents, 47 Intestinal Diseases,—See Colic, Constipa- tion, Diarrhoea, Duodenitis, Dysentery, Enteritis, Hemorrhoids, Hernia, Intes- tinal Obstruction, Intussusception, Ty- phlitis, Tabes Mesenterica, Worms. Intestinal Obstruction, 705 Parasites,—See Worms, 812 Intussusception, 705 Inula, 315 Inulin, 163, 315 Iodides, 316,—See also their basic titles. Iodine, 315 as an Antidote, 850 Antidotes and Antagonists, 857 Carbolated, 315 Disulphide, 458 Iodism, 317 Iodized Cotton, 683 Phenol, 315 Iodol, 321 Iodoform, 316, 320 Iodum 315 Ipecacuanha, 321 Antidotes and Antagonists, 857 Ipomoea Jalapa, 323 Iridin, 323 Iris. 323 Irish Moss, 234 Irisin, 323 Iritis, 706 Iron, 280 as an Antidote, 850 Antidotes. 857 Dialysed, 283, 521 and Manganese, 337 Pills, 554 Irritability, 706 Irritants, Cutaneous, 57 Ischuria,—See Urinary Disorders, 803 Isinglass, 314 Isobutyl-orthocresol Iodide, 320 Isonandra Gutta, 273 Iso naphtol, 349 Itch,—See Scabies, 774 Itching,—See Lichen, Prurigo, Pruritus, Pediculi, Scabies, Urticaria, etc. Ivy, Poison, 415 Jaborandi, 388 Jaboridine, 388 Jaborine, 388 Jalap, 323 Jalapin, 323, 436 Jambul, 324 James’ Powder, 140 Jamestown Weed, 450 Jamun, 324 Japaconitine, 96 Jasmine, Yellow, 289 Jateorhiza palmata, 203 Jaundice, 706 Javelle Water, Antidotes, 857 Jeaunel’s Antidote, 851 Jequirity, 65 Jervine, 483 Joint Affections, 707 Juglans, 324 Juniperin, 325 Juniper, 325 Juniperus communis, 325 Oxycedrus, 325 Sabina, 422 Virginiana, 422 Kairin, 239 Kairolin, 239 Kalium, 398 Kalmia latifolia, 341 Kamala, 326 Kaputin, 68 Kavahin, 326 Kava-kava, 326 Kawin, 326 Keeley Gold Cure, 834 Kefir, 328 Keratitis, 708 Kermes Mineral, 140 Ketone, 107 Kidneys, Diseases of,—See Albuminuria, Bright’s Disease, Calculi, Colic Renal, Diabetes, Dropsy, Gout, Hematuria. Kino, 84, 326 Kinoin, 326 Kino-red, 326 Kinovin, 236 Koch’s Lymph, 473 Kola, 196, 198 Kolanin, 196 Komb6 arrow-poison, 453 Koomiss, 327 Koussi n, 264 Kousso, 264 Krameria, 84, 326 Kumyss, 108, 327 Kumysgen, 327 Kurung Oil, 398 Labarraque’s Solution, 61, 232 Antidotes, 857 Labor, 708 Lac Sulphuris, 457 Lactation, 709 Lactophenin, 378 Lactopeptine, 375 Lactose, 425 Lactuca virosa, 328 Lactucerin, 328 Lactucin, 328 Lactucarium, 328 Lactyl-paraqlienetidin, 379 Ladies’ Slipper, 265 La Fayette’s Mixture, 254 INDEX. 883 Lallemand’s Specific, 674 Lanolin, 98 Lanthopine, 359 Lapathin, 421 Lappa, 328 Larch, 104, 465 Lard, 98 Benzoinated, 98, 183 Oil, 98 Larix Europaea, 465 Laryngismus Stridulus, 710 Laryngitis, 710 Laryngotomy, 711 Latin Numerals, 828 Phrases and Terms, 816 Laudanine, 359 Laudanosine, 359 Laudanum, 360 Laurel, Cherry, 87 Mountain, 341 Laurocerasus, 87 Lavandula, 329 Lavender, 329 Laville’s Gout Mixture, 251, 834 Laxatives, 46, 556 Lead, 394 Colic, 614 Plaster, 394 Salts, Antidotes, etc., 857 Sugar of, 394 Water, 395 and Laudanum, 542 White, 395 Lecithin, 136 Leek, 117 Legal’s Disease, 733 Lemon, 330 Lentigo,—See Freckles, 664 Leopard’s Bane, 163 Leprosy, 712 Leptandra, 329 Leptandrin, 329 Lettuce, 328 Leucocythaemia, 712 Leucolin, 219 Leucoma,—See Corneal Opacities, 621 Leucorrhoea, 713 Levigation, 526 Levulose, 341, 424 Lice,—See Pediculi, 747 Lichen, 713 Lichenin, 218 Licoperdon giganteum, 329 Lignum Vitae, 297 Lily-of-the-Valley, 253 Lily, Water, 358 Pond, 84 Lime, 200, 330 Antidotes and Antagonists, 857 Chlorinated, 232 Kinovate, 236 Sulphurated, 458 Water, 200 Limon, 330 Linimenta, 540 Liniments, Formulae, 200, 331, 541 Linseed, 331 Lint, Boracic, 71 Linum, 331 Lips,—See Chapped Lips, 607 Lip-salve, Red, 468 Liquid-ambar orientalis, 454 Liquids, Normal, 537 Liquores, 541 Liquorice Root, 203 Wild, 65 Listerine, 71 Lithaemia, 714 Litharge, 395 Lithium, 332 Benzoate, 183 Lithontriptics, 53, 202 Liver,—See Hepatalgia, etc., 690 Liver of Sulphur, 458 Lixiviation, 523 Lobelacrin, 333 Lobelia, 333 Antidotes and Antagonists, 857 Lobelin, 333 Lobeline, 333 Lochia,—See Labor, 708 Lock-jaw,—See Tetanus, 789 Locomotor Ataxia, 714 Loeffler's Solution, 637 Loganin, 351 Log-wood, 84, 298 Lotion, 541 Black, of Mercury, 304 Boric, 71 Evaporating, 700 Yellow, of Mercury, 304 Loxopterygium Lorentzii, 170 Lozenges, 562 Lugol’s Solution, 315 Lumbago, 715 Lumbrici,—See Worms, 812 Lung Diseases, 716 Gangrene of, 716 Lupulin, 301 Lupuline, 301 Lupus, 717 Lycetol, 392 Lycopodium, 334 Lyctonine, 96 Lymphangeitis, 7x8 Lymphatic Extract, 139 Lysidin, 391 Lysol, 74, 79 Mace, 347 Maceration, 523 Macis, 347 Macrotin, 234 Magendie’s Solution, 361 Magenta, 288 884 INDEX Magma, 524 Magnesia, 335 as an Antidote, 849 Magnesium, 334 Boro-citrate, 71, 599 Silicate, 443 Magnolia, 336 Magnolin, 336 Maize, 128, 488 Malakin, 67, 426 Malaria, 718 Male Fern, 169 Mallein, 480 Mallotus phillipinensis, 326 Malt, 337 Extract, Hoff’s, 337 Maltum, 337 Mammary Abscess, 568 Manaca, 337 Mandrake, 397 Manganauro, 173 Manganese, 337 Mangano-ferri Peptonatus, 338 Manganum, 337 Mangifera indica, 340 Mango, 340 Mango-fruit, 340 Mangosteen, 340 Mania, 719 Puerperal, 767 Manna, 340 Mannit, 340 Mannite, 295 Manzanita, 481 Marasmus,—See Atrophy, Emaciation, Tabes Mesenterica. Marc, 536 Margarin, 98, 344 Marginal Shield Fern, 169 Marigold, 203 Marjoram, Wild, 370 Marrubiin, 340 Marrubium, 340 Marsh-mallow, 119 Mass, Blue, 302 of Copaiba, 254 of Ferrous Carbonate, 280 of Mercury, 302 Vallet’s, 280 Massse, 542 Mastic, 340 Mastiche, 340 Mastichin, 340 Mastitis, 720 Mastodynia, 720 Masturbation,—See Emissions, 648, Sper- matorrhoea, 781 Mat6, 195 Materia Medica, 17, 65 Matico, 340 Matricaria, 341 May Apple, 397 McMunn’s Elixir of Opium, 360 Meadow Anemone, 405 Saffron, 249 Measles, 720 Diagnosis of, 840 False,—See Roseola, 774 Temperature in, 844 Measures, Apothecaries’, 495 Approximate, 497 Domestic, 497 Metric, 496 and Weights, 494, 863 Wine, 495 Meconidine, 359 Meconoiosin, 360 Meconin, 360 Medicines, Administration of, 23 Classification of, 30 Dosage of, 28 Patent, 833 Medulline, 137 Meerschaum, 443 Mel, 341 Melachol, 381 Melaleuca Leucadendron, 199 Melancholia, 721 Puerperal, 767 Melia Azedarach, 177 Melissa, 342 Mellin’s Food, 337 Mellita, 542 Meniere’s Disease,—See Vertigo, 809 Meningitis, Cerebral, 722 Cerebro-spinal, 722 Spinal, 723 Tubercular, 723 Menispermin, 386 Menispermum, 342 Cocculus, 386 Menopause,—See Climacteric, 613 Menorrhagia, 724 Menstrual Disorders, 725 Menstruum, 523 Mentagra, 725 Mentha arvensis, 342 canadensis, 342 piperita, 342 viridis, 343 Menthol, 342 Mercaptan, 455 Mercaptol, 455 Mercauro, 173, 176 Mercurio-vegetal, 337 Mercury, 302 Antidotes and Antagonists, 857 Vegetable, 337 Mesenteric Disease,—See Tabes Mesen- terica, 788 Metabolism, Agents affecting, 49 Metadioxybenzol, 411 Metallic Salts, Antidotes, etc, 858 Methacetin, 379 Methane, 102 Methene Chloride, 102 INDEX. 885 Methol, 107 Methyl-acetanilid, 67 Methyl Alcohol, 102, 107 Bromide, 102 Chloride, 102, 227 Bichlorinated, 226 Coniine, 251 Creosol, 256 Ether, 102 Ether of Protocatechuic Aldehyde, 483 Hydrate, 107 Pyrocatechin, 256 Salicylate, 289, 426 Terchloride, 226 Methylal, 102, 222 Methylated Spirit, 107 Methylene Bichloride, 227 Blue, 343 Methylene-dimethyl Ether, 222 Methysticin, 326 Metric Prescriptions, 506 System of Weights, etc., 496 Table for Conversions, 864 Metritis, Acute, 725 Metrorrhagia, 725 Mezereon, 344 Mezereum, 344 Antidotes and Antagonists, 858 Mica Panis, 550 Microbe-killer, 835 Microbes, Agents affecting, 59 in Water, 159 Migraine, 684 Migranin, 143 Miliary Fever, 726 Milk,—See Agalactia, 572, Lactation, 709 Milk of Asafetida, 168 Papaw, 376 of Sulphur, 457 Substances excreted in, 709 Milk-fever,—See Lactation, 709 Mindererus, Spirit of, 122 Mineral Green, 165 Waters, 157 Mint, 343 Miscarriage,—See Abortion, 567 Mistletoe, 487 Misturse, 542 Mixture, A. C. E., 100 Antimonial and Saline, 700 Basham’s, 282 Bismuth, for children, 546 Brown, 293 Chalk, 200 Clarke’s, 834 Copaiba, Compound, 254 Cough, Formulae, 623, 721, 751, 756 Coxe’s Hive, 140, 436 Diarrhoea, 361 Ferro-saline, 284 Griffith’s, 281 Hope’s, 634 Iron, Aromatic, 284 Mixture, Iron, Compound, 281 Laxative, 284 Lafayette’s, 254 Laville’s, 250, 834 Liquorice, Compound, 293 Magnesia and Asafetida, 168, 335 Quinine, 546 Potassium Citrate, 399 Rhubarb and Soda, 413 Saline, 700 Scudamore’s, 674 Squibb’s, 361, 609 Mixtures, 542 Anaesthetic, 100 Compounding of, 545 Substances suitable to, 543 Moccasin-plant, 265 Molasses, 424 Mole,—See Naevus, 727 Mollities Ossium,—See Bone Diseases, 589, Rachitis, 768 Monkshood, 95 Monsel’s Solution, 282 Moonseed, Canadian, 342 Morbilli,—See Measles, 720 Morphine, 359, 361, 365 and Atropine, 369 Antidotes and Antagonists, 859 Habit, 739 Morrhuse Oleum, 344 Morrhuine, 345 Morrison’s Pills, 204, 835 Moschus, 346 Mosquitoes, 784 Motor Depressants, 32 Excitants, 31 Mouth Diseases,—See Aphthae, Cancrum Oris, Gums, Parotitis, Ptyalism, Stoma- titis, Toothache, Tongue. Mouth Washes, Formulae, 675 Mucilages, 546 Mucilagines, 546 Mucus in Urine, Test for, 846 Mullein, 486 Mumps,—See Parotitis, 747 Muscae Yolitantes, 726 Muscarine, 104 Antidotes and Antagonists, 858 Muscular Disorders,—See Atrophy,Chorea, Hydrophobia, Laryngismus, Lumbago, Myalgia, Pleurodynia, Rheumatism, Tetanus, Torticollis. Mushrooms, Antidotes, etc., 858 Musk, 346 Mustard, 443 Myalgia, 726 Mydriasis, 37, 180 Mydriatics, 37 Myelitis, 727 Mykose, 275 Myopia, 727 Myotics, 37 Myrcia, 347 886 INDEX. Myrica, 84 cerifera, 217 Myricin, 217 Myristica, 347 Myristicol, 347 Myronate, Potassium, 443 My rosin, 443 Myrrh, 348 Myrrhin, 348 Myrrhol, 348 Myrtle, 84, 217, 348 Myrtol, 348 Myrtus communis, 348 Chekan, 349 Myxoedema, 727 Naevus, 727 Nails, Ingrowing, 728 Napelline, 96 Naphtalene, 349 Naphtalin, 239, 349 Naphtol, 349 Camphorated, 350 Narceine, 359, 366 Narcosis, 363 Narcotics, 34 Antidotes and Antagonists, 858 Narcotine. 359, 362, 365 Nasal Affections, 728 Natrium, 444 Nausea, 728 Necrosis, 729 Nectandra, 374 Nepenthe, 362 Nephritis, Acute, 837.—See also Bright’s Disease, 590 Nervous Affections, 729 Exhaustion,—See Neurasthenia, 733 Nervousness, 730 Nervous System, Agents affecting, 31 Neuralgia, 731 Ovarian, 742 Neurasthenia, 733 Neuritis, 734 Neurodin, 68 Nicotiana Tabacum, 461 Nicotianin, 461 Nicotine, 461 Antidotes and Antagonists, 861 Bitartrate, 462 Niemeyer’s Pill, 756 Nightmare, 735 Nightshade, Black, 272 Deadly, 179 Woody, 272 Night Sweats,—See Hectic Fever, Per- spiration, Phthisis. Nipples, Fissured, Sore, 735 Nitrates,—See their metallic titles. Antidotes and Antagonists, 860 Nitre, 400, 445 Chili, 445 Nitre, Sweet Spirit of, ioo Nitrites, 126,—See also their basic titles. Nitro-benzene, 238 -benzol, 125 Antidotes, etc., 858 -glycerin, 126 Antidotes, etc., 858 Nitrous Ether, 100, 103 Oxide, 102 Antidotes, etc., 858 Nodes, 735 Normal Liquids, 537 Norwood’s Tincture, 484 Norway Spruce, 392 Nose-bleed,—See Epistaxis, 654 Nucin, 325 Nuclein, 133 Numerals, Latin, 828 Nutgall, 84, 288 Nutmeg, 347 Nux Vomica, 351 Antidotes and Antagonists, 858 Nyctalopia, 684 Nymphsea, 84 Odorata, 358 Nymphomania, 736 Oak-bark, 84, 409 Oak, Dyer’s, 288 Poison, 415 White, 409 Oat, 177 Obesity, 736 Odontalgia, 736 CEsophageal Affections, 737 Official Operations, 519 Preparations, 527 Oil of Allspice, 390 of Almond, Bitter, 125 Expressed, 126 of Amber, 455, 466 of Anise, 139 of Anthemis, 140 of Aurantium Cortex, 172 Flores, 172 of Bay, 347 Benne, 442 of Bergamot, 185 of Betula, 426 of Birch, 426 of Cade, 325 of Cadinum, 325 of Cajuput, 199 Camphorated, 205 of Caraway, 214 of Carum, 214 Carron, 200, 331 of Cassia, 243 Castor, 417 of Caryophyllus, 214 of Cedar, 432 Chamomile, 140 INDEX. 887 Oil, Chaulmoogra, 218 of Chenopodium, 219 of Cinnamon, 243 of Cloves, 214 Cod-liver, 344 of Copaiba, 254 of Coriander, 255 of Cotton-seed, 294 Croton, 471 of Cubeb, 260 Disinfection, 75 of Erigeron, 277 Ethereal, 100 of Eucalyptus, 278 of Fennel, 287 of Fleabane, 277 Fusel, 107 of Gaultheria, 289, 426 of Gossypium-seed, 294 Hamlin’s Wizard, 834 of Hedeoma, 299 of Hemlock, 394 Hydrated, 344 Jecoris Aselli, 344 of Juniper, 325 Kurung, 398 Lard, 98 of Lavender-flowers, 329 of Lemon, 330 of Linseed, 331 of Linum, 331 of Mace, 347 of Mentha Piperita, 342 of Mentha Viride, 343 of Mirbane, 125 of Morrhua, 344 of Mustard, Volatile, 443 of Myrcia, 347 of Myristica, 347 of Myrtle, 348 of Neroli, 172 of Nutmeg, 347 Olive, 358 of Orange flowers, 172 of Orange-peel, 172 of Origanum, 370 of Pennyroyal, 299 of Peppermint, 342 Phosphorated, 380 of Pimenta, 390 of Pinus Silvestris, 393, 466 of Pix Liquida, 393 of Pongamia, 398 of Ricinus, 417 of Rose, 419 of Rosemary, 419 of Rue, 421 of Ruta, 421 of Sabina, 422 Salad, 358 of Sandalwood, 432 of Santal, 432 of Sassafras, 435 Oil of Savine, 422 of Scotch Fir, 393 Sequah’s, 836 of Sesamum, 442 of Sinapis, Volatile, 443 of Spearmint, 343 of Spruce, 394 St. Jacob’s, 96, 836 Sweet, 358 of Succinum, 455. 466 of Tabacum, 462 of Tanacetum, 464 of Tansy, 464 of Tar, 392 Teel, 442 of Terebinthina, 465 of Theobroma, 468 of Thuja, 466, 469 of Thyme, 469 of Tiglium, 471 of Tobacco, 462 of Turpentine, 465 as an Antidote, 849 of Valerian, 482 of Wintergreen, 289, 426 Wizard, 834 Wood, 298 Oils, as Antidotes, 848 Expressed, 522 and Fats, 345 Fixed, 522 Ointment, 217 Antipruritic, 565 Basilicon, 410 Blue, 302 Boracic, 71 Calamine, 491 of Carbolic Acid, 73 Citrine, 303, 304 Diachylon, 395 Flolloway’s, 834 Pagenstecker’s, 617 of Rose Water, 218 Spermaceti, 2x8 Tar, 393 White Precipitate, 303 Ointments, 563 Compounding, 564 Formulae for, 565 Olea Europaea, 358 Oleaginous Preparations, 527 Oleata, 546 Oleates, 90, 546 Olein 98, 344, 358 Oleoresina, 546 Olive, 358 Onion, 117 Onychia, 737 Operations, Pharmaceutical, 519 Ophthalmia, 738 Opisthotonos,—See Tetanus, 789 Opium, 359 Antidotes and Antagonists, 859 888 INDEX. Opium, Denarcotized, 360 Deodorized, 360 Habit, 739 Opodeldoc, 434 Orange, 171, 330 Blossom, 835 Orchitic Extract, 135 Orchitis, 740 Ordeal Bark, 215 Oregon Grape, 184 Origanum, 370 Ortho-dihydroxy-benzene, 239 Otalgia, 741 Otitis, 741 Otorrhcea, 742 Ouabain, 454 Ovarian Extract, 139 Neuralgia, 742 Tumors,—See Cysts, 627 Ovaritis, 742 Ovis Aries, 442 Oxaluria, 743 Ox-gall, 280 Oxides, 370.—See also their metallic titles. Oxidizers, 513 Oxyethyl-acetanilid, 378 -chinolin, 239 Oxygen, 370 Oxymel, 341 Oxymethyl-acetanilid, 379 Oxytocics, 56 Oyster-shell, 200 Ozsena, 743 Ozone, 370 Pagliari’s Styptic, 688 Pain, 368, 744 Gastric, 45 Pains, After-, 572 Chest, 607 False, 660 Paints, 547 Palmitate of Cetyl, 218 Palmitin, 358 Pancoast’s Styptic, 687 Pancreas, Agents affecting, 48 Pancreatic Extract, 139 Pancreatin, 376 Pancreatine, 137 Pancreopepsine, 375 Pannus,—See Corneal Opacities, 621 Pansy, 487 Papain, 376 Papaiva, 376 Papaver somniferum, 359 Papaverine, 359 Papaw Milk, 376 Paper, Filtering, 522 Papers (Chartse), 529, 555 Papine, 360 Papoid, 376 Para Rubber, 273 Parachinanisols, 239 Paraconiine, 251 Paracoto Bark, 256 Paracotoin, 256 Paraldehyde, 107, 373 Paralysis, 745, 782 Agitans, 746 of the Bladder, 588 Para-acetphenetidin, 378 Para-dihydroxy-benzene, 239 Paramenispermin, 386 Paramorphine, 359 Paraphenetol Carbamide, 423 Paraphimosis,—See Phimosis, 752 Paraplegia,—See Paralysis, 745, 782 Parasiticides, 61 Paregoric, 360 Pareira, 374 Parenchymatous Injection, 27 Paresis,—See Paralysis, 745, 782 Parigenin, 434 Parilla, Yellow, 342 Parillin, 434 Paris Green, 165 Paronychia, 737 Parotitis, 747 Parsley, 156 Parrish’s Chemical Food, 381 Participles, Latin, 829 Parvule, 548 Paste, Black, 673 Vienna, 399 Pasteur’s Inoculation, 479 Pastilles, 562 Pasque-flower, 405 Patent Medicines, 833 Paullinia curare, 263 Cupana, 195, 298 Pavy’s Solution, 845 Pearson’s Solution, 165 Pectin, 409 Pediculi, 747 Pelletierine, 295 Pellitory, 408 Pelosine, 374 Pemphigus, 747 Pencils, 558 Penis,—See Chancre, Chancroid, Chordee, Gleet, Gonorrhoea, Phimosis, Urethra. Pennyroyal, 299 Pennywort, 310 Pental, 102 Pepo, 374 Pepper, African, 211 Black, 390 Cayenne, 211 Water, 398 Peppermint, 342 Pepper-vine, 390 Pepsin, 375 Pepsinum, 375 Peptenzyme, 375 INDEX. 889 Peptogenic Milk Powder, 375 Pepto-mangan, 338 Perchloride of Iron, 281 Percolation, 523 Pericarditis, 748 Diagnosis of, 838 Periostitis, 748 Peritonitis, 748 Puerperal, 767 Tubercular, 749 Permanganate, Potassium, 337 as an Antidote, 339, 850 Pernicious Fever,—See Intermittent Fever, 703, Remittent Fever, 770 Peroxide, Barium, 179 Hydrogen, 370 Perry Davis’s Pain-Killer, 835 Persimmon, 84 Perspiration, 749 Pertussis, 750 Peruvian Bark, 235 Petrolatum, 377 Petroleum Ether, 182 Ointment, 378 Petroselinum sativum, 156 Peumus Boldo, 187 Phaeoretin, 413 I Phagedena,—See Chancre, Chancroid, Gangrene, Ulcers. Pharmaceutical Incompatibility, 513 Operations, 519 Preparations, 527 Rules, 518 Pharmaceutists,—Their objectionable prac- tices, 508, 516, 539 Pharmacodynamics, 17 Pharmacology, 17 Pharmacopoeias, List of, 493 Pharmacy, 493 Extemporaneous, 516 Official, 519 Rules for neophytes, 518 Pharyngitis, 751 Phaseo-mannit, 424 Phenacetin, 378 Antidotes and Antagonists, 859 Phenatol, 68 Phenazone, 142 Phenocoll Hydrochloride, 379 Phenol, 72, 238 Camphor, 74 Iodized, 74* 315 Sodique, 74 Phenolid, 68 Phenols, 74 Phenopyrin, 143 Pheno-resorcin, 74 Phenosalyl, 74, 80 Phenyl, 238 Alcohol, 72 Hydride, 182 Salicylate, 426 Phenyl-acetamide, 66 Phenyl-dimethyl-pyrazolon, 142 Phenyl-methyl-acetone, 107, 221 Phimosis, 752 Phlebitis, 752 Phlegmasia Alba Dolens, 752 Phlegmon, 75-3 Phlorol, 256 Phosphates, 381 Phosphide, Zinc, 380 Phosphites, 380 Phospho-albumen, 137 Phosphorus, 380 Antidotes and Antagonists, 859 Photophobia, 753 Phthisis, 753 Diagnosis of, 840 Temperature in, 844 Physeter macrocephalus, 217 Physiological Antagonism, 62 Physostigma, 383 Antidotes and Antagonists, 860 Physostigmine, 383, 384 Phytolacca, 385 Phytoline, 386 Pichi, 386 Picrsena excelsa, 409 Picrates, 92 Picroglycion, 272 Picropodophyllin, 398 Picrotoxin, 386 Antidotes and Antagonists, 860 Pierce’s Favorite Prescription, 835 Golden Discovery, 835 Pigmenta, 547 Piles, 530, 689 Pill, Anaphrodisiac, 554 Ayer’s, 833 Blancard’s, 281 Blaud’s, 281 Blue, 302 Brandreth’s, 833 Cathartic, Compound, 250 Vegetable, 250 Chalybeate, 281 Ferruginous, 554 Holloway’s, 834 Lady Webster’s, 119 Morrison’s, 204, 835 Niemeyer’s, 756 Plummer’s, 140, 142 Tanjore, 784 Pill-mass, 548 Pills, 547 Coated, 552 Compressed, 553 Excipients for, 549 Formulae for, 554 Official, 547 Process of making, 548 Substances suitable for, 550 Pilocarpidine, 388 Pilocarpine, 388 Antidotes and Antagonists, 860 890 INDEX. Pilocarpine-phenyl-hydroxide, 74 Pilocarpus, 388 Pilulre, 547 Pimenta, 390 Pimpinella Anisum, 139 Pimples,—See Acne, 569 Pine, Prince’s, 219 Yellow, 465 Pineapple, 376 Pineal Extract, 137 Pinene, 348, 466 Pines, 392 Pinipicrin, 469 Pinites succinifer, 455 Pink, Carolina, 448 Pink-root, 448 Demarara, 449 Pinus, 392, 465 australis, 466 Canadensis, 393 palustris, 392, 465 sylvestris, 466 Taeda, 466 Piper, 390 angustifolium, 340 cubeba. 260 methysticum, 326 nigrum, 390 Piperazin, 391 Piperin, 390 Pipsissewa, 219 Piscidia, 392 Piscidin, 392 Pissenlit, 464 Pistacia Lentiscus, 340 Terebinthus, 465 Pitaya Bark, 236 Pitch, 392 Pituitary Extract, 137 Pityriasis, 756 Pix, 392 Pix Liquida, 392 Planat’s Tincture, 387 Plantago, 394 Plantain, 394 Plaster, Adhesive, 410 Anodyne, 532 Cantharidal, 209 Counterirritant, 532 Court, 3x4 Diachylon, 395 Isinglass, 314 Pitch, 393 Strengthening, 282 Vesicating, 532 Warming, 209, 393 Plasters, 531 Formulae for, 532 Plethora, 757 Abdominal, 567 Pleurisy, 757 Diagnosis of, 840 Pleurisy-root, 169 Pleuritis, 757 Pleurodynia, 758 Pleuro-pneumonia, 758 Plum, 404 Plumbum, 394 Plummer’s Pills, 140, 142 Pneumonia, 758 Diagnosis of, 840 Podophyllin, 398 Podophyllitoxin, 398 Podophyllum, 397 Poison Ivy, 415 Nut, 351 Oak, 415 Antidotes and Antagonists, 860 Sumach, 415 Poisoning, 61, 847.—See also the several poisons under their titles in Part I. Antidotes and Antagonists, 61, 847 Treatment of,—Indications for, 61 General Principles of, 847 Poisonous Compounds, 513 Poisons, Energetic, 847 Poke-berry, 385 Poke, Indian, 483 Poke-root, 385, 483 Polygala Senega, 439 Polygonum, 398 Polyporus fomentarius, 104 officinalis, X04 Polypus, 760 Polyuria,—See Diabetes Insipidus, 630 Pomade de Bareges, 757 Pomegranate, 84, 295 Pond’s Extract, 299 Pond Lily, 84 Pongamia, 398 Poplar, 425 Poppy, White, 359 Populus, 425 Porphyrization, 526 Porphyroxin, 360, 430 Porrigo Capitis,—Tinea Tonsurans, 792 Porter, 108 Port Wine, 108 Potash, 399 Antidotes, etc., 860 Potassa, 399 Alum, 120 cum Calce, 399 Sulphurata, 458 Potassio-ferric Tartrate, 283 Potassium, 398 Bichromate, 83, 860 Cyanide, 87, 89, 856 Ferro-cyanide, 87, 89 Myronate, 443 Nitrite, 127 Permanganate, 337, 850 Silicate, 443 Tartra-borate, 71, 599 Potato, 272 Spirit, 107 INDEX. 891 Potentilla Sarmentosa, 749 Potus, 554 Poultices, 529, 760 List of Br. Official, 529 Powder, Antimonial, 140 Aromatic, 243 Bleaching, Antidotes, 857 Dover’s, 321, 360 Effervescing, 400 Gray, 302 James’, 140 Liquorice, 293 Purgative, 323 Seidlitz, 400 Tully’s, 361 Powders, 554 Formulae for, 556 Substances suitable to, 555 Prairie Flower, 836 Precipitant Solutions, Table of, 512 Precipitate, White, 303 Red, 303 Precipitation, 524 Pregnancy, Disorders of, 760 Vomiting of, 810 Premna tatiensis, 472 Preparations, 527 Prepositions, Latin, 830 Prescription Writing, 500 Latin Phrases used in, 816 Prescriptions, 499 Analysis of, 500 Blanks for, 510 Contractions, 508, 816 Filling of, 517 Latin Phrases used, 816 Metric, 506 Renewals, 508 Table of Doses,—See cover. Tonic, 577 Prickly Heat,—See Lichen, 713 I Pride of China, 177 Prince’s Pine, 219 Principles in Drugs, 20 in Extracts, 535 Prinos, 404 Proctitis,—See Rectum, 769 I’rodigiosus Toxin, 477 Prolapsus Ani, 761 Uteri, 761 Pronunciation, 829 | Propyl Oxide, 344 | Propylamine, 164 ‘Prosopalgia,—See Neuralgia, Odontalgia, Tic Douloureux. Prostate, Hypertrophied, 761 1 Prostatitis, 761 : Prostatorrhoea, 762 : Protectives, 59 ! Protonuclein, 135 ; Protopine, 359 j Prune, 404 Prunum, 404 Prunus Amygdalus, 125 domestica, 404 Laurocerasus, 87 Serotina, 404 Virginiana, 87, 404 Prurigo, 762 Pruritus, 762 Pseudaconitine, 96 Pseudo-jervine, 483 Pseudo-morphine, 359 Pseudotropine, 311 Psoriasis, 764 Pterocarpus inarsupium, 326 santalinus, 432 Pterygium, 764 Ptosis, 764 Ptyalism, 43, 305, 765 Puccine, 430 Puerperal Convulsions, 765 Disorders, 766 Fever, 766 Mania, 767 Melancholia, 767 Peritonitis, 767 Puff-ball, 329 Pulmonary Sedatives, 39 Pulsatilla, 405 Antidotes and Antagonists, 860 Pulse, 767 and Temperature, 844 Pulveres, 554 Pulverization, 526 Pulvis Purgans, 323 Pumpkin-seed, 374 Punica Granatum, 295 Purgatives, 46 Purging Agaric, 104 Cassia, 216 Purpura, 767 Pus in Urine, Test for, 846 Pustule, Malignant,—See Anthrax, 578 Pustules,—See Anthrax, Ecthyma, Erup- tions, Impetigo, Variola. Pustulants, 58 Pyaemia, 768 Pyrethrine, 408 Pyrethrum, 408 Pyretine, 68 Pyridine, 239, 462 Pyrocatechin, 238, 239, 392 Pyrogallol, 84, 238 Pyrrol, 321 Pyrosis, 768 Pyroxylin, 294, 424, 530 Pyrozone, 371 Quaker Button, 351 Quantities, Table of,—See Cover. Quassia, 408 Quassin, 409 Quebrachine, 170 Quebracho, 170 892 INDEX. Queen’s Delight, 449 Root, 449 Quercin, 409 Quercitrin, 409, 418 Quercus Alba, 84, 409 Lusitanica, 288 Tinctoria, 409 Quicksilver, 302 Quillaja, 410 Quinalgen, 68, 220 Quince-seed, 264 Quinetum, 238 Quinicine, 236 Quinidine, 236 Quinine, 236 Antidotes and Antagonists, 860 Mixture, 544, 546 Poisoning by, 240 Solutions of, 544 Quinoidin, 238 Quinoline, 219 Quinquinina, 238 Quinsy,—See Tonsillitis, 793 Rabies,—See Hydrophobia, 695 Toxin, 479 Rachitis, 768 Radam’s Microbe-killer, 835 Radway’s Ready Relief, 835 Resolvent, 835 Raspail’s Eau Sedative, 122, 205 Raspberry, 420 Rat-pastes, Antidotes, etc., 860 Recamier Balm, etc., 835 Rectum, Absorption by, 24 Diseases of, 769 Prolapse of, 761 Ulceration of, 769 Red Gum,—See Strophulus, 785 References and Bibliography, 566 Refrigerants, 43 Relapsing Fever, 770 Remittent Fever, 770 Diagnosis of, 842 Renal Depressants, 52 Extract, >39 Renewals of Prescriptions, 508 Resin, 22, 410, 466 Cerate, 410 Plaster, 410 Resina, 410, 466 Resinse, 556 Resinol, 393 Resins, 22, 556 Resolvents, 50 Resorcin, 74, 238, 411 Antidotes and Antagonists, 860 Resorcinol, 411 Respiration,—See Bronchitis, Croup, Dysp- noea, Emphysema, Pneumonia, etc. Respiration, Agents affecting, 39 Artificial, 583 Respiratory Depressants, 39 Stimulants, 39 Restoratives, 49 Retina, Affections of, 770 Retinol, 393 Revalenta Arabica, 835 Rhamnoxanthin, 288 Rhamnus Frangula, 288 Purshiana, 412 Rhaphidophora vitiensis, 47 Rhatanine, 326 Rhatany, 84, 326 Rheum, 413 Rheumatism, Acute, 770 Chronic, 772 Diagnosis of, 839 Gonorrhoeal, 774 Muscular, 774 Rheumatoid Arthritis, 581 Rhinacanthin, 414 Rhinacanthus, 414 Rhinitis,—See Catarrh Acute Nasal, In- fluenza, Nasal Affections. Rhoeadine, 359 Rhubarb, 413 Rhus, 414, 415 Antidotes and Antagonists, 860 Ricin, 147, 417 Ricinine, 417 Ricinolein, 417 Ricinus communis, 417 Rickets,—See Rachitis, 768 Rigors,—See under Fever, 660 Ring-worm, 791, 792 Risus sardonicus, 353 Roasting, 525 Rochelle Salt, 400 Rosa, 84, 418 Rosanilin, 288 Rose, 84, 418 Attar of, 419 Honey of, 341, 419 Ros6ine, 288 Rosemary, 84, 419 Roseola, 774 Rosmarinus, 419 Rottlera, 326 Rottlerin, 326 Rubber, India, 273 Rubefacients, 57 Rubeola,—See Measles, 720 Rubidium, 420 Rubijervine, 483 Rubini’s Tincture, 205 Rubus, 84, 420 Rue, 421 Rules for Incompatibility, 515 for Pharmaceutists, 518 Rum, 108 Kay, 347 Rumex, 420 Rumicin, 421 Rupia,—See Pemphigus, 747 INDEX. 893 Ruta, 421 Russian Spirit, 773 Rye, 274 Sabadilla, 484 Sabina, 442 Antidotes and Antagonists, 861 Saccharin, 423 Saccharum, 423 Lactis, 425 Sacred Bark, 412 Safflower, 260 Saffron, 260 American, 260 Meadow, 249 Saffron-tea, 260 Safrol, 204, 435 Sage, 429 Sage’s Catarrh Remedy, 835 Sal-ammoniac, 122 Salbromalide, 67 Salfene, 68 Salicin. 425 Salicylate, Para-amidol, 426 Physostigmine, 384 Sodio-Theobromine, 198 Salicylates, 426 Salicyl-bromalide, 67 Salicyl-para-phenetidin, 67, 426 Saligenin, 427 Saline Mineral Waters, 158 Purgatives, 46 Salipyrin, 143, 426, 429 Saliva, Agents affecting, 43 Salivation, 43, 305, 765 Salix, 425 Nigra, 425 Salol, 426, 428 Salophen,426,429 Salt, common, 445 Epsom, 335 Glauber’s, 445 Rochelle, 400 Saltpetre, 400 Antidotes and Antagonists, 860 Chili, 445 Salt-rheum,—See Eczema, 646 Salts, Deliquescent, List of, 552 Efflorescent, List of, 552 Insoluble, 512 Metallic, Antidotes, etc., 858 Salve, Red Lip, 468 Salvia, 429 Sal viol, 430 Sambucus, 430 Sandal-wood, 431 Oil, 432 Sand-brier, 448 Sanford’s Catarrh Cure, 835 Sanguinaria, 430 Antidotes and Antagonists, 861 Sanguinarine, 430 Sanitas, 61, 371, 466 Santalum Album, 431 citrinum, 431 Rubrum, 432 Santonica, 432 Santonin, 432 Sapo, 433 Sapogenin, 439 Saponification, 433 Saponin, 217, 410, 439 Saprol, 75 Sarcinse, 774 Sarcocele,—See under Cancer, Testicles. Sarsaparilla, 434 Ayer’s, 833 Sassafras, 435 Swamp, 336 Sassy Bark, 2x5 Saunders, Red, 432 Savine, 422 Antidotes and Antagonists, 861 Sayre’s Method for Chloroform, 231 Scabies, 774 Scald-head,—See Eczema, Tinea. Scalds, 597 Scammonium, 435 Scammony, 435 Scarlet Fever, 775 Diagnosis of, 840 Temperature in, 844 Scheele’s Acid, 87 Green, 165 Sciatica, 776 Scilla, 436 Scillin, 436 Scillipicrin, 436 Scillitin, 436 Scillitoxin, 436 Scirrhus,—See Cancer, 599 Diagnosis of, 838 Sclererythrin, 275 Scleroderma, 778 Scleromucin, 275 Sclerosis, 778 Scleroxanthin, 275 Scoparin, 437 Scoparius, 437 Scopolamine, 311 Scopoleine, 311 Scopolia carniolica, 311 Scorbutus,—See Scurvy, 779 Screaming,—See Nightmare, 735 Scrofulosis, 778 Scudamore’s Mixture, 674 Scurvy, 779 Scutellaria, 439 Scutellarin, 439 Sea-sickness, 779 Seborrhcea, 779 Sea-wrack, 288 Secale cereale, 274 Secaline, 488 Sedative, Battley’s, 361 894 INDEX. Sedatives, 31 Cardiac, 31, 42 Gastric, 45 General, 45 Pulmonary, 39 Urinary, 53 Uterine, 57 Vascular, 42 Vesical, 53 Seidlitz Powder, 400 Seigel’s Syrup, 835 Senega, 439 Senegin, 439 Senna, 440 Sennacrol, 440 Sennapicrin, 440 Separation, 524 Septicaemia, 768 Sequah's Oil, 836 Prairie Flower, 836 Serpentaria, 441 Serpent-venom, Antidotes, etc., 861 Serum, Antitoxic, 147 Artificial, 734 Serum-therapy, 148 Sesamum, 442 Sevum, 442 Shampoo Mixtures, 675 Shells, 196 Sheep, 442 Sherry Wine, 108 Shingles,—See Herpes Zoster, 694 Shock, Surgical, 779 Sialogogues, 43 Sickness at Stomach,—See Nausea, Sea- sickness, Vomiting. Sick-room, 780 Siddhi, 207 Silicates, 442 Silicious Mineral Waters, 158 Silver, 161 Antidotes and Antagonists, 861 Sinai bin, 443 Sinapine, 443 Sinapis, 443 Singultus,—See Hiccough, 694 Sinigrin. 443 Sinistrin, 436 Skin, Agents affecting, 57 as an Absorbent, 27 Skin Diseases,—See Acne, Anthrax, Boils, Burns, Carbuncles, Chapped Hands and Lips, Chilblains, Condylomata, Ecchy- mosis. Ecthyma, Eczema, Elephantiasis, Eruptions, Erysipelas, Erythema, Freckles, Herpes, Herpes Zoster, Ich- thyosis, Impetigo, Intertrigo, Lichen, Lupus, Mentagra, Naevus, Onychia, Pemphigus, Phlegmon, Pityriasis, Prurigo, Pruritus, Psoriasis, Roseola, Scabies, Scleroderma, Seborrhcea. Strophulus, Syphilis, Tinea, Ulcer, Urticaria, Wart, Wen. Skull-cap, 439 Sleep, Abnormal,—See Delirium, Insom- nia, Nightmare, Somnambulism. Slippery Elm Bark, 481 Smallpox,—See Variola, 808 Diagnosis of, 840 Smart-weed, 398 Smell, Agents affecting, 38 Smilacin, 434 Smilax, 434 Snake-root, Black, 234 Virginia, 441 Sneezing, 780 Agents producing, 40 See also Catarrh, Hay Fever, Influ- enza. Soaloin, 118 Soap, 433 as an Antidote, 849 Bark, 410 Soda, 445 Antidotes and Antagonists, 861 Caustic, 444 Chlorata (Chlorinated), 232 Water, 80 Sodio-Theobromine Salicylate, 198 Sodium, 444 Benzoate, 183 Bisulphite, 93 Hyposulphite, 93 as an Antidote, 850 Nitrite, 157 Silicate, 443 Sulphite, 93 Sulpho-carbolate, 73 Tetra-borate, 71 Solanine, 272 Solanum Carolinense, 448 Dulcamara, 272 Solid Preparations, 527 Soluble Substances, 543 Solution, 524 Aids to, 544 Alkaline Cupric Tartrate, 261 Antiseptic, 309, 709 Circulatory, 525 Clemens’, 165 Crocq’s, 383 Donovan’s, 165 Fehling’s, 261, 845 Fowler’s, 165 Glass, 443 Labarraque’s, 61, 232 Lceffler’s, 637 • Lugol’s, 315 Magendie’s, 361 Monsel’s, 282 Pavy’s, 845 Pearson’s, 165 Quinine, 544 Saturated, 524 Villate’s, 263, 601 Solutions (Liquores), 541 INDEX. 895 Solutions, Hypodermic, 832 Precipitant, Table of, 512 Stock, 518 Solutol, 75 Solvents, 525 Solved, 75 Somnal, 221, 224 Somnambulism, 780 Sores, 800 Bed, 587 Sorghum, 423 Sorrel, 420 Soz-albumin, 476 Sozodont, 836 Spanish Flies, 209 Sparteine, 437 Spasmodic Affections, 781 Spearmint, 343 Specific Gravity and Volume, 498 Table of, 862 Spermaceti, 217 Spermatorrhoea, 781 Spermine, 137 Spigelia, 448 Spina Bifida, 782 Spinal Concussion, 782 Congestion, 782 Inflammation,—See Meningitis, Mye- litis, etc. Irritation, 782 Paralysis, 782 Softening, 782 Spirit, Methylated, 107 Perfumed, 108 Potato, 107 Proof, 108 Rectified, 108 Russian, 773 Wood, 107 Spirits (Spiritus), 557 Splenic Affections, 783 Extract, 139 Spongia Usta, 778 Spotted Fever,—See Typhus Fever, Men- ingitis Cerebro-spinal. Sprains, 783 Spruces, 392 Spunk, 104 Squamae,—See Ichthyosis, Pityriasis, Pso- riasis, etc. Squaw-root, 217 Squibb’s Mixture, 361, 609 Squill, 436 St. Ignatius’ Bean, 314 St. Jacob’s Oil, 96, 836 St. Mary’s Thistle, 214 St. Vitus’ Dance,—See Chorea, 611 Stains, 783 Stammering, 783 Staphisagria, 449 Starch, 128, 424 as an Antidote, 849 Star-wort, 117 Statice, 84 Stavesacre, 449 Stearin, 98 Sterility, 784 Sternutatories, 40 Stigmata Maydis, 488 Stillingia, 449 Stimulants, 31 Cardiac, 41 Hepatic, 47 Local, 33 Pancreatic, 48 Respiratory, 39 Vascular, 42 Stings, 784 Stock Solutions, 518 Stomach Diseases,—See Dyspepsia, Gas- tralgia, Gastric Ulcer, Gastritis, etc. Stomachics, 43 Stomatitis, 785 Stone,—See Calculi, 55, 598 Storax, 454 Strabismus, 785 Straining, 519 Stramonium, 450 Antidotes and Antagonists, 861 Strangury,—See Cystitis, Dysuria. Stricture,—See Rectum, 769 Urethral, 802 Strontium Salts, 451 Strophanthin, 453 Strophanthus glabrus, 454 hispidus, 453 Strophulus, 785 Strychnine, 301, 314, 351 Antidotes and Antagonists, 858 Strychnos Ignatii, 314 Gautheriana, 301 Nux Vomica, 351 Sturgeon, 314 Stye,—See Eyelids, 659 Styptic Collodion, 94, 294 Styptics, 59,687, 688 Styracin, 454 Sty rax, 454 Benzoin, 183 Styrol, 454 Sublimation, 525 Substances best given alone, 515 difficult to combine in pill, 551 suitable for mixtures, 543 suitable for pills, 550 suitable for powders, 555 unsuited to pill-form, 551 Succinum, 455 Sudorifics, 54 Suet, 442 Sugar, 423 of Lead, 394 of Milk, 425 in Urine,—See Diabetes Mellitus, 630 Tests for, 845 Sulphates,—See their basic titles. 896 INDEX. Sulphates as Antidotes, 850 Sulphides, 458 Sulphites, 93 Sulpho-carbolates, 73, 79 Sulpho-cyanate, Acrinyl, 443 Sulpho-cyanide, Allyl, 443 Sulpho-ichthyolates, 458 Sulphonal, 455 Antagonists, 861 Sulphur, 457 Antidotes and Antagonists, 861 Sulphurated Antimony, 140 Lime, 458 Potassa, 458 Sulphuretted Hydrogen, 458 Sulphurous Mineral Waters, 158 Sumach, 414, 415 Sumbul, 461 Sun-dew, 271 Sunstroke, 785 Suppositoria, 557 Suppositories, Formulae, 558 Official in Br. Phar., 559 Suppuration, 785 Surgeon’s Agaric, 104 Surgical Fever, 786 Sus scrofa, 376 Svapnia, 360 Swallowing,—See Dysphagia, (Esopha- geal Affections. Swamp Sassafras, 336 Sweet Bay, 336 Flag, 199 Gum, 454 Swertia Chirata, 220 Swift’s Specific, S. S. S., 836 Sycosis, 786 Sydenham’s Laudanum, 360 Syncope, 786 Synovitis, 786 Syphilis, 787 Diagnosis, 838 Syrup, Siegel’s, 835 Mrs. Winslow’s Soothing, 362 Syrupi (Syrups), 559 Tabacum, 461 Tabes Mesenterica, 788 Table of Antagonistic Drugs, 64 Drops in a Drachm, etc., 498, 863 Latin Words, Phrases, etc., 816 Metric Conversion, 864 and cover Precipitant Solutions, 512 Prescription Doses and Quantities,— See cover. Specific Gravities and Volumes, 862 Tables of Differential Diagnosis, 837 of Weights and Measures, 495, 863 Tablets. 562 Compressed, List of, 563 Hypodermic, List of, 27, 563 of Nitroglycerin, 127 Tseniafuges, 49, 170, 296, 812 Taenise,—See Tapeworms (below). Tag Alder, 118 Tamarind, 464 Tamar-Indien, 440, 836 Tamarindus, 464 Tanacetin, 464 Tanacetum, 464 Tannigen, 95 Tannin, 94 as an Antidote, 848 Tansy, 464 Tapeworms, 49, 170, 296, 812 Tar, 392 Tar-water, 393 Taraxacerin, 464 Taraxacin, 464 Taraxacum, 464 Tartar, Cream of, 400 Crude, 399 Emetic, 140 Antidotes and Antagonists, 853 Tartraborate of Potassium, 71, 599 Tartrate, Ammonio-ferric, 283 Antimony and Potassium, 140 Potassio-ferric, 283 Potassium and Sodium, 400 Tartrates, 95 Taste, Agents affecting, 38 Disordered, 789 Taurocholate of Sodium, 280 Tea, 195 Boneset, 280 Flaxseed, 331 Garfield, 834 German Breast, 119 Hamburg, 834 Linseed, 331 Saffron, 260 Tansy, 464 Worm, 449 Teel Oil, 442 Teeth, 789 Agents affecting, 43 Teething,—See Dentition, 629 Temperature in Disease, 842 Drugs affecting, 50 Tenesmus,—See Dysentery, 639 Terebene, 466 Terebinthene, 466 Terebinthina, 465 Terpin, 466 Terpinene, 466 Terpinol, 466 Testa Prseparata, 200 Testicles, 789 Testicular Juice, 135 Testing, 525 Tests for Morphine, 362 Urinary Constituents, 845 Tetanus, 152, 789 Tetraborate, Sodium, 71 Tetrachloride, Carbon, 102, 228 INDEX 897 Tetra-hydromethyl-chinolin, 239 Tetra-hydroparamethyl-oxychinolin, 239 Tetra-iodo-pyrrol, 321 Tetra-methyl-Thionine Chloride, 343 Tetronal, 457 Tetter,—See Herpes, Pityriasis, Psoriasis. Thallin, 239 Thea sinensis, 193 Thebaine, 359, 366 Theine, 193, 195, 197, 198 Theism, 195 Theobroma Cacao, 195, 468 Theobromine, 195, 197, 468 Therapeutical Incompatibility, 514 Therapeutics, 17 Applied, 18, 566 Empirical, 18 Natural, 17 Rational, 18 Special, 566 Theriaca, 424 Thermodin, 68 Thermometer, Clinical, 842 Thimble-berry, 420 Thiol, 458, 461 Thirst, 790 Agents allaying, 43 Thistle, Blessed, 2x4 St. Mary’s, 214 Thompson’s Eye-water, 836 Tincture, 380 Thorn-apple, 450 Thorough-wort, 279 Throat,—See Aphonia, Croup, Diphtheria, Laryngitis, Pharyngitis, Scarlet Fever, Tonsillitis, etc. Throat, Sore, 790 Thrush,—See Aphthae, 580 Thuja, 469 Thujetin, 469 Thujin, 469 Thus Americanum, 466 Thyme, Garden, 469 Thymene, 470 Thymol, 470 Thymus (gland) Extract, 133 vulgaris, 469 Thyreoidin, 133 Thyreo-antitoxin, 133 Thyroid Extract, 133 Tic Douloureux, 791 Tiglii Oleum, 471 Tin, Antidotes and Antagonists, 861 Tincture, Fleming’s, 96 Hager’s, 237 Huxham’s, 237 Norwood’s, 484 Planat’s, 387 Pyrexialis, 237, 242 Rubini’s, 205 Thompson’s, 380 Warburg’s, 237, 242 Tincturae (Tinctures), 560 Tinea Circinata, 791 Decalvans, 792 Favosa, 792 Sycosis,—See Mentagra, 725 Tonsurans, 792 Tobacco, 461 Antidotes and Antagonists, 861 Indian, 333 Symptoms,—See Amaurosis, Ner- vousness. Toe-nails,—See Nails, 728 Tolene, 178 Toluene, 423 Toluifera Pereirse, 177 Balsamum, 178 Tomato, 272 Tonga, 472 Tongine, 472 Tongue, 793 Tonics, 49 Cardiac, 41 Formulae, 572, 577, 734 Gastric, 43 Hair, 675 Nerve, 730, 734, 740 Pills for Women, 554 Uterine, 57 Vascular, 42 Vesical, 53 Tonsillitis, 793 Tonsils, Enlarged, 794 Ulcerated, 794 Toothache,—See Odontalgia, 736 Toothrash,—See Strophulus, 785 Torrefaction, 525 Torticollis, 795 Torulae,—See Sarcinse, 774 Toxalbumins, 472, 476 Toxicological Antagonism, 63 Toxicology, 17, 61, 847 Toxin, Cholera, 478 Erysipelas, 477 Prodigiosus, 477 Rabies, 479 Tuberculosis, 473 Toxins, 472 Tracheitis,—See Croup, 624 Trachoma,—See Conjunctivitis Granular, 617, Ophthalmia, 738 Tragacantha, 480 Transfusion, 25 Traumaticin, 273 Traumatic Fever, 786 Treacle, 424 Tree of Heaven, 105 Tremor, 795 Tri-bromo-methane, 187 Trichiniasis, 795 Trichloraldehyde, 220 Tricophytosis capitis,—See Tinea, 791 Trimethylamine, 163, 164, 275, 301, 344 Trihydroxy-benzene, 84, 238 Trikresol, 74, 79 898 INDEX Trimethyl-ethylene, 102 -xanthin, 193 Trinitrin, 126 Trinitrophenol, 92 Trional, 456 Trismus, 796 Triticin, 480 Triticum, 480 Trituration, 526 Triturationes, 561 Triturations, their advantages, 561 of Elaterin, 274 Formulae, 562 of Mercury, 303, 562 Troches, 562 Trochisci, 562 Tropeius, 180 Tropical Fruit-Laxative, 440 Tropin, 180 Trypsin, 376 Tubercular Laryngitis, 711 Meningitis, 723 Peritonitis, 749 Phthisis, Diagnosis, 840 Tuberculin, 473 Tuberculocidin, 476 Tuberculosis, 153.—See also Tubercular Laryngitis, etc., above, also Phthisis, Scrofulosis, Tuberculous Affections. Acute, 796 Antitoxin, 153 Tuberculous Affections, 796 Tully’s Powder, 361 Tumenol, 458, 461 Tumors, 797 Diagnosis of, 838 Uterine, 806 Turnera aphrodisiaca, 265 Turpentine, 465 as an Antidote, 849 Antidotes and Antagonists, 862 Turpeth Mineral, 303 Tympanites, 797 Typhlitis, 797 Typhoid Fever, 797 Diagnosis of, 841 Temperature in, 844 Typho-malarial Fever,—See Typhoid, 797 Typhus Fever, 800 Diagnosis of, 841 Tyrotoxicon, Antidotes, etc., 862 Ulcers and Sores, 800 of Rectum, 769 of Stomach, 668 of Tonsils, 794 of Uterus, 806 Ulmus, 481 Umbelliferon, 288 Umbrella-tree, 336 Unguenta, 563 Unguentum, 217, 563 Uraemia, 802 Urea, Agents affecting, 48 in Urine, Test for, 846 Urethan, 222 Urethral Stricture, 802 Injections, 540 Urethritis, 802 Urginea maritima, 436 Uric Acid Diathesis,—See Lithaemia, 714 Urinary Astringents, 53 Disorders, 803 Sedatives, 53 Urine, Acidifiers of, 53 Alkalinizers of, 53 Articles coloring, 844 Examination of, 844 Urticaria, 804 Ursone, 289, 481 Ustilago, 488 Uterine Affections, 804 Alteratives, 57 Cancer, 804 Congestion, 805 Depressants, 57 Displacements, 806 Extract, 139 Hypertrophy, 805 Prolapse, 761 Tonics, 57 Tumors, 806 Ulceration, 806 Uva Ursi, 481 Uvula, 807 Vaccination, 807 Vaginismus, 807 Vaginitis, 807 Valerene, 482 Valerian, 265, 481 Valerianate, Butyl, 140 Valerianates, 482 Valerol, 301, 482 Vallett’s Mass, 280 Van Buskirk’s Sozodont, 836 Vanilla, 483 Vanillin, 483 Vao, 263 Vapores (Vapors), 539 Vaporization, 526 Varicella, 807 Varicocele, 808 Varicosis, 808 Variola, 808 Diagnosis of, 840 Vascular Sedatives, 42 Stimulants, 42 Tonics, 42 Vaselin, 378 Vegetable Drugs, their Constituents, 20 Veins,—See Phlebitis, Phlegmasia, Vari- cosis. Veins, Transfusion by, 25 INDEX. 899 Velatine, 242 Vellarine, 310 Venice Turpentine, 465 Venom, Insect, Antidotes, 854 Serpent, Antidotes and Antagonists 861 Venous Medication, 25 Veratralbine, 483 Veratrine, 484 Veratroidine, 483 ' Veratrum Album, 484 Sabadilla, 484 Viride, 483 Antidotes and Antagonists, 862 Verbascum, 486 Verbs, Latin, 829 Verdigris, 262 Vermicides, 48 Vermifuges, 48, 296, 812 Veronica Virginica, 329 Vertigo, 809 Verruca,—See Warts, 811 Vesical Tonics, 53 Sedatives, 53 Vesicants, 58 Viburnin, 486 Viburnum, 486 Vienna Paste, 399 Villate’s Solution, 263, 601 Vina (Wines), 108, 563 Vinegar, 70 Bitters, 836 Vinegars (Aceta), 528 Vinum, 108 Viola Cucullata, 487 Tricolor, 487 Violet, 487 Violine, 487 Viscin, 487 Viscum, 487 Visions, Agents producing, 38 Vita Nuova, 836 Vitellin, 487 Vitellus, 487 Vitriol, Elixir of, 92 Volkmann’s Antiseptic Fluid, 470 Vomiting, 809 of Pregnancy, 810 Diagnosis of, 842 Vulva, Eczema, etc., 811 Vulvitis, 8lI Wade’s Bougies, 558 Wafers, 555 Wahoo, 279 Walker’s Vinegar Bitters, 836 Walnut, White, 324 Warburg’s Tincture, 237, 242 Warming-plaster, 209 Warner’s Safe Cure, 836 Warts, 811 Wash, 541 Black, 304 Hair, 675 Lead and Opium, 542 Mouth, 675 Nasal, 540 Yellow, 304 Washing, 527 Waste, Agents promoting, 50 Wasting,—See Atrophy, Emaciation. Diseases,—See Emaciation, 648 Water, 157 of Carbolic Acid, 73 Carbonated, 80, 82 Cherry-laurel, 87, 89 Cologne, 108 of Crystallization, 520 Distilled, 157 Eye, Thompson’s, 836 Hunyadi, 619 Javelle, Antidotes, 857 Oxygenated, 370 Sedative, 122, 205 Soda, 80, 82 Water-brash,—See Pyrosis, 768 -lily, 358 -pepper, 398 Waters (Aquae), 528 Mineral, 80, 157 Nomenclature, 157 Wax, 217 Myrtle, 84, 217 Weakness,—See Adynamia, Exhaustion. Weight of a Drachm in Grains, 863 Weights and Measures, 494, 863 Apothecaries’, 495, 863 British Pharmacopoeial, 495 Metric, 496, 863 Wen, 812 Whiskey, 106, 107 White-leg,—See Phlegmasia, 752 White-swelling,—See Joints, Synovitis. Whitlow,—See Onychia, 737 Whooping-Cough,—See Pertussis, 75° Willow, 425 Wine, 108 Wines (Vina), 108, 563 Winslow’s (Mrs.) Soothing Syrup, 362 Winterberry, 404 Wintergreen, 289, 425 Witch-hazel, 84, 299 Wood Oil, 298 Spirit, 107 Woorara, 263 Words and Phrases, Latin, 816, 830 Worms, 48, 296, 812 Worm-grass, 449 Wormseed, 219 Levant, 432 Worm Tea, 449 Wormwood, 66 Wounds, 813 Poisoned, Antidotes, etc., 862 900 INDEX. Writers’ Cramp,—See Spasmodic Affec- tions, 781 Wry-neck,—See Torticollis, 795 Xantho-puccine, 309 Xanthoxyline, 488 Xanthoxylum, 487 Xeroderma,—See Ichthyosis, 697 Yam, Wild, 271 Yellow Fever, 814 Diagnosis of, 842 Yerba Santa, 277 Yolk of Egg, 487 Yvon’s Hypnotic Elixir, 703 Zea, 488 Zea Mays, 128, 423, 488 Zinc, 489 Phosphide, 380 Salts, Antidotes, etc., 862 Zincite, 489 Zincum, 489 Zingiber, 492 Zona,—See Herpes Zoster, 694 READ “SPECIAL NOTE” BELOW. CATALOGUE No. 1. 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