irvr;*[*:rrrr*JK«K »*«*-».-*.;ififU»I',i'':.:':.'':' ♦ # !!;;.■;&;. Tkc ttif t nf llr *r0firC ~&^rt~ HARVARD INIVIRS1TY. fikanr of % Utass. liltbital College. RULES AND REGULATIONS. 1. Students attending any of the Lectures in the Massachusetts Medical College may take books from the Library during the course, by depositing Five Hollars with the Dean; and the Students of any of the Medical Professors may have the same privilege on the same terms throughout the year. '1. The Library shall be open on the afternoon of every Saturday, from 3 to 4 o'clock, for the delivery and return of books. _ .^. 3. kept Two each who i any 4. fore befoi tory Libn o. of ti- the injury, as the case may be, will be deducted from the sum deposited; otherwise the whole amount will be returned to the depositor, when he ceases to use the Library. ra*jc? SELECTIONS FROM FAVORITE PRESCRIPTIONS OF LIVING AMERICAN PRACTITIONEKS, y BY HORACE GREEN, M.D., LED., PEBSIDENT OF THE FACULTY, AND EMERITUS PROFESSOR OF THE THEORY AND PRACTICE OF MEDICINE IN THE NEW YORK MEDICAL COLLEGE ; CORRESPONDING FELLOW OF THE LONDON MEDICAL SOCIETY; MEMBER OF THE AMERICAN MEDICAL ASSOCIATION, ETC. Ma»*. JifcOical Cullegc NEW YOKK: WILEY & HALSTED, 351 BKOADWAY. 1858. QV 1858 FNT£".sr> according: to Act of Congress, id the year 1?5S, by HORACE GREEN, in the Clerk's Office of the District Court of the United States, for the Southern District of New York. W. H. Tinson, Stereotyper, Rear of 43 & 45 Centre St., N. Y. '' ,3 CONTENTS. CHAPTER I. NARCOTICS AND SEDATIVES. Hydrocyanic Acid with Morphia, etc.,......1 " " " Antimony, etc.,......2 " " " Ipecacuanha,......3 u " " Liquor Potassse, ...... 4 i' " " Belladonna, .......5 Cyanide of Potassium,.........6 Hyoscyamus with Morphia, etc.,.......? " " Valerianate of Iron,......8 it » " Zinc,......9 Belladonna " Quinine, etc.,.......10 " " Zinc and Ipecacuanha,......11 Hyoscyamus " Nitrate of Silver,.......12 Conium with Calomel, etc.,...... .13 Belladonna with Quinine, ........14 Opium with Capsicum, ^Ether, etc.,.......15 Hyoscyamus with Bismuth, etc.,.......16 Conium with Nitrate of Silver, etc.,.......H Lupuline " " " ".......18 Hyoscyamus with Morphia, etc.,.......19 Quinine " ....... 20 Muriate of Ammonia with Opium, etc.,......21 Assafcetida with Morphia,........22 CHAPTER II. TONICS AND STIMULANTS. Carb. Iron with Extract Conium, etc.,......23 it " " " Taraxicum,......24 Citrate of Iron with Syr. Aurantia, ......25 Phosphate of Iron with Quinine,.......26 IV CONTENTS. Syr. Iodide of Iron with Tr. Aconitine, Extract Hyoscyamus with Conium, etc., . Sulphate of Iron with Iodide of Potassium, Fowler's Solution with Tr. Cinchonse, " " " Quinine, Arsenic with Quinine, .... Phosphate of Manganese with Tr. Cinchonse, " " " Phos. Iron, Malate " " Cinchona, Iodide " " Tr. Cardamom., Carb. " " Carb. of Iron, " " " Tr. Columbo, " " " Iod. Potass., Fusil Oil or Grain Oil, .... Extract of Nux Vomica with Tr. Cardamom., " " " " Opium, Nux Vomica with Oxide of Silver, Bismuth with Columbo, Solution of Strychnia, etc, " " with Cardamom., " " " Quinine, etc., " " " Morphia, Quinine with Piperine, Strychnine,..... " with Lobelia, Corrosive Sublimate with Nux Vom., etc., Extract Aconite with Arsenic, . " Belladonna with Iron, etc., . Potass. Hydrocyanic Acid, etc., CHAPTER III. EXCITANTS AND ALTERATIVES. Iodide of Potass., Tr. Rhubarb, etc., Decoc. Senega and Potass., Iodine and Iodide of Potass., . Iod. Potass., Senega and Lobelia, Iodide of Mercury, Iod. Potass., Iodide Potass., Tr. Gentian, etc., Extract Conium, Iod. Potass., etc., Donovan's Solution, etc., . Iodide Potass, and Antimony, . " " " Ipecacuanha, " " " Hydrocyanic Acid, " " " Iodine, etc., CONTENTS. V Iodine Liquor Potassee, etc.,........68 Iodide of Potass, and Tr. Hyoscyamus,......69 Syrup Iodide of Iron, Potass., etc.,.......70 Arsenic with Extract Conium,........71 " " Liq. Iod. Potass.,.......72 Iodide of Lead Ointment,.........73 Manganese with Iod. Potass.,........74 Corrosive Sublimate with Extract Conium,.....75 " " " Opium,.......76 " " in pills, . ......77 " " with Gentian.,.......78 Calomel with Sugar,..........79 " " Opium and Ipecac, . . .... .80 Podophyllum with Aloes, .........81 " " Calomel,........82 " " Gentian, etc.,.......83 Podophyllin with Sugar, .........84 Sanguinaria with Tinct. Aloes,........85 14 " Ipecacuanha,........80 11 " Tinct. Opium,.......87 " " Morphia, Antimony, etc., ..... 88 " " Digitalis, " ".....89 " " Rliubarb, etc.,.......90 Actea Racemosa with Potassa,........91 " " " Sanguinaria,.......92 " " Infusion of,........93 " '• with Myrrh, etc.,.......94 Veratrum with Squills,.........95 .........96 CHAPTER IV. CATHARTICS AND LAXATIVES. Aloes with Guiac. and Gamboge,.......97 " " Calomel, Jalap, etc.,.......98 " " Rhubarb, etc.,........99 " " Aromatics,.........100 " " Ipecacuanha, etc.,........101 " " Mastic, etc.,.........102 " " Antimony, Calomel, etc.,......103 Extract Colocynth, Calomel, etc.,.......104 Blue Mass with Aloe's, etc,........105 Aloes with Carb. Soda, etc.,........106 VI CONTENTS. Aloes with Syrup Rhubarb, Extract Taraxicum with Manna, " " " Aloes, etc., Magnesia with Rhubarb, etc., . Sulphate of Magnesia, etc., Nitrate Potass, with Castor Oil, Infusion of Senna, Rhubarb, etc., Extract Hyoscyamus, Blue Mass, etc " Conium with Calomel, " Hyos. with Sulph. of Iron, Aloes, Rhubarb, Jalap, etc., " Belladonna and Rhubarb, Sulphate Magnesia with Elix. Vit., 107 108 109 110 111 112 113 114 115 116 117 118 119 CHAPTER V. EMETICS AND EXPECTORANTS. Antimony and Ipecacuanha, " " etc.; Sulphate of Zinc with Ipecac, . Turpeth Mineral, etc., Sulphate of Copper and Sulphate of Zinc, Ipecacuanha, etc, .... Ipecacuanha with Mint water, . Sanguinaria Emetic, .... Lobelia with Squills, Senega with Iodide of Potassa, Ammoniacal mixture with Squills, Syr. Squills with Bloodroot, Potassa with Musk, etc., . Senega with Morphia, etc., " " Ipecacuanha, " " Squills, Opium, etc., " " Antimony, Ipecac, etc, Canada Balsam with Potass., etc., " " " Cyanide of Potass., Copaiba " Opium, Ipecac, etc, Cyanide of Potass, with Morphia, etc., Wine of Ipecac, with Tolu., Glycerine with Iodide of Iron, " " Hypophosph. Soda, . Sulph. Magnesia with Elix. Vitriol, . 120 121 122 123 124 125 126 127 12S 129 130 131 182 133 134 185 136 137 138 139 140 141 142 143 144 CONTENTS. vii CHAPTER VI. ASTRINGENTS. Opium with Camphor and Soap,.......145 " " Acetate of Lead, etc.,.......146 " " Nitrate of Silver,........147 Acetate of Lead with Digitalis, etc.,.......148 " " " Tinct. Opium, «......149 " " " Cinnamon water,......150 Catechu with Opium, etc.,........151 Oil of Turpentine with Opium, etc.,.......152 Nitrate of Silver " " .......153 Cascarilla with Nux Vomica, etc.,.......154 Sulphate of Zinc with Opium, etc.,.......155 " Copper with Opium, etc.,......156 Tannin with Extract Gentian,........157 " " Opium, etc.,........158 " " UvaUrsi,.........159 Gallic Acid with Acacia,......• . . .160 " " " Tolu., etc.,........161 Camphor with Capsicum,.........162 CHAPTER VII. DIAPHORETICS. Spts. of Mindereri with Antimony, etc.,......163 " " " Camphor, etc.,......164 Antimonial Wine, with Nitrate of Potass.,.....165 Sulph. Magnesia with Antimony, etc.,......166 James's Powder with Calomel, etc.,.......167 Nitrate of Potass, with Opium,........168 Dover's Powder with Calomel, etc.,.......169 Spts. Mindereri with Spts. Nitre, etc.,......170 Antimony with Cinnamon Water,.......171 Ipecacuanha with Snakeroot,........172 Carb. Potass, with Paregoric,........173 Carb. Soda with Spirits of Nitre,.......174 Nitrate of Potass, with Antimony,.......175 Carb. Ammonia with Paregoric, etc.,......176 Vlll CONTENTS. CHAPTER VIII. DIURETICS. Juniper with Spirits of Nitre,........177 Digitalis with Corrosive Sub., etc,.......178 Camphor with JSther, Digitalis, etc.,......179 Colchicum with infusion of Juniper,.......180 " " Iodide of Potass., etc.,......181 Ealterium with Digitalis, etc.,........182 Tincture Cantharides with Nitre, etc.,......183 " Cinchona with Cantharides, etc.,.....184 Juniper with Nitrate of Potass.,.......185 CHAPTER IX. ANTISPASMODICS. Assafcetida with Morphia,........186 " " Camphor and Morphia,......187 " " " " Musk,......188 Musk with Mther and Opium,........189 Castor with Assafcetida, etc.,........190 " " Morphia, Valeriana, etc.,...... 191 Valeriana with Magnesia, Opium, etc.,......192 Spirits of Lavender, ^Ether, etc.,.......193 Valerianate of Zinc with Tr. Valeriana,......] 94 Hyoscyamus with Bismuth, etc.,.......llto Valerianate of Ammonia, etc.,........196 CHAPTER X. ANTHELMINTICS. Spigelia, Infusion of,.........jc/7 with Tin,..........198 " " Senna, etc.,...... jgg " " Potass., Jalap, etc.,.......200 Male Fern,......... 201 " " in Infusion,........ 202 Kousso in Infusion,........ 203 Oil Turpentine with Barley decoction,..... 204 Oil of Worm Seed,..........205 Biniodide of Mercury,........ 206 CONTENTS. ix CHAPTER XI. EMMENAGOGUES. Sulphate of Iron with Iodine, ... .... 207 Carb. of Iron with Columba, etc.,.......208 Citrate of Iron with Syr. Orange peel,......209 Aloe's with Sulph. of Iron,........21° Iodide of Potass, with Colchicum,.......211 Aloes with Sulphate of Iron, etc.,.......2i2 " " Borax, Castor, etc., . .... 213 Colchionm with Strammonium, etc., . . . • • • 214 Iodide Potass, with Proto-Iod.,.......215 oi 6 Guiacum with Soda, etc., .... ... CHAPTER XII. GARGLES AND LOTIONS. Nitrate Silver with Rose Water, Nitrate of Potass, with Honey, . Creosote with Tinct. Myrrh, etc., " " " Capsicum, etc, Decoction Barley with Myrrh, etc., Chloride Soda with Honey of Roses, Corrosive Sublimate with Spirits Wine, etc Infusion of Roses with Tr. Myrrh, Tinct. Capsicum with Alum, Docoction of Oak with Alum, . Alum with Zinc, Chloride Lime with Opium, 217 218 219 220 221 222 223 224 225 226 227 228 CHAPTER XIII. ANTACIDS AND ANTILITHICS. Carb. of Soda with Aromat. Sp. of Ammon.,.....229 Soda with dilute Sulph. Acid, etc.,.......230 Magnesia with Lime water, etc.,.......231 " " Sulph. of Magnes., etc.,......232 Chalk mixture,..........233 Carminative of Dr. Dewees,........234 Prepared Chalk with Acacia, etc.,.......235 Aquae Ammon. with Infus. Gentian.,......236 Liquor of Potassa with Tr. of Hops,......^ Iodide of Potass, with Liquor. Potass.,......238 Potassio-Tartrate of Soda, Colchicum, etc., .... 239 X CONTENTS. CHAPTER XIV. DERIVATIVES OR COUNTER-IRRITANTS, OINTMENTS, ETC. Oil of Origanum, Ammonia, etc., .....•• 240 " " Tinct. Opium, etc.,.......241 " " Camphor, Chloroform, etc.,.....242 Tinct. of Arnica, Ammonia, etc.,.......243 " Aconite, Chloroform, etc.,.......244 Soap Liniment and " .......245 Camphor, Chloroform, Turpentine, etc.,......246 Ointment, Antimony, Camphor, etc.,......247 " " and Ipecac,.......248 Solution " and Potassium,......249 Ointment, " Croton Oil, etc,......250 Soap Liniment and " ".......251 Sulph. ^Ether " " ".......252 Ointment, Potassium, etc.,.........253 " /" and Iodine,.......254 " Strammonium and Lead,.......255 " Galls, ... ... 256 " Galls, Opium, etc., .... ... 257 Iodine Ointment,...... ... 258 Veratrine Ointment,...... ... 259 " and Rose Ointment, .... ... 260 Oil of Tobacco and Precipitate Ointment,......261 Ointment, Red Precipitate,........262 Lotion for Ophthalmia,........ 263 INTRODUCTION. ---------*►--------- A part of the Prescriptions contained in this volume have already appeared in the American Medical Monthly. The following are the circumstances under which they were originally collected: For many years past, the Author's Rooms, for the treatment of patients, have been visited daily by medical men from all parts of the Union, who have called on him, either from curiosity, or from a desire to observe every improvement in practical medicine. It will be within the truth to state that the numbers of those by whom he has been in this way honored, have equalled nearly one thousand annually. Ever ready to communicate to the profession any, and whatever, practical knowledge might be in his pos- session, the author has never hesitated to ask of others such useful information as they might have derived from experience and observation. Acting on this princi- ple, he has accustomed himself for many years, when visited by experienced, practical physicians, to request of them copies of some of their favorite prescriptions— those prescriptions, from the employment of which they have derived the greatest advantage in the treatment of disease. In this way he has collected together two large manuscript volumes of medical formulae, obtained from practitioners who have come from every section of the 11 xii INTRODUCTION. Union—many of them being the contributions of some of the most distinguished American physicians and sur- geons of the present time. These therapeutic excerpts, which have come to the author through individual con- tributions, and are the collections of much labor, he pro- poses to give back to the whole faculty, as the choice formulae of many of the profession of our country. He has been induced to publish this volume of " Fa- vorite Prescriptions of Living American Practitioners," by several considerations. A part of the formulas having appeared from time to time in different numbers of the Medical Monthly during the last two or three years, they have been extensively copied, not only into the medical journals of this country and of the Canadas, but, also, into many of the European journals, which clearly shows that some degree of esti- mation was placed upon the value of these preferred formulae of American practitioners. But a stronger inducement than the above, has been presented to the author, in the many requests that have come to him from eminent physicians in different parts of the Union— physicians, upon whose judgment he feels disposed to rely—urging him to collect and publish these Prescrip- tions in a Book form. Moreover, since the intention of the publication of this volume was known, a large number of additional excel- lent formulae, which cannot fail to enhance the value of the collection, have been furnished for the work, by dif- ferent medical men of skill and experience. "With the scientific physician it is a matter of regret that, in our present state of medical knowledge, we cannot claim for the principles of Therapeutics that they are fully established on rational grounds. Until the relations which exist between the pathological condition of inter- nal diseased organisms, and the action of therapeutic agents, are better understood, our knowledge of the ulti- mate influence of medicinal substances upon these mor- INTRODUCTION. xiii bid conditions must, necessarily, be imperfect, and our system of Therapeutics be considered rather empirical than rational. "We know from experience—and expe- rience only—that certain remedies are valuable in the treatment of certain diseases; but, even this knowledge is limited; and hence the importance of extending its boundaries by collecting further materials from the prac- tical observations of the experienced in our profes- sion. The publication of these tried formulae, with appended observations—which are the contributions of many of the distinguished practitioners of our country—will not fail, it is believed, to add to our stock of knowledge in both Rational Therapeutics, and Practical Medicine. To the young and inexperienced practitioner, the work will afford material aid. But, in placing in the hands of this class of the profession so many powerful " instru- ments for combating the aggressions of disease," we must not omit to caution the practitioner against a too energetic adoption of active therapeutic agents in resisting diseased action. There is in every, living body a vital principle whose constant tendency is, not only to repel the action of morbific causes, but to restore that body when diseased, to its original normal condition. The scientific and experienced physician will always respect this conservative power or principle; and in each in- stance of disease, will seek to ascertain how far the case may be safely intrusted to the care of Nature, and to what extent the intervention of Art may be required. From long experience, in observing the practice of medi- cal men, the author is convinced that, as good judgment and as careful discrimination are required, in the prac- titioner, to enable him to decide at what point, and how long, to withhold, altogether, the administration of reme- dies, as to know when, and to what extent, therapeutic measures are to be invoked, in the management of dis- ease. But he cannot do the profession a better service xiv INTRODUCTION. than to embody here the experience of one of the most eminent and judicious living practitioners of this country, as it is given, in his own words, in a recent com- munication to the Author. " I have seen, and have prescribed," writes he, " and, in some instances, with apparent, signal advantage, some of the ' Prescriptions of Distinguished Living American Physicians,' which have appeared from time to time under your sanction, in the American Medical Monthly, and I rejoice that you are about to embody and publish them in a book form, for the benefit, and at the call of the profession.....During my whole medical life (now counting forty full years !) I have always been, and, for the last decennial period, have almost daily been becoming more and more a dear lover of simplicity in my use of the Materia Medica, especially in all forms of chronic disease. My medical armamentarium com- prises but a very small number of the articles which go to swell the bulk of our pharmacopoeias and Dispen- satories—my distrust of these, and my confidence in the old fashioned ' vis medicatrix naturae," have been for several years past increasing ' pari passu.' " When I commenced my profession (in the spring of 1818), and for many years after, my reliance on medication was most unbounded ; that there were known means for the cure of every disease, and that any fatal event within my manor would be justly chargeable to me, I confi- dently believed. I gloried in the reputation, which I did not fail soon to acquire, both with the profession, and the little public (whose misfortune it was first to receive the yet unfledged diploma-ti&t as their future medical adviser), of being ' a most heroic practitioner,' not in the way of reproach, indeed, but of applause. I had just emerged from the ' Philadelphia School,' and Dr. Sangrado him- self never wielded the lancet more indiscriminately than did I, having just returned from listening to the lectures of Dorsey, Physick, Chapman, and others, who, it has INTRODUCTION. XV often seemed to me, actually thought, that there was no limit to the supply of blood in the human body. They had taught, and I had received the dictum, without the slightest grain of doubt, that all disease had its origin in increased vascular energy and force, for which the only legitimate remedy was primarily venesection, and then its congeners, cathartics, sudorifics, emetics, sialogogues, diuretics, ' et id omne genus,'—that all disease was an entity, and like some wild beast, was to be hunted with- out parley or delay; and, with all the energies and means at command, to be exterminated, lest his ravages should incontinently raze to the ground the citadel of life. And—oh, the delusion !—success seemed, not only to me, but, to my confiding patrons, to be the reward of this mad medical philosophy. But a change soon ' came over the spirit of my dream? For many years past, a masterly inactivity has, in many cases, supplanted this energetic draught upon tissue, organ and function. I still have faith in the efficacy of Opium, Antimony, Calo- mel, Elaterium, ' Nitrate of Silver,' but action waits upon ■patient—patient Diagnosis; nor is one of those potent life-preservers permitted to make its irreparable entrance into the inner man, until, by scrutinizing observation assured of the ' Nodus vindice dignus.' " "Whenever simple remedies can be employed with equal efficiency, such, undoubtedly, are to be preferred to compound medicines in the treatment of disease. It should never be forgotten, however, that " it sometimes happens that the most skillful physician is he who pre- scribes nothing." On this great question in Medicine—the powers of Nature to arrest the processes of disease—Sir John Forbes has just published a most valuable work, and the author would earnestly recommend, particularly to the younger members of the profession, a careful perusal of this Essay, on " Nature and Art in the Cure of Disease." In the following Prescriptions several ingredients are XVi INTRODUCTION. frequently combined in one formula. In some instances this is done in order to obtain, simultaneously, the effects of two or more remedies ; in others, to increase or dimin- ish, as the case may require, the action of the base, or principal remedy. But still more frequently are combi- nations effected for the purpose of rendering the remedies indicated as agreeable as possible, without, in any degree, impairing their efficacy. Many of the formulae, as here presented—the propor- tions of their combinations varied to meet particular cases—nave teen employed by the author, and their value tested in an extensive practice, and through many years. For obvious reasons the various formulae have been arranged under their appropriate heads. Horace Green. New York, 12 Clinton Place, August, 1858. FAVORITE PRESCRIPTIONS OP LIVING AMERICAN PRACTITIONERS. CHAPTER I. NARCOTICS AND SEDATIVES. The narcotic principle in medicine differs from that of the sedative in this, that its primary action is in some degree stimulant, whilst the sedative principle tends directly to depress the vital powers without inducing any previous excitement. The ultimate action of both narcotics and sedatives is to diminish the sensibility of the nervous system, thereby allaying pain and promoting sleep. Among the direct sedatives Hydrocyanic Acid is one of the most prompt and efficient. Adminis- ii 2 18 NARCOTICS AND SEDATIVES. tered in appropriate doses, it tends directly to lower the sensibility of the nervous system, to diminish the frequency of the pulse, and to induce a sensation of quiet and calmness throughout the whole system. Alone, or in conjunction with other remedies, Prussic Acid constitutes one of our most valuable therapeutic agents. The following combinations with this remedy have been proved to be of great service in the treatment of disease : 1. I$s Acidi Hydrocyanici, Medicinalis, gtt. lx. Morphiae Sulph......gr. iij. Tinct. Sanguinarise, Vini Ipecacuanhas, . . . . aa f. 5 ss. Syr. Pruni Virginianae, Vel Misturae Amygdala?, Fiat mistura cujus sumat cochlearium parvum bis terve in die. We have found the above a most valuable remedy in the treatment of chronic bronchial dis- ease ; in allaying the cough present in tubercu- losis, and in all pulmonary catarrhal diseases, unattended with fever. As the acid is apt to float on the top of the liquid, the phial should be shaken on the administration of each dose. f.gv. NARCOTICS AND SEDATIVES. 19 2. fy Acidi Hydrocyanici, gtt. xl. Yini Antimonii, . f. S ss. Syrupi Tolutan., . f. § ss. Mucil. Acaciaa, . f. Sij. Fiat mistura, capiat cochl. parvum ter qua- terve in die. This may be used in the same cases as the former, when the cough is troublesome, and is attended with some degree of fever. As a remedy in the treatment of hooping-cough, Hydrocyanic Acid surpasses in efficiency every other known general remedy. We have employed it for many years in this disease, and can fully substantiate the declaration of Dr. Hamilton Roe, that " Hydrocyanic Acid of Scheele's strength will, if exhibited as soon as the whoop is heard, effect a cure in almost every case of simple hoop- ing-cough. If the disease has been going on for many weeks, its effects are not so immediately felt, but nevertheless it will cure in most in- stances." * The following formula we are accustomed to employ: * A Treatise on the Nature and Treatment of Hooping-Cough, by Geo. Hamilton Roe, M.D., Fellow of the Royal College of Physicians, etc., Lon- don, pp. 95-6. 20 NARCOTICS AND SEDATIVES. 3. ty Acidi Hydrocyanici, Medicinalis, gtt. xxv. Yini Ipecacuanhas, . . . . f. 3 ij. Syr. Tolutan.......f. gj. Aquae Destillatae,.....f. S iij. Fiat mistura, cujus sumatur cochl. parv. quarta quaque hora. It is important that its use be entered upon as soon as the presence of the characteristic whoop determines the nature of the disease. If the breathing is oppressed, or the symptoms present indicate the existence of bronchial inflammation, the administration of the sedative should be pre- ceded by the exhibition of an emetic, and perhaps by the application of a few leeches to the chest. If administered too freely, the acid will produce a greatly depressing effect on the vital powers. Should much debility, therefore, occur during its employment, the remedy should be omitted, and mild tonics, with a more stimulating expectorant, be exhibited for a few days, when the use of the Hydrocyanic Acid may be renewed. " The dose of Hydrocyanic Acid for an infant," says Dr. Roe, " is about three-quarters of a minim of Scheele's strength, gradually increased to a minim, which may be given every fourth hour ; for a child of three years of age, about one minim, NARCOTICS AND SEDATIVES. 21 gradually increased, if necessary, to a minim and a half every fourth hour ; for children of ten or twelve years of age, a minim and a half, increased to two minims every fourth hour. It is safer to give this medicine in small doses at very short intervals, than to run any risk of producing too great depression by a large dose. The frequency of its exhibition must depend upon the strength of the patient and the severity of the attack. The dose should be repeated when the effects begin to subside, which, in mild cases, generally happens in three or four hours ; but when much fever is pre- sent, its influence is felt but a very short time ; under such circumstances, a larger quantity may be given and at shorter intervals, without any apprehension of danger, so long as the fever lasts." * 4. Ify Acidi Hydrocyanici, Medicinalis, f. 3 j. Liquor, potassae,.....f. g ss. Infus. Columbae,.....f. S ij. Misturae Amygdal., . . . . f. S iv. M. Capiat cochl. minim, ter in die. In cases of long-continued chronic bronchitis, the physician occasionally finds this disease complicated, * Op. citat. pp. 89-90. 22 NARCOTICS AND SEDATIVES. with a peculiar irritable condition of the gastric mucous membrane, manifested by tenderness of the epigastrium, a red tongue, frequent headache, and a feverish condition of the system. In such cases where the inflammation has extended to the mu- cous membrane of the stomach, producing this not uncommon form of broncho-gastritis, the exhibition of the above combination, with the hydrocyanic acid, the alkali, and the bitter vegetable infusion, will exert a prompt and a decidedly happy influ- ence on this diseased action. Combined with the extract of Belladonna, Hy- drocyanic Acid has also been found very useful in the treatment of gastralgia, and in " irritable gas- tric dyspepsia." The following mixture prepared, and a teaspoon- ful of the medicine administered three or four times daily in these affections, will, by acting on the nerves of the stomach, greatly diminish their irrita- bility : 5. IJj Extract. Belladonnas, . . . gr. x. Acidi Hydrocyanici, Medicinalis, gtt. lx. Tine. Columbas, Syr. Simp., ......aa. f. gj. Aquae DestillataB, . . . . f. g ij. Misce. NARCOTICS AND SEDATIVES. 23 The above combination has likewise been em- ployed with great benefit in the treatment of spas- modic asthma. These, then, are some of the useful combinations of one of our most important therapeutic agents ; and we can assure the practical physician that not only in these affections, to which allusions have been made, but in the treatment of many other diseases, he will find these remedies invaluable aids in controlling diseased action. The anhydrous, or pure Hydrocyanic Acid, which consists of one equiv. of Cyanogen, and one equiv. of Hydrogen, is of a nature so exceedingly poison- ous, that it cannot be employed with safety in medicine. The medicinal acid, which is the prepa- ration that should always be directed to be used in our prescriptions, contains only 2.5 per cent. (Uni- ted States Pharmacopoeia) of the pure acid. That of the Apothecaries' Hall, London, contains 3.2 per cent.; whilst the medicinal Acid of the French Apothecaries is nearly equal to that of the United States Pharmacopoeia—namely, 2.4 per cent, of the pure acid of Gay Lussac. As the strength of the different medicinal acids cannot be depended on, as being always of the same uniform power, it has been proposed that the Cyanide of Potassium be substituted in medicine for the Hydrocyanic Acid. 24 NARCOTICS AND SEDATIVES. 6. fy Cyanidi Potassii, gr. xxii Alcohol. Officinalis, f. 3 xi Misce. This preparation of Cyanogen, which possesses the same medicinal qualities, and is of the same strength with the Hydrocyanic Acid, is greatly preferred by many practitioners as a therapeutic agent, inasmuch as it can be depended on as being always of a uniform strength. It may be used in the same doses and under the same circumstances in which the Hydrocyanic Acid is administered. Besides the preceding formulae, in the combina- tion of which the Hydrocyanic Acid is employed, we have several other preparations into which enters, either the Cyanide of Potassium, or the Hydrocyanic Acid, and which have been found to be of great value in practical medicine. These pre- scriptions will be given under the head of expecto- rants. As palliatives in the treatment of all forms of neuralgia, the narcotics and sedatives are very generally resorted to by practitioners, especiaUy during the paroxysms of the disease. When appro- priately combined, their efficacy in these affections is more prompt and decided than when separately administered. NARCOTICS AND SEDATIVES. 25 7. 15* Extracti Hyoscyami, 3 ss. Morphiae Sulphatis, gr. iij. Strychniae, . . . gr. ij. Capsici pulv. . . 5 ss. Zinci Sulphatis, . gr. xv. M. Fiat massa, in pilulas xxx. dividenda ; capiat imam, ter quaterve in die. In neuralgia, unattended by organic lesions, the above pills, exhibited every sixth or fourth hour, according to circumstances, will be found to be an excellent remedy. They have proved especially serviceable in that form of neuralgia in which the divisions of the fifth pair of nerves are so frequently involved. Not only in facial neuralgia, but in all cases where the disease has been caused by mala- ria, this combination may be administered with con- fidence that the result will be favorable. The vale- rianate of iron conjoined with the extract of Hyos- cyamus is an excellent antispasmodic and tonic, and may be employed with great advantage for the treatment of chorea and all the neuralgic affections of anaemic and debilitated females. 8. IJs Extracti Hyoscyami, 3 ss. Ferri Yalerianatis, 3 i. 26 NARCOTICS AND SEDATIVES. Fiat massa, et in pilulas xxx. dividenda ; qua- rum date unam ter in die. The Yalerianate of Iron and the Yalerianate of Zinc are two highly valuable remedies, and, were the therapeutic powers of these medicines better understood by the profession, they would be much more extensively employed than they now are for the treatment of disease. The Yalerianate of Zinc, Dr. Neligan says, is " one of the most valuable modern additions to the Materia Medica." 9. fy Extracti Hyoscyami, 9 iss. Zinci Yalerianatis, 9 j. Fiant pilulas xxx. Capiat unam bis terve in die. The above pill is a valuable remedy in the treat- ment of facial neuralgia, and, indeed, is equally serviceable in all the nervous and neuralgic affec- tions for which the Yalerianate of Iron has been advised. 10. IJs Extracti Belladonnas, gr. viij. Camphori pulv., . 3j. Quiniae Disulphatis, 9 ij. Misce ; Fiant pilulas triginti. NARCOTICS AND SEDATIVES. 27 These pills are very effective in the treatment of dysmenorrhoea. One pill may be exhibited every hour or two hours till the pain ceases. In females of a nervous temperament, when painful menstrua- tion occurs, independent of organic lesions, these pills, administered as above directed, seldom fail of affording relief. In those cases of dysmenorrhoea where a tonic is not particularly indicated, the fol- lowing are more appropriate, and are equally effi- cacious : 11. Jfy Extracti Belladonnas, gr. viij. Ipecacuanhas pulv., gr. x. Zinci Sulphatis, . 3 ss. M. Fiant pilulas xxx., quarum capiat unam qua- que hora, donee leniatur dolor. The following pills are highly recommended by an intelligent and experienced practitioner, in the treatment of leucorrhcea, occurring in anemic and nervous females : 12. I}* Extracti Hyoscyami, 3 j. Argenti Nitratis, . gr. x. Cantharidis pulv., . gr. xii. Quinias Disulphatis, 9 ij. Fiant pilulas xl. Sumat unam mane et nocte. 28 NARCOTICS AND SEDATIVES. The same physician advises the subjoined formu- la as a combination that may be employed with great advantage as a diuretic and alterative in the treatment of cellular dropsy : 13. ^s Extracti Conii, . 3j. Cantharidis pulv., 9 ij. Hydrarg. Submur., 3 ss. Ipecacuanhas pulv., 9j. M. Fiat massa, in pilulas xl. dividenda. Cujus capiat unam ter quaterve in die. A combination of the extract of Belladonna with Quinine has been employed, very efficaciously, in the treatment of gastralgia. 14. fy Extracti Belladonnas, 9 ss. Quinias Disulphatis, 3 j. M. Fiant pilulas xxx. Sumat unam ter in die. Professor C. C. Cox, of Maryland, who has con- tributed some valuable prescriptions to this volume of Medical Formulas, advises the following mixture to be administered in gastralgia : NARCOTICS AND SEDATIVES. 29 15. ^ Tinct. Opii, Tinct. Capsici, JEther. Sulph. Tinct. Camphori, aa. 3 iij. Chloroformi, . 3j. Fiat mistura cujus capiat cochl. parv. pro re nata. The efficacy of the above medicine is much in- creased if taken in a wineglass of hot ginger tea. In that variety of gastralgia which is not unfre- quently occurring in the course of chronic gastritis, we have derived the greatest benefit from the employment of the following pills : 16. I$j Extracti Hyoscyami, 3j. Argenti Nitratis, . gr. x. Bismuthi Subnitratis, 3 iss. Fiant pilulas xl.: quarum sumatur una mane ac nocte. The Nitrate of Silver combined with some one of the sedative extracts, may be employed advan- tageously in the treatment of almost all chronic 30 NARCOTICS AND SEDATIVES. gastric affections.* In cases of obstinate, chronic gastritis, or long continued dyspepsia, we have found the following pills more efficacious than any other single remedy. They should be continued for several weeks : 17. fy Extracti Conii, vel Lupuli, 3 j. Argenti Nitratis, ... gr. x. Capsici pulv. Quinias Disulphatis, . . aa. 9 ij. M. Fiat massa, in pilulas xl., dividenda. Capiat unam bis terve in die. There is a troublesome and often an obstinate form of gastric irritability, denominated by the French estomac glaireuse, in which the patient occa- * With regard to the danger of " discoloration of the skin," from the internal administration of this remedy, it may be proper to remark that although we have used the Nitrate of Silver very freely, not only in topical applications to the mucous membrane of the air-passages, etc., but have administered it for many years internally in the treatment of diseases of the alimentary canal; yet in no instance has such an event occurred in our practice. We have seldom continued its daily internal use for a period longer than six weeks, or two months, without intermitting the medicine for a time. In doses of from one-eighth to one-fourth of a grain, adminis- tered twice or thrice a day, the Nitrate of Silver may be given for two months without incurring the slightest risk of producing discoloration. Indeed, Sir James Johnson asserts, in his " Essay on the Morbid Sensibility of the Stomach and Bowels," that there is not an instance on record where the complexion has been affected by the medicine when restricted to three months' administration. NARCOTICS AND SEDATIVES. 31 sionally ejects, by eructafion, a tasteless watery fluid, and which is accompanied, often, by a severe burning pain in the epigastric region. This variety of the disease is arrested with great certainty by the exhibition of either the preceding, or the fol- lowing pills : 18. IJ* Extracti Lupulinas, 3j. Argenti Nitratis, . gr. x. Bismuthi Subnitratis, 3 iss. Quinias Disulphatis, 9 ij. Fiant pilulas xl. ; cujus sumatur una bis terve in die. In all forms of chronic disease, attended with acute pain, as well as in all painful nervous affec- tions, in the treatment of which, for any cause, full doses of opium are contra-indicated, the following combination may be administered with great advan- tage : 19. ty Extracti Hyoscyami, gr. xv. Extracti Stramonii, gr. iv. Extracti Humuli, 3j. Morphias Sulphatis, gr. iss. M. Divide in pilulas xxx.; quarum capiat unam omni semihora, donee leniatur dolor. 32 NARCOTICS AND SEDATIVES. " I have found," writes Dr. Porcher, of Charles- ton, " a combination of Sulphate of Quinine and Sulphate of Morphia to be particularly beneficial in reheving pain, proceeding from irregular nervous excitement:" 20. I^s Quinias Disulphatis, 9 ij. Morphias Sulphatis, gr. x Fiant pilulas xx., quarum sumat unam pro re nata. The above pills may also be administered, with great advantage, often, in neuralgia and rheuma- tism. Of the therapeutic effects of muriate of ammonia, when internally administered, but little is known, as in this manner it is but rarely employed in this country. With the German physicians it has ob- tained a high reputation as a good alterative, and a promoter of healthy secretions in chronic diseases of the mucous and serous tissues. It not only pro- motes the mucous secretions, says Dr. Sunderlin, but the cutaneous exhalations, and improves also nutrition and assimilation. Combined with a seda- tive and narcotic, we have found it highly valuable, in allaying irritation and in promoting expectora- tion, in the early stage of phthisis : NARCOTICS AND SEDATIVES. 33 21. IJs Ammonias Muriatis, 3 ss. Opii pulv., . . . gr. x. Digitalis pulv. Scillas pulv., . . aa. 9j. M. Divide in pilulas xxx. Sumat unam quaque sexta hora. Sleeplessness, occurring in hypochondria, hyste- ria, and, indeed, in all nervous affections, may be overcome with great certainty by the administra- tion of the following pills : 22. Jty Assafoetidas, . . 3j. Morphias Sulphatis, gr. iij. M. Fiant pilulas xxx., quarum exhibe unam vel duas hora de cubitus. The above pills—two to four exhibited daily— are very efficacious in arresting the dry cough which is occasionally consequent on disordered menstruation in nervous females. CHAPTER II. TONICS AND STIMULANTS. Although these two agents are here arranged together, and are frequently combined in their administration, yet they differ essentially in their therapeutic effects. Tonics, although not confined in their action to the muscular fibre, are generally defined to be those '' medicinal agents which restore relaxed and weakened muscles to their state of healthful tone, which renew their elasticity, eon- tractibility, and tension," * and thereby impart strength and vigor to the whole system. Stimu- lants, by increasing the sensibility and irritability of the parts to which they are applied, powerfully augment, through the nervous system, the organic actions. Stimulants exalt the functions of innerva- tion and circulation without imparting permanent strength to the system. Tonics give tone and strength to the muscular and nervous system at the same time, without increasing, necessarily, the * Thompson's Therapeut. 84 TONICS AND STIMULANTS. 35 action of the heart. '' Tonics give strength, stimu- lants call it forth." The tone or energy of the system which is gradu- ally acquired through the administration of tonics, becomes permanent, and is not replaced by a con- sequent exhaustion or depression. The introduc- tion of stimulants into the living body is quickly followed by increased energy of the vital actions, and is succeeded as rapidly by a state of depression or collapse. Stimulants are not indicated when inflammation is present, but " tonics, by imparting strength to the capillaries, operate beneficially in inflammation, even when the use of the lancet is requisite to keep down the action of the heart." * Both tonics and stimulants may produce their effects on the system, by making their impression chiefly on the stomach, or by operating through the medium of the blood, or through the medium of the nerves. As tonics, strictly speaking, are neither stimu- lant nor sedative, they may be appropriately, and, often, very usefully combined with either stimu- lants or sedatives. In many cases, where tonics are indicated, and yet from some cause are not well borne, they may be administered, especially the martial preparations, with much safety, and often with great advantage, by combining them * Thompson. 36 TONICS AND STIMULANTS. with some of the peculiarly sedative medicines. The different forms of iron, whether employed as found in the natural chalybeates, or in the arti- ficial preparations of the chemist, make their pri- mary impression on the digestive organs, augment- ing, ultimately, the power of the secretory and excretory systems, and rousing the nutritive faculty in every part of the body. The following combination of a chalybeate with a stimulant and a sedative has, for many years in our hands, proved a most valuable tonic, particularly when administered during convales- cence from disease, and in all debilitated and anaemic cases. 23. Ify Extracti Conii, . 3 j. Sesqui-oxydi Ferri, 3 ij. Tinct. Columbas, . f. g iss. Syr. Tolutan., . f. g ss. 01. Gaultherias, . gtt. x. Aquas fontanas, . f. g ij. Fiat mistura ; cujus sumat coch. parv. mane ac nocte. Or the following may be substituted : TONICS AND STIMULANTS. 37 24. ty, Sesqui-oxydi Ferri, Extracti Taraxici, aa. g ss. Yini Sherii, . . f. g vj. Tinct. Gaultherias, g ss. Aquas font. . . f g iv. M. Capiat coch. magn. bis in die. The following is a very excellent tonic, and may be exhibited whenever any of the ferruginous pre- parations are indicated. 25. fy Ferri Citratis, ... 3 ij. Syr. Citri vel Aurantias, Aquas Menth. Pip., . aa. f g ij. Aquas puras, . . . f. g iv. M. Exliibe cochlearium parvum ter quaterve m die. In young anaemic females, with indications of a chlorotic condition of the system ; and also in children of strumous habits, the Phosphate of Iron, exhibited in combination with the Sulphate of Quinine, is a therapeutic agent of great value. 38 • TONICS AND STIMULANTS. 26. 3^ Ferri Phosphatis, . 3j. Quinias disulphatis, gr. xii. M. Fiant pulv. xii., quarum capiat unam bis terve in die. A physician of great experience, and celebrated for his successful treatment of diseases of females, has employed for many years, and with much advantage, the subjoined combination of an altera- tive and a tonic in the management of certain forms of uterine disease. 27. I$s Syrup. Ferri Iodidi, . g j. Tinct. Actasas Racemsoas, f. 3 v. Tinct. Rad. Aconiti, . f. 3 iij. Fiat mist, cujus cap. gtt. xx. ter in die. We have seen engorgement of the os tineas and non-malignant induration of this organ, disappear rapidly under the persevering internal administra- tion of the above tonic ; while, at the same time, the following ointment was applied once a week, by means of friction, with the finger, to the indu- rated os. TONICS AND STIMULANTS. 39 28. ~Ejs Extracti Hyoscyami, Extracti Conii, Extracti Belladonnas, aa. p. e. To each ounce of which mixture add one drachm of Iodide of Potassa—mix thoroughly, and apply as above. 29. Ify Ferri Sulphatis, 3 ij. Potassas Iodidi, 3 iss. Tinct. Colombas, Syrup. Zinziberis, aa. f. g ij. Fiat mist, capiat coch. parv. ter in die. This mixture may be exhibited with advantage whenever we desire to promote the absorption of glandular enlargements, and in all cases where a tonic and an alterative are indicated. Not unfrequently the general practitioner will encounter cases of obstinate intermittent; and of uncontrollable neuralgic affections, which will resist, altogether, the effects of the ordinary antispas- modics, when singly administered. In such in- stances, we have often succeeded perfectly, by the combination and exhibition of a vegetable and mineral tonic—as the following : 40 TONICS AND STIMULANTS. 30. I£s Liquor. Potassas Arsenitis, f. 3 iss. Tinct. Cinchonas, . . f. g iij. Syr. Aurantias, . . . f. gj. M. Hujus mist., sumat cochl. min. bis terve in die. During the last two years, intermittent fevers have occurred more frequently, in some parts of this city and in the vicinity of the city, than for many previous years. In some of these cases, where the disease has proved obstinate, not yield- ing to large doses of Quinine, long continued, we have found it to be promptly arrested by the administration of a teaspoonful of the following mixture, twice or thrice a day—the last dose being administered a short time before the period of the anticipated paroxysm. 31. 1^ Quinias Disulph., . . 3j. Liquor. Potassas Arsenitis, f. 3 ij. Acidi Sulph. Aromat., . f. 3 j. Tinct. Cinch. Co., Syr. Zinziberis, . . . aa. f. g ij. When the preparations of Arsenic are employed, it is safest to give the medicine after a meal. TONICS AND STIMULANTS. 41 When thus exhibited, larger, or more effectual doses may be given with more safety, than when taken fasting. Should, however, gastric irritation arise, under its use, or swelling and stiffness of the eyelids occur, the medicine should be immediately discontinued. Should it from any cause be desirable to adminis- ter these remedies in the form of a pill, we may employ the following formula : 32. Tfy Acidi Arseniosi, gr. ij. Quinias Disulphatis, 3 j. Conserv. Rosas, . 3 ss. Misce optime, et fiat massa, in pilulas xxx. di- videnda ; sumat unam bis quotidie. Arsenic is not only a valuable antiperiodic, but it is a most powerful alterative, and has proved efficacious, when judiciously administered, in many cases of obstinate disease. A late number of the Edinburgh Medical Journal (May, 1858), contains a highly valuable paper on the " Physiological and Therapeutical effects of Arsenic," by Dr. James Begbie, in which the author expresses, in strong terms, his confidence in Arsenic as a most useful and available therapeutical agent, " powerful in 42 TONICS AND STIMULANTS. many intractable affections, and exercising a com- manding influence over ailments hitherto considered incurable." The diseases in which this remedy has proved to be particularly efficacious, are, neuralgia, chorea, chronic rheumatism, and, indeed, all that class of diseases which originate in the rheumatic diathesis. "The papular, pustular, vesicular and squamous affections, in their chronic and non-con- tagious forms, are especially amenable to its influ- ence " (p. 975). Under its use in the treatment of numerous and various diseases, Dr. Begbie affirms, that an improved digestion and a better appetite invariably occur ; and in no instance has he ob- served any injurious consequences to result from its employment. The Liquor Arsenicalis of the pharmacopoeia, is the preparation ordinarily employed for securing the remedial effects of the medicine, although Dr. B. frequently administers Arsenic in combination with Quinine, Iodine, Colchicum, etc. In exhibit- ing the Liquor Arsenicalis, it is given, by him, to adults in doses of five drops of the solution, after each"meal, largely diluted with water—the medi- cine being increased one drop every third day, until the physiological action of the remedy is manifested, such as itchiness and swelling of the eyelids ; a silvered tongue, or tenderness of the epigastrium. The dose, on the occurrence of any TONICS AND STIMULANTS. 43 of these symptoms, should be diminished, or the intervals of its administration lengthened. It is in the persistent use of Arsenic—in cases of obstinate and intractable disease—that its highest beneficial effects are ultimately obtained. But, throughout the entire use of this mineral, its poi- sonous action should be guarded against, by limit- ing its exhibition to the production of those symp- toms only which indicate its earliest physiological action. We have had, recently, much experience in the use of the different preparations of Manganese, and have become fully satisfied that this mineral tonic, in its different combinations, will prove a most valuable addition to our pharmaceutic preparations. The presence of Manganese in the blood has been fully established by the experiments of MM. Mil- lou, Hannon, and others ; and, recently, M. Burin, in a memoir presented to the French Academy of Medicine, has given an analysis, by which he shows the amount of Manganese in the blood globules, and exhibits the condition in which it exists.* It is, indeed, as constant an ingredient of this fluid, in its normal condition, as iron, and it is well known that a deficiency in quantity, of both these metals, may be observed in the blood in * Bull, de Therapcutique. 44 TONICS AND STIMULANTS. many cases of anaemia, chlorosis, tuberculosis, etc. ; and hence the employment of Manganese is proper, in most instances, where the administration of iron is indicated. It can be administered, moreover, with entire safety in those cases in which haemop- tysis is an occasional symptom. Frequently, both remedies may be given in combination with great advantage. The most important preparations of Manganese, for pharmaceutical purposes, are the Phosphate, the Malate, and the Iodide of Manganese. After the subjoined formula, we have adminis- tered, in tuberculosis, to a large number of patients, the Phosphate of Manganese, with most favorable results. 33. ty Manganesii Phosphatis, 3 ij. Tinct. Cinchonas, . . f. g iij. Syr. Sarsas, . . . f. g iv. Mucil. Acacias, . . f. g j. 01. Gaultherias, . . gtt. xx. Fiat mistura, cujus sumantur coch. duo vel tria minima bis terve in die. Or we may administer, under similar circum- stances, and to the same amount, the Manganese TONICS AND STIMULANTS. 45 combined with some of the preparations of Iron ; as in the following : 34. 1^ Manganesii Phosphatis, 3 iss. Ferri Phosphatis, . 3 iij. Tinct. Colombas, . . f. g ij. Syr. Tolutan., . . . f. g iv. Ess. Gaultherias, . . f. 3j. These mixtures should be kept in well closed bot- tles, and as the Manganese is not altogether solu- ble, the medicine should be shaken before being administered. The Malate of Manganese is considered by some practitioners a more ehgible preparation, inasmuch as it is quite soluble, and the base of the salt is in the form of protoxide, the acid being easily di- gested. 35. Jty Manganesii Malat., 3 ij. Tinct. Cinch., . f. g ij. Syr. Simp., . . f. g iv. Ess. Limon., . . f 3 j. Fiat mistura, date coch. parv. mane ac nocte. The Iodide of Manganese is an efficient remedy in the treatment of glandular enlargements, especially 46 TONICS AND STIMULANTS. those of the neck and of the spleen, hi constitu- tional syphilis, and in the anaemia arising from scro- fula and from cancerous affections. It may be administered in the form of pills ; or, as a mixture in the following formula : 36. ^ Manganesii Iodid., 3 ij. Tinct. Cardamom., f. g j. Syr. Sarsa., . . f g v. M. Sumat coch. parv. bis terve in die. In a paper published in a late number of the Bulletin de Thei'apeutique, M. Petriquin recom- mends a combination of Manganese and Iron, as a highly valuable agent in the treatment of disease. He has found these combined medicinal bodies especially useful in blood diseases, such as the chloro-anaemia, after haemorrhage, operations, me- trorrhagia, etc. In the chlorosis which appears about puberty, in that also which occurs at the critical period of women, especially when profuse haemorrhage prevails, and in the depraved state of the blood, which succeeds intermittent fevers, M. Petriquin has found the Ferro-Manganese pre- parations of remarkable efficacy. We have spoken of the Phosphate, the Malate, and the Iodide of Manganese as being among the TONICS AND STIMULANTS. 47 most important of the pharmaceutical preparations of this metal. With some practitioners, the Car- bonate of Manganese, in combination with the Car- bonate of Iron, is considered a valuable therapeu- tic agent. These two Carbonates, combined in equal quantities, and administered in doses of from five to ten grains daily, constitute a favorite reme- dy with a distinguished practitioner of Massa- chusetts. 37. ty Manganesii Carb. Ferri Carb., . . aa. 3j. Sacchar. Alb. Pulv., 3 ij. Misce et in pulv. xv. divide, quorum cap. ij. vel. iij. quaque die. Should a liquid preparation of these remedies be preferred, they may be exhibited, combined with some vegetable tonic, as in the subjoined formula : 38. IJs Manganesii Carb. Ferri Carb., . aa. 3 ij. Tinct. Columbas, Syr. Sarsa. Co., aa. f. g iij. M. Capiat coch. min. bis in die. 48 TONICS AND STIMULANTS. This combination of the Carbonate of Manganese and the Carbonate of Iron is especially appropriate for the improvement of that condition of the sys- tem which is attended with an ulcerative action of mucous membranes. In the treatment of that often troublesome affection, ulcerated sore mouth, this Ferro-Manganese preparation, it will be found, will prove to be particularly efficient: 39. Tfy Manganesii Carb., 3 j. Ferri Carb., . . 3 iss. Potass. Iodid., . 3 ij. Tr. Gentianas Co., Syr. Sarsa. Co., . aa. f. g iij. Fiat mistura. Capiat cochleare parvum bis in die. In mesenteric obstructions, and for the discussion of glandular swellings in any part of the body, the above preparation is a valuable remedy. 40. Within a few years, Fusel Oil has been much employed by some experienced practitioners, in New England, by whom it is spoken of as a most valuable therapeutic agent. Fusel Oil, or Grain TONICS AND STIMULANTS. 49 Oil, is the Hydrated Oxyde of Amyle, and is ob- tained in the distillation of Alcohol. " This remedy," writes Dr. Henry J. Bowditch, of Boston, who has communicated valuable informa- tion to the author on its use, " was first brought to my notice by Dr. Wyman, of Cambridge, who, on theoretical grounds, suggested it to the profession as a palliative in tuberculous cases. " For the past few years, I have used it, almost to the total exclusion of Cod-Liver Oil. It pro- duces, at its exhibition, stimulating effects, similar to those caused by the coarser liquors. It also excites nutrition, so that patients grow fat as when using Cod-Liver Oil. '' I have noticed, likewise, in many instances, that it seems directly to influence the cough, almost like an opiate—checking it and lessening the amount of sputa. In some persons it produces nau- sea ; in others it causes fever. In such circum- stances I lessen the dose or discontinue the remedy. " But I have been as much pleased with the effects of this remedy in another series of cases, viz.: in those poor, miserable, emaciated, whining children, who are so thin that one can see the bones almost as well through the thinned skin, as if they were actually exposed to view. I have seen such individuals (even when there were some suspicions of pulmonary or abdominal disease), 4 50 TONICS AND STIMULANTS. arise with an extraordinary degree of elasticity, marked even from the first dose. A week changes them very much, and sometimes a month restores the little creatures to health and plumpness. Of course, I do not mean to say that it always pro- duces this effect, but I have seen it successful so often, that I may consider it as my ' favorite reme- dy.' In conclusion, let me add, that my doses vary from half to one drop for a child five or six months old, up to five or ten drops for an adult. I give it in syrup to a child, and often in a little whisky and water to an adult." The alkaloid, and the extract of Nux Yomica, are ordinarily arranged under the head of Excitants. We have employed these preparations, however, with great advantage, in cases where both tonics and excitants were indicated. Strychnia and the ex- tract of Nux Yomica, as therapeutic agents, it is generally supposed, produce the same, or nearly the same effect upon the animal system. By some practitioners it is believed that the extract deter- mines more to the head than Strychnia. This salt may be exhibited in appropriate doses without pro- ducing any obvious effect on the cerebral circula- tion. The alkaloid, therefore, should be preferred in those cases where we would excite the powers of the nervous system without increasing the action of the brain. TONICS AND STIMULANTS. 51 41. ty Extract. Nucis Yomicas, gr. xxxii. Tinct. Cardamom., Syr. Zinziberis, . . aa. f. g j. Aquas font., . . . f. gij. Fiat mistura, cujus cap. gtt. xx., vel xxx., bis terve in die. In chronic, gastric affections, with diminished energy of the digestive powers, the administration of the above preparation will, in many cases, by improving the appetite, and increasing the powers of assimilation, impart tone and energy to the whole system. With one of our oldest and most experienced physicians the following pills, exhibited one night and morning, is a favorite remedy in chronic gas- tric affections, chronic diarrhoea, etc. : 42. Tty Extract. Nucis Yomicas, gr. iv. Extract. Opii, . . . gr. vi. M. Fiat massa, et in pilulas xvi. dividenda. Under similar circumstances Prof. Cox, of Mary- land, recommends the following as a valuable remedy : 52 TONICS AND STIMULANTS. 43. IJj Nucis Yomicas, . 9 ij. Argent. Oxydi, . gr. xvi. Extract. Gentianas, 3 iss. M. Fiat massa et in pil. lx. div. Sumat unam ter in die. Yel: 44. ty Bismuth. Subnit., . 3j. Rad. Columbas Pulv., g ss. Acacias Pulv., . . 3 ij. M. Fiat massa, in pilulas xx. divide. To be taken as the above. On account of the great insolubility of Strychnia, this alkaloid is generally administered in the form of pills, the salt being made up with the conserve of roses, or the extract of Gentian or of Liquorice. It is of importance, in the exhibition of Strychnia, in many cases, gradually to increase the dose ; but this is with difficulty effected when the medicine is made up in the form of pills. A perfect solution of the salt may be' obtained in the following man- ner ; and we would advise that prescriptions be made up from such a solution : TONICS AND STIMULANTS. 53 45. Solution of Strychnia. Ify Strychnias, . gr. xii. Acidi Acetici, gtt. lx. Alcohol, . f. gj. Aquas font., f. g xi. M. The above solution may be administered in doses of from ten to thirty drops, twice or thrice daily. Beginning with the smallest number of drops, and gradually increasing the dose, the medicine may be continued until its specific effects on the system are slightly induced, when the remedy should at once be arrested for a few days, and its administration be recommenced, if necessary, beginning again with the minimum dose. We have found it a most valuable and efficient remedy in some obstinate forms of neuralgia. The following preparation may be often em- ployed with great advantage in the treatment of chronic gastric irritation : 46. IJ} Solutio. Strychnias, . f. g ss. Tinct. Cardamom. Comp., f. g iiiss. M. Cap. coch. parv. ter in die. 54 TONICS AND STIMULANTS. A physician of much experience in the manage- ment of malarious diseases, recommends the follow- ing mixture as a most efficient remedy in the treat- ment of obstinate cases of intermittent fever-: 47. Ij* Solutio. Strychnias, . . f. 3 ij. Quinas Disulphatis, . . 3 ss. Tinct. Ferri Sesquichloridi, f. g ss. Aquas fontanas, . . . f. g iss. Fiat mistura, cujus sumatur coch. parvum quarta quaque hora, intermissionis tempore. An eminent German physician, M. Frisch, has recently recommended a similar combination, in the treatment of intermittents, when the Sulphate of Quinia fails. This physician prescribes " from six to ten grains of the rasped seed mixed with two ounces of the Cinchona Bark, or with twelve grains of the Disulphate of Quinia, to be taken in divided doses in the intervals of the paroxysms." In some forms of neuralgia we have derived more prompt and decided effects from the use of the Strychnia, when administered in combination with an anodyne, as in the following combination : TONICS AND STIMULANTS. 55 48. ty> Solutio. Strychnias, . . . f. 3 iij. Solutio. Morphias (Majendie), f. 3 iss. Tinct. Gentianas, . . . . f. g ij. Syr. Acacias,.....f. g iss. M. Exhibe cochleare parvum, quaterve ter in die. A distinguished physician of Maryland, highly recommends the following as a very useful anti- periodic : 49. IJj Quinias Disulphatis, 3 ss. Piperin. Pulv., . gr. xv. Strychnias, . . gr. j. M. Fiat massa et in pil. xii. div. Sumat unam ter in die. 50. In certain forms of impotence, writes an expe- rienced practitioner, of South Carolina, proceeding from a feeble action of the erector muscles, " I have found, in many cases, Strychnia to have an excellent effect; I administer it in doses of a 12th of a grain, three times a day." Not only in the diseases already named, have the 56 TONICS AND STIMULANTS. extract of Nux Yomica and Strychnia proved use- ful, but in hemiplegia, in general paralysis, and in spasmodic asthma, great advantage has been de- rived from the use of these remedies. In adminis- tering Strychnia in paralysis we obtain the greatest benefit from its use, if the dose is gradually in- creased, until slight tetanic movements of the para- lytic limbs are produced. Administered alone, or in combination with the Tincture of Lobelia, Strychnia has proved service- able, in some instances, in the treatment of spas- modic asthma. 51. fy Solutio. Strychnias, Tinct. Lobelias, . aa. 3 ij. Syr. Tolutan., . g iss. M. Ft. mistura, cujus date coch. parv. ter qua- terve in die. In one very common form of dyspepsia, attended with derangement of the biliary organs, the sub- joined combination constitutes a most valuable remedy, administered in doses of one teaspoonful three times a day. TONICS AND STIMULANTS. 57 52. ^ Hydrarg. Bichloridi, gr. iv. Tinct. Nucis Yomicas, Yel Solutio. Strych., g ss. Tinct. Rhei Comp., . g iss. Syr. Aurantias, . . g ij. M. In the administration of so powerful a remedy as Strychnia, much caution should always be ob- served. As it is one of the most valuable of our medicinal agents, every practitioner should become acquainted with its therapeutic powers, and with its best modes of administration. By commencmg with small doses, and gradually increasing the amount, the remedy may be continued with safety, until slight tetanic twitchings of the muscles are produced. In one case of most obstinate and long-continued neuralgia, occurring in a lady of this city, we ad- ministered the Strychnia, and gradually increased the dose, until the spasmodic movements of the muscles were quite apparent, but without any abatement of the disease. Commencing with the original dose, the medicine was again administered up to the same point; and this was done for the third time, and with the effect of completely arresting 58 TONICS AND STIMULANTS. the disease. In most cases, however, it will not be necessary to continue the remedy until these tetanic movements are manifested. Other remedies have been employed with advan- tage in the treatment of neuralgia. Prof. Harvey Lindsly, of Washington, recommends highly the following. One pill, he affirms, administered every four hours and perseveringly taken, has proved very efficient in his hands. 53, fy Extract. Aconiti, gr. x. Acidi Arseniosi, gr. j. Quinias Disulph., 3 ss. M. Fiat massa, et in pil. xx. div The addition of Morphia to the above pill is of advantage in some cases. The same physician recommends the following in neuralgia : 54. ty Extract. Belladon., gr. x. Ferri Pulv., Quinias Disulph., aa. 9 j. M. Fiat mass, et in pil. xx. divid. quarum cap. iv. vel v. quaque die. In neuralgia of the kidneys and stomach, Dr. TONICS AND STIMULANTS. 59 Cox, of Maryland, advises the employment of the following combination : 55. IJ* Bi-Carb. Potass., . 3j Acidi Hydrocianici, gtt. xxiv. Sol. Sulph. Morph., gtt. xxiv. Aquas Camphori, . g iv. M. Fiat mistura, cujus capiat coch. parv. ij. pro re nata. CHAPTER III. EXCITANTS AND ALTERATIVES. In the therapeutical classification of medicinal agents, by Dr. Thomson, Iodine and its compounds are arranged under the head of excitants. Uncombined, Iodine is a powerful excitant, stimulating the tissues of the organs and accelerat- ing their action. In some of its combinations, it acts with much energy upon the capillary and secre- tory systems ; combined with Mercury it is a most valuable alterative, and in combination with Potas- sium it not only stimulates the whole of the glandu- lar system, but acts in a special manner upon the kidneys. It is Dr. Clark's opinion, that the action of Iodine upon the animal economy resembles in a great degree that of Mercury. In some respects the therapeutical effects of these two remedies may be similar. The action of the tissues of the organs is accelerated, and the excretory system is pro- moted, it is true, by both remedies, but not in the same degree. Paleness, or blanching, is frequently produced by a course of Mercury, an effect which EXCITANTS AND ALTERATIVES. 61 has been ascribed to the diminished number of red globules of the blood; whilst, on the other hand, an increased nutrition of the body, or embonpoint, is the frequent result of the employment of Iodine. We have found no other general remedy, to compare, in its beneficial effects, with that of Iodine and its compounds in the commencement of the treatment of follicular, and other diseases of the air-passages. In uncomplicated folliculitis of the pharyngo- laryngeal membrane, the administration of the fol- lowing mixture, conjoined with the topical applica- tions of a solution of the crystals of Nitrate of Sil- ver to the diseased membrane, will, in most cases, effect a speedy cure : 56. I$5 Potass. Iodid., . 3 ij. Tinct. Rhei, . f. g i. Syr. Sarsa. Co., Aquas font., . aa. f. g ij. Fiat mistura, cujus sumatur cochl. parv. mane ac nocte. In chronic bronchitis, whether idiopathic, or con- sequent upon foUicular disease, we have derived great advantage from the use of the subjoined pre- paration : 62 EXCITANTS AND ALTERATIVES. 57. Ij* Decoc. Polygalas, g v. Potass. Iodid., . 3 iij. Tr. Opii Camphor., f. g j. Syrupi Tolutan., f. g ij. Fiat mistura. Capiat cochleare parvum bis in die. Although the constitutional effects of Iodide of Potassium are very analogous to those of Iodine, yet it may be given in larger doses, and for a longer period, without producing disorder of the system, than the free Iodine. When indications of a scro- fulous diathesis are present, in any case, it will be preferable, and will prove more efficacious, to exhi- bit the two preparations in combination : 58. I$s Iodini puras, . gr. vj. Potass. Iodid., 3 iss. Tinct. Cardamom., f. g i. Syr. Sarsa. Co., f. g iij. Fiat mistura. Exhibe cochl. parv. bis terve in die. In the treatment of asthma, particularly when this disease is consequent upon, or is complicated with, bronchial inflammation, we have found the Iodide of Potassium, conjoined with the use of EXCITANTS AND ALTERATIVES. 63 Lobelia, and Decoc. Polygalas prove greatly bene- ficial. 59. IJ* Potass. Iodid., . . 3 ij. Decoc. Polygalas, . g iv. Tinct. Lobelias, Tinct. Opii Camphor., aa. g j. Fiat mist, capiat cochl. parv. bis terve in die. The Iodides, which are formed by the combina- tion of Iodine and Mercury, are valuable medicinal agents. The Protiodide of Mercury, and the Biniodide are the preparations ordinarily used in the treat- ment of disease. But for several years we have been accustomed to use a combination of the Pro- tiodide of Mercury, with the Iodide of Potassium, by which combination a double salt, a Hydrargyro- Iodide of Potassium is formed, a remedy which, in our experience, has proved altogether the best alterative we have ever employed : 60. "Eji Protiodid. Hydrarg., gr. iij. Potass. Iodid., . . 3 ij. Tinct. Rhei, . . . f.gj. Syr. Sarsa. Co., . . f. g iij. Fiat mistura, et date cochl. parv. bis in die. 64 EXCITANTS AND ALTERATIVES. We desire to call particular attention to this compound, because of the striking advantages we have obtained from its use in the treatment of dis- ease. Administered in the early stage of tubercu- losis, or in cases of obstinate and long-continued follicular laryngitis, with ulcerations of the epiglot- tis, or within the larynx, this medicine, as a gene- ral remedy, has proved more efficient, in our expe- rience, than any other single agent in the Materia Medica. In secondary, or constitutional - syphilis, it will be found "an invaluable remedy. Under its administration, the syphilitic, ulcerated throat will quickly assume a more healthy appearance ; and. ordinarily, will heal rapidly, when appropriate topical measures are conjoined. We generally commence the treatment of such cases, by adminis- tering the following combinations: 61. 1^ Potass. Iodid., . . 3 ij. Protiodid. Hydrarg., gr. ijss. Tinct. Gentianas, Syr. Sarsa. Co., . . aa. f. g ij. M. Sumatur cochl. parv. bis terve in die. The apothecary will sometimes object to the above combinations, because a decomposition is effected—the Protiodide of Mercury being con- EXCITANTS AND ALTERATIVES. 65 verted, by the Iodide of Potassium, into the Bin- iodide, and Metallic Mercury. But it is well known to chemists, that these different Iodides will unite together in different proportions, by which those compounds, which Berzelius terms double Iodides, are formed. The Biniodide thus formed in the above solution, immediately unites with a portion of the Iodide of Potassium, in solution, and a dou- ble salt—the Bydrargyro-Iodide of Potassium—is the result. Our experience in the employment of this thera- peutic agent has been extensive, and we have found it more efficacious in the treatment of disease, in a fourfold degree, than the use of either the Prot- iodide or the Biniodide alone. Not only in the preceding diseases—severe folli- culitis, and secondary, or constitutional disease— has this combination of the Iodides, the Hydrar- gyro-Iodide of Potassium, been found useful, but its administration in many obstinate cutaneous affections has proved, in our hands, to be highly advantageous. 62. ^4 Extract. Conii, . . 3 iss. Proto-Iodid. Hydrarg., gr. iv. Potassas Iodidi, . . 3 iij. Tinct. Cardamom., . f. g ij. Syr. Sarsa. Co., . . fgiv. 5 66 EXCITANTS AND ALTERATIVES. Fiat mistura. Capiat cochl. parv. bis terve in die. This preparation, administered as above, may be employed in the treatment of lupus, lepra, and other obstinate cutaneous affections, especially those of a scaly character, with safety and advantage. With my colleague, Prof. J. M. Carnochan, sur- geon-in-chief to the State Hospital, Donovan's solution—which is a combination of Iodine, Arsen- ic, and Mercury—is a favorite remedy in the treat- ment of lupus, venereal eruptions, impetigo, and other chronic cutaneous diseases. 63. I$s Liquor Arsenici et Hydrarg. Iodid., g ss. Syr. Sarsa. Co.,......g viij. M. Sumat cochl. una parv. ter quotidie. In laryngeal and bronchial disease, and also in the early stage of phthisis, when any degree of fe- brile action is present, the Iodide of Potassium, in combination with Antimony, will frequently prove more useful than when administered alone. EXCITANTS AND ALTERATIVES. 67 64. ty Potass. Iodidi, . . . 3 ij. Antimon. et Potass. Tart., gr. ij. Syr. Zinziber., Aquas font., ... aa. f. g iij. Fiat mistura cujus sumat. cochl. parv. bis in die. Or we may, under the same circumstances, exhi^ bit the following : 65. I^ Potass. Iodidi, 3 iiss. Syr. Ipecac, f. gij. Aquas font., f. g iv. M. Capiat cochl. parv. bis terve in die. A combination of the medicinal Hydrocyanic Acid, with a solution of Iodide of Potassium, con- stitutes a favorite remedy with some practitioners in the treatment of phthisis. 66. ty Potass. Iodidi, . 3 ij. Acidi Hydrocyanici, gtt. xl. Syr. Sarsa. Comp., Aquas font, . . aa. f. g ij. Fiat mist. Sumatur cochl. min. mane ac nocte. 68 EXCITANTS AND ALTERATIVES. Although, as we have stated, the Iodide of Potassium is a better preparation for administra- tion than the Iodine in most forms of disease ; yet, when indications of a scrofulous diathesis are present, especially in young persons and children, it will be preferable, and will frequently prove more efficacious, to exhibit the two preparations in combination. 67. IJ* Iodini, . . gr. x. Potass. Iodid., 3 j. Syr. Rhei, Aquas puras, aa. f. g ij. Fiat mistura, date cochl. parv. ter in die. Few remedies will be found more efficacious for promoting the absorption of glandular swellings in the neck, or of those in other parts of the body, than the following preparation : 68. ^s Iodini, . . gr. x. Potass. Iodid., 3 j. Liquor. Potass., f. gj. Syr. Sarsa., . f. g iij. Fiat solutio. Capiat cochl. parvum bis in die. EXCITANTS AND ALTERATIVES. 69 In the treatment of hypertrophy of the heart, and in other diseases of this organ, when it is important to reduce vascular action, the subjoined mixture may be advantageously exhibited : 69. IJ* Potass. Iodidi, . 3 iiss. Tinct. Hyoscyami, Tinct. Digitalis, . aa. f g ss. Syr. Sarsa. Co., . f. g v. Fiat mistura, date cochl. min. mane ac nocte. The combining of Iodine and Iron was first practised by Dr. Pierquin, and the product of this combination—the Iodide of Iron—was employed by him for the treatment of disease, in 1824, although the credit of first introducing the remedy into medical practice is attributed to Dr. Thomp- son, of London. The Iodide of Iron is a valuable therapeutic agent. In its operation on the system it is con- sidered to be more nearly allied to the prepara- tions of Iron than to those of Iodine. In scrofu- lous debility, in strumous enlargements of the glandular system, in chlorosis, and amenorrhoea, and in most affections, where ferruginous prepara- tions are indicated, the Iodide of Iron has been found especially useful. It is most frequently 70 EXCITANTS AND ALTERATIVES. administered in the form of a syrup. Syrup of the Iodide of Iron may be used as a tonic in doses of from xv. to xxv. drops, twice daily, in the treat- ment of any of the preceding diseases. Several years ago, Dr. Dupasquier, of Lyons, published some interesting statements in regard to the favorable effects of the Protiodide of Iron in the treatment of pulmonary phthisis. An emi- nent physician of New Orleans, who has had much experience in the treatment of thoracic disease, strongly recommends in phthisis, chronic bron- chitis, etc., the following combination : 70. ty Syr. Ferri Iodidi, 3 vl Potass. Iodidi, . gr. xii. Glycerinas Pur., Syrupi Limonis, aa. f. g j. Aquas font., . f. g iv. Fiat mistura, cujus capiat cochl. ampl. ter in die, ante cibum. It is highly desirable that so important a thera- peutic agent as the Iodide of Potassium should be of such a degree of purity as not to affect its medi- cal use. But, unfortunately, not only impurities, but adulterations of the commercial article are often found to exist. It is frequently found adul- EXCITANTS AND ALTERATIVES. 71 terated with Carbonate of Potassa, with the Chlo- ride of Sodium, and when not prepared with care, will often contain the lodate of Potassa. Some test, therefore, which will enable us to detect these adulterations easily and with certainty, is quite desirable. When adulterated with Carbonate of Potassa, it may readily be detected by dissolving the suspected article in alcohol. Iodide of Potas- sium which contains no water of crystallization, is freely dissolved by alcohol; but the Carbonate of Potash will.not dissolve. A very simple and cer- tain test is given in a late number of the London Pharmaceutical Journal, to detect the presence of either Carbonate or lodate of Potash. This is the syrup of the Iodide of Iron. To a small amount of the Iodide of Potassium in solution, add a drop or two of the syrup* of Iodide of Iron. If pure, no change will be produced ; but if Carbonate of Potash be present, a pale blue precipitate is formed at once. If the specimen contain lodate of Potassa, a red precipitate occurs immediately. If both Car- bonate and lodate of Potash are present, on adding the test, first a deeper blue, and then a red precipi- tate will be found. If the usual precautions, as to equal quantities, etc., are observed, with the sam- ples examined, the resultant precipitates will show the relative amount of the adulterating agents in each. We have used this test frequently in exam- 72 EXCITANTS AND ALTERATIVES. ining different preparations of the Iodide of Potas- sium, and have found it efficient in detecting their presence, when these adulterations have existed. We have spoken of the valuable properties of the Protiodide of Mercury, especially when this salt is administered with the Iodide of Potassium. There are several other salts, the product of Iron and its combinations, which are medicinal agents of great value. The therapeutic action of these com- pounds is various. The Iodide of Iron acts as a tonic; the Iodide of Mercury, as we have stated, operates as an alterative; the Iodide of Arsenic, as an excitant and tonic; the Iodide of Lead, as a diuretic; and the Iodide of Sulphur acts most decidedly on the skin. 71. ^5 Arsenici Iodidi, gr. iij. Extract. Conii, 3 ss. M. Fiant pilulas xxx. quarum sumatur una ter in die. This medicine, after many other remedies have failed, has been employed with great success, in the treatment of some most inveterate cases of certain chronic cutaneous disease ; particularly lepra, psoriasis, and venereal eruptions. The dose may be cautiously increased to the one-fifth of a EXCITANTS AND ALTERATIVES. 73 grain, three times a day. When gastric disorder supervenes, the medicine should be for a time sus- pended,, and be subsequently renewed in the origi- nal dose. Some practitioners in this country employ, with success, in the same affections, a combination of a solution of the Arsenite of Potash, and of the com- pound solution of Iodine ; as in the following extemporaneous preparation : 72. ^5 Liquor. Potassas Arsenitis, . f. g ij. Liquor. Iodidi Potassii Comp., f. g ss. Fiat mist, cujus cap. gtt. v. ter in die. Both of the above preparations of Iodine and Arsenic are employed with great advantage in the treatment of cancerous affections, particularly when these remedies are conjoined with the use of the following ointment of the Iodide of Lead, employed as an external application : 73. ' ty Plumbi Iodidi, 3 ij. Axungias, . g ij. Misce intim. A small amount of this ointment may be rubbed 74 • EXCITANTS AND ALTERATIVES. in, twice a day, over cancerous, or other indolent tumors. Under the head of Tonics and Stimulants, we have spoken of the therapeutic value of the Iodide of Manganese in the treatment of cancerous affections, glandular enlargements, and some other obstinate diseases. We have had prepared by an excellent apothecary of this city, after the formula of Proc- tor, a syrup of the Iodide of Manganese, which, as an excitant and alterative, is superior to the syrup of the Iodide of Iron, in the treatment of many diseases. This medicine—the syrup of the Iodide of Manganese—may be readily prepared in the fol- lowing way : 74. 15* Manganesh Sulph., 3 xvj. Potass. Iodidi, . 3 xix. Dissolve the Manganese and the Potassium sepa- rately, each in three fluid ounces of water, to which are added two fluid drachms of syrup. When the precipitation of the crystals of Sulphate of Potassa, which will follow, is .completed, filter the super- natant hquor through a fine mushn into a vessel containing twelve ounces of pulverized sugar. Then add to this, water sufficient to make the whole amount to one pint. Shake until the sugar is well EXCITANTS AND ALTERATIVES. 75 dissolved, and keep the syrup in a glass-stopped bottle. In tuberculosis, in scrofulous and cance- rous affections, in the treatment of glandular en- largements, such as those of the spleen and of the neck, and in constitutional syphUis, the syrup of the Iodide of Manganese, administered in doses of from ten to twenty drops, twice or thrice a day, will be found to be a valuable remedial agent. As alterative remedies, the preparations of Mer- cury are more employed by practitioners, than any of the other inorganic agents. Administered in small doses, the Bi-Chloride of Mercury is a valua- ble excitant. Its effects are more decidedly altera- tive, says Neligan, than those of any other prepara- tion of the metal. In cases of chronic foUicular disease, where the symptoms indicate the presence of a thickening of the mucous membrane of the larynx, and in the early stage of some forms of pulmonic disease, we have found the Bi-Chloride of Mercury a most efficient alterative, and alto- gether one of the best therapeutic preparations of this mineral. 75. fy Hydrarg. Chlorid. Corrosiv., gr. iv. Extract. Conii, . . . . 9 ij. Fiat massa in pflulas xl. divide. Sumat unam, mane et nocte. 76 EXCITANTS AND ALTERATIVES. An experienced practitioner affirms that in hepatization of the lungs, the solid matter depo- sited in the air-cells is often absorbed and the ceUs rendered permeable to air by the use of this prepa- ration. In irritable subjects, opiates should be conjoined with this remedy, as the mucous mem- brane of the stomach and bowels is sometimes irri- tated by its use. 76. ^5 Hydrarg. Chlorid. Corrosiv., gr. iv. Extract. Opii, . . . . gr. x. Extract. Gentian., . . . 9 ij. M. Fiant pilulas xl. quarum sumatur una bis terve in die. This preparation has also been highly extolled in secondary venereal affections, in chronic cuta- neous diseases—particularly those which are at- tended with dry, scaly eruptions—and in chronic rheumatism and arthritis. The following is the formula of Dzondi, of Halle, who is a great advo- cate for the use of the Bi-Chloride of Mercury : 77. Tfy Hydrarg. Chlorid. Corrosiv., gr. xii. Solve in Aq. distil, q. s. Adde micas Panis Albi, Saccharis albi aa. q. s. ut fit pilulas numero ccxl. EXCITANTS AND ALTERATIVES. 77 Of these pills—each of which contains the twen- tieth of a grain of the Mercury—two may be given night and morning. In many of the above chronic forms of disease, this medicine is advantageously administered, con- joined with a vegetable bitter tonic : 78. fy Hydrarg. Chlorid. Corrosiv., gr. iv. Tinct. Gentianas, . . . g iv. Syr. Aurantii, . . . . g ij. Fiat mistura, cujus date cochl. parv. ter in die. As an excitant and an alterative, in many of the diseases in childhood, the Hydrargyrum cum Creta has been more universally employed than any of the other preparations of this mineral. It is, how- ever, like the blue mass, not always a perfect pre- paration, as it consists of Metallic Mercury in a state of minute division, mechanically combined with the Sub-oxide of Mercury, and the Carbonate of Lime. But it has not been ascertained in what proportions the metal and the oxide exist. As a gentle and more certain laxative and altera- tive, and one equally weU adapted for infancy and childhood, some eminent American practitioners 78 EXCITANTS AND ALTERATIVES. prefer, altogether, the Chloride of Mercury minutely subdivided by being thoroughly triturated with a large amount of sugar. To one part of Calomel add ten parts, by weight, of white sugar. 79. 3$$ Hydrarg. Chlorid. Mitis, 3j. Sachari Alb., ... 3 x. Triturate the two substances in a wedgewood mortar for ten or fifteen minutes, so as to subdivide minutely, and intimately to blend the Calomel and the Sugar. Those who have never tried the Mercury thus prepared, will be surprised at the increased activity which will be imparted to the medicine, by this fine subdivision of its particles. Indeed, it is to this well-estabhshed fact, that many medicines become much more active by minute subdivision, that the whole secret of the Hahnemannic " po- tency," or dynamization of remedies, may be referred.* * The editors of the " British Journal of Homoeopathy," admit, in a late number of this Journal, " the theory of dynamization to be untenable, and that it is now rejected by the great majority of Hahnemann's disciples."— Journal of Homoeopathy, July, 1852. EXCITANTS AND ALTERATIVES. 79 Five grains of the above preparation will con- tain half a grain of Calomel, and this smaU amount, taken on going to bed, will produce, with most persons, a mild laxative effect the following day. With young children, half this amount, or from two to three grains of the medicine placed on the tongue (and children take it as readily as they will pure sugar), will be sufficient, ordinarily, to prove cathartic. A physician of this State, of large experience, who practises in a region of the country where dysentery prevails as an endemic almost annually, assures us that this preparation of Calomel is his favorite and most efficient remedy in the treatment of dysentery in children. He administers one grain of the powder, once in four or six hours ; employ- ing, at the same time, injections of a solution of Morphia, to control the dysenteric discharges. With this plan of treatment he has succeeded, he affirms, in arresting the disease more frequently than with any other method. More than twenty years ago, we were instructed by our preceptor—who has since been a distin- guished lecturer and writer on Materia Medica— to employ the following combination, as our " offi- cinal " preparation of Calomel: 80 EXCITANTS AND ALTERATIVES. 80. Rs Hydrargyri Chloridi Mitis, 3 ij. Extract. Opii, Ipecac. Pulv., . . . . aa. gr. vj. Pulverize, and mix intimately and thoroughly, as in the preceding combination. Thus prepared; every scruple of Calomel wiU contain one grain each of Opium and Ipecacuanha, intimately combined with the mineral. During a period of twenty years, we have used no other preparation of Calomel than the above in our practice. We have recommended its employ- ment in our lectures to the students and graduates of the N. Y. Medical College, and to many physi- cians, who have adopted its use ; and we venture the assertion, that no practitioner, after having once employed this combination, will prefer, after- wards, to prescribe pure Calomel in the treatment of disease. Under all circumstances, a given amount of this combination, whether administered as a laxative or as an alterative, wfll prove fuUy as efficient as double the amount of pure or uncom- bined Calomel; and without producing—whether given to chfldren or adults—at all that degree of irritation which ordinarily foUows the administra- tion of the latter. As a laxative, from three to EXCITANTS AND ALTERATIVES. 81 five grains may be administered to an adult, and from one and a half to three grains to children. Besides the excitants and alteratives, which are obtained from inorganic substances, there are some important therapeutic agents of this kind belonging to the organic or vegetable kingdom, which are of much value. The extract of Podophyllum, or May-apple, is much used as a remedial agent by physicians in some parts of this country ; and when the remedial value of the preparations of this plant are better known, they will be still more extensively em- ployed by the profession. 81. fy Extracti Podophylh, . 3 j. Extract. Aloes Hepat., 3 iij. Gambogias, . . . . 3j. M. Fiat pilulas lx. The above constitutes exceUent alterative and cathartic piUs, and may be administered with great advantage in cases of hepatic derangement, in ana- sarca, and in aU glandular diseases. The foUowing is the favorite cathartic piU of an eminent practitioner of Connecticut: 6 82 EXCITANTS AND ALTERATIVES. 82. I£ Extracti PodophyUi, . 3 ij. Hydrarg. Chlorid. Mitis, 3 j. Olei Cajuputi, . . . gtt. vj. M. Fiat massa, in pilulas lx. div. Instead of the extract we have recently employed the Podophyllin, which is the active principle of the plant, obtained from its root, and which, from the commendation of several of our professional friends and from the trial we have ourselves made, we are confident wiU prove to be an addition to our Mate- ria Medica of great value. Judiciously administered, it is a superior exci- tant and alterative, and in appropriate doses, a cer- tain and safe cathartic. Care should be taken not to prescribe this remedy in too large doses, as it is apt to produce griping and nausea when thus administered. This, however, is said to be effect- uaUy prevented by combining the medicine with a diffusible stimulant. 83. I$s Podophyllin, . gr. xv. Zinziberis Pulv., 3 ss. Ext. Gentianas, 3 ss. M. Fiat Mass. et in pilulas xxx. div. EXCITANTS AND ALTERATIVES. 83 These piUs may be administered in all cases in which the blue mass or other mfld mercurials are given. This remedy has been highly recommended in cases of secondary syphilis, when Mercury has been long-continued, or is from any cause inadmis- sible. Administered in a fuU cathartic dose, it is declared to have been eminently successful in the expulsion of ascarides ; and, also, when thus ad- ministered and foUowed in four or six hours with a fuU draught of Olive Oil to the amount of four or six ounces, Podophyllin has proved successful, it is said, in many instances, in the dislodgement and expulsion of large quantities of bfliary calculi, with very little pain. Triturated with sugar in the same manner as we have recommended Calomel to be prepared, PodophyUin is a most exceUent laxa- tive and alterative. 84. fy PodophyUin, . 3j. Sacchari Albi, 3 xix. Mix and triturate until the two be finely sub- divided and thoroughly blended. As a mild laxa- tive and alterative, this powder may be exhibited in doses of from five to ten grains. The medicine may be given in all cases where mercurials are indicated. 84 EXCITANTS AND ALTERATIVES. Among the remedies obtained from the organic or vegetable kingdom, are several therapeutic agents that are not found in many foreign pharma- copoeias, but which are much employed, and are held in high estimation by many American prac- titioners. Among these may be mentioned the Sanguinaria Canadensis, the Aetata Racemosa, or Cimicifuga Racemosa, as this plant is named by some botanists ; and the Veratrum Viride, or American Hellebore. The Sanguinaria, or Bloodroot, has been long employed as an excitant and alterative, and is a favorite remedy with many practitioners in New England, and in the Western States. It is ordina- rily administered in the form of tincture ; but the officinal preparation of our pharmacopoeias (four ounces of the root in two pints of diluted alcohol), is nearly an inert preparation ; and, as this is the strength of the tincture ordinarily kept and dis- pensed by our apothecaries, we have long been of the opinion, that the disappointment in the effects of this remedy, which has occurred to many prac- titioners, has arisen altogether from the fact, that they have prescribed a preparation too weak to be efficient. We have used the Sanguinaria in the treatment of disease, during a period of many years, but we have always employed the saturated tinc- ture (four ounces of the bruised root macerated in EXCITANTS AND ALTERATIVES. 85 one pint of diluted alcohol), and we can speak with much confidence, with regard to its valuable thera- peutic properties. The foUowing combination of the bloodroot, with the compound Tincture of Aloes, is employed by some experienced practitioners in Ohio, in the treatment of a torpid condition of the bowels, arising from a derangement of the hepatic organs, and is esteemed an excellent eccoprotic : 85. fy Tinct. Sanguinarias Sat. Tinct. Aloes Comp. p. as. Fiat mistura. From 30 to 60 drops of this preparation may be administered twice, daily. It tends to improve the digestive organs, and to increase the peristaltic action. 86. fy Tinct. Sanguinarias Sat. Yini Ipecacuanhas, p. as. To which, in some instances, a little laudanum is added. The above combination is employed by many Western practitioners, in the treatment of fevers, and is considered by them a most excellent febri- 86 EXCITANTS AND ALTERATIVES. luge. But, it is in the treatment of some forms of cough, dependent upon bronchial or pulmonary irritation, that we have found the saturated tinc- ture of Sanguinaria to be a remedy of the highest exceUence.* 87. ^ Tinct. Sanguinarias, gj. Tinct. Opii, . . 3 ij. Yini Ipecacuanhas, 3 vj. Syr. Tolutan., . . g ij. Fiat mistura, quarum capiat M. xxx. usque ad lx. quater in die. In catarrhal affections, and in cases of trouble- some cough following influenza, the above prepara- tion may be given with much advantage. We have employed the preceding mixture for many years, to mitigate the cough in the early and in the advanced stage of phthisis. * The following is the original formula for the preparation of " Ayer's Cherry Pectoral:" 88. R Morph. Acetat.....gr. iij. Tinct. Sanguin. Canaden., 3 ij. Vini Antim. et Potass, tart., Vini Ipecacuanha?, . . . aa. 3 iij. Syrupi Pruni Virgin., . . § Iij. M. EXCITANTS AND ALTERATIVES. 87 Should the cough be dm, or much inflammatory action be present, antimonial wine may be substi- tuted for the syrup of Ipecac, and less of the ano- dyne be added, as in the foUowing : 89. ]$$ Tinct. Sanguinarias, gj. Morph. Sulph., . gr. iss. Tinct. Digitalis, Yini Antimo., . aa. g ss. 01. Gaultherias, . gtt. x. Misce. This may be administered, as above, in doses of from 20 to 40 drops twice or thrice, daily. We are assured by an old and experienced phy- sician of this State, that he has succeeded in over- coming habitual constipation more frequently with the following pill, than with any other laxative : 90. IJ* Sanguinarias Pulveris, Rhei Pulveris, . . aa. 3 j. Saponis, .... 9ij. Misce. et cum aquas fiat mass, in pilulas xxxii. dividenda, quarum capiat una mane ac nocte. 88 EXCITANTS AND ALTELATINES. The Aetata Racemosa,#r Cimicifuga Racemosa, or Cohosh, or Black Snakeroot—names by which this plant is sometimes called—is a native of the United States and of the Canadas. It has been employed as a popular remedy in this country, for many years, for the treatment of pulmonary dis- eases, rheumatism, chorea, anasarca, etc. Early in the present century, a nostrum, or secret reme- dy, which obtained great celebrity in many of the New England States, on account of its success in the treatment of rheumatism, was composed prin- cipally, as it was subsequently ascertained, of a saturated tincture of Actasa Racemosa. We find this remedy to be held in high estima- tion by many exceUent practitioners from different parts of the United States, for the treatment of the above named, and other kindred diseases. During a period of more than twenty years, we have em- ployed the Actasa as a therapeutic agent, either alone, or in combination with other remedies, with great advantage. It is best administered in the form of tincture, but it may be given in substance or in decoction. The saturated tincture (four ounces of the root to one pint of alcohol), should only be employed. It may be given in doses of from twenty to forty drops, repeated every two or three hours, in the treatment of acute rheumatism. EXCITANTS AND ALTERATIVES. 89 Its powers in rheumatic affections, and in ana- sarca, are greatly increased by administering it in the following combination : 91. ^ Tinct. Actasas Racemosas, g j. Potassas Iodid., . . . 3 ij. Syr. Ipecacuanhas, . . g j. Aquas font., .... g ij. M. d. coch. parv. bis terve in die. In chronic bronchial disease, and in the early stage of phthisis, it has been proved to be an excel- lent and efficient remedy, when combined with an anodyne, and the tincture of Sanguinaria. 92. fy Tinct. Cimicifugas Racemosas, Tinct. Sanguinarias, . . . aa. gj. Morph. Sulph., . . . . gr. ij. Syr. Acacias,.....g ij. Ft. mistura exhibe coch. parv. tusse urgenti. In the treatment of chorea, the Cimicifuga has been extensively employed in the United States. After free purging for several days, preparatory to its use, many practitioners depend altogether 90 EXCITANTS AND ALTERATIVES. upon this remedy for the cure of chorea. By some it is administered in the form of decoction. 93. ^ Cimicifugas Racemosas, gj. Aquas ferventis, . . Oj. M. Ut fiat decoction, cujus sumant, coch. mag. ij. ter in die. Other practitioners prefer the use of the pow- dered root, administering it in doses of a teaspoon- ful three times a day. In the treatment of dropsy, the following is a preferred prescription, and has been much em- ployed by an experienced practitioner in Massa- chusetts : 94. IJ* Tinct. Cimicifugas Racemosas, g j. Tinct. Myrrhas, .... 3 vj. Tinct. Opii, Tinct. Capsici, . . . . aa. 3 j. Fiat mist, capiat M. xxx. vel xl. quater in die. The Veratrum Viride, or American HeUebore, is found in various parts of the United States, and is, also, a native of the Canadas. The plant is known EXCITANTS AND ALTERATIVES. 91 in some places as Swamp Hellebore, Indian Poke, etc., and is found growing in swampy places, in meadows, and along the borders of water courses. It belongs to the same order of plants as the Col- chicum Autumnale, and was highly recommended, many years ago, by Professor Tuliy, of New Haven, as a substitute for Colchicum in the treatment of many of those diseases for which this latter reme- dy has been employed. Within the last few years, public attention has been called especially to the remedial powers of the Yeratrum Yiride, by Dr. W. C. Norwood, of South Carolina, who has devoted much time and careful attention to ascer- tain the nature, properties, and uses of this power- ful remedy ■ and whose vast experience in its use, he declares, "fully justifies him in confidently asserting to the profession, that it stands unrivalled as a curative agent." The experience of Dr. Nor- wood as to the effects of Yeratrum in disease, has been corroborated by some of the most eminent physicians of the Southwest. In a paper read before the Tennessee State Medical Society, and published subsequently in the Nashville Journal of Medicine and Surgery, Professor C. K. Winston asserts that the Yeratrum Yiride is an arterial sedative of high power ; that the most remarkable and, at the same time, the most important physio- logical effect of the remedy is the reduction of the 92 EXCITANTS AND ALTERATIVES. heart's action. The pulse, he affirms, may be reduced by the veratrum, " from 130 to 40 beats in the minute, with entire safety to the patient, and without the least injury to the circulatory or nervous system." Employed in the early stage, before the occur- rence of organic lesions, the Yeratrum Yiride is peculiarly adapted to the treatment of pneumonia, pleurisy, rheumatism, typhoid fever, pulmonary inflammation ; and, in the phlegmasias generally it is regarded as more or less valuable. In a pam- phlet recently published by Dr. Norwood, on the "Therapeutical Powers and Properties of Yeratrum Yiride," the author reiterates his confidence in the great value of the remedy, and appends the favora- ble opinions of many eminent physicians of the South and West, who have employed the Yeratrum with great success in the treatment of disease. " We rely on it," writes the author, " as the remedy in typhoid fever, and administer it with every assurance of success. We put the patient on the free use of it, and press it till every symp- tom is controlled or arrested. Our plan is to reduce the pulse to between 55 and 75 beats, and keep it at the point desired night and day. In some cases, it should be reduced at least to the natural standard, if not below it. By this kind of reduction the febrile and inflammatory symptoms EXCITANTS AND ALTERATIVES. 93 vanish, and the patient is kept quiet and tranquil and comfortable." In pneumonitis, Dr. Norwood " considers it as much a specific as Quinine is for intermittent fever; and in combination with diuretics, in the treatment of scarlet fever, he " finds it superior to all other remedies he has ever tried." With regard to the power of the Yeratrum Yiride to reduce the heart's action, no doubt whatever can remain. We have employed the remedy frequently since 1851, when Dr. Norwood gave us a quantity of the tincture prepared by himself. It has never failed in our hands, when properly administered, to diminish arterial action. In one instance of tuber- culosis, a pulse of 120 was reduced to 58 beats in a minute, and kept steadily at that point day after day. Its effect, as an arterial sedative, has been fully tested by our colleague, Professor Carnochan, on many of his patients in the Emigrant's Hospital. In one case, a pulse of 130 was reduced 68 in fifteen hours ; and in a case of articular rheuma- tism, the exhibition of the tincture in doses of from five to eight drops every three hours, a pulse of 120 was reduced to 30, in fifteen hours. The saturated tincture, "made by macerating eight ounces of the dried root in sixteen ounces of alcohol for at least two weeks," is the form in which the remedy is usually employed. 94 EXCITANTS AND ALTERATIVES. In the foUowing combination, the tincture is administered by Dr. Norwood : 95. IJs Tinct. Yeratri Yiride, Syrupi SciUas p. as. Misce intim. Of this mixture to an adult male, Dr. Norwood advises to begin with from four to six drops, increasing the amount from one to two drops at each subsequent dose, until the pulse is reduced, or nausea and vomiting are occasioned, when the medicine is to be diminished one-half, and con- tinued as long as may be necessary to prevent a return of the symptoms. In females, commence with from three to four drops, and increase the above until the necessary result is obtained. When administered to children, the remedy is given in the following proportions : 96. ~fy, Tinct. Yeratri Yiride, g ss. Syrupi SciUas, . . g jss. Misce bene. From two to three drops of this combination may be administered to children (from one to two or EXCITANTS AND ALTERATIVES. 95 three years old) according to the age, increasing one drop at each subsequent potion, until arterial action is reduced, or nausea or vomiting occa- sioned. When the Yeratrum is administered too freely, nausea and vomiting will, in some instances, be very severe, and will be attended with prostration, and great coldness of the surface. When these symp- toms occur, they are promptly relieved by the administration of an opiate, and brandy or any of the alcoholic stimulants. CHAPTER IY. CATHARTICS AND LAXATIVES. Cathartics and Laxatives may be classed to- gether, although, as pharmacological agents, a dis- tinction between them is of considerable import- ance in practice. Cathartics are usually divided into purgatives and laxatives. Purgatives are those medicinal sub- stances which, by producing a temporary irritation on the mucous membrane of the intestines, excite the action of the exhalant and secreting organs of these parts, causing them, thereby, to evacuate their contents. Laxatives are those agents which, by their relax- ing efforts on the intestines, excite alvine evacua- tions without occasioning irritation, or stimulating the exhalants of this tube. From a very early period in medicine, purgative remedies have been in greater requisition than medicines of any other class ; and physicians of all ages have considered them as the most effectual, cer- tain, and valuable of all other therapeutical agents. 96 cathartics and laxatives. 97 In the intelligent administration of these remedies, it is necessary to consider their immediate and re- mote effects, as weU as the anatomical structure and physiological relations of the parts affected by pur- gatives. Purgatives act powerfuUy on the mucous membrane of the smaU and large intestines ; it is only by accident that the stomach is affected. An irritation is set up on the intestinal surface, by exciting the exhalant and secreting organs, by which action, the serous and mucous discharges are greatly augmented. The excretory ducts of the liver and pancreas open on the interior of the duodenum, and the irritation of their extremities is communicated to these glands, by which their secreting functions are much increased. The fibres of the muscular tunic, through which the vermicular motion of the intes- tinal canal is effected, becoming stimulated by the action of purgatives, have their contractions accelerated, whereby the peristaltic action of the intestines becomes more rapid, all of which tends to urge their contents on towards the rectum. " The irritation caused by purgatives on the inner surface of the intestines, increases the secre- tions of the liver and pancreas, as weU as those of the mucous follicles, covering this surface ; it aug- ments the energy of the intestinal exhalants ; aU these products flow into the alimentary canal, by 7 98 cathartics and laxatives. which means aU the abdominal organs are dis- gorged. . . . During their operation, the blood is carried, in increased quantity, towards the abdo- men ; there is, then, more heat and increased movement in this part of the system ; this increased action of the abdominal organs exercises a deriva- tive or revulsive effect with respect to the head and chest. The irritation produced by purgatives on the nerves distributed over the intestinal surface, is communicated to the plexuses of the ganghonic nerves, to the spinal cord—rarely to the medulla oblongata ; this movement is diffused over the whole system, and gives a shock to the entire frame." * In prescribing cathartics, regard should be had to the fact that each purgative substance is charac- terized by a peculiarity of action, as regards the part of the intestinal canal affected by it; mercu- rials produce their effect, mainly on the upper por- tion of the tube ; Gamboge exerts its influence on the stomach, while Aloes, passing by the superior portions of the intestinal canal, spends its powers on the inferior part of the tube. Hence the import- ance of exercising care in the selection of a cathartic to be prescribed, that the article may be adapted to the impression we desire to make. * A Manual of General Therapeutics, etc. By D. Spillan, M.D., Lon- don, p. 211. CATHARTICS AND LAXATIVES. 99 When we wish to evacuate the contents of the bowels, without occasioning irritation, or any in- creased action of the exhalants—as in those diseases in which irritation or inflammation of the gastro- intestinal surface already exists—we then have recourse to laxatives or aperients. In disease, cathartics may be administered at any period during the twenty-four hours ; ordinarily, they are best given in the morning, when the sto- mach is empty. In intermittent diseases they should be administered during the period of inter- mission. Most physicians of experience have a favorite piU, which they are accustomed to employ as their ordinary, every day cathartic. Pills composed of the foUowing ingredients have been used for many years, by a physician of large experience and extensive practice, in Yermont: 97. Bs Extract. Aloes Pulveris, 3 ij. Guiaci Pulveris, . . 3j. Gambogias Pulveris, . 3 iss. Saponis,.....3j. Fiat massa et in pU. lxxxii. asquales div. sumant. ij. vel iij. pro dosi. Pills, made with care, of these ingredients, in the 100 CATHARTICS AND LAXATIVES. above proportions—the materials being intimately pulverized and blended—constitute a most excel- lent, ordinary purgative. From two to four, taken at bed-time, wiU be foUowed, the next morning, by decided catharsis, without producing, ordinarily, any disturbance of the stomach whatever. Prof. P., of New England, an old and expe- rienced practitioner, recommends the foUowing aa " a valuable purgative, and every day cathartic:" >lass^[c.litral Collet 98. fy Ext. Aloes Pulv., Gambogias Pulv., . aa. 3 j. Hydrarg. Chlo. Mite. Jalapas Pulv., Saponis Dur., . . aa. 3 ss. 01. Ricini Syrupi, q. s. Fiat massa, in pi. lx. asquales div., quarum capiat ij. vel iij. pro dosi. 99. fy Ext. Aloes Pulv., g ss. Gambogias, . . 3j. Rhei Pulv., . . 3 ss. Olei Cinnamomi, m. xx. Syrupi Rhamni, q. s. Fiat massa, in pflulas 120 dividenda. CATHARTICS AND LAXATIVES. 101 The above is the favorite laxative piU of a dis- tinguished lecturer and practitioner of Massachu- setts. For overcoming habitual constipation in dyspep- tic patients, the foUowing are useful piUs : 100. IJ* Aloes Socat. Rhei Pulveris, aa. 3 ij. Pulv. Aromat., 9 ij". Saponis, . . 3j. Syrup. Rhamni q. s. Fiat massa in pfl. lx. div. quarum sumat ij. pro dosi. 101. B* Extract. Aloes Pulv. Rhei Pulv., . . aa. 3 j. Ipecac. Pulv. Sapon. dur., . . aa. 3 ss. Fiat massa et in pfl. xxx. div. sumat. j. vel ij. pro dosi. By some practitioners, the above piU is preferred in the habitual constipation of dyspeptics. The following were the favorite anti-dyspeptic piUs of Dr. Chapman : 102 CATHARTICS AND LAXATIVES. 102. B» Extract. Aloes, . 3 j. Ipecacuanhas Pulv., 9j. Mastich, . . . 3j. Olei Faeniculi, . . gtt. xx. Fiat massa in pil. xl. div. sumat una mane nocteque. Many distinguished physicians of this country are accustomed to combine a small amount of Calo- mel and Tartarized Antimony, in their ordinary aperient piU: 103. Bs Extract. Aloes, . . 3 ss Rhei Pulv., . . . 3j. Hydr. Chlorid. Mite, gr. iv. Ant. et Potass. Tart., gr. ij. M. intim. Ft. massa et in pil. xxx. divid. sumat ij. pro dosi The above are the favorite cathartic piUs of many Southern practitioners. Dr. Cox, of Maryland, commends the following as a valuable cathartic piU : CATHARTICS AND LAXATIVES. 103 104. B Hydrarg. Chlorid. Mite, Extract. Coloeynth. Co., aa. 9 ij. 01. Tiglii Croton., . . gtt. ij. M. Fiat massa et in pil. xii. divid. capiat ij. vel iij. pro dosi. 105. fy Massas Hydrarg., Rhei Pulv., Extract. Aloes, aa. 3 ss. 01. Tiglii Croton., gtt. iv. Sodas Bi-Carb., Capsici Pulv., . aa. gr. xii. M. Fiat Mass. et in pil. xxx. div. sumat j. vel ij., hora decubitus. The above is considered an exceUent aperient by the same eminent practitioner With many patients, aperient mixtures, or elec- tuaries, are preferred to pills. The following mild laxative mixture, which was originaUy prescribed by an eminent physician of Yirginia, has been since employed by many practitioners of our acquain- tance—aU of whom speak of it as a most exceUent and efficient aperient: 104 CATHARTICS AND LAXATIVES. 106. 3J$ Aloes Soc. Pulv., . 3 v. Sodas Bi-Carb., . . 3 iss. Tr. Lavendul. Comp., f. g ss. Aquas puras, . . . f. Oj. Fiat mistura, cujus capiat coch. j. mag. quo- tidie. After constipation is overcome by the administra- tion of the medicine in the above doses, a teaspoon- ful taken at bed-time wiU in most persons be suffi- cient to keep the bowels in a soluble condition. In cases of constipation, attended with flatulence or acidity, an experienced practitioner of Yirginia, highly recommends the subjoined : 107. B Extract. Aloes Pulv., 3 iij. Potassas Bi-Carb., . 3 vj. Syrupi Rhei Aromat., f. g ij. Sp. Lavendul. Comp., f. 3 ij. Aquas puras, . . . f. g vj. Fiat mistura, cujus capiat coch. parv. una me- ridie nocteque. Physicians are frequently caUed on to prescribe for cases of habitual, or occasional costiveness, in which laxatives, although indicated, yet have the CATHARTICS AND LAXATIVES. 105 effect to weaken the patients, or induce debility of the alimentary canal, whenever they are adminis- tered. Under such circumstances, our colleague, Professor Peaslee, has been accustomed to employ, for many years, in his practice, the subjoined mix- ture, which is a combination of a tonic and a laxa- tive, and which, after years of experience in its use, he assures us, is admirably adapted to such cases— being especiaUy useful in troublesome constipation occurring in feeble persons, and in that which often attends convalescence from fevers and other severe diseases. It may be employed for several weeks in succession without irritating or weakening the aUmentary canal: 108. fy Rad. Columbse Contus., g ss. Fol. Sennas, . . . gj. Extract. Taraxaci Mannas,.....aa. g ss. Aquas fervent., . . f. g xij. Macera per horam, cola et adde Holland Gin, g iv. M. Sumat cochleare mag. j. vel ij. pro dosi. The above is also an excellent vehicle for the administration of Iron and other tonics, in cases of 106 CATHARTICS AND LAXATIVES. anemia and dyspepsia, accompanied by constipa- tion. When it is desirable to employ a very certain cathartic in cases of obstinate constipation, arising particularly from inaction of the liver, or from other causes, the same physician places great re- liance in the foUowing mixture : 109. "Sji Extract. Aloes, . . . 3 ij. Extract. Taraxaci, . . g ss. Sennas Fob, . . . . gj. Rhei Contus., . . . . 3 iij. Nucis Yomicas Pulv., . 3 iss. Aquas fervent., . . . f. g xij. Macera per horam, cola et adde Magnesias Sulph., g iss. Holland Gin, . . . . g iv. M. Cujus sumat. cochl. mag. pro dosi, secunda" quaque hora, donee alvus soluta sit. In robust adults, two tablespoonfuls may be administered at first, foUowed by one spoonful every two hours until relief is obtained. A tablespoonful may be taken every night to prevent a recurrence of the constipation. CATHARTICS AND LAXATIVES. 107 110. IJs Magnesias Carb., . 3 ij. Rhei Pulveris, . . 3 iss. Tinct. Rhei, Syrupi Simp., . . f. aa. gj. Aquas Menthas Piper., f. g iv. M. Fiat mistura, cujus capiat cochl. mag. j, pro re nata\ The above is a very gentle and excellent aperient in some forms of dyspepsia, attended with flatu- lency or acidity of the stomach. Prof. J. H. Dixon is accustomed to employ the foUowing cathartic mixture : 111. fy Rhei Pulv., .....3j. Magnes. Sulph.,.....gj. 01. Anisi vel Menth. vel Sassifi, gtt. ij. Aquas puras,......f. g vj. Fiat mistura, sumat cochl. mag. j. vel. ij. pro dosi. An exceUent, active cathartic, writes Dr. F. Y. Porcher, of Yirginia, is the foUowing. In dropsical affections accompanied by high arterial action, it procures copious alvine evacuations, and often, at the same time, a copious flow of urine : 108 CATHARTICS AND LAXATIVES. 112. ^ 01. Ricini, .... g j. Potassas Nitrat., Hydrarg. Chlorid. Mite, aa. gr. x. M. As a mUd and refrigerant aperient in febrUe complaints, the subjoined mixture may be given when a laxative operation is desired. It may also be advantageously prescribed for patients laboring under torpidity of the liver. 113, ^ Infusi Sennas Comp., f. g iij. Rhei Pulveris, . . 3 j. Tinct. Sennas, Tinct. Cardam. Co., aa. f. g iij. Syrupi Zinziberi, . f. 3 ij. M. Fiat mistura, cujus sumat cochl. ij. ampx. pro re nata. The physician is not unfrequently called upon to prescribe for patients enfeebled by chronic dis- ease, in whose cases tonics, although indicated, are not weU borne because of the presence of a de- ranged condition of the digestive organs. In such cases we have often administered for a week or CATHARTICS AND LAXATIVES. 109 ten days the foUowing aperient alterative piU; after which, tonics, may, generally, be advan- tageously exhibited: 114. IJ» Extract. Hyosciami, 3 j. Massas ex Hydrarg., 9 j. Ipecacuanhas Pulv., 9j. Fiat massa in pfl. xl. div. sumat unam mane nocteque. Under the same circumstances as above, Profes- gor t----. of New Haven, recommends the foUow- ing : 115. ^ Hydrarg. Chlorid. Mite, gr. iv. Capsici Pulveris, Extracti Conii, . . aa. 3 j. M. Fiat mass, in pil. xxxii. divid. One of these piUs may be administered morning and evening. In dyspeptic phthisis, in cases of ordinary dyspepsia, attended with inaction of the Uver, the exhibition of these piUs for a short time will often prepare the system for the administra- tion of a tonic or supporting plan of treatment. 110 CATHARTICS AND LAXATIVES. 116. fy Ext. Aloes Pulv., . 3j. Ferri Sulphatis, . 3 j. Ext. Hyosciami, . 3j. Ext. Nucis Yomicas, gr. x. M. Fiat massa et in pilulas lx. dividenda, qua- rum sumat j. mane ac nocte. The above pUls, Prof. Davis assures us, he has used many years with the most satisfactory results, in cases of imperfect digestion compUcated with habitual constipation. One pUl each night, or one night and morning—sufficient to procure, daily, a regular intestinal evacuation, should be adminis- tered. 117. fy Ext. Aloes Pulv., . 9j. Rhei Pulv., Jalapas Pulv., Scamman., . . . aa. gr. xvj. Ant. et Potass. Tart., gr. j. vel ij. Olei Croton., . . gtt. j. vel ij. Gambogias, . . . gr. vj. Fiat massa et in pil. lxiv. divid. quarum capiat unam vel duos in die, post prandium. The above pill, writes Dr. John Ware, of Bos- CATHARTICS AND LAXATIVES. Ill ton, " I have used very much for habitual costive- ness. It has been used a good deal in this city, and is kept by some of the druggists under the name of the compound Alvine piU." In habitual constipation, the foUowing cathartic or eccoprotic pill, is highly commended by Dr. Dickson, of South Carolina. One or two of the piUs are advised by him, to be taken every second night, on going to bed. 118. IJs Extract. BeUadon., gr. v. Rhei Pulv., Extract. Aloes, . aa. gr. xvj. M. Fiat massa in pil. xii. div. 119. The best remedy I have ever tried, writes Prof. Lindsly, in habitual constipation, is to take half a drachm of Epsom Salts, dissolved in half a pint of water—adding ten drops of Elixir of Yitriol—one hour before breakfast. The smaUer the dose of salts the better, provided it wiU operate. It may be taken for weeks, tUl a cure is effected. CHAPTER Y. EMETICS AND EXPECTORANTS. We may arrange Emetics and Expectorants together, inasmuch as some of the direct emetics are among the best remedies for promoting expec- toration ; although as therapeutical agents, and in a pharmacological sense, they are widely different in many instances. Emetics are those substances which excite vomit- ing. Expectorants are the medicinal agents which possess the property of increasing the secretion from the pulmonary mucous membrane. Direct emetics operate by an irritation which they cause of the gastro-duodenal surface. The production of vomiting has been thus explained : " The irritation of the stomach makes a call upon the brain for the aid of the diaphragm and the abdominal muscles, in order to expel its contents ; the diaphragm then becomes contracted and fixed, the ribs drawn down. the abdominal muscles drawn inwards, so that the stomach is pressed on aU sides by voluntary mus- 112 EMETICS AND EXPECTORANTS. 113 cles, which, together with its own contraction, expels the contents." In the administration of an emetic, the irritation of the gastric and duodenal surface is communi- cated to the mucous folhcles of these parts, by which the ordinary exhalation is accelerated and greatly increased ; the irritation of the mouths of the excretory ducts of the liver and pancreas, which, as we have seen, open on the duodenal sur- face, is transmitted to these glands, by which their fluids become quickly augmented, and the bile' thus secreted in increased quantity, flows into the duodenum, from thence it ascends into the sto- mach and is rejected by the mouth. " We are not to suppose that all the bile passed by vomiting existed in the stomach or primas vias before the emetic was taken. The secretion of this fluid is caused by the emetic, and is the result of its influ- ence upon the Uver." * In the operation of an emetic, not only is an action aroused in the viscera, to which we have alluded, but an irritation is communicated, through the nervous filaments of the stomach, which are received from the pneumogastric nerve to the meduUa oblongata, and finaUy to the whole gan- glionic system of nerves ; so that, by reason of the * Manual of Gen. Thera., p. 254. 8 114 EMETICS AND EXPECTORANTS. sympathetic connections which the stomach main- tains with the different centres of innervation, the shock caused by the administration of an emetic is at once transmitted throughout the entire system. Hence it is that the well-timed exhibition of an appropriate emetic will often destroy disease in embryo. As in selecting cathartics the physician is guided by the indication to be fulfilled, so in the adminis- tration of emetics it is important that the emetic agent chosen, should be adapted to the existing cir- cumstances or nature of the disease prescribed for. There often occurs a morbid state of the diges- tive organs, manifested by a sense of fullness in the epigastrium, a loss of appetite, a bitter taste in the mouth, the tongue is moist, and is covered with a whitish coat; symptoms which indicate turgescence of the liver, and a congested condition of the gas- tro-duodenal mucous membrane. Under such cir- cumstances the following emetic is indicated : 120. I}» Ant. et Potassas Tartrai, gr. ij. Ipecacuanhas Pulv., . 9j. Aquas puras, . . . f. g iv. Fiat mistura, sumat cochleare j. amplum omni horas quadrante donee super venerit vomitas. EMETICS AND EXPECTORANTS. 115 In administering Tartarized Antimony to young children, great caution should always be observed. We have before attempted to show the uncertain, energetic, and Often dangerous effects of this pow- erful agent, when administered in continued doses to young persons.* In membranous croup, and some other acute diseases of children, Emetic Tar- tar, when employed to a certain extent, and with that caution which should always be observed when administering so powerful an agent, is an invalua- ble remedy • but after one or two exhibitions of this remedy some other agent should be substituted, when it becomes necessary to repeat the emetic operation in the course of the progress of the same disease. 121. ^j Ant. et Potass. Tart., gr. j. Ipecacuanhas Pulv., 9 ss. Aquas tepidas, . . f. g iv. Fiat mistura, sumat cochleare parv. omni horas quadrante ad emesim. In the commencement of croup, the above may be administered in teaspoonful doses, once in five, ten, or fifteen minutes, according to the urgency of the symptoms, until vomiting is effected. Should * Observations on the Pathology and Treatment of Croup, pp. 104-7. 116 EMETICS AND EXPECTORANTS. the continuance and severity of the disease require the emetic operation to be several times repeated, the foUowing combination may be substituted. We have found it to be one of the most certain, efficacious, and safe emetics that can be adminis- tered. 122. IJs Zinci Sulphatis, . gr. x. Ipecacuanhas Pulv., 9 j. Aquas tepidas, . f. g iv. Fiat mistura. This emetic may be administered under the same circumstances as the preceding, and to the same amount. Turpeth Mineral is another active mineral emetic, much employed by some practitioners in New England, in the treatment of membranous croup. Some years ago the attention of the profession was caUed to the properties of this remedy by Dr. Hubbard, of Maine, who highly recommends it as a certain and sure remedy in croup. 123. ^ Hydrarg. Sulph. Flav., gr. x. Syrupi Simplicis, . f. g ss. M. Cap. cochl. parv. j. omni horas quadrante, ad effectum. EMETICS AND EXPECTORANTS. 117 In cases of poisoning, where it becomes import- ant to evacuate the stomach as quickly as possible, and to prevent absorption, an emetic which occa- sions but Uttle nausea, and operates promptly, should be selected. 124. fy Cupri Sulphatis, gr. x. Aquas tepidas, f. g ij. M. Fiat haustus emeticus. Yel: fy Zinci Sulphatis, gr. xv. Aquas tepidas, f. g ij. M. Fiat haustus emeticus. In the treatment of haemorrhage, particularly haemorrhage from the lungs, some eminent Ameri- can practitioners are accustomed to place much rehance on the use of nauseating emetics, it being weU known that the force of the circulation is greatly diminished during the period of nausea. The following is a suitable emetic in haemorrhage : 125. ^s Ipecacuanhas Pulv., . 9 j. Aquas Menth. Pulegii, f. g iv. Fiat mistura, sumat cochleare mag. j. omni horas quadrante ad emesim. 118 EMETICS AND EXPECTORANTS. In the treatment of chronie diarrhoea and dysen- tery, emetics act in some cases as reveUents, and thus prove very serviceable. 126. ^ Ipecacuanhas Pulv., gr. xv. Aquas Menth. Pip., f. g iv. Fiat mistura. The above may be given in divided doses in chronic diarrhoea. Among the vegetable emetics are two remedies much used among some American practitioners, particularly in the treatment of croup, and spas- modic asthma ; these are the Sanguinaria Cana- densis and the Lobelia Infiata. Bloodroot is an acrid, stimulating emetic, and has been highly extolled by some physicians, in croup, in asthma, and in pertussis. It is administered as an emetic in the form of infusion, and the saturated tincture of the root. 127. ^s Sanguinarias Canadensis, gj. Aquas ferventis, . . . Oss. Macera. Sumat cochl. ampl. omni horas quad- rante ad emesim. EMETICS AND EXPECTORANTS. 119 The tincture of Sanguinaria, administered in tea- spoonful doses, is equaUy effective as an emetic. Lobelia is an active and powerful remedy, and is seldom employed as an ordinary emetic. But in the treatment of spasmodic asthma, it is esteemed by many as a most efficient and valuable thera- peutic agent. The officinal tincture is the best form in which to administer Lobelia as an emetic. In asthma, it may be given in doses of from one to two fluid drachms, repeated every half hour, or oftener, until vomiting occurs, or relief is obtained. If continued for any length of time, however, in full doses, it is apt to produce distressing relaxa- tion. It is, therefore, advised not to continue the remedy beyond three or four doses, if vomiting does not follow. To relax the spasm, in attacks of asthma, some practitioners administer the tincture in half drachm doses every half hour, sufficient to effect nausea for a time without producing vomiting, and they as- cribe to the medicine thus exhibited most extraor- dinary efficacy, occasionaUy, in the paroxysm of spasmodic asthma. 128. fy Tinct. Lobehas Inflatas, Syrupi SciUas, aa. . . f. g j. M. Sumat M. xx. vel xxv. bis terve in die. ; 120 EMETICS AND EXPECTORANTS. The above combination has been recommended by experienced physicians in the treatment of hooping cough. In doses of twenty or thirty drops, it may be administered with safety, and often with much advantage, several times a day to young chfldren affected with hooping cough. Expectorants, we have stated, are those medici- nal agents which are supposed to have the power of increasing the secretion from the pulmonary mucous membrane, and of aiding in the expulsion of secreted matter from the air-passages. Expec- torants are frequently given in combination with alteratives ; and, to allay irritation, in some forms of bronchial and pulmonary disease, they are, with advantage, frequently combined with sedatives. In chronic bronchitis, and in catarrhal affections, after the inflammatory symptoms are somewhat subdued, we have found, after much experience in its use, the following to be a most valuable expec- torant : 129. ^ Decoct. Polygalas Senegas* f. g iv. Potass. Iodid., . . . . 3 ij. Yini Antimonii, . . . f. g ss. Syr. Tolutan., . . . . f. g iss. Fiat mistura, capiat cochl. parvum bis terve in die. EMETICS AND EXPECTORANTS. 121 A similar combination is highly recommended by Dr. Stokes for the treatment of bronchitis.* For cases of chronic bronchial disease, attended with profuse expectoration, the subjoined stimu- lant expectorant has been much commended : 131. I$s Misturas Ammoniaci, f. g vi. Syr. SciUas, . . . f. gj. Tr. Opii Camph., . f. g ss. Tinct. Hyosciami, . f. 3j. Yini Ipecacuanhas, f. 3 iij. Fiat mistura, cujus capiat cochl. mag. pro dosi. In the treatment of both bronchial and pulmo- nary disease the following mixture is highly recom- mended by an eminent physician of Connecti- cut : * " Among the local or specific stimulants in bronchitis," says Dr. Stokes, in his work on Diseases of the Chest, " I know of none to be com- pared with the following: 130. B, Decoct. Polygalai Senegas, f. § v. Syr. Tolu. Tr. Opii Camph., Tinct. Scillae, aa. . . . f. 3 ij. Ammonia? Carb., . . . gr. xv. vel xx. Fiat mistura." 122 EMETICS AND EXPECTORANTS. 132. ty Syrupi SciUas Comp., Syrupi Tolutan., aa. f. g ij. Tinct. Sanguinarias, f. g j. Tinct. Lobelias, . f. 3 vj. Tinct. Camphori, . f. 3 ij. Acidi Hydrocyanici, m. xl. Fiat mistura, sumat cochl. parv. pro re nata. When the cough is severe, from two to four grains of the Sulphate of Morphia may be added to the above mixture. The subjoined antispasmodic cough mixture has been recommended by Prof. S. H. Dickson, as a remedy well adapted " to pertussis, and to all ner- vous and habitual coughs." 133. IJ* Potass. Iodid., . . 3 iss. Aquas Amygd. Amar., f. 3 iij. Tinct. Mosch. Fact., f. 3 ij. Tinct. Opii Camph., f. 5 ij. Aquas puras, . . . f. g iv. Fiat mistura, sumat cochl. parv. pro re nata. In troublesome and chronic cough, Prof. Cox recommends the foUowing: EMETICS AND EXPECTORANTS. 123 134. fy Decoct. Polygalas Senegas, f. g iv. Syrupi Tolutan., . . . f. g ss. Morph. Sulph., . . . gr. j. Ext. Pruni Yirgin., . . g ss. Fiat mistura, sumat cochl. ampl. pro re nata\ 135. I£ Polygalas Senegas Pulv., 3 ij. Ipecacuanhas Pulv., . 3 j. Mel. Opt., . . . . g ij. Aquas fervent., . . . g vj. Fiat mistura, cujus sumat cochl. parv. pro re nata. The above is the ordinary expectorant pre- scribed by Prof.------, of Philadelphia, in the treatment of catarrhal affections. It is a very use- ful remedy in the early stage of bronchial irritation, and may be employed before the more stimulant expectorants are indicated. In catarrhal and bronchial inflammation of child- ren, when it becomes important to promote promptly the expulsion of phlegm from the bron- chi, the foUowing combination wfll be found to be of great efficiency: 124 EMETICS AND EXPECTORANTS. 136. ty Decoct. Polyg. Seneg., f. g iij. Oxymel. ScUlas, Yini Ipecacuanhas, aa. f. 3 ij. Yini Antimonii, . . f. g ss. M. Et exhibe m. xv—xxv. omni horas quad- rante ad emesim. After the occurrence of nausea or vomiting, it may be administered in diminished doses once in two hours, sufficient to promote expectoration. As stimulant expectorants, the balsams are fre- quently employed, alone, or in combination with nauseants and sedatives. Among this class of remedies the Canadian Balsam is one of the most agreeable and useful, and is much employed in some parts of the United States and in the Canadas. 137. ^ Balsam. Canadensis, Liquor. Potass., aa. f. g j. Yini Ipecacuanhas, f. g ss. Syrupi Tolutanis, f g iss. Aquas font., . , f. g ij. Fiat mistura, sumat cochl. parv. bis terve in die. A useful remedy in chronic catarrhal and bron- chial affections. EMETICS AND EXPECTORANTS. 125 The following combination is the favorite expec- torant and cough mixture of a distinguished physi- cian of Montreal: 138. I$s Balsam. Canadensis, f 3 vj. Potass. Cyanidi, . gr. iss. Tinct. Aconiti, . f 3 j. Liquor. Potass., . f. g j. Syrupi Tolutan., . f. g ss. Aquas font., . . f. g iijss. Fiat mistura cujus sumat cochl. parv. pro re nata. In chronic bronchial disease, and in long-con- tinued catarrhal affections which are attended with a copious muco-purulent expectoration, the Balsam of Copaiba is a valuable stimulant expectorant. 139. I£ Copaiferas Officinalis, f. g ss. Tinct. Opii Camph., f. g j. Yini Ipecacuanhas, f. g ss. Syrupi Acacias, . . f. g ij. 01. Gaultherias, . . gtt. xx. Fiat mistura, capiat cochl. parv. bis in die, vel saspius. 126 EMETICS AND EXPECTORANTS. In the treatment of chronic diseases of the air passages, the following mixture is strongly recom- mended by an experienced practitioner, as an effi- cient remedy for aUaying the cough and diminish- ing the expectoration : 140. ^s Morphias Acetat., . gr. iv. Potass. Cyanidi, . gr. iij. Yini Antimonii, Yini Ipecacuanhas, aa. f: 3 ij. Tr. Sanguinarias, . f. g ss. Syrupi Tolutanis, . f. g iij. Fiat mistura, cujus capiat cochl. parv. ter qua- terve in die. As a mild expectorant for yoimg chfldren, when threatened with an attack of croup, or in the com- mencement of bronchitis or catarrhal fever, the fol- lowing mixture will prove highly useful: 141. Tfy Yini Ipecacuanhas, f. 3 iij. Syrupi Tolutani, . f. 3 v. MucUaginis Acacias, f. g j. Fiat mistura, sumat cochl. parv. omni hora" vel quaque secunda hora. EMETICS AND EXPECTORANTS. 127 Among some valuable formulas contributed by Professor N. S. Davis, of Chicago, are several most exceUent remedies for the treatment of tho- racic disease. 142. fy Glycerin., . . f. g iij. Syr. Ferri Iodid., f. g ss. Morphias Sulph., gr. ij. Fiat mistura, capiat cochl. parv. ter quaterve in die. " To aUay cough, retard emaciation, and palliate the symptoms of phthisis pulmonalis," writes Dr. Davis, " I have no remedy superior to the above ; or, the following, namely : 143. I$s Glycerin., . . f. g iij. Sodas Hypophos., g j. Morphias Sulph., gr. iy. Fiat mistura, cujus capiat cochl. parv. ter qua- terve in die." Whenever the anodyne effect of Opium is needed, and the ordinary preparations of that article al- ways produce secondary vomiting and exhaustion, as is the case with many patients, Dr. Davis recommends the foUowing combination: 128 EMETICS AND EXPECTORANTS. 144. I£ Magnesias Sulph., . 3 ij. Acidi Sulph. Aromat., Tinct. Opii,aa. . . f. 3 ij. Aquas font., . . . f. S ij. Fiat mistura, sumat cochl. parv. pro re nata. CHAPTER VI. ASTRINGENTS. Astringent medicines are usuaUy defined, sub- stances which coming in contact with living organ- isms corrugate and condense their fibres, and thus diminish the action of secretion and excretion. As astringents exert, ultimately, a tonic influence on the human body, and as some tonics often prove astringent, many writers have considered tonics and astringents as identical. Tannin, which is an im- portant ingredient in many astringents, is not indis- pensable to tonics ; in many respects, however, they appear to be very nearly aUied. Some of the most powerful of the astringent remedies are de- rived from the mineral kingdom, but by far the largest and most important portion of this class of medicinal substances is obtained from the vegeta- ble kingdom. Caution should be observed in adopting the astringent plan of treatment, in most diseases. In acute inflammations, in all affections which are Q 129 130 ASTRINGENTS. accompanied with any degree of fever, or even those of a chronic nature attended with serious alteration of the tissues, medicines of the astringent class are likely to prove injurious. Some of the more powerful of the astringents, are frequently employed locaUy, for the purpose of arresting haemorrhages ; they are then called Styptics. In some cases where astringents are indicated, if irritability exists, Opium, although belonging to the division narcotics, may be administered with great advantage, either alone or combined with some more immediate astringent. As the most convenient preparation of Opium for the ready formation of piUs, we recommend to practitioners the officinal mass of Dr. TuUy : 145. Tfy Opii Pulveris, . g ss. Camphoras Pulv., 3 j. Saponis Alb., . 3 vij. Subige in massam, divid. equal, in pil. ccxl. Each of the above pills will contain one grain of opium. This mass wiU remain of the same consistence for a great length of time, and may be readfly formed into pills of any desired size ; or other ASTRINGENTS. 131 medicinal substances, or astringents, can be most conveniently combined with it. 146. IJ$ PU. Opii Officinalis, . 3 ss. Plumbi Acetatis, . . 3j. Ipecac. Pulv., . . . gr. xv. Fiat massa in pil. xxx. divid. cap. unam pro re nata. These piUs, administered once in two or four hours, according to circumstances, are useful in hasmoptysis, and other internal haemorrhages. 147. fy Pil. Opii Officinalis, 3 ss. Argent. Nitratis, . gr. viij. Fiat mass, in pU. xxx. divid. quarum sumat unam terve in die. In chronic diarrhoea, and in the latter stage of dysentery, the above pills have been successfuUy employed by us to allay the irritation of the intes- tinal membrane. In active haemorrhages, the subjoined astringent piUs have been much extoUed : 132 ASTRINGENTS. 148. I$s Plumbi Acetatis, 3 ss. Digitalis, . . 9j. Opii Pulv., . . gr. v. Conservas Rosas, 3 ss. Fiat massa divide in pU. xx. et exhibe unam ter quaterve in die. An experienced physician of this city has em- ployed for many years in pulmonary hasmorrhage the following astringent mixture : 149. ^ Plumbi Acetatis, 3j. Tinct. Opii, . f. 3 ij. Aceti, . . . f. 3 v. Aquas font., . giij. Fiat mistura, cujus capiat cochl. unum parv. pro re nata. This mixture is declared to be more efficacious in arresting hasmorrhage from the lungs, than the Lead and Opium are, when administered in the form of a piU. The medicine may be exhibited in teaspoonful doses once in two hours, or oftener if required. ASTRINGENTS. 133 150. Ity Plumbi Acetatis, 3j. Tinct. Opii, . . f. 3 iss. Aquas Cinnamom., Aquas fontanas, aa. f. g ij. Fiat mistura, sumat cochl. parv. ter quaterve in die. In both uterine and pulmonary hasmorrhage, we can recommend, from experience, the above mix- ture as a most excellent remedy ; and less dis- agreeable than the preceding mixture. 151. Ify Tinct. Catechu, f. g iss. Aquas Cinnam., f. g vss. Tinct. Opii, . f. 3 ij. Syr. Simp., . f. gj. Fiat mistura, cujus capiat cochl. mag. pro dosi. In the last stage of dysentery, or in protracted diarrhoea, attended with profuse evacuations, the above mixture may be administered after each liquid evacuation, often with great benefit. In cases of incipient ulceration of the mucous membrane of the ilium and colon which so often occurs in the latter stage of typhoid fever, and 134 ASTRINGENTS. dysentery, Prof. N. S. Davis is accustomed to recommend, as a remedy of great value, the fol- lowing : 152. fy Olei Terebinth., Tinct. Opii, aa. . f. 3 ij. Acacias Pulv., Sach. Alb. Pulv., aa. 3 iij. Aquas Menth. Pip., f. g ij. Fiat mistura, sumat cochl. parv. tertia vel quarta" quaque hora. For the same purpose the above practitioner employs the following piU : 153. ^5 Argenti Nitratis, gr. viij. Opii Pulv., . 9 j. M. Et in pU xx. divid. In persistent chronic diarrhoea, the foUowing preparation is much employed by Dr. Ware, of Boston: ASTRINGENTS. 135 154. I^ CascariUas, . g j. Cinnamonii, . g ss. Gentianas, Nucis Yomici, aa. 3 ij. Aquas puras, . Oss. Fiat infusio, et adde Sach. Alb., g iv. capiat g ss. vel g j. pro dosi. 155. fy Zinci Sulphat., . . 9 ij. Opii Extracti, . . gr. x. Confectionis Aromat., 3 ss. Syrupi q. s. ut fiant pil. xl. sumat unam ter in die. The above pUls may be employed advantageously in some forms of chronic bronchitis, when the expectoration is profuse. They are also a valuable astringent and tonic remedy in the treatment of leucorrhoea. Under the same circumstances the following piUs, if preferred, may be administered: 156. fy Cupri Sulphatis, gr. x. Opii Extracti, . gr. x. Confectionis Rosas, 3 j. 136 ASTRINGENTS. Fiat massa in pil. xxx. div. sumat unam ter qua- terve in die. In hasmorrhage from the kidneys or bladder, or from the intestinal mucous membrane, Tannic Acid is by far the most effectual astringent of this class of remedial agents. 157. fy Acidi Tannici, . • 3 j. Extracti Gentian., 9 ij. Misce in pil. xx. divide, cap. unam tertiis vel quartis horis. Combined with Opium, Tannic Acid is often suc- cessfully administered in the treatment of uterine hasmorrhage, and in protracted diarrhoea. 158. Acidi Tannici, . 3j. Extracti Opii, . gr. x. Conserves Rosas, 3 ss. Fiat massa in pil. xxx. divid. sumat unam ter quaterve in die. In uterine hasmorrhage one of the above piUs may be administered every hour. ASTRINGENTS. 137 159. I£ Decoc. Uvas Ursi, g iv. Acidi Tannici, . 3j. Tinct. Oph, . . f. 3 ij. Syr. Acacias, . g ij. Fiat mistura, sumat cochl. parv. ter in die, vel saspius. In albuminuria, and in chronic catarrh of the bladder, the above astringent mixture is a most valuable remedy. By some practitioners the GaUic Acid is con- sidered preferable to Tannic Acid, inasmuch as the administration of the latter is apt to be foUowed by constipation of the bowels. Gallic Acid is said not to produce this effect. The following mixture may be employed : 160. ty Acidi Gallici, . . 3 j. Mucfl. Acacias, Syrupi Aurantias, aa. f. g ij. Aquas fontanas, . . f. g iv. Fiat mistura, cujus sumat cochl. j. mag. ter qua- terve in die. In menorrhagia, hematuria, and other internal 138 ASTRINGENTS. haemorrhages, the above mixture may be given with great advantage. The foUowing preparation, which does not differ materially from the above, is a favorite prescrip- tion of our colleague, Prof. Barker, in mono- rrhagia. 161. fy Acidi GaUici, Acacias Pulv., aa. 3 ij. Syrupi Tolutan., Aquas font., aa. . f. g ij. Fiat mistura, sumat cochl. parv. pro dosi. Although belonging more properly, perhaps, to the class narcotics, we shall, under the head of astringents, speak of a medicine, which, after its employment for many years, not only by ourselves, but by many professional friends, we can confi- dently recommend as one of the most useful, and, in one class of maladies, the most certainly reme- dial, of any of our therapeutical agents. 162. Tty Tinct. Camphoras, . f. g iss. Tinct. Capsici, . . f. g ss. Spiriti Lavendul. Co., Tinct. Opii, aa. . . f. g j. Fiat mistura, capiat m. xx. vel xl. pro re nata. ASTRINGENTS. 139 Not only in the mflder forms of diarrhoea have we found the above mixture an exceUent remedy, but it has proved in our experience, most valuable and efficient when promptly administered on the occurrence of the " premonitory diarrhoea," in the early stage of epidemic cholera. During the prevalence of the cholera in this city, in 1849, and again in 1850, we administered this mixture in a large number of cases of cholera, in the access of the disease, with entire success. On the occurrence of the earliest symptoms of the choleraic diarrhoea, it should be given in doses of from thirty to sixty drops, every hour (or oftener if required), confining the patient strictly to a hori- zontal position, until aU tendency to the diarrhoea is entirely overcome. The adoption of other mea- sures will, of course, be required, if the disease is much advanced. When traveUing in summer, we are accustomed always to take a small phial of the above mixture with us ; as this medicine is quite sure to arrest, in children or adults, the intestinal irritation which, in the warm season, is so liable to foUow a change of diet and the drinking of a different, and, per- haps, a harder kind of water than that to which we had been accustomed. CHAPTER VII. DIAPHORETICS. Those medicinal agents which promote or in- crease the insensible transpiration are caUed dia- phoretics. The term sudorifics is applied to the same reme- dies when they produce free perspiration or sweat- ing. Diaphoretics, which operate by promoting diminished, or reestablishing suppressed perspira- tion, are important agents in the treatment of many forms of disease. They are indicated in some varieties of febrile disease ; in chronic cutaneous inflammations, in anasarca, pulmonary catarrh, and in rheumatic and gouty affejctions. In common colds, and in pulmonary catarrhs, we have long employed the following mixture with great advantage : 163. I$s Liquor. Ammonias Acetatis, t g ij. Yini Antimonii, Tinct. Opii Camph., aa. . f. g ss. Syrupi Tolutan., . . . f. gj. Fiat mistura, sumat cochl. parv. bis terve in die. 140 DIAPHORETICS. 141 After the exhibition of a cathartic in a severe cold, or in influenza, the above diaphoretic mix- ture, administered in drachm doses, every four or six hours, we have found to be a most valuable remedy. 164. fy Liquor. Ammon. Acetatis, f. g ij. Misturas Camphoras, . . f. g hjss. Vini Ipecacuanhas, . . f. g ss. Syrupi Tolutan., . . . f. gij. Fiat mistura, cujus exhibe cochl. mag. sextis horis vel saspius. In the commencement of fevers, and other in- flammatory affections, the above mixture is a cool- ing and highly useful diaphoretic. As a refrigerant and exceUent diaphoretic in pneumonia, and in the commencement of febrile diseases, the foUowing is employed : 165. fy Vini Antimonii, . . . f. g ss. Potass. Nitratis, . . . 3 ij. Liquor. Ammon. Acetatis, f. g ijss. Syrupi Tolutan., . . . f. g j. Aquas puras, . . . . f. g iv. 142 DIAPHORETICS. Fiat mistura, sumat. cochl. mod. tertia vel quarta quaque hora. In the commencement of fevers, or other inflam- matory diseases, when it is desirable to obtain a purgative and diaphoretic effect, the subjoined mixture may be advantageously employed : 166. ^ Magnes. Sulph., . f. gj. Ant. et Potass. Tart., gr. ss. Syrupi Simp., . . f. g j. Aquas Cinnam., . f. g ij. Aquas puras, . . f. g v. Fiat mistura, sumat. cochleare unum ampl. omni hora. As a diaphoretic and alterative, in rheumatic and other inflammatory affections, the following pills are useful: 167. fy Pulvis Antimonialis, . 3 ss. Hydrarg. Chlo. Mite, 9j. Opii Pulv., . . . . gr. x. Conserv. Rosas, . . q. s. Divide in pilulas xx. sumat unam quartis horis. DIAPHORETICS. 143 In acute rheumatism, when an anodyne diapho- retic is indicated, we may employ the foUowing with great advantage : 168. Tty Potassas Nitratis, 3 ij. Opii Pulv., . . gr. xii. Ipecacuanhas Pulv., gr. xviij. Fiant pulv. xii. cujus sumat unam hora somni. When a still more powerful diaphoretic is re- quired, as in the treatment of dropsical affections, and in the early stage of acute bronchitis, we may have recourse to the following pill: 169. ty Pulvis Ipecac, Comp., . 3j. Ant. et Potass. Tart., . gr. iij. Hydrarg. Chlorid. Mite., gr. xii. Mucil. Acacias, . . . q. s. M. Fiant pil. xii. cujus sumantur ij. mane noc- teque. If, after taking the above pills, the patient drink plentifully of warm fluids, a free perspiration will be likely to ensue. In the commencement of fevers, and in catarrhal affections, attended with increased vascular action, the following is a useful diaphoretic : 144 DIAPHORETICS. 170. ^ Liquor. Ammon. Acetatis, f. g ij. Spirit. JEther. Nitrici, Vini Antimonii, aa. . . f. g ss. Syrupi Acacias, . . . f. gj. Fiat mistura, cap. cochl. parv. quaque hora. Yel: 171. 3$* Ant. et Potass. Tart., gr. ijss. Aquas Cinnam., . f. g ij. Syrupi Simp., . . f. g ss. Aquas puras, . . f. g iijss. Fiat mist., cujus sumat. cochl. parv. secunda vel tertia hora. In inflammatory affections of the respiratory organs, such as pneumonia, bronchitis, croup, etc., Prof. Samuel H. Dickson, of Charleston, adminis- ters the following with advantage, as a diaphoretic and expectorant: 172. fy Ipecacuan. Pulv., . . 3j. Infus. Rad. Serpentaria, g vj. Tinct. Opii Camph., . f. 3 ij. Fiat mistura, sumat. cochl. parv. pro re nata. DIAPHORETICS. 145 The dose may be varied according to the age of the patient and emergency of circumstances, from one drachm to half an ounce, at intervals varying from half an hour to two hours. 173. ^ Potassas Bi-Carb., 9j. Tinct. Opii Camph., f. 3 ij. Aquas Puras, . . f. g viij. Fiat mistura, cap. cochl. ampl. omni bi hora\ The above is recommended by the same dis- tinguished practitioner, in cases of fever, with (or without) marked gastric irritability. 174. If* Sod. Carb., . . 9 ij. Spts. iEthe^. Nitrici, Syr, Zingiberi, Aquas puras, aa. . f. g j. M. Yel: 175. !$» Potass. Nitrat., . . 3 iij. Ant. et Potass. Tart., gr. j. Aquas puras., . . . g iv. M. Fiat solutio., cujus sumant. cochl. parv. ij. secunda vel terti& hora. 10 146 DIAPHORETICS. Either of the above preparations, says Dr. Lindsley, of Washmgton, may be administered in fevers, and wfll prove efficient and valuable reme- dies. " The foUowing," writes a very excellent physi- cian, of Massachusetts, " I have often used with very happy effect in scarlet fever : 176. Tfy Ammon. Carb., . 9iiss. Tinct. Opii Camph., f. 3 ij. Vini Ipecacuanhas, f. 3 ss. Aquas puras, . . f. g vj. Fiat mistura, sumat. cochl. mag. quarta vel sexta* quaque hora." The above remedy should be taken in the fol- lowing way : To one spoonful of the mixture, add two ounces of water, sweeten, and mix with it one drachm of lemon juice, and take whUe effervescing. CHAPTER VIII. DIURETICS. Diuretics are a class of remedies which have the property of augmenting the secretion of urine. Some diuretic agents, being absorbed by the mucous or cutaneous surfaces, are received into the circulation, and act by directly stimulating the kidneys to secrete an increased quantity of urine. Other remedies of this class, by making a general impression on the absorbent system, act indirectly or secondarily, exercising in this way an influence on the amount of urine secreted. It is important to recollect that the diuretic treatment is ordinarily merely secondary ; and is not generally indicated until other remedies, which have reference to the primary cause of the disease, have been employed. "Like all medicines en- dowed with special properties, diuretics require two conditions to produce their effects. The first is, that the organ into which they are introduced should be exempt from inflammation ; and second- ly, that the organ on which they arp. intended to 148 DIURETICS. act after being absorbed, should be a healthy one. Let the stomach be inflamed, and diuretics will increase the inflammation without producing the diuretic effect; or let the kidney be inflamed, and we shall only inflame it stiU more without increas- ing its secretion." * If administered on an empty stomach, and fol- lowed by gentle exercise in the open air, or if the surface of the body be kept cool, diluent drinks taken freely, the operation of diuretics wUl be greatly promoted. 177. ^ Infus. Juniperi, . g vss. Spirit, ^ther. Nitrici, Tinct. Cinch. Co., aa. f. g j. Tinct. Cardamom., f. g ss. Fiat mistura, capiat cochl. mag. ter quarterve horis. The above diuretic mixture has been found very beneficial in anasarca attended with much debUity. When it is desirable to promote free diuresis, in cases of general effusion into the whole cellular tissue, the subjoined mixture can be relied upon as a most useful diuretic : * Manual of Therapeutics, p. 301. DIURETICS. 149 178. fy Infusi. Digitalis, . . f. g vi. Hydrarg. Chlo. Corrosiv., gr. ij. Tinct. Cantharid., . . f. 3 ij. Aquas Menth. Pip., . . f. g ij. M. Fiat mistura, sumat. cochl. mag. bis terve in die. In hydrothorax, and other forms of dropsical effusions, where a tonic is indicated, the follow- ing diuretic combination has been much recom- mended : 179. IJs Misturas Camphoras, g viiss. Spir. either. Nitric, f. gj. Tinct. Digitalis, . f. g ss. Tinct. Opii, . . f. 3 ij. Tinct. Columb., . f. g j. M. Fiat mistura, sumat. cochl. mag. bis quo- tidie. Should a still more powerful diuretic be re- quired, the subjoined may be substituted : 150 DIURETICS. 180. fy Tinct. Colchici, . . . f. g ss. Infus. Juniperi, . . f. g vi. Tinct. Aurant. Comp., f. g j. Potassas Carb., . . . 3 ij. Potassas Nitrat., . . 3 j. M. Fiat mist., capiat cochl. larga j. vel ij. ter quaterve in die. In the treatment of the different forms of ana- sarca, but particularly in that which arises from diseased heart, we have employed for many years, and frequently with great advantage, the follow- ing diuretic combination : 181. fy Yini Colchici, . f. 3 ij. Tinct. Digitalis, . f. 3 vi. Potass. Iodid., . 3 iiss. Syr. Sarsa. Comp., f. g ij. Aquas puras, . . f. g iij. M. Fiat mistura, cujus sumat. cochl. parv. ter quaterve in die. By some practitioners Elaterium is esteemed a most valuable diuretic, especially in anasarca con- sequent on cardiac disease. DIURETICS. 151 182. fy Elaterii, . . . gr. v. Digitalis Pulv., . gr. xv. Extracti Gentianas, 9 j. M. Fiat massa et div. in pilulas xx. quarum capiat unam mane nocteque. 183. ^5 Aquas Foeniculi Dulcis, f. g vi. Tinct. Cantharid., . . f. 3 ij. Spirit, ^ther. Nitrici, Syrupi Cort. Aurant., aa. f. g j. M. Fiat mistura, sumat. coch. j. amp. pro re nata. The above mixture is a very pleasant, and quite an active diuretic. In some cases of anasarca, where the disease is attended with, or proceeds from debility, the fol- lowing tonic and diuretic may be exhibited fre- quently with great advantage : 184. fy Tinct. Cinch. Comp., . f. g iij. Tinct. Cardamom. Comp., f. g ij. Tinct. Cantharid., . . f. 3 iij. Syr. Acacias, . . . . f. gj. M. Fiat mistura, sumant. cochlearia duo parv. ter in die. 152 DIURETICS. With some practitioners, the subjoined stimu- lant diuretic is a favorite remedy in general ana- sarca attended with debility : 185. fy Juniperi Fructi, g ij. Potass. Nitrat., g ss. Vini Albi, . . Oij. Macera per horas duodecim ; sumant. cochl. duo ampl. bis terve in die. CHAPTER IX. ANTISPASMODICS. We define antispasmodics to be medicines which exert a direct control over spasmodic action ; or those substances which counteract irregular or inordinate muscular action. It is doubted by some therapeutists whether we possess any medicinal substances which do act directly on the muscular fibre. Those agents which are ordinarily arranged in the class anti- spasmodics are, by many, believed to act as indi- rect agents, relieving spasmodic action by revul- sion, or through the influence which they exert upon other parts of the nervous system than those concerned in the muscular contraction. There is, however, a class of medicinal agents which exerts, unquestionably, a direct control over spasmodic muscular action. We have, therefore, both direct and indirect antispasmodics. As an efficacious remedy, in the treatment of hysterical affections, and in subduing great ner- vous irritation, we may administer the following antispasmodic : 153 154 ANTISPASMODICS. 186. fy Assafoetidas, . 3 iss. Morph. Sulph., gr. v. Saponis Dur., 9 ij. M. Fiat massa in pil. xl. divide, quarum capiat unam pro re nata, vel binas, hora somni. Should a more stimulant antispasmodic be re- quired, the following may be substituted : 187. ^ Assafoetidas, . 5j. Morph. Sulph., gr. iij. Camphori Pulv., 9 ij. M. Fiat massa et in pil. xxx. divide. Sumat unam ter quaterve in die. Musk, when it can be obtained pure, is a power- ful nervous stimulant. It is sometimes given in nervous and hysterical affections, in combination with other antispasmodics. 188. ^ Moschi, . . . 3j. Assafoetidas, . 3 iss. Camphori Pulv., 3 ss. Extracti Gentianas, q. s. Ut fiat pil. xxx. quarum capiat unam ter in die. ANTISPASMODICS. 155 The administration of musk has been much com- mended in hiccough, and in the subsultus of typhus and other low and malignant fevers. 189. ^s Moschi, . . 3j. Mther. Sulph., Tinct. Opii, aa. f. 3 iss. Aquas Cinnam., f. g iiss. Syrupi Simp., f. g iss. M. Fiat mistura, de qua capiat cochl. j. mag. ter in die. By a combination of two or more of the anti- spasmodics, we obtain a more powerful effect in the treatment of hysterical and other nervous affections, than results, ordinarily, from the single administration of any one of these remedies. 190. I$s Tincturas Castori, Tinct. Assafoetidas, aa. . f. g iss. Aquas Camphoras, . . f. gj. Spirit. Ammon. Aromat., f. g ss. Syrupi Acacias, . . . f. g iss. M. Fiat mistura, quarum capiat cochl. j. mag. pro re nata. 156 ANTISPASMODICS. The above mixture, given in doses of a table- spoonful every hour or two, has been recom- mended as a powerful antispasmodic in hysteria. We have found the following mixture a very useful medicine in various nervous and spasmodic diseases : 191. fy Tinct. Castori, . f. g iss. Morph. Sulph., gr. iv. Tinct. Valerianae, f. g iss. Syrupi Acacias, . f. gj. E. Fiat mistura, sumat. cochl. j. mod. secunda quaque hora. In spasm of the stomach, arising from flatu- lence ; and for relieving cardialgia, the subjoined mixture will be found very efficacious : 192. ^ Tinct. Valerianae, . f. g j. Magnesias Carb., . 3 ij. Tinct. Opii, . . . f. 3j. Aquas Menth. Pip., f. g iij. Olei Anisi, . . . m. xl. M. Fiat mistura, cujus capiat cochl. parv. omni hora, vel saspius. Vel: ANTISPASMODICS. 157 193. ^ Tinct. Lavendul. Comp., f. g iss. Spirit. Carui, . . . f. g ij. Tinct. Opii, . . . . f. 3j. ^ther. Sulph., . . . f. g ss. Aquas font., . . . . f. g iv. M. Fiat mistura, capiat cochl. j. mag. pro re nata. The Valerianate of Zinc has been much em- ployed by some practitioners, by whom it is recommended as a valuable tonic and antispas- modic, in the treatmeat of hysteria and other ner- vous affections. 194. fy Zinci Valerianatis, . gr. xii. Tincturas Valerianae, f. g ss. Aquas Cinnam., . . f. g ij. Syrupi Simp., . . f. g ss. Aquas font., . . . f. g iij. M. Fiat mistura, cujus capiat semiunciam sex- tis horis. As an antispasmodic in the treatment of chorea, the Valerianate of Zinc has been much commended by some experienced physicians. In combination 158 ANTISPASMODICS. with the Subnitrate of Bismuth, and the extract of Hyoscyamus, we can recommend the Valeria- nate of Zinc as a most useful remedy not only in chorea, but in neuralgia and other nervous dis- eases. 195. IJj Extract. Hyoscyami, 9 ij. Zinci Valerianatis, . 9 ij. Bismuth Subnit., . 3j. M. Fiat massa, et in pil. xl. div., quarum capiat unam, ter quaterve in die. The Valerianate of Ammonia has been recom- mended, recently, by practitioners, both at home and abroad, as an antispasmodic in hysteria, but more especially in the treatment of facial neural- gia. It has been employed by Dr. Declat, and some other foreign practitioners, with great suc- cess, in the treatment of nervous diseases. Administered in doses of a teaspoonful, morning and evening, it has succeeded in controlling neu- ralgic pains after all the ordinary means have been tried, in succession, without avail. If pure, it should be administered in diminished doses from those recommended by Dr. Declat. We have employed the following mixture in severe facial neuralgia : ANTISPASMODICS. 159 196. I$s Ammon. Valerianatis, f. 3 j. Syrupi Tolutan., . f. gj. M. Sumat cochl. parv. quartis horis. \ CHAPTER X. ANTHELMINTICS. That class of medicinal agents which possesses the property of destroying worms, or of expelling them from the intestinal canal, is called anthel- mintics. The principle on which anthelmintics operate is not the same with all. Some by their disagreeable odor destroy or dislodge the worms ; others by mechanical irritation ; and others, again, by some unknown, specific operation. In selecting these remedies, regard should be had to the character of the agent employed, and to the mode of application, with reference to the species of intestinal worms to be. destroyed or removed. A great variety of animal parasites have been found, from time to time, in the human body.* Of those whose habitat is the alimentary * A very valuable work on the " Animal and Vegetable Parasites of the Human Body," by Dr. Friederich Kiichenmeister, of Germany, has been, very recently, translated and published by the Sydenham Society. It contains much that is new and interesting on this subject, and adds to our knowledge of human parasites. 160 ANTHELMINTICS. 161 canal, and for whose removal medicinal agents are frequently required, there are four species ; the taenia or tape worm, the trichuris or tricocephalus, ascaris vermicularis, and ascaris lumbricoides. The preparations of Mercury have long been employed for expelling the lumbrici from the intestinal canal. Calomel, especially, administered in the ordinary purgative doses, has proved a most efficient anthelmintic for the removal of the round worm. In the United States, the Spigelia Mari- landica is much employed, and is considered one of the most powerful and certain of the anthel- mintics. 197. 1^ Spigelias Mariland., g ss. Aquas ferventis, . Oj. Macera per horam, quarum sumat cochl. mag. tertiis vel quartis horis. If a moderate dose of Calomel be given in the evening, sufficient to produce a mild cathartic effect, and its operation followed the next day by the administration of the infusion of Pinkroot, in doses of from half a fluid ounce to a fluid ounce, once in three or four hours, we have found this plan altogether more efficient than when the Spigelia is given without the Calomel. An active 11 162 ANTHELMINTICS. dose of Castor Oil should follow the last dose of Pinkroot. 198. I$f Spigelias Pulv., 3 iss. Stanni Pulv., g j. Syrupi Simp., q. s. M. Fiat electuarium, cujus sumat. 3j. omni mane nocteque. After the second or third day this medicine should be followed by a full dose of Castor Oil. The above combination of Spigelia and Tin is con- sidered, by some practitioners, as being a very powerful and efficacious anthelmintic. Kiichen- meister, however, protests against the administra- tion of tin-filings, not only because of the uncer- tainty of the remedy, but because of the irritation of the intestinal membrane, excited by this agent. It is advised by some practitioners to unite a purgative with the Pinkroot. 199. Jfy Spigelias Mariland., g ss. Sennas, .... 3 iij. Anisi, . . . . 3j. Aquas ferventis, . Oj. Macera per horam, sumant. cochl. ij. ampla ter- tiis horis. ANTHELMINTICS. 163 Dr. A. L. Cox, a distinguished, and, for many years, a successful practitioner in this city, was accustomed to employ the following anthelmintic : 200. ty Spigelias Mariland., Sennas, aa. . . . g ss. Potassas Bitart., . 3 j. Jalapas Pulv., . 3 ss. Sem. Cardamom., 3 ss. Extract. Glycyrrh., 3 ij. Aquas ferventis, . Oss. Macera per horam, sumat. cochl. j. vel ij. ampla, pro re nata. The Filix Mas, or Male Fern, although a foreign remedy, has been much employed in the United States as a vermifuge, particularly for the expul- sion of the tape worm. It may be administered in the form of powder, or in decoction. 201. fy Filicis Maris Pulv., g j. Syrupi Simp., q. s. M. Fiat electuarium, cujus sumat 3j. vel 3 ij. omni mane nocteque. 164 ANTHELMINTICS. The remedy should be given on an empty stomach, and after being continued two or three days should be followed by an active cathar- tic. 202. ^ Filicis Maris, . g j. Aquas ferventis, Oj. Macera per horam, sumant. cochl. ij. ampla, mane ac nocte. To an adult, a wineglassful of the above decoc- tion may be given, fasting, twice or thrice daily ; and followed by a cathartic as above. The Kousso, another foreign remedy, has also been employed by American practitioners with considerable success, for the treatment of the tape worm Kousso is the flowers of a plant, the Brayera Anthelmintica. It is ordinarily given in powder, and should be administered on an empty stomach. It will prove more certainly efficacious if pre- ceded by a cathartic. ANTHELMINTICS. 165 203. 1^ Flo. Brayeras Anthelmint., g ss. Aquas tepidas, .... Oss. M. Sumant. g ij. omni hora quadrante. The infusion should be taken in divided doses as above, on an empty stomach. After a few hours, a full dose of Castor Oil, or some other brisk cathartic, should be administered. Prof. Raimann, of Vienna, has been quite suc- cessful of late in the employment of Kousso, exhi- bited after the following manner: An infuso- decoction is made by macerating 3 vi. of Kousso for twenty-four hours in cold water, and then boiled for half an hour. It is then taken whilst fasting, in two portions, without straining, and two hours afterwards from one to two ounces of Castor Oil. This remedy acts with great certainty.* Many American practitioners consider the Oil of Turpentine the best anthelmintic in tinea. Large doses are required for the treatment of the tape worm. 204. ^ Olei Terebinth., gj. Decoc. Hordii, g ij. M. Fiat haustus. * Kiichenmeister, pp. 161-2. 166 ANTHELMINTICS. After repeating this dose for two or three morn- ings, if it does not purge, it should be followed by a dose of Castor Oil. Kuchenmeister likewise regards Oil of Turpen- tine one of the best and most energetic remedies for tape worms. He advises that this medicine be administered at bed time, and in a dose of one ounce triturated with the same amount of Castor Oil and honey, and the yolks of three eggs. It should be given in divided doses, and all in the course of an hour or an hour and a half. Under the name of Semen Contra, the East has furnished to Europe a species of worm-seed, which has enjoyed a great reputation as an anthelmintic. It has seldom been used in this country. It con- tains two principles, which are equally efficacious. a volatile oil and Santonin. This latter principle has recently been introduced into this country, and is especially recommended for the treatment of worms in children, on account of its want of taste. It is given in the dose of from a half a grain to three grains, twice a day. An agreeable form for children is the sugar-coated pills of Gar- nier, Lamoureux & Co., which contain each one half of a grain, and invite the little patient by their appearance to take what otherwise he would struggle against. The dose should be repeated for several days. It seldom requires a cathartic, ANTHELMINTICS. 167 as it acts efficaciously as a cathartic in the larger doses. The species of worm-seed better known to prac- titioners in this country is the Chenopodium An- thelminticum. It is reputed for its expulsive powers over the round worm. The oil is a favor- ite anthelmintic in some of the dispensaries of this city. In this form the Chenopodium is used with much success by one of my friends, Physician to the Children's Department of the Demilt Dispen- sary. 205. ty 01. Chenopodii, gtt. x. Syr. Simp., . f. g j. M. Cochl. parv. ter in die. The dose should be continued for two or three days, and then followed up by a brisk cathartic. To dislodge ascarides of the rectum, we have employed, successfully an enema composed of Olive Oil. From four to six ounces of the oil should be administered to an adult, and retained as long as possible in the rectum. Young children, who often suffer greatly from the presence of ascarides in the rectum, are frequently promptly 168 ANTHELMINTICS. relieved by the employment of an enema com- posed of two ounces of Olive Oil. In the treatment of this troublesome parasite, Trousseau and Pidoux have found injections of the Biniodide and Bi-Chloride of Mercury extremely effective. To an adult they administer, two or three days successively, an enema consisting of a quart of water in which five centigrammes (about three-fourths of a grain) of the Biniodide are dis- solved by means of one-tenth of Iodide of Potas- sium ; or they employ the same quantity of Corro- sive Sublimate without the Iodide of Potassium. Injections of the following strength may be used with safety : 206. ^ Hydrarg. Biniodid., gr. j. Potass. Iodid., . gr. ss. Aquas font., . . Oij. M. Pro enema. When administered to children, from four to six ounces of this solution may be employed. These authors say they have rarely failed of success in the employment of either of the above remedies. ANTHELMINTICS. 169 They advise a repetition of the enemata in a fortnight afterwards, and again at the end of four or five weeks.* * Trait6 de Therapeutique. CHAPTER XI. EMMENAGOGUES. All those means or agents, whether external or internal, which possess the power of stimulating the generative organs, and of causing a determina- tion of blood to the uterus, are considered emmena- gogues. In therapeutics the term is restricted to those medicinal agents which " have the property of promoting or restoring the menstrual discharge." Before employing emmenagogues we should carefully investigate the causes which tend to obstruct menstruation, that our efforts to remove these causes may be intelligently directed. Sup- pression, or absence of this discharge, is generally dependent upon some abnormal conditions of the system ; or, the irregularity may be the effect of debility or of some organic disease of the genera- tive organs ; therefore, the remedies which are to be employed must have reference to these varied causes. When the suppression of this discharge is de- pendent upon general debility, tonics are the 170 EMMENAGOGUES. 171 appropriate remedies ; and of these, bark and the preparations of steel are the most efficacious. Occurring in persons of a full and plethoric habit, venesection, or other antiphlogistic measures may be required. Under other circumstances and con- ditions, again, amenorrhcea may be successfully treated with active purgatives, or with stimulating diuretics ; and sometimes antispasmodics are the means indicated. Hence, no single remedy, nor only one plan of treatment can be adopted as being applicable to all cases. The subjoined medicinal agents belong to that class of remedies which experience has proved to be the most efficient in promoting the menstrual discharge. 207. fy Ferri Sulphatis, . 3 iss. Potass. Iodid., . 3 ij. Tinct. Cardamom., Syr. Simp., aa. . f. g j. Aquas font., . . f. g ij. M. Fiat mist, cujus capiat cochl. parv. ter in die. In cases of suspended menstruation, attended with headache, and with pains in the pelvic regions, the above preparation may be advan- tageously administered. 172 EMMENAGOGUES. In chlorotic amenorrhoea attended with debility, other ferruginous preparations are often very ser- viceable, particularly when combined with vegeta- ble tonics. 208. fy Ferri Carb., . 3 iij. Tinct. Columbas, Syr. Zingiberi, aa. f. g ij. M. Fiat mistura capiat cochleare parv. mane ac nocte. Vel: 209. ^ Ferri Citrat,, ... 3 ij. Syrupi Aurantii, Aquas Menth. Pip., aa. f. g ij. Aquas puras, . . . f. g iv. Fiat mistura, de qua sumatur cochl. parv. bis terve in die. " There is one formula," writes Dr. John Ware, " I have used for many years in chlorosis, and think it the most satisfactory remedy in this dis- ease which I have ever employed. I mean for cases of young girls with pale catamenia, pale cheeks, pale lips—in short, paleness everywhere ; with thin, transparent alabaster fingers and ears, EMMENAGOGUES. 173 short breath, palpitating throbbings m head, bruit du diable, etc. etc. Ecce signum. 210. ^s Aloes, Ferri Sulph., aa. . . gr. xvi. Hydrarg. Chlorid. Mitis, gr. iv. Fiat massa et in pil. xvi. div. , " Taken twice or thrice a day ; the quantity of Aloes to be varied according to the state of the bowels, which are best kept moderately relaxed— at least two stools a day if this can be borne. The quantity of Calomel also to be varied, if necessary, and the mouth carefully watched. '' I know of hardly any combination in medicine so sure of doing its duty." When we have reason to suspect the obstruction to depend upon a rheumatic condition of the womb, the greatest benefit may be anticipated from the exhibition of the following combination: 211. fy Potass. Iodid., . 3ij. Vini Colch., . f. 3 iss. Syrupi Sarsa., Aquas font., aa. f. g ij. M. Fiat mistura, de qua capiat cochl. parv. ter de die. 174 EMMENAGOGUES. In connection with any of the preceding emme- nagogue preparations the following pills may be taken, should a laxative be indicated : 212. Tfy Aloes Pulv., . 3 iss. Ferri Sulphatis, 9 ij. Myrrhas Pulv., 3 ij. M. Fiat massa, in pil. xl. divide ; quarum sumat. j.-ij. bis quotidie. In difficult and painful menstruation, attended with a torpid condition of the bowels, the follow- ing is a useful remedy : 213. ^ Decoc. Aloes Comp., g iij. Sodas Sub-boratis, 3 j. Tr. Aloes Comp., Tinct. Castori, aa. . f. g ss. Aquas Cinnam., . f. g ij. M. Fiat mistura, capiat cochl. amplum ter in die. In those cases of dysmenorrhoea which are dependent on rheumatic irritation of the os and cervix uteri, Prof. Davis is accustomed to employ, EMMENAGOGUES. 175 with great advantage, the following combina- tion : 214. ty Vini Colchici Sem., . . g j. Tinct. Strammonii, . . f. g ss. Tinct. Cimicif. Racemosas, f. g iss. M. Fiat mistura. " Administered during the interval, between two or more menstrual periods," says Dr. Davis, " in doses of from half a drachm to a drachm, three times a day, it will often completely cure in the above cases." After other remedies have failed, we have em- ployed successfully the following mixture for the treatment of suppressed menstruation : 215. fy Proto-Iodid. Hydrarg., gr. iij. Potass. Iodid., . . 3 ij. Tinct. Gentianas, . . f. g iij. Aquas Cinnam., . . f. g ij. Syr. Simp., . . . f.Sj. M. Fiat mistura, cujus capiat cochl. parv. bis terve in die. 176 EMMENAGOGUES. The emmenagogue recommended and employed by Dr. Dewees, has been for many years, among American practitioners, one of the most popular of all remedies for the treatment of suppressed catamenia. The following are the directions as given by Dr. Dewees : * 216. fy Guiacaci Pulv., . . g iv. Sodas Carb., vel Potass, 3 iss. Pimentas Pulv., . . g j. Alcohol. Officin., . . Oj. vtacera. Dr. Dewees directs, that the volatile spirits of Ammonia be added to the above mixture, after it has digested for a few days, in proportion of one or two drachms to each four ounces of the tinc- ture ; and given in doses of a teaspoonful three times a day in a glassful of sweetened milk, or wine. " I have," adds he, " for more than forty years, almost daily used this medicine in suppressed catamenia, and more especially in those of long standing, without its having failed in any case proper for its use." Treatment on Diseases of Females, pp. 123-4. CHAPTER XII. GARGLES AND LOTIONS. Gargles and lotions may, with propriety, be arranged together, for both are medicated, local baths ; the former being employed as washes for the mouth and fauces, whilst lotions are used as washes externally, and for injections. In affections of the mucous membrane of the mouth and throat, gargles are only serviceable when the disease is limited to the fauces and pharynx ; when it has extended into the larynx, or even into the sub-tonsillary fossae, these parts are not reached by lotions employed as gargles. As a gargle in inflammatory sore throat, and in the early stage of follicular disease of the throat, we have been accustomed to employ the follow- ing : 217. ^ Argent. Nitratis, 9j, Aquas Rosas, . f. g iv M. Fiat gargarisma. 178 GARGLES AND LOTIONS. The subjoined may also be used under the same circumstances: 218. Ify Potassas Nitratis, 3 ij. Mellis Rosas, . g j. Aquas Rosas, . f. g v. M. Fiat gargarisma saspe utendum. In chronic inflammation of the throat, and in the latter stage of follicular disease of the pha- ryngo-laryngeal membrane, we have often derived great benefit from the frequent use of the follow- ing Creosote gargle : 219. fy Creosotii......gtt. xxiv. Tinct. Myrrhas, Tinct. Lavendul., Co., aa. f. g ss. Syrupi Simp., . . . f. gj. Aquas font., . . . . f. g vi. M. Fiat gargarisma. Or the following: GARGLES AND LOTIONS. 179 220. ty Creosotii,.....gtt. xx. Tinct. Capsici, . . . f 3 ij. Tinct. Myrrhas, Tinct. Lavendul. Co., aa. f. g ss. Syr. Simp., . . . . gj. Aquas font., . . . . f. g vi. M. Fiat gargarisma. In aphthous affections of the throat, the follow- ing is an excellent gargle : 221. fy Decoc. Hordii, . g vj. Mel. Rosas, . . gj. Tinct. Opii, . . f. 3 iss. Tinct. Myrrhas, . f. 3 vi. M. Fiat garg. Or the following, which has been highly recom- mended in ulcerated sore throat, may be used: 222. I$i Liquor. Calcis Chloridi, f. g ss. Mellis Rosas, . . . g j. Aquas font., . . . f. g vss. M. Fiat gargarisma. 180 GARGLES AND LOTIONS. As a most excellent detergent lotion in venereal ulcerations of the throat and fauces, the following may be frequently employed : 223. 3^ Hydrarg. Chlorid. Corrosiv., gr. iij. Solve in Spirit. Yin. rect., 3 ss. et adde Decoct. Cinchon., f. g vj. Tinct. Myrrhas, . . . . f. g iv. Mellis Rosas,.....g iss. M. Fiat gargarisma. Young children, when affected with inflamma- tory sore throat, or in aphthous affections of the throat, are often much relieved by using frequently a mild wash ; the following may be employed : 224. I$5 Infus. Rosas, . g vj. Tinct. Myrrhas, f. g ss. Mellis commun., g j. M. Fiat gargarisma. Or the following may be substituted when a more stimulating gargle is required : GARGLES AND LOTIONS. 181 225. fy Tinct. Capsici, . f.3j. Aluminis, . . 5j. Mellis commun., Bj- Aquas puras, f. g ivss. Misce, pro gargarism. In chronic sore throat, attended with relaxation of the uvula, the following astringent gargle is frequently employed : 226. ^$ Decocti Quercus, g vij. Aluminis, . . 3 ss. Vini Gallici, . f. gj. M. Fiat gargarisma. The above is also a useful injection in leucor- rhoea, or in ulceration of the rectum or vagina. As a vaginal injection in leucorrhoea, the foUow- ing lotion has been found excellent: 227. ^ Liquor. Alumin. Co., Aquas font., aa. . f. gvj. M. Fiat injectio. 182 GARGLES AND LOTIONS. In the treatment of old and indolent ulcers, par- ticularly ulcers of the leg, we have employed, for many years, the following stimulating and sedative lotion. 228. R Calcis Chloridi, 3 j. Opii Pulv., . 3 iss. Aquas font., . f. g vj. M. Fiat lotio et cola. By applying constantly pledgets of lint, wet with the above wash, to old and troublesome ulcers, they have been healed, frequently, after other applications have failed. In the treatment of chancre, also, after cauterizing the ulcer, it is the most efficacious remedy that can be employed. Frequently applied by means of the lint, it soon changes the character of the sore, and arrests the ulcerative process. The employment of constitu- tional remedies, however, should not be omitted. CHAPTER XIII. ANTACIDS AND ANTILITHICS. Those substances which are capable of com- bining chemically with the free acid that is often found to exist in the stomach and primas vias, and of neutralizing it, are denominated antacids. By combining with the acid of the stomach and digestive organs, a new innoxious compound is formed, and thus a temporary palliative effect is produced, relieving the symptoms caused by the presence of a morbid acidity. The employment of antacids, however, do not serve to correct, per- manently, that peculiar state of the digestive organs, which favors the formation of acids. Their favorable action is only temporary j their pro- tracted use not infrequently serves to debilitate the powers of the stomach, and, therefore, " in no case should their administration be long persisted in without occasional interruptions." Where the acid exists in the stomach, and the upper portion of the intestinal canal, alkalies of the volatile kind, as Ammonia and its carbonate, 188 184 ANTACIDS AND ANTILITHICS. or the preparations of Magnesia or of Lime, should be preferred. If the acid exists in the urinary organs, those alkalies which have a tendency to act more directly on the kidneys, as the prepara- tions of Potash, Magnesia and its salts, should be employed. In cases of headache arising from acidity of the stomach and primas vias, the subjoined has been most efficacious in many instances : 229. IJ* Sp. Ammon. Aromat, f. 3 vj. Sodas Bi-Carb., . . 3 iss. Infus. Cascarillas, . f. g viiss. M. Fiat mistura, cujus capiat cochl. ampl. ij. bis in die, ante cibum. In gastrodynia, and in other gastric and intes- tinal disturbances, the following is an elegant and invaluable mixture : 230. ^ Sodas Subcarb., . . 3 iss. Aquas puras, . . . Oj. Acidi Sulp. dilut., . f. 3 j. Confectionis Aromat., Aquas Menth. Pip., aa. f. g ss. M. Fiat mistura, cap. cochl. ij. mag. bis in die. Or the following : ANTACIDS AND ANTILITHICS. 185 231. IJ* Liquor. Calcis., . . . f. g viiss. Magnesias Calcin., . . 3 ss. Spirit. Ammon. Aromat., f. 3 iij. Tinct. Card, comp., . . f. g j. M. Sumat. cochl. ij. larga bis die, vel saspius. In heartburn and other cases of acidity of the stomach and primae vias, the carminative mixture first recommended by Dr. Meigs, is much em- ployed, and often with great advantage : 232. IJ$ Magnesias Carb., . 3 ss. Magnesias Sulph., . 3 iiss. Sp. Ammon. Aromat., f. 3 j. Tinct. Rhei, . . . f. g ss. Tinct. Hyos., . . . f. 3 ss. Aquas Menth., . . f. g iv. M. Fiat mistura, cujus sumat cochl. unam mag. bis terve in die. In chronic diarrhoea depending on a redundancy of acid in the stomach and intestines, the follow- ing will be found useful: 186 ANTACIDS AND ANTILITHICS. 233. I}» Mistur. Cretas, . f. g vj. Spirit. Cinnam., . f. g iss. Aquas Ammon., . f3iss. Tinct. Opii, . . gtt. 1. M. Fiat mist, sumat cochl. j. vel ij. ampl. pro re nata. The carminative mixture of Dr. Dewees has been extensively employed in this country in acidity, flatulent colic, diarrhoea, etc., of young children. It is an excellent remedy : 234. fy Magnes. Carb., . 3j. Tinct. Assafoetidas, f. 3 ss. Tinct. Opii, . . gtt. xl. Sach. Alb., . . 3 ij. Aquas puras, . . f. g ij. M. Fiat mistura, date m. xx. vel xxx., pro re nata. My coUeague, Prof. Davis, highly recommends, under the same circumstances, the following : ANTACIDS AND ANTILITHICS. 187 235. Tfy Cretas prep., Sach. Alb., aa. . 3 j. Acacias Pulv., . 3 ij. Aquas Cinnam., f. g iv. M. Sumat. cochl. parv. bis terve in die. In the treatment of the lithic acid diathesis, the alkaline bi-carbonates are the appropriate reme- dies. Their exhibition should be preceded or accompanied by counter-irritation over the lum- bar region, and, if indicated, active purgation. 236. IJ* Aquas Ammon. Carbonatis, f. g j. Infus. Gentianas Co., . . f. g v. Sp. ^Etherei Nitrosi, . . f. g ss. Aq. Cinnam., . . . . f. g iss. M. Fiat mistura, de qua sumat. cochl. j. vel ij., ampl. ter in die. In those cases where the urine indicates the presence of lithic acid, the above mixture may be employed with advantage. Or the following : 188 ANTACIDS AND ANTILITHICS. 237. 3^ Liquor. Potassas, . f. g ss. Tinct. Humuli, . f. g iss. Infusi Columbas, . f g iv. Syr. Aurantias, . f. g ij. Fiat mistura, capiat cochl. larga unam bis terve in die. In the arthritic or rheumatic diathesis, in which a tendency to the morbid formation of lactic acid may exist, we have employed, advantageously, the following : 238. 1^ Potassas Iodid., . 3 iij. Liquor. Potass., f. 3 iiss. Tinct. Colchici, . f. 3 ij. Tinct. Cardamomi, f. g ij. Syr. Sarsa., . . f. g iv. M. Fiat mistura, cujus capiat cochl. parv. ter in die. The Potassio- Tartrate of Soda, in combination with the wine of Colchicum and an anodyne, is the great remedy on which Dr. Fuller, of St. George's Hospital, London, depends, in the treat- ment of acute, rheumatic affections. He adminis- ters these remedies in a simple saline or a nitre draught, as the following : ANTACIDS AND ANTILITHICS. 189 239. ty Haustus Salini, . . . f. g iss. Sodas Potassio Tartratis, 3 ij. Vini Colchici, ... gtt. xv. Tinct. Opii, .... gtt. vij. M. Fiat haustus. " This draught is repeated," says Dr. Fuller, " for the first twelve or twenty-four hours, at intervals of three or four hours, according to the strength of the patient and the severity of the attack." * * Dr. H. W. Fuller, " On Rheumatism, Rheumatic Gout," etc., p. 99. CHAPTER XIV. DERIVATIVES OR COUNTER-IRRITANTS, OINTMENTS, ETC. Derivative remedies are often of the highest importance in the treatment of disease. The revulsive method is employed when we wish to remove or relieve a diseased condition of some internal organ or part, by producing a new irritation on the surface of the body, or determina- tion to some part, remote from the disease. In the employment of derivatives, we should have regard to the condition of the system, and the character and degree of inflammation present. " That state of the system, usually called irrita- ble, seldom admits of revulsive action, the seconda- ry disorder so induced frequently reacting on the primary."* When any internal organ is the seat of active inflammation, as the lungs, for instance, powerful derivatives should not be applied until vascular excitement has been reduced by general measures. Counter-irritation is of the most value * Manual of Therapeut., p. 334. 190 DERIVATIVES, OR 191 in the treatment of obstinate chronic disease ; in local congestions, and irritations of important internal organs. The principal agents employed as derivatives, in the practice of medicine, are rubefacients, vesicants, pustular counter-irritants, and issues or setons. The following rubefacient liniment is strongly recommended by an experienced physician, by whom it has been employed for many years, in the treatment of intercostal rheumatism, and other rheumatic pains of the chest and back : 240. fy Olei Origani, Olei Terebinth., aa. g ss. Tinct. Opii, Aquas Ammonias, Olei Olivas, aa. . g j. M. Fiat linimentum. A very celebrated " Rheumatic Liniment," was extensively sold in New England, several years ago, as a patented medicine, the formula for which was pirated from an American medical journal, published nearly thirty years ago. It was first recommended by an able physician, for the treat- ment of rheumatic affections of the joints. The following is the formula : 192 COUNTER-IRRITANTS, OINTMENTS, ETC. 241. fy Olei Origani, Aquas Ammonias, Tinct. Opii, Olei Olivas, aa. . gj. M. Fiat liniment. This liniment should be applied and followed by frictions with the hand ; or, pieces of cotton or flannel, wetted with the liniment, may be laid over the inflamed joint, and evaporation pre- vented by covering the whole with oiled silk. In rheumatic and neuralgic affections, the fol- lowing liniment is recommended by Prof. Cox : 242. fy Olei Origani, Tinct. Camphori, aa. f. g ss. Granville's Lotion, . f.3iij. Chloroformi, . . . 3 iijss. Tinct. Aconiti, Tinct. Capsici, aa. . f. g ss. 01. Sassafras., . . 3 ss. Lin. Sapon. Comp., . sj. M. Fiat Liniment. In the treatment of incipient sore throat, and in various pains and aches, we have derived great DERIVATIVES, OR 193 advantage from the use of the following, employed as a liniment, with cutaneous frictions : 243. fy Tinct. Arnicas, Aquas Ammonias, aa. f. g j. Spirit. Camphorat., Tinct. Opii, aa. . . f. g ss. Olei Olivas, . . . f. g j. M. Fiat linimentum. To relieve neuralgic or rheumatic pains, the following has often proved very serviceable : 244. I$s Tinct. Aconiti, Tinct. Opii, Tinct. Camphorat., Chloroformi, aa. g ss. Misce pro liniment. As a stimulating anodyne embrocation, the fol- lowing is much employed by an eminent physician of Philadelphia : 245. ty Liniment. Saponis, g iij. Chloroformi, . . gj. M. Fiat Liniment. 13 194 COUNTER-IRRITANTS, OINTMENTS, ETC. Prof. Harvey Lindsly recommends the following as a valuable anodyne liniment: 246. fy Camphori, . 3j. Chloroformi, vel, 01. Terebinth, gj. Tinct. Opii, 01. Olivas, aa. gj. M. Fiat liniment. All active rubefacients may become vesicants, if applied for a sufficient length of time. The nature and use of vesicating agents proper, are well understood. Among counter-irritants, tartar-emetic is the principal agent. It is the most certain of all means for exciting pustular counter-irritation; and pustular inflammation, long-continued, is alto- gether more effective than vesication, in the treat- ment of chronic bronchitis, parenchymatous inflam- mation, and, indeed, in most forms of deep-seated, thoracic disease. The following ointment may be employed when we wish to insure fuU, pustular counter-irritation : DERIVATIVES, OR 195 247. fy Antim. et Potass. Tart., 3 ij. Camphoras Pulv., . . 5 ss. Adipis Preparat., . . g j. M. Fiat unguentum. If the part, to which the ointment is to be applied, be first wet with strong vinegar, or stimulated by friction, the effect will be more cer- tain and uniform. If a milder effect be desired, we may employ the following : 248. R Ant. et Potass. Tart., . 3 iss. Ipecac. Pulv., . . . . 3 j. Cerati Simp., vel Adipis, g j. M. Fiat unguent. In acute inflammation of the lungs and air-pas- sages, where vesication would be improper before vascular action is reduced, we have advised for many years the employment of a saturated aqueous solution of Emetic-tartar. After friction, as for the ointment, the solution should be rubbed on gently with a piece of soft flannel; and should be applied as hot as the skin can bear it. A full and uniform eruption is thus speedily produced which 196 COUNTER-IRRITANTS, OINTMENTS, ETC. proves a very valuable counter-irritant, in these affections. Or a liniment may be formed of equal efficacy. 249. fy Solutio. Ant. et Potass. Tart, saturat., Potass. Iodid.,........ Olei Terebinth vel Olivas, .... M. Fiat liniment. 250. 1$ Ant. et Potass. Tart., 3 ss. Olei Tiglii, . . . gtt. xx. Ipecac. Pulv., . . 3 j. "Unguent. Rosas, . gj. M. Fiant unguent. The above ointment is a mild and very elegant counter-irritant; one which we have long em- ployed when a revulsive has been indicated in the treatment of diseases in delicate females and young children. One equally mild is recommended by a physi- cian from a neighboring city, as a valuable coun- ter-irritant. giss. g ss. DERIVATIVES, OR 197 251. ty Olei Tiglii, . . . 3j. Liniment. Saponis Co., g j. M. Fiat liniment. Or the following may be employed : 252. ^ Olei Tiglii, . gtt. xxx. ^Ether. Sulph., gj. M. Fiat mistura. As a derivative in the treatment of tuberculosis, we have employed extensively the following mild counter-irritant. It is a very valuable external remedy : 253. 1$ Potass. Iodid., . . 3j. Proto-Iodid. Hydrarg., gr. x. Unguent. Rosas, . . g j. M. Fiat unguent. A portion of this ointment should be applied to the part of the chest over the diseased lung, night and morning, and be rubbed in by friction with the hand. A distinguished French practitioner recommends 198 COUNTER-IRRITANTS, OINTMENTS, ETC. the following ointment to be employed in the same way, and for the above disease : 254. fy Iodinii, . . . . gr. xii. Potass. Iodid., . 3 j. Adipis preparat., g j. M. Fiat unguent. The method of establishing setons and issues, and their effects as counter-irritants, are well understood. Under the head of unguents, we shall speak of some valuable remedial agents which are not properly classed among the derivatives. Ointment for haemorrhoids. 255. ^ Unguent. Stramonii, . gj. Plumbi Carb. Pulv., . 3 j. Opii Pulv., .... 3 iss. M. Fiat unguent. In the treatment of haemorrhoids, we have long employed the above ointment, and in many cases with entire success. A more stimulating and astringent ointment is DERIVATIVES, OR 199 much commended by an old practitioner of this city. 256. I£ Unguent. Stramonii, . gj. Gallas Pulv. intim., . 3 j. Camphori Pulv., . . 3 ij. M. Fiat unguent. The following is much employed by foreign physicians : 257. ^ Gallas Pulv., . . 3j. Opii Pulv., ... 3 ij. Liq. Plumbi Ace tat., f. 3 ij. Adipis preparat., Cerati Cetacei, aa. gj. M. Fiat unguent. In discussing scrofulous, and other indolent tumors, we have derived great advantage from the use of the subjoined ointment: 258. ^ Proto-Iod. Hydrarg., gr. x. Potass. Iodid., . . 3 j. Cerati Simp., . . gj. M. Fiat unguent. 200 COUNTER-IRRITANTS, OINTMENTS, ETC. As an external application in the treatment of neuralgia, the following ointment is declared, by an experienced practitioner, to be almost infallible ; it should be rubbed over the painful part once or twice a day. It is a powerful application : 259. I}« Veratriae, gr. v. Adipis, . 3j. M. Fiat unguent. The venerable Dr. Boyd, of this city, was accus- tomed, for many years, to use an ointment of Yeratrine in the commencement of nervous deaf- ness. 260. ty Veratrias, . . 9j. Unguent. Rosas, g j. Misce pro unguento. A small portion of the above ointment should be applied night and morning, with friction behind the affected ear. As an external application in eczema, and some other forms of obstinate cutaneous disease, the DERIVATIVES, OR 201 following ointment is recommended by our col- league, Prof. Carnochan : The internal administration of the Arsenical solution is advised at the same time. 261. ty Olei Tabac, ... gtt. vj. Hydrarg. Prascip. Alb., 9j. Cerati Simp., . . . gj. M. Fiat unguent. In the treatment of chronic inflammation of the eyes, particularly in ophthalmia tarsi, the follow- ing we have found to be an invaluable remedy: 262. fy Hydrarg. Oxydi Rubri, gr. v. Cerati Simp., . . . g ss. M. Fiat unguent. A small portion of the ointment should be applied at night, along the borders of the eyelids. As a highly useful lotion in ophthalmia, the fol- lowing is recommended by Prof. Cox, of Mary- land : 202 COUNTER-IRRITANTS, OINTMENTS, ETC. 263. ^ Hydrarg. Oxydi Mur., gr. j. Mucil. Sassafras., . 3 ij. Vini Opii (Sydn.) . f. 3 ij. Aquas Rosas, . . . f. g viij. M. Fiatlotio. In a communication from Dr.' Porcher of Charleston, containing several valuable formulas, that experienced practitioner writes : " As a Col- lyrium in simple inflammation of the conjunctiva, as well as in pustular inflammation of that mem- brane, I have found no lotion so good, as com- mon vinegar—one drachm to two ounces of water. A few drops to be inserted into the eye, three times a day, and a cloth wet with it, should be placed, at the same time, over the closed eyelids. It is far superior to Acetic Acid, diluted, for the vinegar contains a mucilage which has a soothing influence on the inflamed membrane." THE END. INDEX. 132 11 23 18 Acetate of Lead with Digitalis, etc.......... Acid, Hydrocyanic .... " " medicinal. . " " in Bronchitis Acid, Hydrocyanic, in Broncho- Gastritis .......22 Acid, Hydrocyanic, in Gastralgia 22 " " in Hooping Cough . 19 " " in Tubercu- losis . .18 Aconite with Arsenic .... 58 Adulterations of Iodide of Po- tassium ........67 Albuminuria, Remedy in . . . 137 Aloes, Guiac and Gamboge Pills 99 Calomel, etc.....100 Carb. of Soda, etc. . . 104 Rhubarb, etc.....101 Sulph. of Iron, etc. . . 110 Taraxicum, etc. . . . 106 American Hellebore .... 90 Amenorrhea, Treatment of .171 Ammonia Carb., with Camph., etc.......... Ammoniacal Mixtures, Squills, etc.......... Antacids and Antilithics. . . Anthelmintics...... Antimony with Iod. of Potas- sium ......• • Antimony with Ipecacuanha . Antispasmodics. . . • • • Arsenic, its Physiological and Therapeutical Effects . . . Arsenite of Potash with Iodine Arthritic Diathesis.Treatmentof 188 Assafcetida with Morphia, etc. . 154 u " Musk, etc. . . 154 146 121 183 160 67 114 153 41 73 129 Astringents .... • "Ayer's Cherry Pectoral . . 86 B. Barker, Prof., in Menorrhagia . 138 Balsam of Canada . . • • • 124 u » with Cyanide of Potass.......125 Balsam of Copaiba with Tinct. Opium........125 Begbie, Dr., on Arsenic ... 41 Belladonna with Quinine . . 58 Bi-Carbonate of Potash . . . 145 Bi-Chlo. of Mercury, excellent Alterative.......75 Bi-Carb. Potash, Hydrocy. Acid, etc..........59 Biniodide of Mercury . . . 168 Blue Mass, Rhei, Aloes, etc. . 103 Bloodroot.......84 " as an Emetic . . . 118 Bowditch, Dr., on Fusel Oil. . 49 Bronchitis, Remedy for . . .135 C. Calomel with Sugar . . . . 78 " " Opium and Ipecac 79 Camphor Mixture with Ether, etc..........149 Canada Balsam......124 Cancerous Affections, Treatment of.........74 Capsicum, Tincture of, etc. . . 138 Carbonate Ammonia, etc. . .146 Carbonate of Mang. in Mesen- teric Disease......148 Carminative Mixture of Dr. Dewees.......186 Carnochan, Prof., on Donovan's Sol..........66 Castor in Hysteria.....155 Castor with Sulph. Morphine . 156 Cathartics and Laxatives . . 96 Chapman's, Dr., Antidyspeptic Pills.......• Chenopodium an Anthelmintic 167 Cholera, Remedy for . . . . 138 Chorea, Cimicifuga in ... 89 Chronic Diarrhoea, Remedy in . 185 Cimicifuga Racemosa . . . . 88 Cinchona Comp., Tinct., etc. . 151 Citrate of Iron......37 Clark, Dr., on Effects of Iodine 60 Colchicum, Tinct., with Infus. of Juniper.......150 Colchicum Wine with Digitalis 150 203 204 INDEX. Collyrium.......202 Conium and Iron as a Tonic . 36 Corrosive Sublimate with Co- nium ........75 Corrosive Sublimate with Opium 76 Cox, Dr. A. L., Anthelmintic . 163 Cox, Dr. C. C, Cathartic Pill . 102 " " " Formula from . 28 Creosote, Tinct. of Myrrh, etc., Gargle........178 Cyanide of Potassium ... 24 D. Davis, Prof. E. H., Carminative 187 Davis, Prof. N. S., Pills for Con- stipation . 110 " " " Remedy in Dysmenorrhoea.....175 Decoction of Senega, etc. . .120 Dewees Dr., Emmenagogue . 176 Derivatives, Ointments, etc. . 190 Diaphoretics.......140 " in Disease of Respi- ratory Organs.....144 Dickson, Prof. S. H., Cathartic Mixture.......107 Dickson, Prof. S. H., Cough Mixture.......122 Discoloration from Nitrate of Silver........30 Diuretics........147 Donovan's Solution .... 66 Dover's Powder, etc.....143 Dropsy, Remedy for .... 28 Dupasquier, Dr., on Proto-Iod. of Iron........70 " Dynamization" of Medicines untenable.......78 Dysentery, Remedy in . . . 133 Dzondi, Dr., on Bi-Chloride of Mercury.......76 E. Elaterium a Diuretic . . . .151 Emetics and Expectorants . .112 Emetics, their Manner of Oper- ating ........112 Emmenagogues......170 Excitants and Alteratives . . 60 Extract of Belladonna and Hy- drocyanic Acid.....22 Extract of Belladonna in Dys- menorrhoea ......27 Extract of Belladonna and Qui- nine in Gastralgia .... 28 Extract of Hyosciamus in Neu- ralgia ........25 Extract of Hyosciamus and Ni- trate of Silver in Leucorrhoea 27 Extract of Hyosciamus and Bis- muth in Gastralgia .... 29 Extract of Hyosciamus and Va- lerianate of Iron .... 25 Extract of Lupulin and Nitrate of Silver in Gastritis ... 31 F. Ferro-Manganese in Ulcerated Sore Mouth......48 Fowler's Solution in Intermit- tent .........40 Frisch, Dr., on Nux Vomica . 54 Fuller, Dr., Treatment of Rheu- matism ........188 Fusel Oil, a substitute for Cod- liver Oil.......49 G. Gallic Acid.......137 " " in Menorrhagia . .137 Gargles and Lotions . . . .177 Gastralgia, Treatment of . . 28 Gastrodynia.......184 Glycerine with Syrup of Iron . 127 Glycerine with Hypophosphate of Soda.......127 H. Heartburn, Remedy for . . .185 Hiccough treated by Musk . .155 Hydrargyrum cum Creta . . 77 Hydrargyro-Iodide of Potass. . 63 Hyosciamus, Blue Mass, and Ipecacuanha......109 Infusion of Digitalis, Tinct. of Cantharides, etc.....149 Injections for Worms . . . .168 Intermittents, Treatment of . 40 Iodide of Arsenic, an Excitant and Tonic . . . 72 " " Iron, a Tonic . . . 72 " " " etc, in Uterine Diseases .... 38 " " Lead, a Diuretic . 7'2 " " Manganese, an Excit- ant and Alterative 74 " " Manganese in Blood Diseases. . . . -iij " " Mercury, an Altera- ative.....72 " " Potassium, Adulter- ations of ... 71 INDEX. 205 PAGE Iodide of Potass, with Senega 63 " " " " Hydro- cyanic Acid 67 " " " in Follicular Disease . 61 " " Sulphur acts on the skin.........72 Iodine with Iodide of Potass. . 62 " in Scrofula.....68 " with Liquor Potassa . . 68 " " Iron.....69 J. Juniper, Infusion of, with Ether, etc.......148 " Berries, with Nitrate of Potash, etc.......152 Kidneys, Haemorrhages from . 136 Kousso an Anthelmintic . . .164 Kuchenmeister on animal and vegetable Parasites. . . .160 L. Lavender with Tinct. of Opium, etc..........157 Laxatives........96 Lindsly, Prof., on Treatment of Neuralgia.......58 Lindsly, Prof., on Treatment of Constipation......Ill Liniment of Arnica, etc. . . . 193 " Dr. Lindsly . . .194 Liniment for Inflammation of the Lungs.......195 Liniment for Sore Throat . .193 Lithic Acid Diathesis, Treat- ment of.......187 Lobelia in Spasmodic Asthma . 56 " as an Emetic .... 118 " and Squills .... 119 Lotion for old Ulcers . . . .182 " " Neuralgia .... 192 " in Ophthalmia. . . .202 M. Magnesia, Rhei, etc., Mixture . 107 " Sulphate, with Elixir of Vitriol.......I28 Male Fern an Anthelmintic . . 169 Manganese in the Blood ... 43 " Carbonate of. . . 47 '< Iodide of .... 46 " Malate of . . . .45 " Phosphate of . . 44 " in Tuberculosis . . 44 Morphine, Acetate, with Cyanide of Potass., etc......126 Muriate of Ammonia in Phthisis 33 Musk with Sulph. Ether, etc. . 155 N. Narcotics and Sedatives ... 17 Nitrate of Potash with Antimony 145 " " Opium . 143 Nitrate of Silver Gargle . . .177 Norwood, Dr. W. C, on Vera- trum Viride......91 Nux Vomica in Gastric Affec- tions ........51 Nux Vomica in Paralysis . . 56 0. Oak Bark as a Gargle . . . .181 Oil, Castor, with Nitrate of Pot- ash, etc........108 Oil of Chenopodium . . . .167 Oil of Turpentine an Anthelmin- tic .........165 Ointment for Counter-Irritation 195 " " Eczema .... 201 " " Hemorrhoids . . 198 " " Neuralgia . . .200 " " Ophthalmia . . 201 " in Tuberculosis . . 197 " for Indurated Os . . 88 " of Iodide of Lead . 73 Olive Oil in Ascarides . . .167 Opium with Lead, etc. . . .131 " " Nitrate of Silver . 131 " Officinal Mass of . . .130 P. Painful Menstruation, Remedy in 174 Peaslee, Prof., Remedy for Con- stipation .......105 Phosphate of Manganese in Tu- berculosis .......44 Phosphate of Iron and Quinine in Chlorosis......37 Pierquin, Dr., on Iodine and Iron 69 Piperine and Quinine an Anti- periodic .......55 Pink Root an Anthelmintic . .163 " " with Tin ... . 162 Podophyllum, Extract of . . 81 Porcher, Dr., Prescription from 32 " " Cathartic Mixture 107 Potassium, Iodide of, in Follicu- lar Disease......61 Protiodide of Mercury with Iodide of Potassium ... 64 Pulse reduced by Veratrum Vi- ride .........92 206 INDEX. Purgatives.......96 Q. Quinine and Arsenic in Inter- mittent ........40 Quinine and Morphine in Rheu- matism ........32 R. Raimann, Prof., on Kousso Refrigerant in Fevers. . , Rheumatism, Cimicifuga in , " Remedy for Rheumatic Liniment . . . Roe, Dr. Hamilton, on Hydro cyanic Acid and on Hooping Cough ...... 165 141 143 191 19 S. Sanguinaria.......84 " as an Emetic . . 118 " with Aloes ... 85 " with Ipecacuanha . 85 " " " and Opium........ 86 Sanguinaria, with Digitalis and Opium........87 Santonine an Anthelmintic . .166 Senega with Iodide of Potassium 62 " " Tolu, etc. . . .123 " " Squills .... 124 Senna, Rhubarb, etc.....108 Serpentaria, Ipecacuanha, etc. . 144 Solution of Strychnia ... 53 " " and Qui- nine in Intermittent ... 54 Spasmodic Asthma, Remedy.in 119 Spirits of Mindereri, Antimonial Wine, etc.......140 Squills, Tolu, Bloodroot, etc. . 122 Stokes, Dr., Mixture in Bron- chitis ........121 Strammonium in Nervous Dis- eases ........3 Strychnine as a Therapeutic Agent........50 Strychnine in Impotence . . 55 Styptics........129 Sudorifics........140 Sulphate of Copper an Emetic . 117 Sulphate of Iron and Potassa in glandular enlargements . . 39 Sunderlin, Dr., on Muriate of Ammonia.......32 Syrup of Iodide of Iron ... 70 " " Manganese. 74 PAOB T. Tannic Acid.......136 " " with Opium. . .136 Taraxicum and Iron as a Tonic 37 Test for the Purity of Iodide of Potassium.......71 Tincture of Cimicifuga Racemosa 88 " Catechu, etc. . . . 133 " Veratrum Viride . 94 Tobacco Ointment.....201 Tonics and Stimulants ... 34 " " Their differ- ence ........34 Trousseau and Pidoux . . .168 Tully, Prof., on Veratrum Viride 91 Turpentine, Tinct. Opium, etc.. 134 " as an Anthelmintic 165 Turpeth Mineral Emetic . . .116 Typhoid Fever, Remedy in . .134 U. Uterine Haemorrhage, Remedy for.........136 Uva Ursi with Tannic Acid . .137 V. Vaginal Injection.....181 Valerian with Carb. Magnesia, etc..........156 Valerianate of Iron in Chorea . 25 " " Ammonia . .159 " " " in Neu- ralgia ........25 Valerianate of Zinc in Facial Neuralgia.......26 Valerianate of Zinc in Hysteria 157 " " " with Bismuth 158 Veratrum Ointment .... 200 Veratrum Viride.....90 W. Ware, Dr. John, Pills in Con- stipation .......Ill Ware, Dr. John, Remedy for Chlorosis.......172 Ware, Dr. John, Remedy for Diarrhoea.......135 Winston, Prof., on Veratrum Viride........91 Wormseed, Oil of.....167 Wyman, Dr., on Fusel Oil . . 49 Z. Zinc with Ipecacuanha . . .116 " " Opium.....185 f.\?:!f«.'?»t'-"."-*.i."%".*'':^., .,_____________. „ .